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Clin Infect Dis. 2018 Aug 23. doi: 10.1093/cid/ciy707. [Epub ahead of print]

Trends in High-grade Cervical Lesions and Cervical Cancer Screening in Five States, 2008-2015.

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National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
Department of Family and Community Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA, USA.
Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt University Medical Center, New Haven, CT, USA.
Oregon Health Authority Public Health Division, Portland, OR, USA.
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA.
California Emerging Infections Program, Richmond, CA, USA.
Yale School of Public Health, New Haven, CT, USA.
MAXIMUS Federal, contracting agency to National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA.
National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA.



We describe changes in rates of cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ (CIN2+) during a period of human papillomavirus (HPV) vaccine uptake and changing cervical cancer screening recommendations.


We conducted population-based laboratory surveillance for CIN2+ in catchment areas in five states, 2008-2015. Each site used local laboratory or administrative data to estimate the annual proportion of population receiving cervical cancer screening. We calculated population-based CIN2+ rates per 100,000 women by age group. We estimated incidence rate ratios (IRR) of CIN2+ for 2-year periods among all women and in the estimated screened population to evaluate changes over time.


A total of 16,572 CIN2+ cases were reported. Among women aged 18-20 and 21-24 years, CIN2+ rates declined in all sites, whereas in women aged 25-29, 30-34, and 35-39 years, trends in rates differed across sites. The percent of women screened annually declined in all sites and age groups. Compared to 2008-2009, rates among screened women were significantly lower for all three periods in women aged 18-20 years (2010-2011: IRR=0.82 (95% CI 0.67-0.99), 2012-2013: IRR=0.63 (0.47-0.85), 2014-2015: IRR=0.44 (0.28-0.68)) and lower for the latter two time periods in women aged 21-24 years (2012-2013: IRR=0.86 (0.79-0.94); 2014-2015: 0.61 (0.55-0.67)). Rates among screened women increased for age groups 25-29, 30-34, and 35-39.


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.


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