Increased incidence of cervical cancer in Sweden: an unlikely link with human papillomavirus (HPV) vaccination

• Published in: BMJ sexual & reproductive health Vol. 45; no. 4; pp. 303 - 304
• Main Authors: Jørgensen, Lars, Gøtzsche, Peter Christian, Jefferson, Tom
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.10.2019
• Subjects: Cervical cancer; Epidemiology; Human papillomavirus; Immunization; Vaccines; Womens health; Denmark; England; Canada; Sweden; United Kingdom > UK; United States > US; epidemiology; cervical neoplasms; sexually transmitted infections; general practice; human papillomavirus
• ISSN: 2515-1991; 2515-2009
• DOI: 10.1136/bmjsrh-2018-200245

Correspondence to Dr Lars Jørgensen, Copenhagen, Hovedstaden, Denmark; lj@cochrane.dk Background In 2017, the Centre for Cervical Cancer Prevention in Sweden (NKCx) reported an increase in the Swedish cervical cancer incidence from 9.7/100 000 in 2006–2009 to 11.5/100 000 in 2014–2015 with a p value of 0.03 (see the Swedish report’s Table 9 on PDF page 49 of 87).1 In April 2018, the Indian Journal of Medical Ethics (IJME) published a comment entitled 'Increased incidence of cervical cancer in Sweden: possible link with HPV vaccination'. The IJME comment author found that the increase in cervical cancer was most prominent in younger women and that the number of cases in the 20–49-year group increased from 202 cases in 2006 to 317 cases in 2015 – an increase of 50% – but the author did not investigate the catch-up cohort of those aged 20 to 23 years by itself.2 Increased immigration from countries with limited cervical screening and HPV vaccination As of 2018, Sweden’s population was about 10 million. Since 2010, Sweden has had a substantial increase in the number of immigrants.4 From 2012 to 2015, nearly 450 000 people immigrated to Sweden. Advances in cervical screening may also have contributed to cervical cancer identification; for example, the Swedish use of HPV testing as a cervical screening adjunct increased from nearly 10 000 tests in 2010 to more than 150 000 in 2015 (see the Swedish report’s Figure 13 on PDF page 47 of 87).1 No country other than Sweden has reported a similar cervical cancer increase To our knowledge, there have been no other regional or global reports that have reported a significantly increased cervical cancer incidence after the initiation of HPV vaccination programmes since 2006.