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

• Published in: Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2015-02, Vol.24 (2), p.393-399
• Main Authors: Hariri, Susan, Unger, Elizabeth R, Schafer, Sean, Niccolai, Linda M, Park, Ina U, Bloch, Karen C, Bennett, Nancy M, Steinau, Martin, Johnson, Michelle L, Markowitz, Lauri E
• Format: Article
• Language: English
• Subjects: Adenocarcinoma in Situ - pathology; Adenocarcinoma in Situ - prevention & control; Adenocarcinoma in Situ - virology; Adolescent; Adult; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - prevention & control; Cervical Intraepithelial Neoplasia - virology; Cohort Studies; DNA, Viral - genetics; Female; Human Papillomavirus DNA Tests - methods; Humans; Papillomaviridae - classification; Papillomaviridae - genetics; Papillomavirus Infections - pathology; Papillomavirus Infections - prevention & control; Papillomavirus Infections - virology; Papillomavirus Vaccines - administration & dosage; Papillomavirus Vaccines - chemistry; Polymerase Chain Reaction; United States; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - prevention & control; Uterine Cervical Neoplasms - virology; Young Adult
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.epi-14-0649

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 a candidate 9-valent vaccine against HPV6/11/16/18/31/33/45/52/58, could further reduce HPV-associated disease burden. HPV was typed in archived tissues from women ages 21 to 39 years residing in five 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. From 2008 to 2011, 5,498 of 6,306 (87.2%) 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% to 52.4% among those ages 21 to 34 years, and significantly declined in 35 to 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+ was attributable to HPV31/33/45/52/58 in non-Hispanic black (29.9%), Hispanic (29.2%), and Asian (33.1%) women compared with non-Hispanic whites (22.8%; P < 0.001). 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. Vaccines targeting additional oncogenic HPV types could prevent more high-grade cervical lesions, especially among racial/ethnic minorities.