Yale University

HPV type attribution in high grade cervical lesions: assessing the potential benefits of vaccines in a population-based evaluation in the United States.

TitleHPV type attribution in high grade cervical lesions: assessing the potential benefits of vaccines in a population-based evaluation in the United States.
Publication TypeJournal Article
Year of Publication2014
AuthorsHariri, Susan, Elizabeth R. Unger, Sean Schafer, Linda M. Niccolai, Ina Park, Karen C. Bloch, Nancy M. Bennett, Martin Steinau, Michelle L. Johnson, and Lauri E. Markowitz
JournalCancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Date Published2014 Nov 21
ISSN1538-7755
AbstractBackground:Two currently available vaccines targeting human papillomavirus (HPV) types 16 and 18 could prevent 70% of cervical cancers and 50% of high-grade cervical lesions. Next generation vaccines against additional types, such as an investigational 9-valent vaccine against HPV6/11/16/18/31/33/45/52/58, could further reduce HPV-associated disease burden. Methods:HPV was typed in archived tissues from women aged 21-39 years residing in 5 catchment areas in the United States with cervical intraepithelial neoplasia 2/3 and adenocarcinoma in situ (CIN2+) using L1 consensus PCR and type-specific hybridization. Type attribution was estimated using weights to account for lesions with multiple types detected. Results:From 2008-2011, 5,498/6,306 (87.2%) of specimens obtained from 8,469 women with CIN2+ had valid typing results; HPV DNA was detected in 97.3%. Overall, 50.1% of lesions were attributable to HPV16/18, ranging from 50.3%-52.4% among those aged 21-34 years, and significantly declined in 35-39 year-olds (43.5%). HPV16/18 attribution was higher in non-Hispanic whites (56.4%) versus racial/ethnic minorities (range: 41.8%-45.9%) (p<0.001). HPV31/33/45/52/58 attribution was 25.0% overall and increased with age (p<0.001). A higher proportion of CIN2+ were attributable to HPV31/33/45/52/58 in non-Hispanic black (29.9%), Hispanic (29.2%), and Asian (33.1%) women compared to non-Hispanic whites (22.8%) (p<0.001). Conclusions:Overall, 75% of lesions were attributable to 7 oncogenic HPV types: 50% to HPV16/18 and 25% to HPV31/33/45/52/58. HPV16/18 had the largest attributable fraction in CIN2+ across all subpopulations, although to a lesser extent in older women and racial/ethnic minorities. Impact:Vaccines targeting additional oncogenic HPV types could reduce racial/ethnic differences in high-grade cervical lesions.
Alternate JournalCancer Epidemiol. Biomarkers Prev.

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