{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T21:35:00Z","timestamp":1780349700065,"version":"3.54.1"},"reference-count":13,"publisher":"Wiley","issue":"16","license":[{"start":{"date-parts":[[2015,6,22]],"date-time":"2015-06-22T00:00:00Z","timestamp":1434931200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2015,8,15]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Cervical intraepithelial neoplasia grade 2, 3, and adenocarcinoma in situ (CIN2+) lesions can be monitored as early indicators of human papillomavirus (HPV) vaccine impact. Changes to screening utilization will affect observed reductions in CIN2+ rates and complicate the interpretation of vaccine impact.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>From 2008 to 2012, 9119 cases of CIN2+ among 18\u2010 to 39\u2010year\u2010old residents of catchment areas in California, Connecticut, New York, and Oregon were reported to the HPV\u2010IMPACT Project, a sentinel system for monitoring the population impact of HPV vaccine. Age\u2010stratified CIN2+ incidence rates were calculated for each catchment. Annual cervical screening was estimated for California, New York, and Oregon catchments with administrative and survey data. The Cochran\u2010Armitage test was used to examine trends.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>From 2008 to 2012, the incidence of CIN2+ significantly decreased among 18\u2010 to 20\u2010year\u2010olds (California, from 94 to 5 per 100,000 women; Connecticut, from 450 to 57 per 100,000 women; New York, from 299 to 43 per 100,000 women; and Oregon, from 202 to 37 per 100,000 women; <jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u2009&lt;\u2009.0001) and among 21\u2010 to 29\u2010year\u2010olds in Connecticut (from 762 to 589 per 100,000 women) and New York (from 770 to 465 per 100,000 women; <jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u2009&lt;\u2009.001); rates did not differ among 30\u2010 to 39\u2010year\u2010olds. During the same period, screening rates also declined, with the largest decreases among 18\u2010 to 20\u2010year\u2010olds (from 67% in Oregon to 88% in California) and with smaller declines among 21\u2010 to 29\u2010year\u2010olds (13%\u201027%) and 30\u2010 to 39\u2010year\u2010olds (3%\u201021%).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The declines in CIN2+ detection in young women were likely due to reduced screening but could also reflect the impact of vaccination. These data illustrate challenges in interpreting CIN2+ ecologic trends in the new era of cervical cancer prevention and emphasize the importance of information such as HPV types detected in lesions to assess the impact of HPV vaccine on cervical precancers. <jats:bold><jats:italic>Cancer<\/jats:italic> 2015;121:2775\u20102781.<\/jats:bold> \u00a9 <jats:italic>2015 American Cancer Society<\/jats:italic><\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.29266","type":"journal-article","created":{"date-parts":[[2015,6,22]],"date-time":"2015-06-22T09:38:09Z","timestamp":1434965889000},"page":"2775-2781","source":"Crossref","is-referenced-by-count":46,"title":["Population\u2010based trends in high\u2010grade cervical lesions in the early human papillomavirus vaccine era in the United States"],"prefix":"10.1002","volume":"121","author":[{"given":"Susan","family":"Hariri","sequence":"first","affiliation":[{"name":"Division of STD Prevention National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle L.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Division of STD Prevention National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy M.","family":"Bennett","sequence":"additional","affiliation":[{"name":"Center for Community Health and Department of Medicine University of Rochester School of Medicine and Dentistry Rochester New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi M.","family":"Bauer","sequence":"additional","affiliation":[{"name":"STD Control Branch HIV\/STD\/TB Program Center for Public Health Practice, California Department of Public Health Richmond California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ina U.","family":"Park","sequence":"additional","affiliation":[{"name":"STD Control Branch HIV\/STD\/TB Program Center for Public Health Practice, California Department of Public Health Richmond California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Schafer","sequence":"additional","affiliation":[{"name":"HIV\/STD\/TB Program Center for Public Health Practice, Oregon Public Health Division Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M.","family":"Niccolai","sequence":"additional","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases Yale School of Public Health New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Unger","sequence":"additional","affiliation":[{"name":"Division of High\u2010Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauri E.","family":"Markowitz","sequence":"additional","affiliation":[{"name":"Division of STD Prevention National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"HPV\u2010IMPACT Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2008.05.064"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.jncimonographs.a003476"},{"key":"e_1_2_7_4_1","first-page":"626","article-title":"FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on 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