Incidence Of Invasive Cervical Cancer Research Articles

Invasive Cervical Cancer Incidence Disparities in New Jersey--a Spatial Analysis in a High Incidence State.

Although invasive cervical cancer incidence has declined, disparities persist. We identified spatial clusters of census tracts with elevated invasive cervical cancer incidence rates using New Jersey State Cancer Registry cases 20 years or older diagnosed in 2005-2009. Each cluster's population was compared with the rest of New Jersey's population on demographic and socioeconomic characteristics. Odds ratios that assessed associations between statistically significant characteristics (from a univariate comparison of cases in the clusters versus cases in the rest of New Jersey) and being a case in a cluster versus being a case in the rest of New Jersey were calculated from logistic regression models. Significant incidence clusters were identified around Newark, Trenton, and Camden. Being Black (all areas), Hispanic (Newark, Camden), unmarried (Newark), and uninsured/Medicaid-insured (Trenton) were significantly associated with being a case in these areas. These study results can be used to target invasive cervical cancer prevention efforts more effectively.

Soil-Transmitted Helminth Infections Are Associated With an Increase in Human Papillomavirus Prevalence and a T-Helper Type 2 Cytokine Signature in Cervical Fluids.

An ecological correlation between invasive cervical cancer incidence and burden of soil-transmitted helminths (STH) is hypothesized to explain the excess in detectable human papillomavirus (HPV) infection in Latin America, via a global T-helper type 2 (Th2)-biased mucosal immune response secondary to STH infection. The association between current STH infection and HPV prevalence was compared in regions of Peru where STH is or is not endemic. Adjusted prevalence ratios (PRs) with robust variance were estimated as an effect measure of STH infection on HPV prevalence in each study site. Soluble immune marker profiles in STH-infected and STH-uninfected women were compared using Spearman rank correlation with the Sidak correction. Among women in the helminth-endemic region of the Peruvian Amazon, those with STH infection women had a 60% higher prevalence of HPV, compared with those without STH infection (PR, 1.6; 95% confidence interval, 1.0-2.7). Non-STH parasitic/protozoal infections in the non-STH-endemic population of Peru were not associated with HPV prevalence. In Iquitos, A Th2 immune profile was observed in cervical fluid from helminth-infected women but not helminth-uninfected women. A proportion of the increased HPV prevalence at older ages observed in Latin America may be due to a population-level difference in the efficiency of immunological control of HPV across the lifespan due to endemic STH infection.

Abstract IA09: IL-17 and GMCSF may be novel markers for detection of ICC

Abstract IA09: IL-17 and GMCSF may be novel markers for detection of ICC

A Population-Level Evaluation of the Effect of Antiretroviral Therapy on Cancer Incidence in Kyadondo County, Uganda, 1999-2008.

The introduction of antiretroviral therapy (ART) in the United States and Europe has led to changes in the incidence of cancers among HIV-infected persons, including dramatic decreases in Kaposi sarcoma and non-Hodgkin lymphoma, and increases in Hodgkin lymphoma, liver, and anogenital malignancies. We sought to evaluate whether increasing availability of ART is associated with changing cancer incidence in Uganda. Incident cases of 10 malignancies were identified from Kampala Cancer Registry from 1999 to 2008. ART coverage rates for Uganda were abstracted from the Joint United Nations Program on HIV/AIDS reports. Negative binomial and Poisson regression modeled the association between ART coverage and age-adjusted cancer incidence. ART coverage in Uganda increased from 0% to 43% from 1999 to 2008. With each 10% increase in ART coverage, incidence of Kaposi sarcoma decreased by 5% [incidence rate ratio (IRR) = 0.95, 95% confidence interval: 0.91 to 0.99, P = 0.02] and stomach cancer decreased by 13% [IRR = 0.87 (95% CI: 0.80 to 0.95), P = 0.002]. Conversely, incidence of non-Hodgkin lymphoma increased by 6% [IRR = 1.06 (95% CI: 1 to 1.12), P = 0.05], liver cancer by 12% [IRR = 1.12 (95% CI: 1.04 to 1.21), P = 0.002], prostate cancer by 5% [IRR = 1.05 (95% CI: 1 to 1.10), P = 0.05], and breast cancer by 5% [IRR = 1.05 (95% CI: 1 to 1.11), P = 0.05]. ART coverage was not associated with incidence of invasive cervical cancer, lung, colon, and Hodgkin disease. These findings were similar when restricted to histologically confirmed cases. Our findings suggest that AIDS-defining malignancies and other malignancies are likely to remain significant public health burdens in sub-Saharan Africa even as ART availability increases.

