title: Population-based trends in high-grade cervical lesions in the early human papillomavirus vaccine era in the United States.
abstract: BACKGROUND
  Cervical intraepithelial neoplasia grade 2, 3, and adenocarcinoma in situ (CIN2+) lesions can be monitored as early indicators of human papillomavirus (HPV) vaccine impact. Changes to screening utilization will affect observed reductions in CIN2+ rates and complicate the interpretation of vaccine impact.
  
  
  METHODS
  From 2008 to 2012, 9119 cases of CIN2+ among 18- to 39-year-old residents of catchment areas in California, Connecticut, New York, and Oregon were reported to the HPV-IMPACT Project, a sentinel system for monitoring the population impact of HPV vaccine. Age-stratified CIN2+ incidence rates were calculated for each catchment. Annual cervical screening was estimated for California, New York, and Oregon catchments with administrative and survey data. The Cochran-Armitage test was used to examine trends.
  
  
  RESULTS
  From 2008 to 2012, the incidence of CIN2+ significantly decreased among 18- to 20-year-olds (California, from 94 to 5 per 100,000 women; Connecticut, from 450 to 57 per 100,000 women; New York, from 299 to 43 per 100,000 women; and Oregon, from 202 to 37 per 100,000 women; Ptrend  < .0001) and among 21- to 29-year-olds in Connecticut (from 762 to 589 per 100,000 women) and New York (from 770 to 465 per 100,000 women; Ptrend  < .001); rates did not differ among 30- to 39-year-olds. During the same period, screening rates also declined, with the largest decreases among 18- to 20-year-olds (from 67% in Oregon to 88% in California) and with smaller declines among 21- to 29-year-olds (13%-27%) and 30- to 39-year-olds (3%-21%).
  
  
  CONCLUSIONS
  The declines in CIN2+ detection in young women were likely due to reduced screening but could also reflect the impact of vaccination. These data illustrate challenges in interpreting CIN2+ ecologic trends in the new era of cervical cancer prevention and emphasize the importance of information such as HPV types detected in lesions to assess the impact of HPV vaccine on cervical precancers.
authors.affiliation: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Susan
authors.initials: S
authors.lastname: Hariri
authors.affiliation: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Johnson
authors.affiliation: Center for Community Health and Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bennett
authors.affiliation: STD Control Branch, HIV/STD/TB Program, Center for Public Health Practice, California Department of Public Health, Richmond, California.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Bauer
authors.affiliation: STD Control Branch, HIV/STD/TB Program, Center for Public Health Practice, California Department of Public Health, Richmond, California.
authors.forename: Ina U
authors.initials: IU
authors.lastname: Park
authors.affiliation: HIV/STD/TB Program, Center for Public Health Practice, Oregon Public Health Division, Portland, Oregon.
authors.forename: Sean
authors.initials: S
authors.lastname: Schafer
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.affiliation: Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Unger
authors.affiliation: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Markowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D015994:Incidence; D053918:Papillomavirus Vaccines / Q000276:immunology*; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D053918:Papillomavirus Vaccines
keywords: cervical cancer screening; cervical intraepithelial neoplasia (CIN); cervical precancers; high-grade cervical lesions; human papillomavirus (HPV); human papillomavirus vaccine effectiveness; human papillomavirus vaccines