Trends in High-grade Cervical Lesions and Cervical Cancer Screening in 5 States, 2008–2015

Gargano, Julia W.; Park, Ina U.; Griffin, Marie R.; Niccolai, Linda M.; Powell, Melissa; Bennett, Nancy M.; Jones, Michelle; Whitney, Erin; Pemmaraju, Manideepthi; Brackney, Monica; Abdullah, Nasreen; Scahill, Mary; Dahl, Rebecca; Cleveland, Angela A.; Unger, Elizabeth R.; Markowitz, Lauri E.

doi:10.1093/cid/ciy707

Cited by 51 publications

(65 citation statements)

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“…While there were no significant changes in population‐level AIS incidence rates in 25–29 or 30–39 year‐olds, we did note a significant 8.9% increase in AIS incidence rates between 2008 and 2015 among 30–39 year‐old screened women. This finding is similar to CIN2+ incidence trends in the US and the Netherlands . Van der Horst et al .…”

Section: Discussionsupporting

confidence: 83%

“…Importantly, we report significant declines in AIS incidence rates among 21–24 year‐olds, overall and among screened women. Although numbers are small in this group, this reported decline among AIS cases is similar to recent reports of declines among all CIN2+ lesions in the US during the same time period . Revised cervical cancer screening recommendations have resulted in a smaller pool of women screened annually, and thus fewer are available to be diagnosed annually .…”

Section: Discussionsupporting

confidence: 82%

“…Incidence rates were calculated using annual population estimates and the estimated number of screened women in each site as the denominators as described previously. 42 We calculated incidence rates per 100,000 women for age groups 21-24, 25-29, 30-39 and 40-64 years; women in the 18-20 year age group also were excluded from this analysis. We calculated incidence rates per 100,000 screened women for age groups 21-24, 25-29 and 30-39 years.…”

Section: Resultsmentioning

confidence: 99%

“…Although numbers are small in this group, this reported decline among AIS cases is similar to recent reports of declines among all CIN2+ lesions in the US during the same time period. 40,42,48 Revised cervical cancer screening recommendations have resulted in a smaller pool of women screened annually, and thus fewer are available to be diagnosed annually. 49 The decline we observed among screened women in this age group suggests that reductions are not entirely due to increased screening intervals and could result, at least in part, from vaccine impact.…”

Section: Discussionmentioning

confidence: 99%

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Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008–2015

Cleveland

Gargano

Park

et al. 2019

Intl Journal of Cancer

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Primary prevention through the use of human papillomavirus (HPV) vaccination is expected to impact both cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS). While CIN is well described, less is known about the epidemiology of AIS, a rare cervical precancer. We identified AIS and CIN grade 3 (CIN3) cases through population‐based surveillance, and analyzed data on HPV types and incidence trends overall, and among women screened for cervical cancer. From 2008 to 2015, 470 AIS and 6,587 CIN3 cases were identified. The median age of women with AIS was older than those with CIN3 (35 vs. 31 years; p < 0.01). HPV16 was the most frequently detected type in both AIS and CIN3 (57% in AIS; 58% in CIN3), whereas HPV18 was the second most common type in AIS and less common in CIN3 (38% vs. 5%; p < 0.01). AIS lesions were more likely than CIN3 lesions to be positive for high‐risk types targeted by the bivalent and quadrivalent vaccines (HPV16/18, 92% vs. 63%; p < 0.01), and 9‐valent vaccine (HPV16/18/31/33/45/52/58, 95% vs. 87%; p < 0.01). AIS incidence rates decreased significantly in the 21–24 year age group (annual percent change [APC] overall: −22.1%, 95% CI: −33.9 to −8.2; APC among screened: −16.1%, 95% CI: −28.8 to −1.2), but did not decrease significantly in any older age group. This report on the largest number of genotyped AIS cases to date suggests an important opportunity for vaccine prevention of AIS, and is the first to document a decline in AIS incidence rates among young women during the vaccine era.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008–2015

Cleveland

Gargano

Park

et al. 2019

Intl Journal of Cancer

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“…In the United States, data from the HPV Vaccine Impact Monitoring Project (HPV-IMPACT), a population-based, active surveillance system, is used to monitor trends in cervical precancer incidence, including HPV typing on archived diagnostic specimens from women age 18-39 years (8). Since vaccine introduction, cervical precancer incidence has declined 56% among [18][19][20] year olds and 39% among [21][22][23][24] year olds reported to HPV-IMPACT (10). Although a declining cervical precancer incidence is consistent with the impact of HPV vaccination, the interpretation of this decline is complicated by changes to cervical cancer screening guidelines since vaccine introduction, such as delayed initiation of screening and longer screening intervals (11).…”