Changes in cervical cancer incidence following the introduction of organized screening in Italy

ObjectiveTo quantify the impact of organized cervical screening programs (OCSPs) on the incidence of invasive cervical cancer (ICC), comparing rates before and after activation of OCSPs. MethodsThis population-based investigation, using individual data from cancer registries and OCSPs, included 3557 women diagnosed with ICC at age 25–74years in 1995–2008. The year of full-activation of each OCSP was defined as the year when at least 40% of target women had been invited. Incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs) were calculated as the ratios between age-standardized incidence rates observed in periods after full-activation of OCSPs vs those observed in the preceding quinquennium. ResultsICC incidence rates diminished with time since OCSPs full-activation: after 6–8years, the IRR was 0.75 (95% CI: 0.67–0.85). The reduction was higher for stages IB–IV (IRR=0.68, 95% CI: 0.58–0.80), squamous cell ICCs (IRR=0.74, 95% CI: 0.64–0.84), and particularly evident among women aged 45–74years. Conversely, incidence rates of micro-invasive (stage IA) ICCs increased, though not significantly, among women aged 25–44years (IRR=1.34, 95% CI: 0.91–1.96). Following full-activation of OCSPs, micro-invasive ICCs were mainly and increasingly diagnosed within OCSPs (up to 72%). Conclusion(s)Within few years from activation, organized screening positively impacted the already low ICC incidence in Italy and favored down-staging.

Pap test use and cervical cancer incidence in First Nations women living in Manitoba.

This study examined Papanicolaou (Pap) test utilization, Pap test results, and cervical cancer incidence among First Nations (FN) women living in Manitoba, Canada taking into account age group, time period, and area of residence. Six population-based data sources were linked at an individual level. Negative binomial regression was used to compare Pap test utilization and results between FN and all other Manitoba (AOM) women. Poisson regression was used to compare cervical cancer incidence. Among women younger than 25 years, FN were more likely than AOM women to have had a Pap test [rate ratio (RR) = 1.37, 95% confidence intervals (CI), 1.22-1.53, 18-19 year olds; RR = 1.17, 95% CI, 1.05-1.31, 20-24 year olds]. There was no difference in Pap test use for women 25 to 29 or 30 to 39 years. FN 40 years and older were less likely to have a Pap test than AOM women (RR = 0.84, 95% CI, 0.75-0.93, 40-49 years old; RR = 0.71, 95% CI, 0.63-0.79, 50-59 years old; RR = 0.59, 95% CI, 0.52-0.66, 60-69 years old). FN were more likely than AOM women to have a high (RR = 1.88, 95% CI, 1.65-2.13) or low-grade Pap test result (RR = 1.60, 95% CI, 1.48-1.73). The invasive cervical cancer incidence rate was double for FN women 25 to 39 years of age (21.9 per 100,000, FN; 10.2 per 100,000, AOM, P = 0.006) and 40 to 69 years of age (24.3 per 100,000, FN; 12.3 per 100,000, AOM, P = 0.007). In conclusion, cervical cancer screening among FN women over 40 years of age must be increased to address the higher cervical cancer incidence.

Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population.

