HPV vaccination in women treated for cervical intraepithelial neoplasia grade 2 or 3: Evidence-based recommendation from the multisociety Italian guidelines for cervical cancer prevention

Objective: Women treated for Cervical Intraepithelial Neoplasia (CIN) grade 2 or 3 are at increased risk of CIN and cervical cancer. Human Papillomavirus (HPV) vaccination is effective in preventing CIN in women who are not infected by HPV. Some studies suggested that vaccination may reduce the risk of CIN2 or 3 in women treated for CIN. A working group including all Italian scientific societies involved in tackling cervical cancer developed a recommendation on vaccination against HPV for women treated for CIN2 or CIN3. Data sources, methodsofstudyselection: The group conducted a systematic review of the literature published from January 2006 to May 2019. Evidence on safety outcomes was retrieved by a recent Cochrane Review on vaccination in the general population. To develop the final recommendation, evidences were appraised and integrated by a Panel of Experts using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework. Tabulation, integrationandresults: Six eligible studies were included. Four were RCTs and two were cohort studies, with different timing of vaccination. An additional study, published in October 2019, was taken into consideration after external review. A reduction of 70% CIN2+ in the treatment group was estimated; the vaccine was considered safe. Conclusion: The working group recommends the use of HPV vaccination in women treated for CIN2 or 3. The strong recommendation is based on large estimated desirable effects and trivial anticipated undesirable effects (moderate certainty of evidence), negligible costs and savings (no studies included), and a positive judgment in terms of feasibility, acceptability, and impact on equity.