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Showing content from https://pubmed.ncbi.nlm.nih.gov/27685805/ below:

Population-Based Incidence Rates of Cervical Intraepithelial Neoplasia in the Human Papillomavirus Vaccine Era

. 2017 Jun 1;3(6):833-837. doi: 10.1001/jamaoncol.2016.3609. Population-Based Incidence Rates of Cervical Intraepithelial Neoplasia in the Human Papillomavirus Vaccine Era

Affiliations

¹ Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
² Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
³ Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque.
⁴ House of Prevention Epidemiology (HOPE), Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque.
⁵ Department of Health Policy and Management, Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
⁶ Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England.
⁷ Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque.
⁸ University of New Mexico Comprehensive Cancer Center, Albuquerque.

PMID: 27685805
PMCID: PMC5765871
DOI: 10.1001/jamaoncol.2016.3609

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Population-Based Incidence Rates of Cervical Intraepithelial Neoplasia in the Human Papillomavirus Vaccine Era

Vicki B Benard et al. JAMA Oncol. 2017.

. 2017 Jun 1;3(6):833-837. doi: 10.1001/jamaoncol.2016.3609. Authors Vicki B Benard¹, Philip E Castle², Steven A Jenison³, William C Hunt⁴, Jane J Kim⁵, Jack Cuzick⁶, Ji-Hyun Lee⁷, Ruofei Du⁸, Michael Robertson⁴, Scott Norville³, Cosette M Wheeler⁴; New Mexico HPV Pap Registry Steering Committee Affiliations

¹ Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
² Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
³ Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque.
⁴ House of Prevention Epidemiology (HOPE), Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque.
⁵ Department of Health Policy and Management, Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
⁶ Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England.
⁷ Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque.
⁸ University of New Mexico Comprehensive Cancer Center, Albuquerque.

PMID: 27685805
PMCID: PMC5765871
DOI: 10.1001/jamaoncol.2016.3609

Item in Clipboard

Abstract

Importance: A substantial effect of human papillomavirus (HPV) vaccines on reducing HPV-related cervical disease is essential before modifying clinical practice guidelines in partially vaccinated populations.

Objective: To determine the population-based cervical intraepithelial neoplasia (CIN) trends when adjusting for changes in cervical screening practices that overlapped with HPV vaccination implementation.

Design, setting, and participants: The New Mexico HPV Pap Registry, which captures population-based estimates of both cervical screening prevalence and CIN, was used to compute CIN trends from January 1, 2007, to December 31, 2014. Under New Mexico Administrative Code, the New Mexico HPV Pap Registry, a statewide public health surveillance program, receives mandatory reporting of all cervical screening (cytologic and HPV testing) and any cervical, vulvar, and vaginal histopathological findings for all women residing in New Mexico irrespective of outcome.

Main outcome measures: Prespecified outcome measures included low-grade CIN (grade 1 [CIN1]) and high-grade CIN (grade 2 [CIN2] and grade 3 [CIN3]).

Results: From 2007 to 2014, a total of 13 520 CIN1, 4296 CIN2, and 2823 CIN3 lesions were diagnosed among female individuals 15 to 29 years old. After adjustment for changes in cervical screening across the period, reductions in the CIN incidence per 100 000 women screened were significant for all grades of CIN among female individuals 15 to 19 years old, dropping from 3468.3 to 1590.6 for CIN1 (annual percentage change [APC], -9.0; 95% CI, -12.0 to -5.8; P < .001), from 896.4 to 414.9 for CIN2 (APC, -10.5; 95% CI, -18.8 to -1.2; P = .03), and from 240.2 to 0 for CIN3 (APC, -41.3; 95% CI, -65.7 to 0.3; P = .05). Reductions in the CIN2 incidence were also significant for women 20 to 24 years old, dropping from 1027.7 to 627.1 (APC, -6.3; 95% CI, -10.9 to -1.4; P = .02).

Conclusions and relevance: Population-level decreases in CIN among cohorts partially vaccinated for HPV may be considered when clinical practice guidelines for cervical cancer screening are reassessed. Evidence is rapidly growing to suggest that further increases in raising the age to start screening are imminent, one step toward integrating screening and vaccination.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Castle reported receiving personal fees from Guided Therapeutics, Inovio, Merck, Hologic, GE Healthcare, Cepheid, and ClearPath; personal fees and non financial support from Roche and BD; and non financial support from MTM and Qiagen (all outside of the submitted work). Dr Kim reported receiving grants to Harvard T. H. Chan School of Public Health from the National Cancer Institute during the conduct of the study. Dr Cuzick reported receiving grants to Queen Mary University of London from Qiagen, OncoHealth, and Genera, as well as grants to Queen Mary University of London and other support from BD, Abbott, Hologic, Trovagene, and Cepheid (all during the conduct of the study). Dr Wheeler reported receiving grants to the University of New Mexico from the National Cancer Institute and the National Institute of Allergy and Infectious Diseases during the conduct of the study, as well as other support to the University of New Mexico from GSK, Merck, and Roche Molecular Systems (all outside of the submitted work). No other disclosures were reported.

Figures
Figure. Annual Incidence of Cervical Intraepithelial Neoplasia…

Figure. Annual Incidence of Cervical Intraepithelial Neoplasia (CIN) and Cervical Screening Rates by 5-Year Age…
Figure. Annual Incidence of Cervical Intraepithelial Neoplasia (CIN) and Cervical Screening Rates by 5-Year Age Groups, 2007 to 2014

For the CIN1, CIN2, and CIN3 incidence rates, the numerator is the number of women diagnosed as having CIN1, CIN2, and CIN3, respectively, in a year for an age category, and the denominator is the total number of women with cervical cytologic testing in each age category per year recorded in the New Mexico HPV (Human Papillomavirus) Pap Registry. For the cervical cytologic testing rate, the numerator is the number of women with cervical cytologic screening tests in a year for an age category, and the denominator is the total number of women in the population in each age category per year estimated from the US Census; intercensal estimates were used for 2007 to 2009, and postcensal estimates for 2010 to 2014 were obtained in November 2015 at http://www.census.gov . P values for each age group indicate whether the annual percentage change in rates is significant.