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. 2019 Mar;28(3):602-609.
doi: 10.1158/1055-9965.EPI-18-0885. Epub 2019 Feb 21.

Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008-2014

Nancy M McClung  1   2 , Julia W Gargano  3 , Nancy M Bennett  4 , Linda M Niccolai  5 , Nasreen Abdullah  6 , Marie R Griffin  7 , Ina U Park  8 , Angela A Cleveland  3 , Troy D Querec  9 , Elizabeth R Unger  9 , Lauri E Markowitz; HPV-IMPACT Working Group
Affiliations

Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008-2014

Nancy M McClung et al. Cancer Epidemiol Biomarkers Prev. 2019 Mar.

Abstract

Background: The impact of human papillomavirus (HPV) vaccination has been observed in the United States through declining cervical precancer incidence in young women. To further evaluate vaccine impact, we described trends in HPV vaccine types 16/18 in cervical precancers, 2008-2014.

Methods: We analyzed data from a 5-site, population-based surveillance system. Archived specimens from women age 18-39 years diagnosed with cervical intraepithelial neoplasia grades 2-3 or adenocarcinoma in situ (CIN2+) were tested for 37 HPV types. We described the proportion and estimated number of cases of CIN2+ by HPV-type groups over time. Trends in HPV16/18-positive CIN2+ were examined, overall and by vaccination status, age, histologic grade, and race/ethnicity, using Cochrane-Armitage tests.

Results: In 10,206 cases, the proportion and estimated number of cases of HPV16/18-positive CIN2+ declined from 52.7% (1,235 cases) in 2008 to 44.1% (819 cases) in 2014 (P < 0.001). Declining trends in the proportion of HPV16/18-positive CIN2+ were observed among vaccinated (55.2%-33.3%, P < 0.001) and unvaccinated (51.0%-47.3%, P = 0.03) women; ages 18-20 (48.7%-18.8%, P = 0.02), 21-24 (53.8%-44.0%, P < 0.001), 25-29 (56.9%-42.4%, P < 0.001), and 30-34 (49.8%-45.8%, P = 0.04) years; CIN2 (40.8%-29.9%, P < 0.001) and CIN2/3 (61.8%-46.2%, P < 0.001); non-Hispanic white (59.5%-47.9%, P < 0.001) and non-Hispanic black (40.7%-26.5%, P < 0.001).

Conclusions: From 2008-2014, the proportion of HPV16/18-positive CIN2+ declined, with the greatest declines in vaccinated women; declines in unvaccinated women suggest herd protection.

Impact: The declining proportion of HPV16/18-positive CIN2+ provides additional evidence of vaccine impact in the United States.

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Conflict of interest statement

Disclosure of Potential Conflicts of Interest

L.M. Niccolai is a consultant/advisory board member for Merck. No potential conflicts of interest were disclosed by the other authors.

Figures

Figure 1.
Figure 1.
Total reported CIN2+ cases, proportion and estimated number of cases by HPV type category, 2008–2014. CIN2+, cervical intraepithelial neoplasia grade 2 or worse; HR, high-risk. Estimated number of CIN2+ cases in each HPV type category = total cases (typed + nontyped) × proportion of typed cases with types in respective type categories.
Figure 2.
Figure 2.
Proportion of CIN2+ cases among 18- to 39-year-old women that were HPV 16/18-positive, 2008–2014, by vaccination status, age group, histologic grade, and race/ethnicity. A, vaccination status, women with unknown timing of vaccination were excluded (n = 306) B, age group, C, histologic grade, and D, race/ethnicity. Gray bars indicate HPV 16/18-positive cases and sequential years from 2008 (darkest gray) to 2014 (lightest gray). CIN: cervical intraepithelial neoplasia; AIS: adenocarcinoma in situ with or without CIN.
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