Surveillance of high-grade cervical cancer precursors (CIN III/AIS) in four population-based cancer registries, United States, 2009–2012

Meg Watson, Ashwini Soman, Elaine W. Flagg, Elizabeth Unger, Dennis Deapen, Vivien W. Chen, Lauren C. Peres, Glenn Copeland, Thomas C. Tucker, Erin Garnett, Mona Saraiya

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Surveillance of cervical intraepithelial neoplasia grade III (CIN III) and adenocarcinoma in situ (AIS) is important for determining the burden of a preventable disease, identifying effects of vaccination on future diagnoses, and developing targeted programs. We analyzed population-based rates of high-grade cervical cancer precursor lesions using data from four central cancer registries (diagnosis years 2009–2012 from Louisiana, Kentucky, Michigan, and diagnosis years 2011–2012 from Los Angeles) by age, race, and histology. We also compared rates of precursors to invasive cancers. With 4 complete years of data from Michigan, we were able to conduct a trend analysis for that state. Data analysis was conducted in Atlanta during 2016. Kentucky reported the highest rate of CIN III/AIS (69.8), followed by Michigan (55.4), Louisiana (42.3), and Los Angeles (19.2). CIN III/AIS rates declined among women in Michigan by 37% each year for women aged 15–19, 14% for those aged 20–24, and 7% for those aged 25–29. Rates of CIN III/AIS vary by registry, and were higher than invasive cancer. In Michigan, declines in CIN III/AIS among women aged 15–29 are likely related in part to updated screening recommendations, and to the impact of human papillomavirus vaccination.

Original languageEnglish
Pages (from-to)60-65
Number of pages6
JournalPreventive Medicine
StatePublished - Oct 2017

Bibliographical note

Funding Information:
National population-based data on cancers are collected through central cancer registries (CCRs) at the state and regional level. These CCRs are supported by state public health agencies as well as by the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. In 1996, nearly all CCRs ceased collection of data on in situ cervical cancer lesions because of concerns about appropriate case definitions and changes in diagnostic terminology, especially introduction of the Bethesda system for reporting cervical cytology ( [North] American Association of Central Cancer Registries, n.d.; The Bethesda System for reporting cervical/vaginal cytologic diagnoses, 1992 ). In addition, surveillance for these lesions was complicated by increasing diagnosis and treatment of these lesions in outpatient settings ( [North] American Association of Central Cancer Registries, n.d. ). One state, Michigan, continued to collect information on in situ cervical cancer lesions even though doing so was not required by federal cancer surveillance programs.

Publisher Copyright:
© 2017


  • Cervical cancer
  • Cervical intraepithelial neoplasia
  • HPV
  • HPV vaccines
  • Population-based cancer registries

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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