{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:43:15Z","timestamp":1793835795564,"version":"4.6.1"},"reference-count":43,"publisher":"BMJ","license":[{"start":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T00:00:00Z","timestamp":1715731200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2024,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To replicate previous analyses on the effectiveness of the English human papillomavirus (HPV) vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia (CIN3) using 12 additional months of follow-up, and to investigate effectiveness across levels of socioeconomic deprivation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>England, UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women aged 20-64 years resident in England between January 2006 and June 2020 including 29\u2009968 with a diagnosis of cervical cancer and 335 228 with a diagnosis of CIN3. In England, HPV vaccination was introduced nationally in 2008 and was offered routinely to girls aged 12-13 years, with catch-up campaigns during 2008-10 targeting older teenagers aged &lt;19 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Incidence of invasive cervical cancer and CIN3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In England, 29\u2009968 women aged 20-64 years received a diagnosis of cervical cancer and 335\u2009228 a diagnosis of CIN3 between 1 January 2006 and 30 June 2020. In the birth cohort of women offered vaccination routinely at age 12-13 years, adjusted age standardised incidence rates of cervical cancer and CIN3 in the additional 12 months of follow-up (1 July 2019 to 30 June 2020) were, respectively, 83.9% (95% confidence interval (CI) 63.8% to 92.8%) and 94.3% (92.6% to 95.7%) lower than in the reference cohort of women who were never offered HPV vaccination. By mid-2020, HPV vaccination had prevented an estimated 687 (95% CI 556 to 819) cervical cancers and 23\u2009192 (22\u2009163 to 24\u2009220) CIN3s. The highest rates remained among women living in the most deprived areas, but the HPV vaccination programme had a large effect in all five levels of deprivation. In women offered catch-up vaccination, CIN3 rates decreased more in those from the least deprived areas than from the most deprived areas (reductions of 40.6%\n                      <jats:italic>v<\/jats:italic>\n                      29.6% and 72.8%\n                      <jats:italic>v<\/jats:italic>\n                      67.7% for women offered vaccination at age 16-18 and 14-16, respectively). The strong downward gradient in cervical cancer incidence from high to low deprivation in the reference unvaccinated group was no longer present among those offered the vaccine.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The high effectiveness of the national HPV vaccination programme previously seen in England continued during the additional 12 months of follow-up. HPV vaccination was associated with a substantially reduced incidence of cervical cancer and CIN3 across all five deprivation groups, especially in women offered routine vaccination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2023-077341","type":"journal-article","created":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T20:00:13Z","timestamp":1715803213000},"page":"e077341","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":98,"title":["Effect of the HPV vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia by socioeconomic deprivation in England: population based observational study"],"prefix":"10.1136","volume":"385","author":[{"given":"Milena","family":"Falcaro","sequence":"first","affiliation":[{"name":"Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Soldan","sequence":"additional","affiliation":[{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Busani","family":"Ndlela","sequence":"additional","affiliation":[{"name":"National Disease Registration Service (NDRS), NHS England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1509-8744","authenticated-orcid":false,"given":"Peter","family":"Sasieni","sequence":"additional","affiliation":[{"name":"Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,5,15]]},"reference":[{"key":"2025110102341918000_385.may15_6.e077341.1","unstructured":"IARC. Human papillomaviruses. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 90. 2007."},{"key":"2025110102341918000_385.may15_6.e077341.2","unstructured":"World Health Organization (WHO). Global Market Study: HPV 2022https:\/\/cdn.who.int\/media\/docs\/default-source\/immunization\/mi4a\/who-mi4a-global-market-study-hpv.pdf?sfvrsn=649561b3_1&download=true."},{"key":"2025110102341918000_385.may15_6.e077341.3","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2014-202681"},{"key":"2025110102341918000_385.may15_6.e077341.4","unstructured":"Public Health England (PHE). Human Papillomavirus (HPV) vaccine coverage in England, 2008\/09 to 2013\/14. A review of the full six years of the three-dose schedule: Public Health England (PHE); 2015. https:\/\/www.gov.uk\/government\/publications\/human-papillomavirus-hpv-immunisation-programme-review-2008-to-2014; accessed 6 January 2021."},{"key":"2025110102341918000_385.may15_6.e077341.5","unstructured":"UK Health Security Agency. HPV vaccination: guidance for healthcare practitioners (version 6) 2022 [updated April 2022]. https:\/\/www.gov.uk\/government\/publications\/hpv-universal-vaccination-guidance-for-health-professionals; accessed 24 August 2022."},{"key":"2025110102341918000_385.may15_6.e077341.6","first-page":"939","article-title":"Strategies for evaluating the assumptions of the regression discontinuity design: a case study using a human papillomavirus vaccination programme","volume":"46","author":"Smith","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2025110102341918000_385.may15_6.e077341.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30298-3"},{"key":"2025110102341918000_385.may15_6.e077341.8","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiy249"},{"key":"2025110102341918000_385.may15_6.e077341.9","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jis590"},{"key":"2025110102341918000_385.may15_6.e077341.10","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-1968"},{"key":"2025110102341918000_385.may15_6.e077341.11","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines10030387"},{"key":"2025110102341918000_385.may15_6.e077341.12","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiz422"},{"key":"2025110102341918000_385.may15_6.e077341.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-015867"},{"key":"2025110102341918000_385.may15_6.e077341.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02178-4"},{"key":"2025110102341918000_385.may15_6.e077341.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l1161"},{"key":"2025110102341918000_385.may15_6.e077341.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1917338"},{"key":"2025110102341918000_385.may15_6.e077341.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2017.08.062"},{"key":"2025110102341918000_385.may15_6.e077341.18","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.31231"},{"key":"2025110102341918000_385.may15_6.e077341.19","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab080"},{"key":"2025110102341918000_385.may15_6.e077341.20","unstructured":"NHS. 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