Trends in Cervical Precancers Identified Through Population-Based Surveillance - Human Papillomavirus Vaccine Impact Monitoring Project, Five Sites, United States, 2008-2022

Abstract

In 2006, human papillomavirus (HPV) vaccine was first recommended in the United States to prevent cancers and other diseases caused by HPV; vaccination coverage increased steadily through 2021, and increasing numbers of young women had received HPV vaccine as children or adolescents. Since 2008, CDC has monitored incidence of precancerous lesions (cervical intraepithelial neoplasia [CIN] grades 2-3 and adenocarcinoma in situ [AIS], collectively CIN2+), which are detected through cervical cancer screening and can be used as an intermediate outcome for monitoring vaccination impact, via the five-site Human Papillomavirus Vaccine Impact Monitoring Project. This analysis describes trends in incidence of CIN2+ and CIN3+ (i.e., CIN grade 3 and AIS) lesions during 2008-2022. Among women aged 20-24 years who were screened for cervical cancer, rates during 2008-2022 decreased for CIN2+ by 79%, and for CIN3+ by 80%. In the same period, CIN3+ rates among screened women aged 25-29 years decreased by 37%. These data are consistent with considerable impact of HPV vaccination for preventing cervical precancers among women in the age groups most likely to have been vaccinated, and support existing recommendations to vaccinate children at the routinely recommended ages as a cancer prevention measure.

FIGURE

Incidence (cases per 100,000 screened women) of cervical precancers — Human Papillomavirus Vaccine Impact Monitoring Project, five sites, United States, 2008–2022 Abbreviations: CIN = cervical intraepithelial neoplasia; HPV-IMPACT = Human Papillomavirus Vaccine Impact Monitoring Project. * Denominators are the estimated number of screened women aged 20–24, 25–29, 30–34, 35–39, 40–49, or 50–64 years living in the catchment areas. ^† CIN2+ includes grades 2 or worse and adenocarcinoma in situ; CIN3+ includes grade 3 and adenocarcinoma in situ. ^§ HPV-IMPACT sites are Alameda County, California; New Haven County, Connecticut; Monroe County, New York; Davidson County, Tennessee; and 28 zip codes in metropolitan Portland, Oregon. ^¶ Trend lines were modeled using Joinpoint software (version 5.3.0.0; National Cancer Institute). Data from 2020 were excluded from trend analyses.