Cervical dysplasia incidence decreased over 14 years for women younger than 25 years

Key takeaways:

• For women aged 25 to 29 years, incidence of cervical intraepithelial neoplasia grades 1, 2, and 3 increased from 2007 to 2020.
• Yet, incidence of all grades declined in that time for women younger than 25 years

From 2007 to 2020, the incidence of cervical intraepithelial neoplasia grades 1, 2 and 3 continuously decreased among women aged 15 to 25 years while increasing among women aged 25 to 29 years, researchers reported.

“Over the past decade, population-level HPV vaccination coverage has increased, and changes in cervical cancer screening guideline recommendations have occurred,” Rachael Adcock, PhD, assistant professor in the division of epidemiology, biostatistics and preventive medicine at the University of New Mexico Center for HPV Prevention at the New Mexico HPV Pap Registry, and colleagues wrote in a research letter published in JAMA Oncology. “Population-level incidence of cervical intraepithelial neoplasia grades 1, 2 and 3 was previously reported for individuals aged 15 to 29 years from 2007 to 2014.”

In this cohort study, researchers extended the study period with 6 more years of data.

Adcock and colleagues evaluated data from 1,125,851 women who underwent cervical cytology with or without HPV testing from the New Mexico HPV Pap Registry from 2007 to 2020. Researchers estimated incidence of cervical intraepithelial neoplasia grades 1, 2 and 3 annually per 100,000 women screened since cervical intraepithelial neoplasia diagnoses.

Overall, 31.3% of women were aged 15 to 29 years. Of these women, 9.6% underwent cervical biopsy.

Per 100,000 women screened, the incidence of cervical intraepithelial neoplasia grades 1, 2 and 3 decreased among women aged 15 to 19 years from 3,468.3, 896.4 and 240.2 in 2007, respectively, to 743.5, 371.7 and 0 in 2020, respectively. In addition, the incidence of cervical intraepithelial neoplasia grades 1, 2 and 3 also decreased among women aged 20 to 24 years from 3,257.2, 1,027.7 and 528.6 in 2007, respectively, to 1,207.8, 371.6 and 325.1 in 2020, respectively.

However, per 100,000 women screened, the incidence of cervical intraepithelial neoplasia grades 1, 2 and 3 increased among women aged 25 to 29 years from 2007 to 2020 with an annual percentage change of 0.6% for grade 1 (2,092.4 to 2,484.4), 1.3% for grade 2 (681.8 to 725.6) and 5.2% for grade 3 (437.9 to 985.9).

“Using the principle of equal care for equal risk, clinical data from routine clinical practice are crucial to harmonize recommendations from the American Cancer Society to initiate cervical screening at age 25 years and from the U.S. Preventive Services Task Force and others to screen starting at age 21 years,” the researchers wrote. “If high HPV vaccination coverage is sustained, the age at which cervical screening initiation is recommended might be increased further and the number of lifetime cervical screens potentially reduced.”