HPV vaccination coverage and course completion rates for Indigenous Australian adolescents, 2015.

OBJECTIVE: To estimate human papillomavirus (HPV) vaccination coverage and course completion rates for Indigenous adolescents in four Australian states and territories. PARTICIPANTS, SETTING: Adolescents who were 12 years old in 2015 and received the quadrivalent HPV vaccine (three doses: 0, 2, 6 months) as part of the National HPV Vaccination Program in 2015 or 2016 in New South Wales, Queensland, the Northern Territory, or the Australian Capital Territory. MAIN OUTCOME MEASURES: Estimated HPV vaccination coverage by dose and by Indigenous status and sex, based on National HPV Vaccination Program Register data; vaccination course completion rates (proportion of dose 1 recipients who received dose 3) for 12-year-olds vaccinated during 2013-2016, by sex, jurisdiction, and Indigenous status. RESULTS: Dose 1 coverage exceeded 80% for all Indigenous status/jurisdiction/sex groups (range, 83.3-97.7%). Coverage was similar for Indigenous and non-Indigenous girls in Queensland (87.3% v 87.0%), lower for Indigenous girls in the ACT (88.7% v 97.7%) and the NT (91.1% v 97.0%), and higher in NSW (95.9% v 89.9%); it was similar for Indigenous and non-Indigenous boys in all jurisdictions except the NT (88.6% v 96.3%). Dose 3 coverage (range, 61.2-87.7%) was markedly lower for Indigenous than non-Indigenous 12-year-olds in all jurisdictions, except for girls in NSW (82.6% v 83.6%). CONCLUSION: HPV vaccine coverage is high, but course completion is generally lower for Indigenous adolescents. Strategies for improving completion rates for Indigenous Australians are needed to end the higher burden of cervical cancer among Indigenous than non-Indigenous women.

Impact of a population-based HPV vaccination program on cervical abnormalities: a data linkage study.

BACKGROUND: Australia was one of the first countries to introduce a publicly funded national human papillomavirus (HPV) vaccination program that commenced in April 2007, using the quadrivalent HPV vaccine targeting 12- to 13-year-old girls on an ongoing basis. Two-year catch-up programs were offered to 14- to 17- year-old girls in schools and 18- to 26-year-old women in community-based settings. We present data from the school-based program on population-level vaccine effectiveness against cervical abnormalities in Victoria, Australia. METHODS: Data for women age-eligible for the HPV vaccination program were linked between the Victorian Cervical Cytology Registry and the National HPV Vaccination Program Register to create a cohort of screening women who were either vaccinated or unvaccinated. Entry into the cohort was 1 April 2007 or at first Pap test for women not already screening. Vaccine effectiveness (VE) and hazard ratios (HR) for cervical abnormalities by vaccination status between 1 April 2007 and 31 December 2011 were calculated using proportional hazards regression. RESULTS: The study included 14,085 unvaccinated and 24,871 vaccinated women attending screening who were eligible for vaccination at school, 85.0% of whom had received three doses. Detection rates of histologically confirmed high-grade (HG) cervical abnormalities and high-grade cytology (HGC) were significantly lower for vaccinated women (any dose) (HG 4.8 per 1,000 person-years, HGC 11.9 per 1,000 person-years) compared with unvaccinated women (HG 6.4 per 1,000 person-years, HGC 15.3 per 1,000 person-years) HR 0.72 (95% CI 0.58 to 0.91) and HR 0.75 (95% CI 0.65 to 0.87), respectively. The HR for low-grade (LG) cytological abnormalities was 0.76 (95% CI 0.72 to 0.80). VE adjusted a priori for age at first screening, socioeconomic status and remoteness index, for women who were completely vaccinated, was greatest for CIN3+/AIS at 47.5% (95% CI 22.7 to 64.4) and 36.4% (95% CI 9.8 to 55.1) for women who received any dose of vaccine, and was negatively associated with age. For women who received only one or two doses of vaccine, HRs for HG histology were not significantly different from 1.0, although the number of outcomes was small. CONCLUSION: A population-based HPV vaccination program in schools significantly reduced cervical abnormalities for vaccinated women within five years of implementation, with the greatest vaccine effectiveness observed for the youngest women.

Catching up with the catch-up: HPV vaccination coverage data for Australian women aged 18-26 years from the National HPV Vaccination Program Register.

