The HPVIWG Human Papillomavirus Genotypes in High-Grade Cervical Lesions in the United States
ABSTRACT Background. Two vaccines protect against human papillomaviruses (HPV) 16 and 18 that cause 70% of cervical cancer and 50% of cervical intraepithelial neoplasia 2/3 and adenocarcinoma in situ (CIN2+). Monitoring HPV types in CIN2+ may be used to assess HPV vaccine impact.Methods. As part of a multi-site vaccine impact monitoring project (HPV-IMPACT), biopsy specimens used to diagnose CIN2+ were obtained for HPV DNA typing for women aged 18-39 years.Results. Among 4,121 CIN2+ cases reported from 2008-2009 in 18-39 year-old women 3,058 (74.2%) were tested; 96% were HPV DNA positive. HPV16 was most common (49.1%), followed by HPV31 (10.4%) and HPV52 (9.7%). HPV18 prevalence was 5.5% overall. Proportion of CIN2+ cases associated with HPV16/18 was highest (56.3%) in 25-29 year-old women. HPV16/18-associated lesions were less common in non-Hispanic blacks (41.9%) and Hispanics (46.3%) compared to non-Hispanic whites (59.1%) (p<.0001); the difference remained significant when adjusted for covariates. Compared to non-Hispanic white, HPV35 and 58 were significantly more common in non-Hispanic black (14.5% vs. 4.2%; 12.3% vs. 3.4%) and HPV45 was higher in Hispanic cases (3.7% vs. 1.5%).Conclusion. Age and racial/ethnic differences in HPV type distribution may have implications for vaccine impact, and must be considered in monitoring trends.
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ABSTRACT: Information on human papillomavirus (HPV) type distribution is necessary to evaluate the potential impact of current and future HPV vaccines. We estimated the relative contribution (RC) to invasive cervical cancer (ICC) and precancerous cervical lesions of the nine HPV types (HPV 6/11/16/18/31/33/45/52/58) included in an HPV vaccine currently under development. Estimations on ICC were based on an international study of 8,977 HPV positive cases and estimations on precancerous cervical lesions were extracted from a published meta-analysis including 115,789 HPV positive women. Globocan 2008 and 2010 World Population Prospects were used to estimate current and future projections of new ICC cases. RC of the 9 HPV types in ICC was 89.4%, with 18.5% of cases positive for HPV 31/33/45/52/58. Regional variations were observed. RCs varied by histology, ranging between 89.1% in squamous cell carcinomas (SCC) and 95.5% in adenocarcinomas (ADC). HPV 16/18/45 were detected in 94.2% of ADC. RC of the 9 types altogether decreased with age (trend test p < 0.0001), driven by the decrease in older ages of HPV 16/18/45. In contrast, the RC of HPV 31/33/52/58 increased with age. Due to population growth alone, projected estimates of ICC cases attributable to the 9 types are expected to rise from 493,770 new cases in 2012 to 560,887 new cases in 2025. The RCs of individual high risk HPV types varied by cytological and histological grades of HPV-positive precancerous cervical lesions, and there was an under representation of HPV 18 and 45 compared to ICC. The addition of HPV 31/33/45/52/58 to HPV types included in current vaccines could prevent almost 90% of ICC cases worldwide. If the nine-valent vaccine achieves the same degree of efficacy than previous vaccines, world incidence rates could be substantially reduced.Infectious Agents and Cancer 12/2012; 7(1):38. DOI:10.1186/1750-9378-7-38 · 2.07 Impact Factor
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ABSTRACT: BACKGROUND: Current vaccines protect against 2 human papillomavirus (HPV) types, HPV 16 and 18, which are associated with 70% of cervical cancers and 50% of high-grade cervical lesions. HPV type distribution was examined among women with high-grade lesions by individual and area-based measures of race, ethnicity, and poverty. METHODS: This analysis included 832 women aged 18 to 39 years reported to a surveillance registry in Connecticut during 2008 to 2010. Diagnostic specimens were obtained for HPV DNA testing. Individual measures were obtained from surveillance reports, medical records, and patient interviews. Cases were geocoded to census tracts and linked to area-based measures of race, ethnicity, and poverty. Statistical analysis included use of generalized estimating equations. RESULTS: Overall, 44.8% of women had HPV 16/18. In a multivariate model controlled for confounding by age and diagnosis grade, black race (adjusted prevalence ratio [aPR] = 0.54, 95% confidence interval [CI] = 0.34-0.88), Hispanic ethnicity (aPR = 0.59, 95% CI = 0.40-0.88), and higher area-based poverty (aPR = 0.59, 95% CI = 0.40-0.87) were associated with a lower likelihood of HPV 16/18 positivity. Black and Hispanic women were less likely to have HPV 16/18 than white women across all levels of area-based measures. CONCLUSIONS: Black race, Hispanic ethnicity, and higher area-based poverty are salient predictors of lower HPV 16/18 positivity among women with high-grade cervical lesions. These data suggest that HPV vaccines might have lower impact among black and Hispanic women and those living in high poverty areas. These findings have implications for vaccine impact monitoring, vaccination programs, and new vaccine development. Cancer 2013; © 2013 American Cancer Society.Cancer 05/2013; 119(16). DOI:10.1002/cncr.28038 · 4.90 Impact Factor
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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 (US) 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 21-39 years old were examined using a statewide surveillance registry in Connecticut during 2008-2011. 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/non-urban counties. The annual rate per 100,000 females ages 21-24 years declined from 834 in 2008 to 688 in 2011 (Ptrend<.001). No significant declines were observed among women 25-39 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 2008-2011. This is the first report of declines in cervical neoplasia in the US since HPV vaccines became available. Continued surveillance is needed to measure vaccine impact and monitor health disparities.Cancer Epidemiology Biomarkers & Prevention 05/2013; 22(8). DOI:10.1158/1055-9965.EPI-13-0272 · 4.32 Impact Factor