Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008–2015

Abstract

Primary prevention through the use of human papillomavirus (HPV) vaccination is expected to impact both cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS). While CIN is well described, less is known about the epidemiology of AIS, a rare cervical precancer. We identified AIS and CIN grade 3 (CIN3) cases through population‐based surveillance, and analyzed data on HPV types and incidence trends overall, and among women screened for cervical cancer. From 2008 to 2015, 470 AIS and 6,587 CIN3 cases were identified. The median age of women with AIS was older than those with CIN3 (35 vs. 31 years; p < 0.01). HPV16 was the most frequently detected type in both AIS and CIN3 (57% in AIS; 58% in CIN3), whereas HPV18 was the second most common type in AIS and less common in CIN3 (38% vs. 5%; p < 0.01). AIS lesions were more likely than CIN3 lesions to be positive for high‐risk types targeted by the bivalent and quadrivalent vaccines (HPV16/18, 92% vs. 63%; p < 0.01), and 9‐valent vaccine (HPV16/18/31/33/45/52/58, 95% vs. 87%; p < 0.01). AIS incidence rates decreased significantly in the 21–24 year age group (annual percent change [APC] overall: −22.1%, 95% CI: −33.9 to −8.2; APC among screened: −16.1%, 95% CI: −28.8 to −1.2), but did not decrease significantly in any older age group. This report on the largest number of genotyped AIS cases to date suggests an important opportunity for vaccine prevention of AIS, and is the first to document a decline in AIS incidence rates among young women during the vaccine era.

The prevalence of VAIN, CIN, and related HPV genotypes in Japanese women with abnormal cytology

“…Previous reports have suggested geographic differences in the HPV types in CIN. HPV52 was more common in Japan, whereas HPV58 was common in China and Korea . These types may be more common in East Asia than in Western and African countries .…”

“…Chao et al also demonstrated that HPV18 was rarer in VAIN3 than in CIN3. HPV18 preferentially induced AIS over CIN3, suggesting that HPV18 also rarely induces vaginal SCC.…”

Schisandrin B synergizes docetaxel-induced restriction of growth and invasion of cervical cancer cells in vitro and in vivo

“…Cervical cancer is one of the most prevalent tumors in women, especially in impoverished areas (1). For about 90% of patients, cervical cancer is avoidable with the proactive treatment of human papillomavirus (HPV, the leading cause of cervical cancer) vaccination (2). However, since there remains a long way to eliminate poverty, cervical cancer could be a significant health issue in the upcoming decades (3).…”

Prevalence of human papillomavirus genotypes in high‐grade cervical precancer and invasive cervical cancer from cancer registries before and after vaccine introduction in the United States

“…In the New Mexico HPV Pap Registry, which linked population‐based cancer registry and screening data, significant declines from 2007‐2014 among CIN grades 1‐3 were observed among women aged 15‐19 years and also among women with CIN2 aged 20‐24 years 17 . Findings from the CDC's Human Papillomavirus Vaccine Impact Monitoring Project conducted in 5 US catchment areas showed significant declines in CIN2+ from 2008‐2015 among screened women aged 18‐24 years, 7 and in adenocarcinoma in situ cases among women aged 21‐24 years 6 . In addition, this project found that the proportion of HPV 16, 18–positive CIN2+ cases declined from 2008‐2014, with larger decreases among vaccinated women and younger age groups.…”

“…Although coverage was low at first introduction, HPV vaccination coverage has increased; coverage of ≥1 dose of HPV vaccine among female adolescents aged 13‐17 years increased from 37% in 2008 to 73% in 2019 4,5 . The impact of HPV vaccine on cervical disease has been shown by decreasing incidence of cervical precancers and decreases in vaccine‐type HPV prevalence in cervical precancer lesions in young women 6‐8 . The HPV vaccine impact on invasive cervical cancer has not yet been fully shown because of the long duration for cancer development and a lower burden of invasive cervical cancer in younger women in whom HPV vaccination would have the most impact.…”