Research Summary

Optimizing Cervical Cancer Screening by Age at HPV Vaccination in Norway: Modeling Study Suggests Less Frequent Screening

Edited by:
Ashton L. Stahl

Key Highlights

  • Less frequent HPV-based screening was consistently cost-effective across all vaccination age groups.
  • Women vaccinated before age 25 could be screened as few as 2 to 3 times over a lifetime.
  • Screening intensity varied by age at vaccination and by bivalent vs nonavalent HPV vaccine.

A modeling study published in Annals of Internal Medicine evaluated how cervical cancer screening strategies could be adapted for women vaccinated against human papillomavirus (HPV) at different ages. The analysis found that extending screening intervals and reducing lifetime screening tests was cost-effective and reduced harm compared with the current 5-year screening recommendations for unvaccinated populations.

The study focused on Norway, where HPV vaccination began in 2009, and HPV-based screening is recommended every 5 years for individuals aged 25 to 69. As vaccinated cohorts increasingly enter screening programs, understanding how vaccination timing modifies cervical cancer risk is critical for optimizing screening policies.

Researchers conducted an individual-based mathematical modeling study simulating hypothetical cohorts of women vaccinated between ages 12 and 30 with either the bivalent or nonavalent HPV vaccine. The model projected lifetime cervical cancer risk, screening-related harms, and costs under multiple HPV-based screening strategies that varied by start age, interval, and total number of lifetime tests.

Cost-effectiveness was assessed using incremental cost-effectiveness ratios per quality-adjusted life-year (QALY) gained, with a threshold of $55,000 per QALY. Harm–benefit tradeoffs were measured as the number of colposcopy referrals per cervical cancer case averted, using current screening recommendations for unvaccinated women as a benchmark.

Study Findings

Across all vaccination ages and both vaccine types, screening strategies with intervals longer than 5 years were preferred. For women vaccinated between the ages of 25 and 30, screening every 10 years starting at age 25, for a total of 5 lifetime screens, was consistently cost-effective. In contrast, women vaccinated between the ages of 12 and 24 could be screened only 2 or 3 times in their lifetime by delaying screening initiation and extending screening intervals.

For example, women vaccinated from ages 22 to 24 achieved favorable cost-effectiveness with screening at ages 25, 40, and 55 years, with incremental cost-effectiveness ratios of $48,150 per QALY for the bivalent vaccine and $51,460 per QALY for the nonavalent vaccine. Sensitivity analyses showed similar results under assumptions of imperfect screening adherence and reduced vaccine cross-protection.

Clinical Implications

According to the study authors, the findings suggest that cervical cancer screening programs could safely reduce screening frequency for women vaccinated for HPV while maintaining favorable harm–benefit ratios. Tailoring screening recommendations by age at vaccination and vaccine type may reduce unnecessary colposcopy referrals and healthcare costs without compromising cancer prevention.

The authors emphasized that maintaining participation in screening remains essential as screening intervals lengthen and as programs transition away from uniform guidelines developed for unvaccinated populations.

Expert Commentary

“In conclusion, a [cervical cancer] screening program in the era of HPV vaccination that both is cost-effective and minimizes the harm–benefit ratio would require fewer lifetime screening tests at longer intervals, varying by individuals’ vaccination history,” the researchers concluded.

Reference
Pedersen K, Di Silvestre J, Sy S, et al. Optimizing cervical cancer screening by age at vaccination for human papillomavirus: health and resource implications. Ann Intern Med. Published online February 3, 2026. doi:10.7326/ANNALS-25-03192