Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Natl Cancer Inst. 2022 Jun 13;114(6):845-853. doi: 10.1093/jnci/djac034.
Racial and ethnic variations in attribution of cervical precancer and cancer to human papillomavirus (HPV) types may result in different HPV vaccine protection, screening test coverage, and clinical management.
Pooling data from 7 US studies, we calculated the proportional attribution of precancers and cancers to HPV types using HPV DNA typing from diagnosis. All statistical tests were 2-sided.
For all racial and ethnic groups, most cases of cervical intraepithelial neoplasia grade 3 (CIN3) (84.2%-90.8% of 5526) and squamous cell carcinoma (SCC) (90.4%-93.8% of 1138) were attributed to types targeted by the 9-valent vaccine. A higher proportion of CIN3s were attributed to nonvaccine HPV types among non-Hispanic Black women (15.8%) compared with non-Hispanic Asian or Pacific Islander (9.7%; P = .002), non-Hispanic White (9.2%; P < .001), and Hispanic (11.3%; P = .004) women. The proportion of SCCs attributed to 9-valent types was similar by race and ethnicity (P = .80). A higher proportion of CIN3s were attributed to nonvaccine HPV35 among non-Hispanic Black (9.0%) compared with non-Hispanic Asian or Pacific Islander (2.2%), non-Hispanic White (2.5%), and Hispanic (3.0%; all P < .001) women. Compared with CIN3, the proportion of SCCs attributed to HPV35 among non-Hispanic Black women (3.2%) was lower and closer to other groups (0.3%-2.1%; P = .70).
The 9-valent HPV vaccine will prevent nearly all cervical precancers and invasive cancers among major racial and ethnic groups in the United States. Adding HPV35 to vaccines could prevent a small percentage of CIN3s and SCCs, with greater potential impact for CIN3s among Black women. HPV screening tests target high-risk HPV types, including HPV35. Future genotyping triage strategies could consider the importance of HPV35- and other HPV16-related types.
在归因于人乳头瘤病毒（HPV）类型的宫颈癌前病变和癌症方面，不同种族和族裔之间可能存在差异，这可能导致 HPV 疫苗保护、筛查测试覆盖率和临床管理的差异。
我们从美国的 7 项研究中汇总数据，使用 HPV DNA 分型从诊断中计算出癌前病变和癌症归因于 HPV 类型的比例。所有统计检验均为双侧检验。
对于所有种族和族裔群体，大多数宫颈上皮内瘤变 3 级（CIN3）（5526 例中的 84.2%至 90.8%）和鳞状细胞癌（SCC）（1138 例中的 90.4%至 93.8%）归因于 9 价疫苗针对的 HPV 类型。与非西班牙裔亚裔或太平洋岛民（9.7%；P=0.002）、非西班牙裔白人和西班牙裔女性（分别为 9.2%和 11.3%；P<0.001）相比，非西班牙裔黑人女性归因于非疫苗 HPV 类型的 CIN3 比例更高（15.8%）。按种族和族裔划分，归因于 9 价疫苗的 SCC 比例相似（P=0.80）。与非西班牙裔亚裔或太平洋岛民（2.2%）、非西班牙裔白人和西班牙裔女性（分别为 2.5%和 3.0%）相比，非西班牙裔黑人女性归因于非疫苗 HPV35 的 CIN3 比例更高（9.0%；所有 P<0.001）。与 CIN3 相比，非西班牙裔黑人女性归因于 HPV35 的 SCC 比例（3.2%）较低，且更接近其他群体（0.3%-2.1%；P=0.70）。
在美国的主要种族和族裔群体中，9 价 HPV 疫苗将几乎预防所有宫颈癌前病变和浸润性癌症。将 HPV35 添加到疫苗中可能会预防一小部分 CIN3 和 SCC，对于黑人女性，CIN3 的潜在影响更大。HPV 筛查测试针对高危 HPV 类型，包括 HPV35。未来的基因分型分流策略可能需要考虑 HPV35 和其他 HPV16 相关类型的重要性。