IntroductionWomen living with HIV (WLWH) are reportedly at increased risk of invasive cervical cancer (ICC). WLWH in Denmark attend the National ICC screening program less often than women in the general population. We aimed to estimate the incidence of cervical dysplasia and ICC in WLWH in Denmark.MethodsWe studied a nationwide cohort of WLWH and a cohort of age-matched females from the general population in the period 1999–2010. Pathology samples were obtained from The Danish Pathology Data Bank containing nationwide records of all pathology specimens. The cumulative incidence and hazard ratios (HRs) for time from inclusion to first cervical intraepithelial neoplasia (CIN)/ICC and time from first normal cervical cytology to first CIN/ICC were estimated. Sensitivity analyses were performed to include prior screening outcome, screening intensity and treatment of CIN/ICC in the interpretation of results.ResultsWe followed 1,143 WLWH and 17,145 controls with no prior history of ICC for 9,509 and 157,362 person-years. Compared to controls, the overall incidence of CIN1 or worse (CIN1+), CIN2+ and CIN3+ was higher in WLWH and predicted by young age and CD4 count <200 cells/µL. In women with normal baseline cytology, incidences of CIN1+ and CIN2+ were higher in WLWH. However, incidences were comparable between WLWH and controls adherent to the National ICC screening program.ConclusionsOverall, WLWH develop more cervical disease than controls. However, incidences of CIN are comparable amongst WLWH and controls adherent to the National ICC screening program and with a normal baseline cytology.

HPV genotypes and cervical intraepithelial neoplasia in a multiethnic cohort in the southeastern USA.

PurposeFor poorly understood reasons, invasive cervical cancer (ICC) incidence and mortality rates are higher in women of African descent. Oncogenic human papillomavirus (HPV) genotypes distribution may vary between European American (EA) and African-American (AA) women and may contribute to differences in ICC incidence. The current study aimed at disentangling differences in HPV distribution among AA and EA women.MethodsFive-hundred and seventy-two women were enrolled at the time of colposcopic evaluation following an abnormal liquid-based cytology screen. HPV infections were detected using HPV linear array, and chi-squared tests and linear regression models were used to compare HPV genotypes across racial/ethnic groups by CIN status.ResultsOf the 572 participants, 494 (86 %) had detectable HPV; 245 (43 %) had no CIN lesion, 239 (42 %) had CIN1, and 88 (15 %) had CIN2/3. Seventy-three percent of all women were infected with multiple HPV genotypes. After adjusting for race, age, parity, income, oral contraception use, and current smoking, AAs were two times less likely to harbor HPV 16/18 (OR 0.48, 95 % CI 0.21–0.94, p = 0.03) when all women were considered. This association remained unchanged when only women with CIN2/3 lesions were examined (OR 0.22, 95 % CI 0.05–0.95, p = 0.04). The most frequent high-risk HPV genotypes detected among EAs were 16, 18, 56, 39, and 66, while HPV genotypes 33, 35, 45, 58, and 68 were the most frequent ones detected in AAs.ConclusionsOur data suggest that while HPV 16/18 are the most common genotypes among EA women with CIN, AAs may harbor different genotypes.

English

Human papilloma-virus (HPV) infection confers 85-90% of the attributable risk for the development of cervical dysplasia. Worldwide and in particular in Nigeria, HPV 16 has been shown as the most prevalent HPV type and it also contributes more to the development of invasive squamous cell carcinoma. Studies have also shown that the prevalence of HPV is higher among HIV-positive women than among HIV-negative women of all age groups. HIV-positive women also have a higher incidence of squamous intra-epithelial lesion (SIL) and invasive cervical cancer. Progression to cervical cancer is also more rapid amongst these patients and often refractory to treatment with high incidence rates. Current screening recommendations for HIV-positive women are accessible and developed in rich countries. The best strategy for screening infected women in poorer nations where human immunodeficiency virus (HIV) is rampant remains uncertain and challenging. &nbsp; Key words: Human papilloma-virus (HPV), human immunodeficiency virus (HIV), cervical dysplasia, invasive squamous cell carcinoma.

Has the Incidence of Invasive Cervical Cancer in Older U.S. Women Been Underestimated

Hysterectomy is common in the U.S., and the vast majority of these surgeries involve removal of the cervix as well as the uterus. Because total hysterectomy protects women from future invasive cervical cancer (ICC), hysterectomy rates affect estimates of ICC incidence. Using national surveillance data, researchers calculated hysterectomy-corrected, age-specific incidence of …

Effect of VIA Screening by Primary Health Workers: Randomized Controlled Study in Mumbai, India

