Prevalence of human papillomavirus genotypes in high-grade cervical precancer and invasive cervical cancer from cancer registries before and after vaccine introduction in the United States

Cancer. 2021 Oct 1;127(19):3614-3621. doi: 10.1002/cncr.33582. Epub 2021 Jul 21.


Background: US population-based cancer registries can be used for surveillance of human papillomavirus (HPV) types found in HPV-associated cancers. Using this framework, HPV prevalence among high-grade cervical precancers and invasive cervical cancers were compared before and after HPV vaccine availability.

Methods: Archived tissue from 2 studies of cervical precancers and invasive cervical cancers diagnosed from 1993-2005 (prevaccine) were identified from 7 central cancer registries in Florida; Hawaii; Iowa; Kentucky; Louisiana; Los Angeles County, California; and Michigan; from 2014 through 2015 (postvaccine) cases were identified from 3 registries in Iowa, Kentucky, and Louisiana. HPV testing was performed using L1 consensus polymerase chain reaction analysis. HPV-type-specific prevalence was examined grouped by hierarchical attribution to vaccine types: HPV 16, 18, HPV 31, 33, 45, 52, 58, other oncogenic HPV types, and other types/HPV negative. Generalized logit models were used to compare HPV prevalence in the prevaccine study to the postvaccine study by patient age, adjusting for sampling factors.

Results: A total of 676 precancers (328 prevaccine and 348 postvaccine) and 1140 invasive cervical cancers (777 prevaccine and 363 postvaccine) were typed. No differences were observed in HPV-type prevalence by patient age between the 2 studies among precancers or invasive cancers.

Conclusions: The lack of reduction in vaccine-type prevalence between the 2 studies is likely explained by the low number of cases and low HPV vaccination coverage among women in the postvaccine study. Monitoring HPV-type prevalence through population-based strategies will continue to be important in evaluating the impact of the HPV vaccine.

Keywords: United States; cervical cancer; human papillomavirus (HPV); vaccine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Genotype
  • Human papillomavirus 16
  • Humans
  • Papillomavirus Infections* / complications
  • Papillomavirus Infections* / epidemiology
  • Papillomavirus Infections* / prevention & control
  • Papillomavirus Vaccines*
  • Prevalence
  • Registries
  • United States / epidemiology
  • Uterine Cervical Neoplasms* / epidemiology
  • Uterine Cervical Neoplasms* / prevention & control


  • Papillomavirus Vaccines