HPV Vaccine Impact: Genotype-Specific Changes in Cervical Pre-Cancer Share A Similarities with Changes in Cervical Screening Cytology

Authors

• Rachael Adcock, UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, United States.
• Cosette M. Wheeler, UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, United States. Department of Pathology, UNM Health Sciences Center (HSC), Albuquerque, NM, United States.
• William C. Hunt, UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, United States.
• Norah E. Torrez-Martinez, UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, United States.
• Michael Robertson, UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, United States.
• Ruth McDonald, UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, United States.
• Nancy E. Joste, Department of Pathology, UNM Health Sciences Center (HSC), Albuquerque, NM, United States.
• Mark H. Stoler, Department of Pathology, University of Virginia Health System, Charlottesville, VA, United States.
• Maurits NC de Koning, Viroclinics-DDL (A Cerba Research Company), DDL Diagnostic Laboratory, Rijswijk, The Netherlands
• Wim GV Quint, Viroclinics-DDL (A Cerba Research Company), DDL Diagnostic Laboratory, Rijswijk, The Netherlands

Document Type

Article

Publication Date

7-1-2025

Abstract

BACKGROUND: After human papillomavirus (HPV) vaccine introduction, declines in the prevalence of HPV vaccine types have been observed in screening cytology, but data from the United States describing HPV type-specific changes in cervical intraepithelial neoplasia (CIN) grades 2-3 and adenocarcinoma in situ (CIN2/CIN3/AIS) are limited.

METHODS: A statewide sample of individuals with cervical biopsies was selected for broad-spectrum HPV genotyping. CIN2/CIN3/AIS incidence and prevalence were calculated for type-specific high-risk HPV (hrHPV) among individuals aged 15-29 years. Weighted incidence rate ratios (IRR) and relative differences in prevalence (RDP) were computed to compare 3 time periods: 2006-2009 (Cohort 1 [C1], n = 4121), 2012-2015 (C2, n = 2194), and 2015-2018 (C3, n = 1481).

RESULTS: When comparing C1 vs C3 among those aged 21-25 years, statistically significant reductions in hrHPV type-specific CIN2/CIN3/AIS incidence were observed for HPV16, HPV18, HPV31, and HPV33, with corresponding IRRs of 0.4 (95% confidence interval [95% CI] = 0.3 to 0.4), 0.3 (95% CI = 0.1 to 0.7), 0.6 (95% CI = 0.5 to 0.9), and 0.4 (95% CI = 0.1 to 0.8), respectively. The RDP comparing C1 vs C3 for HPV16/18-positive CIN2/CIN3/AIS was -43.8% (P < .001). When excluding HPV16/18 or HPV16/18/31/33 from all hrHPV types, the RDP was +56.6% and +92.5% (P < .001), respectively.

CONCLUSIONS: hrHPV type-specific CIN2/CIN3/AIS incidence decreased with statistical significance for vaccine types HPV16/18 and for HPV31 and HPV33. Although the HPV vaccine is highly beneficial and a top priority for preventing HPV-related cancer, the long-term vaccine impact in cohorts receiving the 4-valent HPV vaccine requires continued follow-up to assess genotype-specific distributions in the remaining CIN2+ lesions and cancers.

Recommended Citation

Adcock R, Wheeler CM, Hunt WC, Torrez-Martinez NE, Robertson M, McDonald R, Joste NE, Stoler MH, de Koning MNC, Quint WGV; New Mexico HPV Pap Registry Steering Committee Members. HPV vaccine impact: genotype-specific changes in cervical pre-cancer share similarities with changes in cervical screening cytology. J Natl Cancer Inst. 2025 Jul 1;117(7):1377-1386. doi: 10.1093/jnci/djaf055. PMID: 40069924; PMCID: PMC12229469.