Journal of the National Cancer Institute · 2026
State-level progress in reducing cervical cancer incidence among US young women between the pre- and post-human papillomavirus vaccination eras.
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Jiang Chenxi, Rosenberg Philip S, Star Jessica, Bandi Priti, Bednarczyk Robert A, Jemal Ahmedin, Sung Hyuna
Аннотация
BACKGROUND: Despite well-documented national declines in cervical cancer incidence among young women following human papillomavirus (HPV) vaccine implementation, state-level data remain limited.
METHODS: Using the US Cancer Statistics Database, differences in cervical cancer incidence rates for women aged 20-31 between the pre-vaccination (2000-2005) and vaccination era (2016-2021) were estimated using rate ratios (RRs) across 47 states and the District of Columbia (DC). Associations between HPV vaccination rates from the National Immunization Survey-Teen and RRs were examined using Spearman's rank test and linear regression models, adjusted for screening rates from the Behavioral Risk Factor Surveillance System.
RESULTS: Nationwide, cervical cancer incidence rates declined by 27% (RR = 0.73, 95% CI = 0.70 to 0.75) during the vaccination era, from 5.1 to 3.7 per 100 000. Reductions exceeded 50% in DC (RR = 0.48, 95% CI = 0.15 to 0.81), Rhode Island (RR = 0.48, 95% CI = 0.21 to 0.76), Michigan (RR = 0.48, 95% CI = 0.38 to 0.57), and Hawaii (RR = 0.49, 95% CI = 0.21 to 0.78), with 28 additional states achieving statistically significant reductions of 15%-50%. Ten states showed slower decreases (<15%). Notably, progress was lacking in Vermont (RR = 1.11, 95% CI = 0.21 to 2.00), West Virginia (RR = 1.09, 95% CI = 0.63 to 1.56), Idaho (RR = 0.97, 95% CI = 0.42 to 1.52), Arkansas (RR = 0.96, 95% CI = 0.64 to 1.29), and Alabama (RR = 0.96, 95% CI = 0.71 to 1.21). Across states, higher vaccination rates were correlated with lower RRs (ie, faster decline) (rho=-0.42, P = .0027). Every 10% increase in vaccination rates was associated with an 11.5% (95% CI = -17.2% to -5.4%) reduction in RRs, adjusted for screening rates.
CONCLUSION: Declines in cervical cancer incidence in young women during the HPV vaccination era varied substantially by state, aligning with HPV vaccination rates.
METHODS: Using the US Cancer Statistics Database, differences in cervical cancer incidence rates for women aged 20-31 between the pre-vaccination (2000-2005) and vaccination era (2016-2021) were estimated using rate ratios (RRs) across 47 states and the District of Columbia (DC). Associations between HPV vaccination rates from the National Immunization Survey-Teen and RRs were examined using Spearman's rank test and linear regression models, adjusted for screening rates from the Behavioral Risk Factor Surveillance System.
RESULTS: Nationwide, cervical cancer incidence rates declined by 27% (RR = 0.73, 95% CI = 0.70 to 0.75) during the vaccination era, from 5.1 to 3.7 per 100 000. Reductions exceeded 50% in DC (RR = 0.48, 95% CI = 0.15 to 0.81), Rhode Island (RR = 0.48, 95% CI = 0.21 to 0.76), Michigan (RR = 0.48, 95% CI = 0.38 to 0.57), and Hawaii (RR = 0.49, 95% CI = 0.21 to 0.78), with 28 additional states achieving statistically significant reductions of 15%-50%. Ten states showed slower decreases (<15%). Notably, progress was lacking in Vermont (RR = 1.11, 95% CI = 0.21 to 2.00), West Virginia (RR = 1.09, 95% CI = 0.63 to 1.56), Idaho (RR = 0.97, 95% CI = 0.42 to 1.52), Arkansas (RR = 0.96, 95% CI = 0.64 to 1.29), and Alabama (RR = 0.96, 95% CI = 0.71 to 1.21). Across states, higher vaccination rates were correlated with lower RRs (ie, faster decline) (rho=-0.42, P = .0027). Every 10% increase in vaccination rates was associated with an 11.5% (95% CI = -17.2% to -5.4%) reduction in RRs, adjusted for screening rates.
CONCLUSION: Declines in cervical cancer incidence in young women during the HPV vaccination era varied substantially by state, aligning with HPV vaccination rates.