This report describes human papillomavirus (HPV) vaccine coverage data for Australian women 18-26 years of age, as notified to the National Human Papillomavirus Vaccination Program Register. A cross-sectional analysis was conducted of notifications to the Register of HPV vaccine doses delivered as part of the National HPV Vaccination Program, which provided free catch-up vaccination to women 18-26 years of age across Australia between 2007 and 2009. HPV vaccination coverage estimates were calculated by age, state or territory of residence and dose number, using the Australian Bureau of Statistics population estimates as the denominator. As at March 2011, approximately 4.49 million doses had been notified to the Register of females of all ages, and 1.7 million of these were for women aged 18-26 years in 2007. Vaccination coverage was highest for females aged 18 years and lowest in females aged 26 years. For the entire 18-26 years cohort, coverage was estimated at 55.2% for dose 1, 44.8% for dose 2 and 31.7% for dose 3. Notified dose 1 coverage rates by single year of age and state or territory ranged between 22% for females aged 26 years in the Northern Territory and 76% in females aged 18 years in Queensland, with dose 1 coverage highest across the age range in the Northern Territory, Queensland and South Australia. These data suggest that over half of Australian women aged 18-26 years commenced HPV vaccine courses and about one-third are fully vaccinated. Some of the differences in the coverage observed between states and territories likely reflect differing mechanisms for notifying to the Register.

Early effect of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study.

BACKGROUND: Australia introduced a human papillomavirus (HPV) vaccination programme with the quadrivalent HPV vaccine for all women aged 12-26 years between 2007 and 2009. We analysed trends in cervical abnormalities in women in Victoria, Australia, before and after introduction of the vaccination programme. METHODS: With data from the Victorian Cervical Cytology Registry between 2003 and 2009, we compared the incidence of histopathologically defined high-grade cervical abnormalities (HGAs, lesions coded as cervical intraepithelial neoplasia of grade 2 or worse or adenocarcinoma in situ; primary outcome) and low-grade cytological abnormalities (LGAs) in five age groups before (Jan 1, 2003, to March 31, 2007) and after (April 1, 2007, to Dec 31, 2009) the vaccination programme began. Binary comparisons between the two periods were done with Fisher's exact test. Poisson piecewise regression analysis was used to compare incident rate trends. FINDINGS: After the introduction of the vaccination programme, we recorded a decrease in the incidence of HGAs by 0·38% (95% CI 0·61-0·16) in girls younger than 18 years. This decrease was progressive and significantly different to the linear trend in incidence before introduction of the vaccination (incident rate ratio 1·14, 1·00-1·30, p=0·05). No similar temporal decline was recorded for LGAs or in older age groups. INTERPRETATION: This is the first report of a decrease in incidence of HGAs within 3 years after the implementation of a population-wide HPV vaccination programme. Linkage between vaccination and screening registers is needed to confirm that this ecological observation is attributable to vaccination and to monitor participation in screening among vaccinated women. FUNDING: None.

Establishing treatment benchmarks for mammography-screened breast cancer population based on a review of evidence-based clinical guidelines.

BACKGROUND: No benchmarks exist in the screened breast cancer population to establish the optimal proportions of newly detected cancer patients who should receive the ideal treatment. The aim of the study was to estimate the optimal proportion of cases diagnosed in a breast-screening program who should receive treatment according to evidence-based cancer treatment guidelines and to compare these optimal rates with actual treatment rates. METHOD.: Optimal surgery, radiotherapy, chemotherapy, and hormone therapy utilization trees were constructed based on indications from evidence-based treatment guidelines. The proportions with clinical attributes that indicated a possible benefit from a particular treatment were obtained from epidemiologic data from BreastScreen Victoria. The optimal proportions of screen-detected breast cancer patients who should receive various therapies were then calculated using TreeAge software and compared with the actual proportions obtained from the epidemiologic data. RESULTS: According to the best available evidence, the proportion of screen-detected breast cancer patients who have attributes suitable for various treatments are: breast-conserving surgery (BCS) 85%, mastectomy 15%, radiotherapy 87%, chemotherapy 34%, and hormonal therapy 68%. The actual BCS utilization rate in Victoria was similar to the optimal rate (79% vs 85%), whereas there appeared to be underuse of radiotherapy (62% vs 87%), chemotherapy (19% vs 34%), and hormonal therapy (49% vs 68%) when compared with guideline recommendations. CONCLUSIONS: This research provided optimal treatment utilization rates for screen-detected breast cancer and a comparison of best practice evidence and actual treatment. The results showed comparable rates for surgery but suggested underutilization of radiotherapy, chemotherapy, and hormone therapy.