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. 2019 Apr 8;68(8):1282-1291.
doi: 10.1093/cid/ciy707.

Trends in High-grade Cervical Lesions and Cervical Cancer Screening in 5 States, 2008-2015

Julia Warner Gargano  1 , Ina U Park  2 , Marie R Griffin  3 , Linda M Niccolai  4 , Melissa Powell  5 , Nancy M Bennett  6 , Michelle L Johnson Jones  1 , Erin Whitney  7 , Manideepthi Pemmaraju  3 , Monica Brackney  4 , Nasreen Abdullah  5 , Mary Scahill  6 , Rebecca M Dahl  8 , Angela A Cleveland  1 , Elizabeth R Unger  9 , Lauri E Markowitz  1 ; HPV-IMPACT Working Group
Affiliations

Trends in High-grade Cervical Lesions and Cervical Cancer Screening in 5 States, 2008-2015

Julia Warner Gargano et al. Clin Infect Dis. .

Abstract

Background: We describe changes in rates of cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ (CIN2+) during a period of human papillomavirus (HPV) vaccine uptake and changing cervical cancer screening recommendations.

Methods: We conducted population-based laboratory surveillance for CIN2+ in catchment areas in 5 states, 2008-2015. We calculated age-specific CIN2+ rates per 100000 women by age groups. We estimated incidence rate ratios (IRR) of CIN2+ for 2-year periods among all women and among screened women to evaluate changes over time.

Results: A total of 16572 CIN2+ cases were reported. Among women aged 18-20 and 21-24 years, CIN2+ rates declined in all sites, whereas in women aged 25-29, 30-34, and 35-39 years, trends differed across sites. The percent of women screened annually declined in all sites and age groups. Compared to 2008-2009, rates among screened women were significantly lower for all 3 periods in women aged 18-20 years (2010-2011: IRR 0.82, 95% confidence interval [CI] 0.67-0.99; 2012-2013: IRR 0.63, 95% CI 0.47-0.85; 2014-2015: IRR 0.44, 95% CI 0.28-0.68) and lower for the latter 2 time periods in women aged 21-24 years (2012-2013: IRR 0.86, 95% CI 0.79-0.94; 2014-2015: IRR 0.61, 95% CI 0.55-0.67).

Conclusions: From 2008-2015, both CIN2+ rates and cervical cancer screening declined in women aged 18-24 years. The significant decreases in CIN2+ rates among screened women aged 18-24 years are consistent with a population-level impact of HPV vaccination.

Keywords: cervical intraepithelial neoplasia; disease surveillance; human papillomavirus; vaccine impact.

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Figures

Figure 1.
Figure 1.
CIN2+ incidence per 100000 women (bars) and estimated proportion of women screened (lines), by age group and site. Participant ages (A) 18–20 years, (B) 21–24 years, (C) 25–29 years, (D) 30–34 years, and (E) 35–39 years. All data are from the Human Papillomavirus Vaccine Impact Monitoring Project (HPV-IMPACT), 2008–2015. Abbreviation: CIN2+, cervical intraepithelial neoplasia grades 2, 3, 2/3 and adenocarcinoma in situ.
Figure 2.
Figure 2.
CIN2+ incidence (A) per 100000 women and (B) per 100000 screened women. All data are from the Human Papillomavirus Vaccine Impact Monitoring Project (HPV-IMPACT), 2008–2015. Abbreviation: CIN2+, cervical intraepithelial neoplasia grades 2, 3, 2/3 and adenocarcinoma in situ.
See this image and copyright information in PMC

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