-thanks, Kev
-my point in this case was only to contrast relative versus absolute risk
-but in general, the objective of the HPVvaccine is to avoid cervical cancer, not to avoid CIN-2
-in adolescents and young women, regression of CIN-2 is common with almost 70% regressing to normal within 3 years
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057366/
-if you have interest in the HPVvaccine impact in cervical cancer the relative risk is lower by 29% https://www.ncbi.nlm.nih.gov/pubmed/29859731 
(the absolute risk is 0.00024, so you need to vaccinated 417,000 females to avoid ONE case onf cancer of cervix, not a death, at a cost of around 185 millions of dolars)
-about the calculation:
-how? with GRADE
-where? from data in the Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Drolet M, Bénard E, Pérez N, Brisson M, on behalf of the HPV Vaccination Impact Study Group. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 2019; published online June 26. http://dx.doi.org/10.1016/S0140-6736(19)30298-3.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30298-3/fulltext
-you have access to the GRADE table at the end of my comment http://www.nogracias.org/2019/07/12/presentacion-en-falso-del-exito-triunfal-de-la-vacuna-del-virus-del-papiloma-manipulacion-emocional-y-estadistica-por-juan-gervas/

Síntesis

En conclusión, el análisis del impacto de la vacuna del virus del papiloma humano, y el de toda intervención sanitaria, debería basarse en la disminución del riesgo absoluto. Dicho impacto es nulo respecto a la vacuna del virus del papiloma (7). Precisamos de una mejor vacuna, y declarar una moratoria en la aplicación de las que tenemos.

NOTA: La tabla adjunta ( vacuna VPH Fact Box por 10.000 mujeres y varones, Vac VPH, seguim 5-8 años. Drolet ) está hecha con el método GRADE, a petición del autor, por Galo Agustín y Cristina Andreu. Es de libre distribución como este texto.


El sáb., 13 jul. 2019 a las 13:01, K Hopayian (<[log in to unmask]>) escribió:
Dear Juan,
Thanks it is good to see some absolute risks.
Now let us consider preferences and values. It is difficult to know if talking about a whole population, unlike say an individual decision regarding whether to take a bisphosphonate for osteoporosis.
So we might have to speculate how much most women would value avoiding CIN cervix, with attendant anxiety, intervention and occasional complications. I do not know what most women would say.  If it were me as an individual, I would consider a lifetime NNT of 159 is pretty good. I would compare it against most NNTs that inform preventive strategies and which are for shorter periods e.g. 5-10 years for CVS diseases.

Kev

Prof. Kev (Kevork) Hopayian, 
MD FRCGP
Clinical Professor, University of Nicosia, Cyprus
RCGP [INT] Educational Consultant
Sessional GP, Suffolk



On 13 Jul 2019, at 11:06, Juan Gérvas <[log in to unmask]> wrote:

RELATIVE RISK VERSUS ABSOLUTE RISK
According with the direct intepretation of the Lancet paper,
"Triumphant success of HPV vaccine" https://www.nature.com/articles/d41586-019-02026-4
"Hopes raised of cervical cancer eradication" https://www.bbc.com/news/health-48758730

1/
An example of the impact of the relative risk: #HPVvaccine.
See you, decrease relative risk and decrease absolute risk from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30298-3/fulltext
You have the analysis (and the table) in Spanish in:
http://www.nogracias.org/2019/07/12/presentacion-en-falso-del-exito-triunfal-de-la-vacuna-del-virus-del-papiloma-manipulacion-emocional-y-estadistica-por-juan-gervas/
2/
Anogenital wart diagnoses decreased
GIRLS aged
15–19 years:
relative risk by 67%
absolute risk by 0.21%
20-24 year:
relative risk by 54%;
absolute risk by 0.28%
25-29 years:
relative risk by 31%;
absolute risk by 0,07%.
BOYS aged
15-19 years:
relative risk by 48%;
absolute risk by 0.04%.
20-24 years:
relative risk by 32%;
absolute risk by 0.14%.
3/
After 5–9 years of vaccination, CIN2+ decreased among screened girls aged
15-19 years:
relative risk by 51%
absolute risk by 0.63%
20-24 years:
relative risk by 31%
absolute risk by 0.28%
-un saludo juan gérvas @JuanGrvas

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