Journal of infection and public health · 2026
Impact of HPV vaccination on cervical precancer and invasive cervical cancer twelve years after vaccine introduction in the Brazilian Public Health System.
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Carneiro Fabiana Pirani, da Silva Rios Chen Salete, de Araujo Oliveira Nakashoji Ísis, Amancio Fabiana Feitosa Cavalcante, da Silva Sousa Ana Lígia, de Vasconcelos Carneiro Marcos, de Resende Ceres Nunes, Motoyama Andrea Barretto
Аннотация
BACKGROUND: The national HPV vaccination program was introduced into the Brazilian public health system for children and adolescents in 2014. However, its population-level impact remains poorly characterized, particularly in the context of regional disparities.
METHODS: We compared the incidence of cervical precancer and invasive cancer between the pre-vaccination period (2010-2012) and the post-vaccination period (2025) among screened women aged < 25 years (vaccine-eligible women) and ≥ 25 years (non-vaccine-eligible women) in Brazil and across its geographic regions.
RESULTS: Among vaccine-eligible women, the incidence of CIN2 +, CIN3 +, and invasive cervical cancer was significantly lower in the post-vaccination period than in the pre-vaccination period in Brazil. Incidence rates were lower across all regions; however, statistically significant reductions in all three outcomes were observed only in the Southeast, South, and Midwest. In the Northeast, significant reductions were observed for CIN2 + and invasive cervical cancer, whereas no significant reductions were observed in the North. The reduction in invasive cervical cancer incidence was significantly greater than those observed for CIN2 + and CIN3 +. Among non-vaccine-eligible women, significant reductions were observed primarily for invasive cervical cancer. Nationally, reductions were observed among women aged 25-29 and 55-64 years. Regionally, reductions occurred in the Southeast among women aged 25-64 years, in the South among those aged 25-29 years, and in the Midwest among those aged 55-64 years. Significant reductions in CIN2 + and CIN3 + were limited to women aged 55-64 years in the Southeast and Midwest. In all other age groups, outcome and regions, incidence showed either significant increases or no statistically significant changes.
CONCLUSIONS: Twelve years after the introduction of HPV vaccination, these findings support a population-level impact of HPV vaccination in Brazil and most regions among vaccine-eligible women. Among non-vaccine-eligible women, the findings suggest possible indirect protection, varying by outcome, age group and region.
METHODS: We compared the incidence of cervical precancer and invasive cancer between the pre-vaccination period (2010-2012) and the post-vaccination period (2025) among screened women aged < 25 years (vaccine-eligible women) and ≥ 25 years (non-vaccine-eligible women) in Brazil and across its geographic regions.
RESULTS: Among vaccine-eligible women, the incidence of CIN2 +, CIN3 +, and invasive cervical cancer was significantly lower in the post-vaccination period than in the pre-vaccination period in Brazil. Incidence rates were lower across all regions; however, statistically significant reductions in all three outcomes were observed only in the Southeast, South, and Midwest. In the Northeast, significant reductions were observed for CIN2 + and invasive cervical cancer, whereas no significant reductions were observed in the North. The reduction in invasive cervical cancer incidence was significantly greater than those observed for CIN2 + and CIN3 +. Among non-vaccine-eligible women, significant reductions were observed primarily for invasive cervical cancer. Nationally, reductions were observed among women aged 25-29 and 55-64 years. Regionally, reductions occurred in the Southeast among women aged 25-64 years, in the South among those aged 25-29 years, and in the Midwest among those aged 55-64 years. Significant reductions in CIN2 + and CIN3 + were limited to women aged 55-64 years in the Southeast and Midwest. In all other age groups, outcome and regions, incidence showed either significant increases or no statistically significant changes.
CONCLUSIONS: Twelve years after the introduction of HPV vaccination, these findings support a population-level impact of HPV vaccination in Brazil and most regions among vaccine-eligible women. Among non-vaccine-eligible women, the findings suggest possible indirect protection, varying by outcome, age group and region.