title: Declining rates of high-grade cervical lesions in young women in Connecticut, 2008-2011.
abstract: Vaccines that prevent infection with human papillomavirus (HPV) types 16 and 18 that are known to cause cervical cancer have been available in the United States since 2006. High-grade cervical lesions are important for monitoring early vaccine impact because they are strong surrogates for cancer yet can develop within years after infection as opposed to decades. Trends in high-grade cervical lesions including cervical intraepithelial neoplasia grades 2, 2/3, and 3 and adenocarcinoma in situ among women ages 21 to 39 years old were examined using a statewide surveillance registry in Connecticut from 2008 to 2011. During this time period, HPV vaccine initiation increased among adolescent females from 45% to 61%. Analyses were stratified by age, according to census tract measures of proportion of population Black, Hispanic, living in poverty, and by urban/nonurban counties. The annual rate per 100,000 females ages 21 to 24 years declined from 834 in 2008 to 688 in 2011 (P(trend) < 0.001). No significant declines were observed among women ages 25 to 39 years. Significant declining trends also occurred in census tracts with lower proportions of the population being Black, Hispanic, or living below the federal poverty level. Declines in high-grade cervical lesions have occurred among young women during 2008 to 2011. This is the first report of declines in cervical neoplasia in the United States since HPV vaccines became available. Continued surveillance is needed to measure vaccine impact and monitor health disparities.
authors.affiliation: Yale School of Public Health and Connecticut Emerging Infections Program, New Haven, Connecticut 06520, USA. linda.niccolai@yale.edu
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Julian
authors.forename: James I
authors.initials: JI
authors.lastname: Meek
authors.forename: Vanessa
authors.initials: V
authors.lastname: McBride
authors.forename: James L
authors.initials: JL
authors.lastname: Hadler
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Sosa
mesh_terms: D000328:Adult; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000302:isolation & purification; D006801:Humans; D060787:Neoplasm Grading; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines