Trends in high-grade cervical lesions and cervical cancer screening in 5 states, 2008-2015

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; Sheelah Blankenship; Stephanie Allen; James Meek; Kyle Higgins; James Hadler; Lynn Sosa; Kayla Saadeh; Ashley Williamson; Deanna Fink; Michael J. Silverberg; Robert Laing; Sean Schafer; Marina Oktapodas; Christina Felsen

doi:10.1093/cid/ciy707

Trends in high-grade cervical lesions and cervical cancer screening in 5 states, 2008-2015

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
, Sheelah Blankenship
, Stephanie Allen
, James Meek
, Kyle Higgins

James Hadler, Lynn Sosa, Kayla Saadeh, Ashley Williamson, Deanna Fink, Michael J. Silverberg, Robert Laing, Sean Schafer, Marina Oktapodas, Christina Felsen

Department of Epidemiology and Environmental Health

Centers for Disease Control and Prevention
University of California at San Francisco
Vanderbilt University
Yale University
Oregon Health Authority
University of Rochester
California Emerging Infections Program
Commonwealth of Massachusetts
Kaiser Permanente

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

Background We describe changes in rates of cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ (CIN2+) during a period of human papillomavirus (HPV) vaccine uptake and changing cervical cancer screening recommendations. Methods We conducted population-based laboratory surveillance for CIN2+ in catchment areas in 5 states, 2008-2015. We calculated age-specific CIN2+ rates per 100000 women by age groups. We estimated incidence rate ratios (IRR) of CIN2+ for 2-year periods among all women and among screened women to evaluate changes over time. Results A total of 16572 CIN2+ cases were reported. Among women aged 18-20 and 21-24 years, CIN2+ rates declined in all sites, whereas in women aged 25-29, 30-34, and 35-39 years, trends differed across sites. The percent of women screened annually declined in all sites and age groups. Compared to 2008-2009, rates among screened women were significantly lower for all 3 periods in women aged 18-20 years (2010-2011: IRR 0.82, 95% confidence interval [CI] 0.67-0.99; 2012-2013: IRR 0.63, 95% CI 0.47-0.85; 2014-2015: IRR 0.44, 95% CI 0.28-0.68) and lower for the latter 2 time periods in women aged 21-24 years (2012-2013: IRR 0.86, 95% CI 0.79-0.94; 2014-2015: IRR 0.61, 95% CI 0.55-0.67). Conclusions From 2008-2015, both CIN2+ rates and cervical cancer screening declined in women aged 18-24 years. The significant decreases in CIN2+ rates among screened women aged 18-24 years are consistent with a population-level impact of HPV vaccination.

Original language	English
Pages (from-to)	1282-1291
Number of pages	10
Journal	Clinical Infectious Diseases
Volume	68
Issue number	8
DOIs	https://doi.org/10.1093/cid/ciy707
State	Published - Apr 8 2019

Keywords

cervical intraepithelial neoplasia
disease surveillance
human papillomavirus
vaccine impact

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10.1093/cid/ciy707

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Gargano, J. W., Park, I. U., Griffin, M. R., Niccolai, L. M., Powell, M., Bennett, N. M., Johnson Jones, M. L., Whitney, E., Pemmaraju, M., Brackney, M., Abdullah, N., Scahill, M., Dahl, R. M., Cleveland, A. A., Unger, E. R., Markowitz, L. E., Blankenship, S., Allen, S., Meek, J., ... Felsen, C. (2019). Trends in high-grade cervical lesions and cervical cancer screening in 5 states, 2008-2015. Clinical Infectious Diseases, 68(8), 1282-1291. https://doi.org/10.1093/cid/ciy707

