Association between HPV vaccination and cervical screening policy changes and cervical cancer incidence and grade-3 cervical intraepithelial neoplasia incidence in England, 2006-2020 - A population-based trends analysis

Sep 21, 2026

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Monitoring disease trends after public health interventions supports surveillance and planning. This population-based analysis examines changes in cervical cancer and grade-3 cervical intraepithelial neoplasia (CIN3) incidence in England from 2006 to 2020, linking observed trends to predictions based on HPV vaccination and cervical screening policy shifts. Incidence was estimated from registry data by age and diagnosis year or birth cohort using Poisson regression, and results show sustained reductions consistent with high vaccine effectiveness as vaccinated cohorts age.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

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Articles Association between HPV vaccination and cervical screening policy changes and cervical cancer incidence and grade-3 cervical intraepithelial neoplasia incidence in England, 2006–2020: a population-based trends analysis Milena Falcaro,a Alejandra Castañón,b Busani Ndlela,c and Peter Sasienia,∗ aCentre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK bHealth Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, UK cNational Disease Registration Service (NDRS), NHS England, London, UK Summary Background Monitoring trends in diseases after the implementation of new public health interventions or policy changes is crucial for public health planning and surveillance. In this study we look at variations in rates of cervical cancer and grade-3 cervical intraepithelial neoplasia (CIN3) incidence between 2006 and 2020 in England and relate them to predictions based on the changes in HPV vaccination and cervical screening policy. Methods Using population-based registry data, we estimated incidence rates and their 95% conﬁdence intervals for cervical cancer and CIN3 by age group and by either year of diagnosis or 1-year birth cohort. Trends were compared over time and across birth cohorts by calculating relative changes with respect to reference time points. We also tested if trends in women offered HPV vaccination were signiﬁcantly different across outcomes (cervical cancer and CIN3) and age groups. To do this, we used Poisson regression with adjustments for interval censoring, overdispersion and correlation between observations. Findings There were 5558 cancers and 164,682 cases of CIN3 from 53.4 million women-years of observation in the age group 20–29.99 years. We found no evidence of increased cervical cancer rates over the age of 26 in cohorts not offered cervical screening until age 24.5 or 25 years. Substantial and increasing reductions in CIN3s and cervical cancers were observed in the cohorts offered HPV vaccination and were consistent with an 80%(95% CI: 72.9%– 87.1%) decrease in cervical neoplasia in the routine vaccination group. Interpretation Plots against different time scales (e.g., calendar year and date ofbirth) may provide important insights that could otherwise be missed. Our ﬁndings are consistent with a sustained high effectiveness of the HPV immunization programme as the catch-up vaccination cohorts age. Funding Cancer Research UK. Copyright © 2024 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ([http://](http://)[ ](http://)[creativecommons.org/licenses/by-nc-nd/4.0/](creativecommons.org/licenses/by-nc-nd/4.0/)). Keywords: Immunization; Vaccination; Papillomaviruses; HPV; Registries; Cervical cancer; Cervical intraepithelial neoplasia; Trends; Incidence; Rates; Screening; Health policy; Data visualisation; Cohort effects Introduction The World Health Organization (WHO)’s global strategy towards the elimination of cervical cancer as a public health concern aims for all its member states to lower incidence of cervical cancer below 4 cases per 100,000 women per year. The strategy relies on three key areas: (1) vaccination against human papillomavirus (HPV), (2) screening and treatment of pre-cancerous lesions, and (3) treatment and palliative care.2 In England, the National Health Service (NHS) has recently pledged to reach this target by 2040 and is planning to do so by boosting the uptake of both HPV vaccination and cervical screening.3 A national HPV vaccination programme has been running in England The Lancet Regional Health - Europe 2025;49: 101157 Published Online xxx [https://doi.org/10](https://doi.org/10) . 1016/j.lanepe.2024 . 101157 *Corresponding author. E-mail [address:](address: p.sasieni@qmul.ac.uk)[ p.sasieni@qmul.ac.uk](address: p.sasieni@qmul.ac.uk) (P. Sasieni). [www.thelancet.com Vol](www.thelancet.com Vol) 4

FAQs

What time period and location does the study analyze for cervical cancer and CIN3 trends?

The analysis covers cervical cancer and grade-3 cervical intraepithelial neoplasia (CIN3) incidence in England from 2006 to 2020.

How did the study relate disease trends to HPV vaccination and cervical screening policy changes?

Using population-based registry data, the study compared incidence trends over time and across birth cohorts and tested whether trends differed by outcomes, vaccination status, and age groups, incorporating policy-related expectations.

What were the main findings regarding cervical cancer and CIN3 after vaccination and screening changes?

The study found no evidence of increased cervical cancer rates over specific ages in cohorts not offered cervical screening until later. It observed substantial and increasing reductions in CIN3 and cervical cancers in cohorts offered HPV vaccination, consistent with an approximate 80% decrease in cervical neoplasia in the routine vaccination group.

Sep 21, 2026

Uploaded by Aurelia