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. 2023 Jan 15;152(2):137-150.
doi: 10.1002/ijc.34231. Epub 2022 Sep 26.

HPV type-specific trends in cervical precancers in the United States, 2008 to 2016

Julia W Gargano  1 , Nancy McClung  1 , Rayleen M Lewis  1   2 , Ina U Park  3 , Erin Whitney  4 , Jessica L Castilho  5 , Manideepthi Pemmaraju  5 , Linda M Niccolai  6 , Monica Brackney  6 , Emilio DeBess  7 , Sara Ehlers  7 , Nancy M Bennett  8 , Mary Scahill  8 , Angela A Cleveland  1 , Troy D Querec  1 , Elizabeth R Unger  1 , Lauri E Markowitz  1 ; HPV-IMPACT Working Group
Affiliations

HPV type-specific trends in cervical precancers in the United States, 2008 to 2016

Julia W Gargano et al. Int J Cancer. .

Abstract

Declines in cervical intraepithelial neoplasia grades 2 to 3 and adenocarcinoma in situ (CIN2+) observed among young women suggest impact from human papillomavirus (HPV) vaccination. To further evaluate vaccine impact including cross-protection and type replacement, we described high-risk (HR)-HPV type-specific cervical precancer incidence rates among women aged 20 to 39 years, 2008 to 2016. We analyzed cross-sectional population-based data on 18 344 cases of CIN2+ from a 5-site surveillance system. Diagnostic specimens were tested for individual HPV types, including 14 HR-HPV types (HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68). We estimated age-specific annual HR-HPV type-specific CIN2+ incidence per 100 000 screened women for individual types, vaccine HR-HPV types (HPV16/18) and nonvaccine HR-HPV types (non-HPV16/18). We evaluated trends using average annual percent changes (AAPC) and 95% confidence intervals (CI), and estimated total declines by comparing 2015-2016 to 2008-2009 using incidence rate ratios. Among 20-24-year-olds, HPV16/18-CIN2+ declined from 2008 through 2016 (AAPC: -21.3%, 95% CI: -28.1%, -13.8%), whereas no trend was observed for non-HPV16/18-CIN2+ (AAPC: -1.8%, 95% CI: -8.1%, 4.9%). After 2010, CIN2+ among 20-24-year-olds was more often caused by nonvaccine vs vaccine HR-HPV types. No significant declining trends were observed in older age groups. In 2015-2016 compared with 2008-2009, HPV16-CIN2+ declined 78%, HPV18-CIN2+ 72% and HPV31-CIN2+ 51% among 20-24-year-olds; no increases were observed in type-specific CIN2+ incidence. Among 25-29-year-olds, HPV16-CIN2+ declined 18%; CIN2+ attributed to seven nonvaccine types increased significantly. No significant declines were observed in older groups. Significant declines in HPV16/18-CIN2+ in 20-24-year-olds and HPV16-CIN2+ in 25-29-year-olds corroborate impact of HPV vaccination. A declining trend in HPV31-CIN2+ is consistent with cross-protection from vaccination.

Keywords: cervical cancer; cervical intraepithelial neoplasia; human papillomavirus; public health surveillance; vaccination.

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References

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