Cervical cancer is the leading cause of cancer mortality among women in India. Because Pap smear screening is not feasible in India, we need to develop effective alternatives. A cluster-randomized controlled study was initiated in 1998 in Mumbai, India, to investigate the efficacy of visual inspection with acetic acid (VIA) performed by primary health workers in reducing cervical cancer mortality. Four rounds of cancer education and VIA screening were conducted at 24-month intervals in the screening group, whereas cancer education was offered once at entry to the control group. The study was planned for 16 years to include four screening rounds followed by four monitoring rounds. We present results after 12 years of follow-up. Poisson regression method was used to calculate the rate ratios (RRs); two-sided χ(2) was used to calculate the probability. We recruited 75360 women from 10 clusters in the screening group and 76178 women from 10 comparable clusters in the control group. In the screening group, we achieved 89% participation for screening and 79.4% compliance for diagnosis confirmation. The incidence of invasive cervical cancer was 26.74 per 100000 (95% confidence interval [CI] = 23.41 to 30.74) in the screening group and 27.49 per 100000 (95% CI = 23.66 to 32.09) in the control group. Compliance to treatment for invasive cancer was 86.3% in the screening group and 72.3% in the control group. The screening group showed a statistically significant 31% reduction in cervical cancer mortality (RR = 0.69; 95% CI = 0.54 to 0.88; P = .003). VIA screening by primary health workers statistically significantly reduced cervical cancer mortality. Our study demonstrates the efficacy of an easily implementable strategy that could prevent 22000 cervical cancer deaths in India and 72600 deaths in resource-poor countries annually.

HPV Genotypes and Cervical Intraepithelial Neoplasiain a Multiethnic Cohort in the Southeastern United States

Background: For poorly understood reasons, invasive cervical cancer (ICC) incidence and mortality rates are higher in women of African descent. Oncogenic human papillomavirus (HPV) genotypes distribution may vary between European American (EA) and African American (AA) women, and may contribute to differences in ICC incidence. Methods: Five-hundred and seventy-two women were enrolled at the time of colposcopic evaluation following an abnormal liquid-based cytology screen. HPV infections were detected using HPV-linear array, and chi-squared tests and linear regression models were used to compare HPV genotypes across racial/ethnic groups by CIN status. Results: Of the 572 participants, 494 (86%) had detectable HPV; 245 (43%) had no CINlesion, 239 (42%) had CIN1, and 88 (15%) had CIN2/3. Seventy-three percent of all women were infected with multiple HPV genotypes. After adjusting for race, age, parity, oral contraception use and current smoking, AAs were two times less likely to harbor HVP16/18 (OR=0.52, 95%CI 0.27-0.98, p=0.04) when all women were considered. This association remained unchanged when only women with CIN2/3 lesions were examined (OR=0.22, 95%CI 0.05-0.95, p=0.04). The most frequent high risk (HR)-HPV genotypes detected among EAs were 16, 18, 56, 39 and 66, while HPV genotypes 33, 35, 45, 58 and 68 were the most frequent ones detected in AAs.

Cervical cancer: Can it be prevented?

Cervical cancer prevention requires a multipronged approach involving primary, secondary and tertiary prevention. The key element under primary prevention is human papilloma virus (HPV) vaccination. So far, only prophylactic HPV vaccines which prevent HPV infection by one or more subtypes are commercially available. Therapeutic HPV vaccines which aid in clearing established infection are still under trial. Secondary prevention entails early detection of precancerous lesions and its success is determined by the population coverage and the efficacy of the screening technique. A number of techniques are in use, including cytology, visual inspection (using the naked eye, magnivisualizer, acetic acid and Lugol's iodine), HPV testing and a combination of these methods. Updated screening guidelines have been advocated by the American Cancer Society in light of the role of HPV on cervical carcinogenesis. Recent research has also focussed on novel biomarkers that can predict progression to cancer in screen positive women and help to differentiate those who need treatment from those who can be left for follow-up. Last but not the least, effective treatment of precancerous lesions can help to reduce the incidence of invasive cervical cancer and this constitutes tertiary prevention. A combination of these approaches can help to prevent the burden of cervical cancer and its antecedent morbidity and mortality, but all of these are not feasible in all settings due to resource and allocation constraints. Thus, all countries, especially low and middle income ones, have to determine their own cocktail of approaches that work before we can say with certainty that yes, cervical cancer can be prevented.

