Estimated Number of Cases of High-Grade Cervical Lesions Diagnosed Among Women - United States, 2008 and 2016

Abstract

Human papillomavirus (HPV) causes approximately 30,000 cancers in the United States annually (1). HPV vaccination was introduced in 2006 to prevent HPV-associated cancers and diseases (1). Cervical cancer is the most common HPV-associated cancer in women (1). Whereas HPV-associated cancers typically take decades to develop, screen-detected high-grade cervical lesions (cervical intraepithelial neoplasia grades 2 [CIN2], 3 [CIN3], and adenocarcinoma in situ, collectively CIN2+) develop within a few years after infection and have been used to monitor HPV vaccine impact (1-3). CDC analyzed data from the Human Papillomavirus Vaccine Impact Monitoring Project (HPV-IMPACT), a population-based CIN2+ surveillance system, to describe rates of CIN2+ among women aged ≥18 years during 2008-2016. Age-specific rates were applied to U.S. population data to estimate the total number of CIN2+ cases diagnosed in the United States in 2008* and in 2016. From 2008 to 2016, the rate of CIN2+ per 100,000 women declined significantly in women aged 18-19 years and 20-24 years and increased significantly in women aged 40-64 years. In the United States in 2008, an estimated 216,000 (95% confidence interval [CI] = 194,000-241,000) CIN2+ cases were diagnosed, 55% of which were in women aged 18-29 years; in 2016, an estimated 196,000 (95% CI = 176,000-221,000) CIN2+ cases were diagnosed, 36% of which were in women aged 18-29 years. During 2008 and 2016, an estimated 76% of CIN2+ cases were attributable to HPV types targeted by the vaccine currently used in the United States. These estimates of CIN2+ cases likely reflect changes in CIN2+ detection resulting from updated cervical cancer screening and management recommendations, as well as primary prevention through HPV vaccination. Increasing coverage of HPV vaccination in females at the routine age of 11 or 12 years and catch-up vaccination through age 26 years will contribute to further reduction in cervical precancers.

FIGURE 1

Estimated number of diagnosed CIN2+ cases, by age group — United States, 2008 and 2016 Abbreviation: CIN2+ = cervical intraepithelial neoplasia grades 2, 3, and adenocarcinoma in situ. * Error bars indicate 95% confidence intervals, which were calculated by applying the upper and lower limits of CIN2+ rates to the age-specific U.S. population.

FIGURE 2

Estimated number of diagnosed CIN2+ cases, by human papillomavirus (HPV) type and age group — United States, 2008 and 2016 Abbreviation: CIN2+ = cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ. * Type-specificity for 2008 was based on typing data from 2008, and for 2016, was based on typing data from 2015 (most recently available) applied to 2016 case counts by diagnosis grade. HPV type group “other HPV” includes HPV-negative cases.