Should patients treated for CIN be vaccinated?
HPV immunisation after LLETZ for cervical dysplasia reduces the risk of recurrence significantly. This is the conclusion of several papers published in the last couple of years.
The currently available HPV vaccines are designed to prevent HPV associated disease. Current vaccination studies suggest that HPV vaccines do not prevent the progression of women with HPV infections to pre-cancer or cancer. However, whether HPV vaccination would lower the risk of subsequent infection with other HPV strains remained unclear.
A publication from BMJ (Joura et al, BMJ 2012) with authors from Europe, USA and Australia analysed data from two large randomised trials. The FUTURE 1 and FUTURE 2 trials enrolled more than 17,000 women from 24 countries. Half of those women received the quadrivalent HPV vaccine and the other half received 3 doses of a placebo vaccine.
A total of 1,350 women had surgical treatment for CIN, VIN or VaIN. Some of those women have received the vaccine previously and others only had the placebo. The study compared the incidence of HPV-related disease in both arms.
In brief, vaccination with the quadrivalent vaccine reduced the incidence of any subsequent HPV-related disease by 40% to 65% in women who had been treated for cervical, vulval or vaginal dysplasia previously.
Similar findings were made in a paper from Korea (Kang et al, Gynecol Oncol 2013) and Sweden (Swedish et al, Clin Infect Dis 2011).
The authors conclude that HPV vaccination was associated with a reduced incidence of subsequent cervical, vulval and vaginal dysplasia in women who had been treated for CIN, VIN or VaIN previously.
The authors emphasize that the effect is not due a therapeutic effect of the vaccine. The data suggest that most of the subsequent disease is from a new infection caused by a different HPV type that was not the causal type of the first lesion.
It appears that many patients who we treat for CIN, VIN or VaIN might benefit from HPV vaccination regardless of their age.
As a consequence I started discussing the pro’s and con’s of HPV vaccination following a LLETZ or other treatment for VIN or VaIN and referred some patients for HPV vaccinations to their GP for HPV vaccination.