The impact of a universal human papilloma virus (HPV) vaccination program on lower genital tract dysplasia and genital warts.

Assess Ontario's school-based human papillomavirus (HPV) vaccination program on reducing rates of cervical dysplasia, colposcopy services and treatment for genital warts, cervical conization, cryotherapy and laser vaporization of the lower genital tract. Women born in 1995 in Ontario, Canada were the first cohort of students to receive the vaccine. We followed these women from age 18-23 and identified pap test cytology results, referral and attendance at colposcopy, treatment of HPV related warts and treatment of lower-genital tract dysplasia using administrative databases. We compared the incidence of these outcomes to women born in 1985, followed during the same age period prior to access to the HPV vaccine. We calculated relative risk ratios for all outcomes over the 5-year period for the unvaccinated group compared to the vaccinated group. Results were stratified at the income and geographic level. A total of 221,039 women were included. Among vaccinated women, 5.2% percent had cytologic abnormalities and 2.7% required treatment for pre-invasive disease or warts compared to 9.2% and 5.2%, respectively among unvaccinated women. The relative risk of developing a low-grade cytologic abnormality if unvaccinated was 1.69 and 3.74 for high-grade abnormalities. The relative risk of requiring colposcopy if unvaccinated was 1.94 and they were 6.15 times more likely to require treatment. There were no differences between socio-economic groups and geographic regions. Vaccination programs are effective at decreasing rates of cervical dysplasia, lead to reduced need for colposcopy, treatment of HPV related warts and pre-invasive disease even at early ages.

The impact of the COVID-19 pandemic on the Ontario Cervical Screening Program, colposcopy and treatment services in Ontario, Canada: a population-based study.

OBJECTIVE: To describe the immediate impact of the COVID-19 pandemic on cervical screening, colposcopy and treatment volumes in Ontario, Canada. DESIGN: Population-based retrospective observational study. SETTING: Ontario, Canada. POPULATION: People with a cervix age of 21-69 years who completed at least one cervical screening cytology test, colposcopy or treatment procedure for cervical dysplasia between January 2019 and August 2020. METHODS: Administrative databases were used to compare cervical screening cytology, colposcopy and treatment procedure volumes before (historical comparator) and during the first 6 months of the COVID-19 pandemic (March-August 2020). MAIN OUTCOME MEASURES: Changes in cervical screening cytology, colposcopy and treatment volumes; individuals with high-grade cytology awaiting colposcopy. RESULTS: During the first 6 months of the COVID-19 pandemic, the monthly average number of cervical screening cytology tests, colposcopies and treatments decreased by 63.8% (range: -92.3 to -41.0%), 39.7% (range: -75.1 to -14.3%) and 31.1% (range: -43.5 to -23.6%), respectively, when compared with the corresponding months in 2019. Between March and August 2020, on average 292 (-51.0%) fewer high-grade cytological abnormalities were detected through screening each month. As of August 2020, 1159 (29.2%) individuals with high-grade screening cytology were awaiting follow-up colposcopy. CONCLUSIONS: The COVID-19 pandemic has had a substantial impact on key cervical screening and follow-up services in Ontario. As the pandemic continues, ongoing monitoring of service utilisation to inform system response and recovery is required. Future efforts to understand the impact of COVID-19-related disruptions on cervical cancer outcomes will be needed. TWEETABLE ABSTRACT: COVID-19 has had a substantial impact on cervical screening and follow-up services in Ontario, Canada.