Susan Hariri1, Michelle L Johnson1, Nancy M Bennett2, Heidi M Bauer3, Ina U Park3, Sean Schafer4, Linda M Niccolai5, Elizabeth R Unger6, Lauri E Markowitz1. 1. Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. 2. Center for Community Health and Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. 3. STD Control Branch, HIV/STD/TB Program, Center for Public Health Practice, California Department of Public Health, Richmond, California. 4. HIV/STD/TB Program, Center for Public Health Practice, Oregon Public Health Division, Portland, Oregon. 5. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut. 6. Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Abstract
BACKGROUND: Cervical intraepithelial neoplasia grade 2, 3, and adenocarcinoma in situ (CIN2+) lesions can be monitored as early indicators of human papillomavirus (HPV) vaccine impact. Changes to screening utilization will affect observed reductions in CIN2+ rates and complicate the interpretation of vaccine impact. METHODS: From 2008 to 2012, 9119 cases of CIN2+ among 18- to 39-year-old residents of catchment areas in California, Connecticut, New York, and Oregon were reported to the HPV-IMPACT Project, a sentinel system for monitoring the population impact of HPV vaccine. Age-stratified CIN2+ incidence rates were calculated for each catchment. Annual cervical screening was estimated for California, New York, and Oregon catchments with administrative and survey data. The Cochran-Armitage test was used to examine trends. RESULTS: From 2008 to 2012, the incidence of CIN2+ significantly decreased among 18- to 20-year-olds (California, from 94 to 5 per 100,000 women; Connecticut, from 450 to 57 per 100,000 women; New York, from 299 to 43 per 100,000 women; and Oregon, from 202 to 37 per 100,000 women; Ptrend < .0001) and among 21- to 29-year-olds in Connecticut (from 762 to 589 per 100,000 women) and New York (from 770 to 465 per 100,000 women; Ptrend < .001); rates did not differ among 30- to 39-year-olds. During the same period, screening rates also declined, with the largest decreases among 18- to 20-year-olds (from 67% in Oregon to 88% in California) and with smaller declines among 21- to 29-year-olds (13%-27%) and 30- to 39-year-olds (3%-21%). CONCLUSIONS: The declines in CIN2+ detection in young women were likely due to reduced screening but could also reflect the impact of vaccination. These data illustrate challenges in interpreting CIN2+ ecologic trends in the new era of cervical cancer prevention and emphasize the importance of information such as HPV types detected in lesions to assess the impact of HPV vaccine on cervical precancers.
BACKGROUND: Cervical intraepithelial neoplasia grade 2, 3, and adenocarcinoma in situ (CIN2+) lesions can be monitored as early indicators of human papillomavirus (HPV) vaccine impact. Changes to screening utilization will affect observed reductions in CIN2+ rates and complicate the interpretation of vaccine impact. METHODS: From 2008 to 2012, 9119 cases of CIN2+ among 18- to 39-year-old residents of catchment areas in California, Connecticut, New York, and Oregon were reported to the HPV-IMPACT Project, a sentinel system for monitoring the population impact of HPV vaccine. Age-stratified CIN2+ incidence rates were calculated for each catchment. Annual cervical screening was estimated for California, New York, and Oregon catchments with administrative and survey data. The Cochran-Armitage test was used to examine trends. RESULTS: From 2008 to 2012, the incidence of CIN2+ significantly decreased among 18- to 20-year-olds (California, from 94 to 5 per 100,000 women; Connecticut, from 450 to 57 per 100,000 women; New York, from 299 to 43 per 100,000 women; and Oregon, from 202 to 37 per 100,000 women; Ptrend < .0001) and among 21- to 29-year-olds in Connecticut (from 762 to 589 per 100,000 women) and New York (from 770 to 465 per 100,000 women; Ptrend < .001); rates did not differ among 30- to 39-year-olds. During the same period, screening rates also declined, with the largest decreases among 18- to 20-year-olds (from 67% in Oregon to 88% in California) and with smaller declines among 21- to 29-year-olds (13%-27%) and 30- to 39-year-olds (3%-21%). CONCLUSIONS: The declines in CIN2+ detection in young women were likely due to reduced screening but could also reflect the impact of vaccination. These data illustrate challenges in interpreting CIN2+ ecologic trends in the new era of cervical cancer prevention and emphasize the importance of information such as HPV types detected in lesions to assess the impact of HPV vaccine on cervical precancers.
Authors: Christian A W Bruhn; Cynthia Schuck-Paim; Esra Kürüm; Robert J Taylor; Lone Simonsen; Daniel M Weinberger Journal: Epidemiology Date: 2017-03 Impact factor: 4.822
Authors: Christian A W Bruhn; Stephen Hetterich; Cynthia Schuck-Paim; Esra Kürüm; Robert J Taylor; Roger Lustig; Eugene D Shapiro; Joshua L Warren; Lone Simonsen; Daniel M Weinberger Journal: Proc Natl Acad Sci U S A Date: 2017-02-01 Impact factor: 11.205
Authors: Michael J Silverberg; Wendy A Leyden; Jennifer O Lam; Steven E Gregorich; Megan J Huchko; Shalini Kulasingam; Miriam Kuppermann; Karen K Smith-McCune; George F Sawaya Journal: Lancet Child Adolesc Health Date: 2018-08-08
Authors: Julia Warner Gargano; Ina U Park; Marie R Griffin; Linda M Niccolai; Melissa Powell; Nancy M Bennett; Michelle L Johnson Jones; Erin Whitney; Manideepthi Pemmaraju; Monica Brackney; Nasreen Abdullah; Mary Scahill; Rebecca M Dahl; Angela A Cleveland; Elizabeth R Unger; Lauri E Markowitz Journal: Clin Infect Dis Date: 2019-04-08 Impact factor: 9.079
Authors: Nancy M McClung; Julia W Gargano; Nancy M Bennett; Linda M Niccolai; Nasreen Abdullah; Marie R Griffin; Ina U Park; Angela A Cleveland; Troy D Querec; Elizabeth R Unger; Lauri E Markowitz Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-02-21 Impact factor: 4.254
Authors: Jong Kim; Christopher Bell; Maggie Sun; Gordon Kliewer; Linan Xu; Maria McInerney; Lawrence W Svenson; Huiming Yang Journal: CMAJ Date: 2016-07-04 Impact factor: 8.262
Authors: Meg Watson; Ashwini Soman; Elaine W Flagg; Elizabeth Unger; Dennis Deapen; Vivien W Chen; Lauren C Peres; Glenn Copeland; Thomas C Tucker; Erin Garnett; Mona Saraiya Journal: Prev Med Date: 2017-07-29 Impact factor: 4.018