Effect of number of human papillomavirus vaccine doses on guideline adherent cervical cytology screening among 19-26year old females.

Abstract

Little is known about how the number of HPV vaccine doses affect adherence to screening guidelines. This study compared adherence to cervical cancer screening by the number of HPV vaccine doses received by young women and assessed whether the specialty of vaccinating providers affected behavior. This retrospective cohort study using administrative insurance claims records included 24,964 19-26year old women who received at least 1 injection of the HPV vaccine between January 2006 and November 2009. Vaccinated young women continuously enrolled in a nationally-representative private insurance plan for 6months prior to and 37months after HPV vaccine administration were included. Logistic regression was used to compare the odds of Papanicolaou (Pap) testing 3years after vaccine initiation by number of vaccine doses and provider type. In this sample, 79.3% had a Pap test 3years following vaccine initiation. Receiving 1 (aOR: 0.60, 95% CI 0.55-0.65) or 2 (aOR: 0.80, 95% CI 0.74-0.87) doses was associated with decreased odds of Pap testing compared to 3 doses. Many young women in our sample (16.5%) were diagnosed with cervical dysplasia prior to HPV vaccination. Patients vaccinated by non-obstetrician/gynecologists were less likely to get a Pap test following vaccination. Women who received 1 or 2 doses of the HPV vaccine were less likely than those who received 3 doses to be screened for cervical cancer 3years following vaccine initiation. Pediatricians and primary care physicians should convey the importance of initiating and continuing screening to HPV vaccinated patients.