#Grand Rounds

The HPV Vaccine Leads to a Reduction in Cervical Precancers in Young Women in the U.S.

BACKGROUND AND PURPOSE:

High-grade cervical lesions (CIN2+) are used to monitor HPV vaccine impact, since they develop much more quickly after infection
McClung et al. (MMWR, 2019) used data from the Human Papillomavirus Vaccine Impact Monitoring Project (HPV-IMPACT) to assess the impact of the HPV vaccination program
The following is the first estimate of the number of CIN2+ cases in the U.S. based on population since introduction of the HPV vaccine

Data review and analysis (2008 to 2016)
- Data set: HPV-IMPACT
- A population-based CIN2+ surveillance system
Data analysis
- Age-specific rates applied to U.S. population data to estimate the total number of CIN2+ cases

An estimated 76% of CIN2+ cases were attributable to HPV types targeted by the vaccine currently used in the US (9-valent HPV vaccine)
The number of CIN2+ cases diagnosed in women aged 18–29 years decreased from 2008 to 2016
- 2008: ~216,000 (95% CI, 194,000–241,000)
- 2016: ~196,000 (95% CI, 176,000–221,000)
From 2008 to 2016, the rate of CIN2+ per 100,000 women in the US
- Declined significantly in women aged 18–19 years and 20–24 years
- Increased significantly in women aged 40–64 years

Rates of cervical precancers have declined in younger women since the introduction of the vaccine
A majority of CIN2+ cases diagnosed are attributable to HPV types that the vaccine targets
These changes are likely due to updated cervical cancer screening and management recommendations, and primary prevention through HPV vaccination
Increasing coverage of the vaccine in females at the routine age of 11-12 years and catch-up vaccination through women 26 years of age will likely contribute to a further reduction in cervical precancers

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