Study Shows Precancerous Cervical Lesions Have Declined

Precancerous cervical lesions, known as high-grade cervical lesions (CIN2+) can develop a few years after infection and have been used to monitor human papillomavirus (HPV) vaccine impact since cancers can take decades to develop. Additionally, HPV causes about 30,000 cancers in the United States each year, with cervical cancer being the most common.¹

The CDC analyzed data from the HPV Impact Monitoring Program (HPV-IMPACT), a population-based CIN2+ surveillance system across 5 locations, to determine rates of CIN2+ among women at least 18 years of age during 2008-2016.¹

The study found that the CIN2+ rates declined significantly in women 18-24 years of age with the number of cases at 216,000 in 2008 and 196,000 in 2016.¹ The rates also increased significantly in women 40-64 years of age.

The decline in precancerous cervical lesions is most likely due to HPV vaccination and updated cervical cancer screening recommendations.¹ In 2006, the HPV vaccine was recommended for routine vaccination in females age 11 or 12 years and through catch-up vaccination through 26 years.¹

Cervical cancer screening recommendations have changed over the years. In 2008, initial screening was recommended within 3 years of beginning sexual activity or by 21 years of age, with annual screenings after.¹ However, the recommendations by 2016 for initial screening were 21 years and every 3 years after.¹ Less frequent screenings may have also contributed to the decline in CIN2+ cases.¹

In 2016, the CDC provided new recommendations for the use of a 2-dose schedule for individuals who initiate the vaccination series at 9 to 14 years of age.² Evidence demonstrates that the 2-dose schedule has equivalent efficacy to the 3-dose series.² Three doses are still recommended for individuals who initiate the vaccine series at 15 through 26 years of age and for immunocompromised patients.² These changes may help to increase patient compliance and also decrease the incidence precancerous lesions and cervical cancer in future studies.

The FDA approved expanded use of the 9-valent HPV vaccine (Gardasil-9) October 2018 to include women and men 27 through 45 years of age.³ This may further decrease the incidence of CIN2+ cases and cervical cancer.

Pharmacists can play an important role in increasing immunization rates by counseling patients and especially parents on the importance of the HPV vaccine to prevent cancers and other diseases. The vaccine is highly effective and can prevent over 90% of cancers and other diseases, and it is safe.² Syncope may occur so the vaccine should be administered while the patient is seated or lying down, and individuals should remain seated and observed for 15 minutes.²

References

• McClung NM, Gargano JW, Park IU, et al. Estimated Number of Cases of High-Grade Cervical Lesions Diagnosed Among Women-United States, 2008 and 2016. MMWR Morb Mortal Wkly Rep 2019;68:337-343. DOI: http://dx.doi.org/10.15585/mmwr.mm6815a1.
• Gershman J. The 9-Valent HPV recombinant vaccine: an introduction. Pharmacy Times. https://www.pharmacytimes.com/publications/supplementals/2018/hpvsupplementmarch2018/the-9valent-hpv-recombinant-vaccine-an-introduction/. Published March 1, 2018. Accessed April 20, 2019.
• FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old [news release]. FDA website. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm622715.htm. Published October 5, 2018. Accessed April 20, 2019.