What are the Implications of Distinct HPV Genotypes in Women of Different Ethnic/Racial Ancestry?

Invasive cervical cancer incidence and mortality continue to disproportionately affect racial/ethnic minorities, and the distribution of HPV genotypes varies by race/ethnicity, providing a potential explanation for such differences in incidence and mortality. It remains unclear whether such differences could be explained by host genetics or epigenetics that increase susceptibility to particular HPV genotypes, viral genetics, differences in HPV genotypes harbored by different social and/or economic networks, or by differences as simply as function of sexual networks. Determining if race-specific vaccines will benefit some subgroups will depend on addressing these questions. In general, it is our opinion that given population admixture, race/ethnicity based vaccine development may have limited value. Necessary to resolving this question will be the deliberate inclusion of minority populations into observational studies and clinical trials, as well as increase efforts in the study of other less racially admixed populations.

HPV-Related Cancers After Solid Organ Transplantation in the United States

Transplant recipients have elevated cancer risk including risk of human papillomavirus (HPV)-associated cancers of the cervix, anus, penis, vagina, vulva and oropharynx. We examined the incidence of HPV-related cancers in 187 649 US recipients in the Transplant Cancer Match Study. Standardized incidence ratios (SIRs) compared incidence rates to the general population, and incidence rate ratios (IRRs) compared rates across transplant subgroups. We observed elevated incidence of HPV-related cancers (SIRs: in situ 3.3–20.3, invasive 2.2–7.3), except for invasive cervical cancer (SIR 1.0). Incidence increased with time since transplant for vulvar, anal and penile cancers (IRRs 2.1–4.6 for 5+ vs. <2 years). Immunophenotype, characterized by decreased incidence with HLA DRB1:13 and increased incidence with B:44, contributed to susceptibility at several sites. Use of specific immunosuppressive medications was variably associated with incidence; for example, tacrolimus, was associated with reduced incidence for some anogenital cancers (IRRs 0.4–0.7) but increased incidence of oropharyngeal cancer (IRR 2.1). Thus, specific features associated with recipient characteristics, transplanted organs and medications are associated with incidence of HPV-related cancers after transplant. The absence of increased incidence of invasive cervical cancer highlights the success of cervical screening in this population and suggests a need for screening for other HPV-related cancers.

Human papillomavirus prevalence and type distribution in invasive cervical cancer in sub‐Saharan Africa

In sub-Saharan Africa, invasive cervical cancer (ICC) incidence and mortality are among the highest in the world. This cross-sectional epidemiological study assessed human papillomavirus (HPV) prevalence and type distribution in women with ICC in Ghana, Nigeria, and South Africa. Cervical biopsy specimens were obtained from women aged ≥ 21 years with lesions clinically suggestive of ICC. Histopathological diagnosis of ICC was determined by light microscopy examination of hematoxylin and eosin stained sections of paraffin-embedded cervical specimens; samples with a confirmed histopathological diagnosis underwent HPV DNA testing by polymerase chain reaction. HPV-positive specimens were typed by reverse hybridization line probe assay. Between October 2007 and March 2010, cervical specimens from 659 women were collected (167 in Ghana, 192 in Nigeria and 300 in South Africa); 570 cases were histologically confirmed as ICC. The tumor type was identified in 551/570 women with ICC; squamous cell carcinoma was observed in 476/570 (83.5%) cases. The HPV-positivity rate in ICC cases was 90.4% (515/570). In ICC cases with single HPV infection (447/515 [86.8%]), the most commonly detected HPV types were HPV16 (51.2%), HPV18 (17.2%), HPV35 (8.7%), HPV45 (7.4%), HPV33 (4.0%) and HPV52 (2.2%). The prevalence of single and multiple HPV infections seemed higher among HIV-positive women and HPV type distribution appeared to differ according to tumor type and HIV status. In conclusion, HPV16, 18, 45 and 35 were the most common HPV types in sub-Saharan African women with ICC and HPV infections were more common in HIV-positive women.

Pap Hub: A system to improve compliance with pap smear screening guidelines in a large health care system.

