Introduction

Subsidized human papilloma virus (HPV) vaccination has been offered on-demand and as catch-up for girls aged 13-18 in Sweden since 2006 with a coverage of 55-60%. Since the first women in Sweden eligible for vaccination entered the cervical screening program in 1993, questions on how to evaluate colposcopic have arisen.

Evidence is inconsistent as to whether colposcopic features for the detection of HSIL are influenced by specific HPV genotypes and there are no previous studies to our knowledge evaluating colposcopy in vaccinated and unvaccinated women from the same birth cohort entering the organized cervical screening program. As colposcopic impression may be different due to a reduction in the prevalence of vaccine-types HPV 16/18, the aim of the study was to compare the colposcopic impression between the groups.

Methods

Women in the 1994 and 1995 birth cohorts who entered in the screening program at age 23 in one region of Sweden and had a positive screening result were identified and underwent colposcopy.

Colposcopic impression was evaluated according to the Swedescore. Colposcopic opinion was assessed as benign, low grade, high grade or invasive. Punch biospsies were taken and histopathologic findings were used as golden standard.

Results

In 2018, 59 women from the 1994 birth cohort attended colposcopy, of which 19 (32%) reported being vaccinated. There were a total of 22 HSILs identified in the 1994 cohort. In the vaccinated group 25% (2/8) of women with HSIL had a Swedescore of 8-10 (indicating HSIL); 40% (4/10) in the unvaccinated group. Colposcopic opinion was evaluated as high grade in 75% (6/8) of women with HSIL in the vaccinated group; 70% (7/10) in the unvaccinated group.

Conclusions

Preliminary results indicate that colposcopic examination including the Swedescore and colposcopic opinion may be useful tools also in the evaluation of vaccinated women entering the cervical screening program in Sweden.