Population Effectiveness of HPV Vaccination on Cervical Cancer Prevention in the

新墨西哥州是唯一有能力全面监测宫颈癌筛查和HPV的州 根据强制报告，使用全州以妇女为基础的信息学系统进行预防。我们就是这样 独特的定位来解决在多元文化的美国中理解HPV疫苗有效性方面的差距 遭受许多健康差距的人口。项目3将使用RealWorid实现4个总体目标 新墨西哥州以人口为基础的评估。1)在30岁的NM女性中，我们的特征是 30,000例正常细胞学和15,000例异常细胞学样本中HPV基因的分布 2007-2008年间采集的标本。我们将估计所有异常结果的5年发病率 组织病理学诊断(CIN1、CIN2和CIN3)在筛查妇女很少(&lt；5- 10%)将接种疫苗。这一目标将提供后续HPV感染的基线发病率 可以比较未来接种疫苗的队列中特定于基因的发病率。2)评估 接种疫苗对宫颈异常发生率的影响，我们将采用NM全州免疫 识别2007-2008年接种HPV疫苗的14-18岁年轻女性队列的信息系统 (-25,000名妇女)和一组没有接种疫苗的同龄队列(-50,000名妇女)。使用数据 我们将估计和比较这些组织学异常诊断的5年发生率 2014年前的两个队列。尽管HPV中宫颈筛查的许多假设性变化 已经建议妇女接种疫苗，在此之前必须观察CIN发病率的降低 修改是有道理的。3)作为人口有效性的早期测量，我们将描述HPV的特征 细胞学诊断(正常、ASC-US、LSIL和HSIL)和组织学中的特定基因型变化 通过正在实施的HPV疫苗接种实现的异常(CIN1、2、3)。要做到这一点 目的：我们将比较HPV基因在这些诊断类别中在25岁女性中的分布。 2007年至2008年和2012至2013年这两个时间段的年龄。在后期，相当大比例的 妇女筛查将接种疫苗。4)我们将描述基于人群的筛查做法 (例如，巴氏和人乳头状瘤病毒检测利用率以及异常诊断和活检或治疗之间的间隔) 2007-2014年间的妇女，并揭示任何可能与HPV疫苗接种有关的变化。这些数据 对于有效集成HPV疫苗接种和筛查策略至关重要，以了解当前 实践与指南，并衡量疫苗接种对筛查遵从性的任何影响。

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.