This is the first population-based estimate of pulmonary NTM disease incidence in a region within the United States. In Oregon, disease incidence rose slightly during 2007 to 2012, and although more common in female individuals overall, disease was more common among male individuals less than 60 years of age.

Population-based data from the United States indicate significant reductions in CIN2+ lesions attributable to types targeted by the vaccines and increasing HPV vaccine effectiveness with increasing interval between first vaccination and earliest detection of cervical disease.

Age and racial/ethnic differences in HPV type distribution may have implications for vaccine impact and should be considered in monitoring trends.

BACKGROUND: Cervical intraepithelial neoplasia grade 2, 3, and adenocarcinoma in situ (CIN21) lesions can be monitored as early indicators of human papillomavirus (HPV) vaccine impact. Changes to screening utilization will affect observed reductions in CIN21 rates and complicate the interpretation of vaccine impact. METHODS: From 2008 to 2012, 9119 cases of CIN21 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 CIN21 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 CIN21 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; P trend < .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; P trend < .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 CIN21 detection in young women were likely due to reduced screening but could also reflect the impact of vaccination. These data illustrate challenges in interpreting CIN21 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. Cancer 2015;121:2775-81. V C 2015 American Cancer Society.KEYWORDS: cervical cancer screening, cervical intraepithelial neoplasia (CIN), cervical precancers, high-grade cervical lesions, human papillomavirus (HPV), human papillomavirus vaccine effectiveness, human papillomavirus vaccines. INTRODUCTIONPersistent infection with oncogenic types of human papillomavirus (HPV) can cause high-grade cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (CIN21); these asymptomatic lesions can, over decades, progress to invasive cervical cancer if they are left untreated. 1,2 Two vaccines against HPV 16 and HPV 18, types that are responsible for 70% of cervical cancers and >50% of CIN21 lesions, are available in the United States, one since 2006. 3 In clinical trials,

Three diagnostic codes used for case finding detect approximately one-quarter of ED- and hospital-treated victims, complement surveys, and facilitate description of injured victims.