@article{b54d4ea135d64c5fbf53033a01daef2c,

title = "Trends in high-grade cervical lesions and cervical cancer screening in 5 states, 2008-2015",

abstract = "Background We describe changes in rates of cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ (CIN2+) during a period of human papillomavirus (HPV) vaccine uptake and changing cervical cancer screening recommendations. Methods We conducted population-based laboratory surveillance for CIN2+ in catchment areas in 5 states, 2008-2015. We calculated age-specific CIN2+ rates per 100000 women by age groups. We estimated incidence rate ratios (IRR) of CIN2+ for 2-year periods among all women and among screened women to evaluate changes over time. Results A total of 16572 CIN2+ cases were reported. Among women aged 18-20 and 21-24 years, CIN2+ rates declined in all sites, whereas in women aged 25-29, 30-34, and 35-39 years, trends differed across sites. The percent of women screened annually declined in all sites and age groups. Compared to 2008-2009, rates among screened women were significantly lower for all 3 periods in women aged 18-20 years (2010-2011: IRR 0.82, 95\% confidence interval [CI] 0.67-0.99; 2012-2013: IRR 0.63, 95\% CI 0.47-0.85; 2014-2015: IRR 0.44, 95\% CI 0.28-0.68) and lower for the latter 2 time periods in women aged 21-24 years (2012-2013: IRR 0.86, 95\% CI 0.79-0.94; 2014-2015: IRR 0.61, 95\% CI 0.55-0.67). Conclusions From 2008-2015, both CIN2+ rates and cervical cancer screening declined in women aged 18-24 years. The significant decreases in CIN2+ rates among screened women aged 18-24 years are consistent with a population-level impact of HPV vaccination.",

keywords = "cervical intraepithelial neoplasia, disease surveillance, human papillomavirus, vaccine impact",

author = "Gargano, \{Julia Warner\} and Park, \{Ina U.\} and Griffin, \{Marie R.\} and Niccolai, \{Linda M.\} and Melissa Powell and Bennett, \{Nancy M.\} and \{Johnson Jones\}, \{Michelle L.\} and Erin Whitney and Manideepthi Pemmaraju and Monica Brackney and Nasreen Abdullah and Mary Scahill and Dahl, \{Rebecca M.\} and Cleveland, \{Angela A.\} and Unger, \{Elizabeth R.\} and Markowitz, \{Lauri E.\} and Sheelah Blankenship and Stephanie Allen and James Meek and Kyle Higgins and James Hadler and Lynn Sosa and Kayla Saadeh and Ashley Williamson and Deanna Fink and Silverberg, \{Michael J.\} and Robert Laing and Sean Schafer and Marina Oktapodas and Christina Felsen",

note = "Publisher Copyright: {\textcopyright} 2018 Published by Oxford University Press for the Infectious Diseases Society of America.",

year = "2019",

month = apr,

day = "8",

doi = "10.1093/cid/ciy707",

language = "English",

volume = "68",

pages = "1282--1291",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "8",

}

Gargano, JW, Park, IU, Griffin, MR, Niccolai, LM, Powell, M, Bennett, NM, Johnson Jones, ML, Whitney, E, Pemmaraju, M, Brackney, M, Abdullah, N, Scahill, M, Dahl, RM, Cleveland, AA, Unger, ER, Markowitz, LE, Blankenship, S, Allen, S, Meek, J, Higgins, K, Hadler, J, Sosa, L, Saadeh, K, Williamson, A, Fink, D, Silverberg, MJ, Laing, R, Schafer, S, Oktapodas, M & Felsen, C 2019, 'Trends in high-grade cervical lesions and cervical cancer screening in 5 states, 2008-2015', Clinical Infectious Diseases, vol. 68, no. 8, pp. 1282-1291. https://doi.org/10.1093/cid/ciy707

TY - JOUR

T1 - Trends in high-grade cervical lesions and cervical cancer screening in 5 states, 2008-2015

AU - Gargano, Julia Warner

AU - Park, Ina U.

AU - Griffin, Marie R.

AU - Niccolai, Linda M.

AU - Powell, Melissa

AU - Bennett, Nancy M.

AU - Johnson Jones, Michelle L.

AU - Whitney, Erin

AU - Pemmaraju, Manideepthi

AU - Brackney, Monica

AU - Abdullah, Nasreen

AU - Scahill, Mary

AU - Dahl, Rebecca M.

AU - Cleveland, Angela A.

AU - Unger, Elizabeth R.

AU - Markowitz, Lauri E.

