A Population-Based Study of HPV Genotype Prevalence among Kentucky Women

Background & need There are currently two vaccines available that are effective for preventing human papillomavirus (HPV) types 16 and 18, which are linked with approximately 70% of invasive cervical cancers. Because of the natural history of infection and neoplastic progression, impact of vaccination on cervical cancer will not be observed for at least 10 years. Although rates of HPV infection observed in young women will be the first measurable impact from the vaccine, this endpoint does not include cervical disease. Pre-invasive cervical disease, cervical intraepithelial neoplasia grade 3 (CIN3) and adenocarcinoma in situ (AIS), are attractive endpoints for monitoring because they occur at younger ages, and are appropriate surrogates for invasive cervical cancer. These endpoints were used for HPV vaccine trials. The feasibility of HPV detection and typing in diagnostic cervical samples has been established in the HPV Genotyping Study pilot with registries participating in the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results Program’s (SEER’s) Residual Tissue Repositories (RTRs). HPV-associated cancers (invasive cancers of the cervix, vagina, vulva, penis, anus and oropharynx; two registries also submitted tissue from in situ cervical lesions) were sampled in central cancer registries (CCRs) and tissue specimens were tracked back to pathology labs, which sent tissue blocks to the CDC HPV lab for genotyping. RTRs sent tissue blocks from all eligible specimens conforming to the project’s selection criteria. The HPV Impact study conducted with Emerging Infections Program (EIP) sites is also genotyping some invasive and preinvasive cancers associated with HPV. Results to date indicate variation in HPV genotype prevalence among demographically diverse populations. Data on preinvasive cancers are being collected through a special study. The proposed study project will expand this project to include genotyping of preinvasive cervical disease in Kentucky, and further demonstrate the feasibility of capitalizing on the NPCR infrastructure to monitor HPV vaccine impact on cervical cancer precursors. Kentucky is a state with a high cervical cancer burden. The rate of invasive cervical cancer in Appalachian Kentucky (10.5 per 100,000 women) is significantly (p