HPV Vaccination History Among Women in the United States with Cervical Cancer Precursors: Preliminary Results From HPV-IMPACT

Powell, Suzanne

Wednesday, March 14, 2012

Hyatt Exhibit Hall

Suzanne Powell, MPH¹, Susan Hariri, PhD, MPH¹, Martin Steinau, PhD², Heidi Bauer, MD, MPH, MS³, Nancy Bennett, MD, MS⁴, Karen Bloch, MD, MPH⁵, Sean Schafer, MD⁶, Linda Niccolai, PhD⁷, Elizabeth Unger, MD, PhD² and Lauri Markowitz, MD⁸, 1Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 2CDC, Atlanta, GA, 3Program Development and Evaluation, California Department of Public Health, STD Control Branch, Richmond, CA, 4Center for Community Health, University of Rochester Medical Center, Rochester, NY, 5Department of Medicine (Infectious Diseases) and Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN, 6Department of Human Services, Oregon Department of Health, Portland, OR, 7Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 8Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA

Background: Vaccination against HPV types 16 and 18 which cause ~70% of cervical cancers is recommended for girls aged 11or 12 years with catch-up through age 26 in the U.S. Cervical intraepithelial neoplasia (CIN) grade 2 or 3 and adenocarcinoma in situ (CIN2+) are used to monitor HPV vaccine impact on CIN2+ incidence and HPV types.

Objectives: To describe HPV vaccination history in women diagnosed with CIN2+.

Methods: As part of a vaccine impact monitoring project (HPV-IMPACT), females 18-39 years with CIN2+ were reported from pathology laboratories in 5 catchment areas (CA, CT, NY, OR, TN). One archived CIN2+ diagnostic block was selected for DNA extraction and HPV typing with the Roche Linear Array and INNO-LiPA test. Abnormal Pap dates and vaccine status were collected.

Results: From 2008–2011, 6,354 CIN2+ cases were reported; 2,571 (40.5%) had HPV DNA testing. Among 4,069 cases investigated, 615 had initiated vaccination and 401 completed the 3-dose series. Among vaccinated cases with known Pap dates (n=546), 51.5% initiated and 28.4% completed vaccination before their abnormal Pap, 94 (17.2%) initiated on/after Pap and 171 (31.3%) initiated on/after biopsy. Blacks were more likely to initiate vaccine on/after biopsy than whites (76.9% vs. 48.0%, p=0.001). Although lower, there was no significant difference in HPV 16/18 detection in those vaccinated >12 months prior to Pap (47.5%) compared to those vaccinated 0-12 months prior to Pap (57.8%) and 50.1% who initiated vaccination on/after biopsy and 50.6% who were unvaccinated, (p = 0.5).

Conclusions: A considerable proportion of women with CIN2+ initiated vaccination on/after Pap test or biopsy. Racial differences in women initiating vaccine after biopsy may be due to pre-existing differential coverage by race.

Implications for Programs, Policy, and Research: Continued monitoring of HPV 16/18-related lesions by vaccination status can determine vaccine impact.

P26 HPV Vaccination History Among Women in the United States with Cervical Cancer Precursors: Preliminary Results From HPV-IMPACT