AU - Blankenship, Sheelah

AU - Allen, Stephanie

AU - Meek, James

AU - Higgins, Kyle

AU - Hadler, James

AU - Sosa, Lynn

AU - Saadeh, Kayla

AU - Williamson, Ashley

AU - Fink, Deanna

AU - Silverberg, Michael J.

AU - Laing, Robert

AU - Schafer, Sean

AU - Oktapodas, Marina

AU - Felsen, Christina

PY - 2019/4/8

Y1 - 2019/4/8

N2 - Background We describe changes in rates of cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ (CIN2+) during a period of human papillomavirus (HPV) vaccine uptake and changing cervical cancer screening recommendations. Methods We conducted population-based laboratory surveillance for CIN2+ in catchment areas in 5 states, 2008-2015. We calculated age-specific CIN2+ rates per 100000 women by age groups. We estimated incidence rate ratios (IRR) of CIN2+ for 2-year periods among all women and among screened women to evaluate changes over time. Results A total of 16572 CIN2+ cases were reported. Among women aged 18-20 and 21-24 years, CIN2+ rates declined in all sites, whereas in women aged 25-29, 30-34, and 35-39 years, trends differed across sites. The percent of women screened annually declined in all sites and age groups. Compared to 2008-2009, rates among screened women were significantly lower for all 3 periods in women aged 18-20 years (2010-2011: IRR 0.82, 95% confidence interval [CI] 0.67-0.99; 2012-2013: IRR 0.63, 95% CI 0.47-0.85; 2014-2015: IRR 0.44, 95% CI 0.28-0.68) and lower for the latter 2 time periods in women aged 21-24 years (2012-2013: IRR 0.86, 95% CI 0.79-0.94; 2014-2015: IRR 0.61, 95% CI 0.55-0.67). Conclusions From 2008-2015, both CIN2+ rates and cervical cancer screening declined in women aged 18-24 years. The significant decreases in CIN2+ rates among screened women aged 18-24 years are consistent with a population-level impact of HPV vaccination.

AB - Background We describe changes in rates of cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ (CIN2+) during a period of human papillomavirus (HPV) vaccine uptake and changing cervical cancer screening recommendations. Methods We conducted population-based laboratory surveillance for CIN2+ in catchment areas in 5 states, 2008-2015. We calculated age-specific CIN2+ rates per 100000 women by age groups. We estimated incidence rate ratios (IRR) of CIN2+ for 2-year periods among all women and among screened women to evaluate changes over time. Results A total of 16572 CIN2+ cases were reported. Among women aged 18-20 and 21-24 years, CIN2+ rates declined in all sites, whereas in women aged 25-29, 30-34, and 35-39 years, trends differed across sites. The percent of women screened annually declined in all sites and age groups. Compared to 2008-2009, rates among screened women were significantly lower for all 3 periods in women aged 18-20 years (2010-2011: IRR 0.82, 95% confidence interval [CI] 0.67-0.99; 2012-2013: IRR 0.63, 95% CI 0.47-0.85; 2014-2015: IRR 0.44, 95% CI 0.28-0.68) and lower for the latter 2 time periods in women aged 21-24 years (2012-2013: IRR 0.86, 95% CI 0.79-0.94; 2014-2015: IRR 0.61, 95% CI 0.55-0.67). Conclusions From 2008-2015, both CIN2+ rates and cervical cancer screening declined in women aged 18-24 years. The significant decreases in CIN2+ rates among screened women aged 18-24 years are consistent with a population-level impact of HPV vaccination.

KW - cervical intraepithelial neoplasia

KW - disease surveillance

KW - human papillomavirus

KW - vaccine impact

UR - https://www.scopus.com/pages/publications/85064137950

U2 - 10.1093/cid/ciy707

DO - 10.1093/cid/ciy707

M3 - Article

C2 - 30137283

AN - SCOPUS:85064137950

SN - 1058-4838

VL - 68

SP - 1282

EP - 1291

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 8

ER -

Trends in high-grade cervical lesions and cervical cancer screening in 5 states, 2008-2015

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Keywords

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