Trends in High-Grade Cervical Cancer Precursors in the Human Papillomavirus Vaccine Era

Introduction The 2006 introduction of human papillomavirus vaccine targeted against genotypes 6, 11, 16, and 18 should result in decreased cervical dysplasia in vaccinated women. However, new cervical cancer guidelines to increase screening intervals complicate interpretation of trends. The hypothesis is that cervical dysplasia would decrease only in young vaccine-eligible women, and not older women. Methods The authors identified Davidson County, Tennessee, women aged 18–39 years with cervical intraepithelial neoplasia (CIN) grade 2 or greater and adenocarcinoma in situ, denoted as CIN2+, through pathology reports from laboratories serving this population. Biopsy specimens for human papillomavirus genotyping were collected. Trends in CIN2+ rates and associated human papillomavirus genotypes, 2008 through 2013, were examined. Results The authors identified 2,031 women with CIN2+. Rates of CIN2+ fell from 188.9 to 58.7 per 100,000 women aged 18–20 years (annual percentage change= –24.2, 95% CI= –41.4, –2.1) and from 495.6 to 332.4 per 100,000 women aged 21–24 years (annual percentage change= –10.2%, 95% CI= –16.3, –3.4). There was no significant change in CIN2+ rates for women aged 25–29 or 30–39 years. In biopsy specimens from 1,319 of 2,031 (65%) women, at least one human papillomavirus genotype was identified in 1,270 (96%). The prevalence of at least one of four vaccine human papillomavirus genotypes (6, 11, 16, and 18) declined from 59% in 2008 to 52% in 2013 ( p =0.003). Conclusions Diagnosis of CIN2+ decreased in women aged 18–24 years, but not in older women. Both changes in screening and human papillomavirus vaccination could have contributed to the decline of CIN2+ in young women.