Population Effectiveness of HPV Vaccination on Cervical Cancer Prevention in the

新墨西哥州（NM）是唯一有能力全面监测宫颈癌筛查和HPV的州 根据规定的报告，利用全州范围内以妇女为基础的信息系统进行预防。因此我们 独特的定位，以解决在了解HPV疫苗的有效性在一个多文化的美国的差距 人口遭受许多健康差距。项目3将使用realworld实现4个总体目标 新墨西哥州基于人口的评估。1)在< 30岁的NM女性中，我们已经描述了 30,000例细胞学正常和15,000例细胞学异常人群HPV基因型分布 2007-2008年收集的标本。我们将估计所有异常结局的5年发生率 组织病理学诊断（CIN 1，CIN 2和CIN 3）在一段时间内，当少数筛选妇女（<5- 10%的人接种了疫苗。这一目标将提供基线发病率， 可以比较未来接种疫苗的队列中的基因型特异性发病率。2)评价 疫苗接种对宫颈异常发生率的影响，我们将使用NM全州免疫接种 确定2007-2008年接受HPV疫苗的14-18岁年轻妇女队列的信息系统 (-25 000名妇女）和一个没有接种疫苗的同龄队列（约50，000名妇女）。使用数据 联系，我们将估计和比较5年的发病率异常组织学诊断，在这些 2014年前的两个队列虽然许多假设的变化，子宫颈筛查HPV 建议接种疫苗的妇女，必须在接种前观察到CIN发病率的降低。 修改是有道理的。3)作为人群有效性的早期测量，我们将描述HPV的特征， 细胞学诊断（正常、ASC-US、LSIL和HSIL）和组织学诊断中的基因型特异性变化 通过HPV疫苗接种实现的异常（CIN 1，2，3），因为它正在实施。为了实现这一 我们将比较这些诊断类别中<25岁女性的HPV基因型分布， 在2007-2008年和2012-2013年两个时期，在后期， 接受筛查的妇女将接种疫苗。4)我们将描述基于人群的筛查实践 (e.g. NM的巴氏和HPV检测利用率以及异常诊断与活检或治疗之间的间隔） 2007年至2014年期间的女性，并揭示任何可能与HPV疫苗摄取有关的变化。这些数据 对有效整合HPV疫苗接种和筛查策略至关重要， 实践与指南，并衡量疫苗接种对筛查依从性的任何影响。

New Mexico (NM) is the only state with the capacity to fully monitor cervical cancer screening and HPV prevention using a state-wide woman-based informatics system under mandated reporting. We are thus uniquely positioned to address gaps in understanding HPV vaccine effectiveness within a multi-cultural US population suffering many health disparities. Project 3 will accomplish 4 overarching objectives using realworid population-based evaluations in NM. 1) Among NM women < 30 years of age, we have characterized the HPV genotype distribution in a population-based sample of 30,000 normal and 15,000 abnormal cytology specimens collected in 2007-2008. We will estimate the 5-year incidence rate for outcomes of all abnormal histopathologic diagnoses (CIN1, CIN2, and CIN3) during a time period when few screening women (<5- 10%) will have been vaccinated. This aim will provide baseline incidence rates to which subsequent HPV genotype-specific incidence rates among future vaccinated cohorts can be compared. 2) To evaluate the impact of vaccination on the incidence of cervical abnormalities, we will use the NM State-wide Immunization Information System to identify a cohort of young women age 14-18 who received HPV vaccine in 2007-2008 (-25,000 women) and a cohort of the same age who did not receive vaccine (-50,000 women). Using data linkage, we will estimate and compare the 5-year incidence rates of abnormal histologic diagnoses in these two cohorts through 2014. Although many hypothetical changes to cervical screening among HPV vaccinated women have been proposed, reductions in CIN incidence rates must be observed before modifications can be justified. 3) As an eariy measure of population effectiveness, we will characterize HPV genotype-specific changes in cytologic diagnoses (normal, ASC-US, LSIL, and HSIL) and histologic abnormalities (CIN1,2,3) realized through HPV vaccination as it is being implemented. To accomplish this aim, we will compare HPV genotype distributions among these diagnostic categories in women <25 years of age during two time periods, 2007-2008 and 2012-2013. In the later period, a significant proportion of women screening will have been vaccinated. 4) We will characterize population-based screening practices (e.g. Pap and HPV test utilization and intervals between abnormal diagnosis and biopsy or treatment) for NM women across 2007-2014 and reveal any changes potentially related to HPV vaccine uptake. These data are critical to effective integration of HPV vaccination and screening strategies, to understanding current practices vs. guidelines and to measuring any impact of vaccination on screening compliance.