Section: Introductionmentioning

confidence: 99%

Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008–2014

McClung

Gargano

Bennett

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: The impact of human papillomavirus (HPV) vaccination has been observed in the United States through declining cervical precancer incidence in young women. To further evaluate vaccine impact, we described trends in HPV vaccine types 16/18 in cervical precancers, 2008-2014. Methods: We analyzed data from a 5-site, population-based surveillance system. Archived specimens from women age 18-39 years diagnosed with cervical intraepithelial neoplasia grades 2-3 or adenocarcinoma in situ (CIN2þ) were tested for 37 HPV types. We described the proportion and estimated number of cases of CIN2þ by HPV-type groups over time. Trends in HPV16/18-positive CIN2þ were examined, overall and by vaccination status, age, histologic grade, and race/ ethnicity, using Cochrane-Armitage tests.Results: In 10,206 cases, the proportion and estimated number of cases of HPV16/18-positive CIN2þ declined from 52.7% (1,235 cases) in 2008 to 44.1% (819 cases) in 2014 (P < 0.001). Declining trends in the proportion of HPV16/ 18-positive CIN2þ were observed among vaccinated (55.2%-33.3%, P < 0.001) and unvaccinated (51.0%-47.3%, P ¼ 0.03) women; ages 18-20 (48.7%-18.8%, P ¼ 0.02), 21-24 (53.8%-44.0%, P < 0.001), 25-29 (56.9%-42.4%, P < 0.001), and 30-34 (49.8%-45.8%, P ¼ 0.04) years; CIN2 (40.8%-29.9%, P < 0.001) and CIN2/3 (61.8%-46.2%, P < 0.001); non-Hispanic white (59.5%-47.9%, P < 0.001) and non-Hispanic black (40.7%-26.5%, P < 0.001).Conclusions: From 2008-2014, the proportion of HPV16/ 18-positive CIN2þ declined, with the greatest declines in vaccinated women; declines in unvaccinated women suggest herd protection.Impact: The declining proportion of HPV16/18-positive CIN2þ provides additional evidence of vaccine impact in the United States. a "Other" and unknown excluded from analysis (n ¼ 1,437, 14.1%); CIN: cervical intraepithelial neoplasia; AIS: adenocarcinoma in situ with or without CIN. b P < 0.05. c Women with unknown timing of vaccination were excluded (n ¼ 266) McClung et al.

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Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

et al. 2023

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ImportanceSince 1996, the US Preventive Services Task Force has recommended against cervical cancer screening in average-risk women 65 years or older with adequate prior screening. Little is known about the use of cervical cancer screening–associated services in this age group.ObjectiveTo examine annual use trends in cervical cancer screening–associated services, specifically cytology and human papillomavirus (HPV) tests, colposcopy, and cervical procedures (loop electrosurgical excision procedure, cone biopsy, and ablation) in Medicare fee-for-service beneficiaries during January 1, 1999, to December 31, 2019, and estimate expenditures for services performed in 2019.Design, Setting, and ParticipantsThis population-based, cross-sectional analysis included health service use data across 21 years for women aged 65 to 114 years with Medicare fee-for-service coverage (15-16 million women per year). Data analysis was conducted between July 2021 and April 2022.Main Outcomes and MeasuresProportion of testing modalities (cytology alone, cytology plus HPV testing [cotesting], HPV testing alone); annual use rate per 100 000 women of cytology and HPV testing, colposcopy, and cervical procedures from 1999 to 2019; Medicare expenditure for these services in 2019.ResultsThere were 15 323 635 women 65 years and older with Medicare fee-for-service coverage in 1999 and 15 298 656 in 2019. In 2019, the mean (SD) age of study population was 76.2 (8.1) years, 5.1% were Hispanic, 0.5% were non-Hispanic American Indian/Alaska Native, 3.0% were non-Hispanic Asian/Pacific Islander, 7.4% were non-Hispanic Black, and 82.0% were non-Hispanic White. From 1999 to 2019, the percentage of women who received at least 1 cytology or HPV test decreased from 18.9% (2.9 million women) in 1999 to 8.5% (1.3 million women) in 2019, a reduction of 55.3%; use rates of colposcopy and cervical procedures decreased 43.2% and 64.4%, respectively. Trend analyses showed a 4.6% average annual reduction in use of cytology or HPV testing during 1999 to 2019 (P &lt; .001). Use rates of colposcopy and cervical procedures decreased before 2015 then plateaued during 2015 to 2019. The total Medicare expenditure for all services rendered in 2019 was about $83.5 million. About 3% of women older than 80 years received at least 1 service at a cost of $7.4 million in 2019.Conclusions and RelevanceThe results of this cross-sectional study suggest that while annual use of cervical cancer screening–associated services in the Medicare fee-for-service population older than 65 years has decreased during the last 2 decades, more than 1.3 million women received these services in 2019 at substantial costs.

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Trends in High-grade Cervical Lesions and Cervical Cancer Screening in 5 States, 2008–2015

Abstract: 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 population-level impact of HPV vaccination.

Cited by 51 publications

References 32 publications

Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008–2015

Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008–2015

Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008–2014

Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

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