Cervical Cancer Incidence Pre- vs. Post-HPV Vaccination Eras

As we mark 20 years of administration of human papillomavirus (HPV) vaccine in the U.S., here’s a quick synopsis of a new study looking at state-level variance in declines in cervical cancer compared to HPV vaccination rates. 

This study, “State-level progress in reducing cervical cancer incidence among U.S. young women between the pre- and post-human papillomavirus vaccination eras,” comes from researchers at Emory University and has been accepted for publication in the Journal of the National Cancer Institute. 

The study compared cervical cancer incidence rates (as reported to the U.S. Cancer Statistics Database) for women aged 20-31 during 2000-2005 (pre-HPV vaccine) and 2016-2021 (post-HPV vaccine) and associated HPV vaccination rates from the National Immunization Survey—Teen. 

Here’s what you need to know: 

• The U.S. cervical cancer incidence rates decreased by 27% during the vaccination era (5.1/100,000 to 3.7/100,000). National HPV vaccination coverage among girls ages 13-17 in 2022 was 77.9%. 
• Jurisdictions with greatest decreases in cervical cancer incidence: DC, RI, MI, and HI. Vaccination coverage among girls ages 13-17 in 2022 was 88.0%, 93.3%, 82.5%, and 88.6%, respectively. DC, RI, and HI have HPV vaccination requirements for school entry. 
• Twenty-eight states showed decreases in cervical cancer incidence rates of <15%. 
• No significant progress in VT, WV, ID, AR, or AL. Vaccination coverage among girls ages 13-17 in 2022 was 89.4%, 71.9%, 84.9%, 78.8%, and 77.2%, respectively. The authors note that VT and ID already had relatively low cervical cancer incidence rates and small case counts, so further improvement in those rates may be difficult to demonstrate. 
• Every 10% increase in vaccination rates was associated with an 11.5% reduction in relative risk for cervical cancer after adjusting for screening rates. 
• Researchers found the likelihood of HPV vaccine initiation was nine times higher when a strong provider recommendation was given. Strong recommendations are less likely to occur in Southern states, with MS and AR having the lowest provider recommendation rates and MA and DC having the highest rates. 
• Variation in cervical cancer incidence between states with similarly high vaccination rates may be attributable to early adoption, faster uptake, and herd immunity through vaccination of boys. 
• Study limitations: 
  • This study cannot determine causality between HPV vaccination rates and cervical cancer incidence rates. 
  • It is difficult to interpret the potential impact of HPV vaccination upon cervical cancer rates in states with low cervical cancer case counts. 
  • NIS-Teen data may introduce selection bias and data is sometimes based on parental recall, which can also introduce bias. 
  • State-level data can mask interstate variability between geographic areas or population subgroups. 

For state-specific outcomes data, see page 22 of this linked PDF.