Jacqueline Mix1, Mona Saraiya1, Benjamin D Hallowell2, Brian Befano3, Li C Cheung4, Elizabeth R Unger5, Julia W Gargano6, Lauri E Markowitz6, Philip E Castle4,7, Tina Raine-Bennett8, Joan Walker9, Rosemary Zuna10, Mark Schiffman11, Nicolas Wentzensen12, Julia C Gage13. 1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA. 2. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA. 3. Information Management Services, Calverton, MD, USA. 4. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA. 5. Divison of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA. 6. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. 7. Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA. 8. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. 9. University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 10. University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 11. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA. 12. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA. 13. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Abstract
BACKGROUND: Racial and ethnic variations in attribution of cervical precancer and cancer to human papillomavirus (HPV) types may result in different HPV vaccine protection, screening test coverage, and clinical management. METHODS: Pooling data from 7 US studies, we calculated the proportional attribution of precancers and cancers to HPV types using HPV DNA typing from diagnosis. All statistical tests were 2-sided. RESULTS: For all racial and ethnic groups, most cases of cervical intraepithelial neoplasia grade 3 (CIN3) (84.2%-90.8% of 5526) and squamous cell carcinoma (SCC) (90.4%-93.8% of 1138) were attributed to types targeted by the 9-valent vaccine. A higher proportion of CIN3s were attributed to nonvaccine HPV types among non-Hispanic Black women (15.8%) compared with non-Hispanic Asian or Pacific Islander (9.7%; P = .002), non-Hispanic White (9.2%; P < .001), and Hispanic (11.3%; P = .004) women. The proportion of SCCs attributed to 9-valent types was similar by race and ethnicity (P = .80). A higher proportion of CIN3s were attributed to nonvaccine HPV35 among non-Hispanic Black (9.0%) compared with non-Hispanic Asian or Pacific Islander (2.2%), non-Hispanic White (2.5%), and Hispanic (3.0%; all P < .001) women. Compared with CIN3, the proportion of SCCs attributed to HPV35 among non-Hispanic Black women (3.2%) was lower and closer to other groups (0.3%-2.1%; P = .70). CONCLUSION: The 9-valent HPV vaccine will prevent nearly all cervical precancers and invasive cancers among major racial and ethnic groups in the United States. Adding HPV35 to vaccines could prevent a small percentage of CIN3s and SCCs, with greater potential impact for CIN3s among Black women. HPV screening tests target high-risk HPV types, including HPV35. Future genotyping triage strategies could consider the importance of HPV35- and other HPV16-related types. Published by Oxford University Press 2022. This work is written by US Government employees and is in the public domain in the US.
BACKGROUND: Racial and ethnic variations in attribution of cervical precancer and cancer to human papillomavirus (HPV) types may result in different HPV vaccine protection, screening test coverage, and clinical management. METHODS: Pooling data from 7 US studies, we calculated the proportional attribution of precancers and cancers to HPV types using HPV DNA typing from diagnosis. All statistical tests were 2-sided. RESULTS: For all racial and ethnic groups, most cases of cervical intraepithelial neoplasia grade 3 (CIN3) (84.2%-90.8% of 5526) and squamous cell carcinoma (SCC) (90.4%-93.8% of 1138) were attributed to types targeted by the 9-valent vaccine. A higher proportion of CIN3s were attributed to nonvaccine HPV types among non-Hispanic Black women (15.8%) compared with non-Hispanic Asian or Pacific Islander (9.7%; P = .002), non-Hispanic White (9.2%; P < .001), and Hispanic (11.3%; P = .004) women. The proportion of SCCs attributed to 9-valent types was similar by race and ethnicity (P = .80). A higher proportion of CIN3s were attributed to nonvaccine HPV35 among non-Hispanic Black (9.0%) compared with non-Hispanic Asian or Pacific Islander (2.2%), non-Hispanic White (2.5%), and Hispanic (3.0%; all P < .001) women. Compared with CIN3, the proportion of SCCs attributed to HPV35 among non-Hispanic Black women (3.2%) was lower and closer to other groups (0.3%-2.1%; P = .70). CONCLUSION: The 9-valent HPV vaccine will prevent nearly all cervical precancers and invasive cancers among major racial and ethnic groups in the United States. Adding HPV35 to vaccines could prevent a small percentage of CIN3s and SCCs, with greater potential impact for CIN3s among Black women. HPV screening tests target high-risk HPV types, including HPV35. Future genotyping triage strategies could consider the importance of HPV35- and other HPV16-related types. Published by Oxford University Press 2022. This work is written by US Government employees and is in the public domain in the US.
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