Yale School of Public Health and Connecticut Emerging Infections Program, New Haven, Connecticut 06520, USA.
Cancer Epidemiol Biomarkers Prev. 2013 Aug;22(8):1446-50. doi: 10.1158/1055-9965.EPI-13-0272. Epub 2013 May 23.
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 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 ages 21 to 39 years old were examined using a statewide surveillance registry in Connecticut from 2008 to 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/nonurban counties. The annual rate per 100,000 females ages 21 to 24 years declined from 834 in 2008 to 688 in 2011 (P(trend) < 0.001). No significant declines were observed among women ages 25 to 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 to 2011. This is the first report of declines in cervical neoplasia in the United States since HPV vaccines became available. Continued surveillance is needed to measure vaccine impact and monitor health disparities.
自 2006 年以来，美国已经可以使用预防人乳头瘤病毒（HPV）16 型和 18 型感染的疫苗，这两种病毒已知会导致宫颈癌。高级别宫颈病变对于监测早期疫苗效果很重要，因为它们是癌症的强有力替代指标，但在感染后几年内就会发展，而不是几十年。从 2008 年到 2011 年，康涅狄格州全州监测登记处检查了 21 至 39 岁女性中高级别宫颈病变（包括宫颈上皮内瘤变 2 级、2/3 级和 3 级以及原位腺癌）的趋势。在此期间，青少年女性中 HPV 疫苗接种率从 45%上升到 61%。根据人口普查区黑人、西班牙裔、生活贫困的人口比例以及城市/非城市县，按年龄分层进行分析。21 至 24 岁女性的年发病率从 2008 年的每 10 万人 834 例下降到 2011 年的每 10 万人 688 例（P<0.001）。25 至 39 岁的女性没有观察到显著下降。在黑人、西班牙裔或生活在联邦贫困线以下的人口比例较低的人口普查区，也出现了显著下降的趋势。在 2008 年至 2011 年期间，年轻女性的高级别宫颈病变有所减少。这是美国自 HPV 疫苗上市以来首次报告宫颈癌发病率下降。需要继续监测，以衡量疫苗效果并监测健康差异。