193 Background: Cervical cancer is the most prevalent gynecologic cancer worldwide, but is third in the U.S. due to pap smear screening. However, American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines are complex and frequently changed, resulting in guideline adherence as low as 33-44%. We describe a centralized pap smear tracking system (“pap hub”) and report preliminary results. Methods: On 1/1/13 we implemented the pap hub, routing all screening pap smear results to a dedicated OB/Gyn nursing staff with a new Epic workbench. Epic Health Maintenance Modifier updated to recommend pap smears for women age 21-65 years (not younger or older per guidelines). Screening Pap/HPV results auto routed to Pap Pool Epic inbasket (not to individual providers). Centralized nurse reviews results alongside past pap results on Pathology flowsheet in Epic If normal Normal history -&gt; appropriate follow-up interval per screening guidelines If abnormal history -&gt; repeat pap as determined by previous history and treatment If abnormal -&gt; manage per ASCCP guidelines Document plan in Epic Result Note Update Epic problems list If Normal: document “Pap Hub Normal History” If Abnormal: document “Pap Hub Abnormal History” with specifics in Overview History Communicate results/plan to the patient. Update Health Maintenance Modifier with next step. Review abnormal results to ensure proper follow-up, with reminders as indicated. Results: Guideline recommendations against pap smears for patients &lt;21 years and &gt;65 years have not changed since 2009. Comparison of first-quarter data for 2010 (pre-Pap Hub) to 2013 (post-Pap Hub) have shown a 63.86% reduction in pap smears in women &lt;21 years. Pap smears in women &gt;65 years has always been low, but has decreased slightly from 2.4% of all pap smears in 2010 to 1.5% of all pap smears in 2013. The 2012 ASCCP guidelines have changed recommended pap smear frequency and abnormal pap smear follow-up, and compliance with these new recommendations is being collected. Conclusions: Pap smear screening has decreased the incidence of invasive cervical cancer in the United States. The Pap Hub, a centralized pap smear tracking system, improves compliance with pap smear screening guidelines.

Trends in incidence of, and mortality from, cervical lesions in Ireland: Baseline data for future evaluation of the national cervical screening programme

AimTo investigate incidence and mortality trends for cervical lesions in Ireland in the period 1994–2008. MethodsWe used data from the National Cancer Registry, Ireland and national death registration data to calculate age-standardised rates for the periods of interest. We used standardised rate ratios to test whether incidence was associated with socio-demographic variables and used Joinpoint to examine trends by morphology grouping. ResultsIncidence of cervical cancer and cervical intraepithelial neoplasia (CIN3) rose over the period 1994–2008. The annual percentage change for cervical cancer was 1.8% and that for CIN3 was 3.8%. Women resident in the most deprived areas had invasive cervical cancer incidence almost twice as high as those resident in the least deprived areas (standardised rate ratio (SRR)=1.8). Comparing incidence in Ireland to England and Wales, Northern Ireland and Scotland in the three years 2005–2007, the SRRs (other areas vs. Ireland) were 0.70, 0.88 and 0.84 respectively. Cervical cancer rates have fallen in these countries in the same period that there is a rise demonstrated in Ireland. ConclusionIncidence rates of cervical cancer rose in Ireland steadily, albeit modestly, during 1994–2008, most likely due to long-term changes in patterns of sexual behaviour and contraceptive use. A more pronounced rise in CIN3 rates point to considerable levels of opportunistic screening during this period. Mortality rates have changed little over the past four decades, in contrast to trends in countries with well-organised screening programmes.

Evolution of the Incidence of Cervical Cancer Among Hispanics and Asians in California Between 1990 and 2004

Purpose/Objective(s): This study aimed to evaluate the evolution of the invasive cervical cancer (CCa) incidence among Hispanics and Asians in California. Materials/Methods: Using data from the California Cancer Registry, comprising four of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program registries, information on all primary CCa diagnosed in California from January 1, 1990, through December 31, 2004 was obtained. We analyzed the influence of ethnicity and nativity on the evolution of CCa incidence. Results: Among the 22,189 CCa cases diagnosed between 1990 and 2004, 50% were non-Hispanic white (NHW), 39% Hispanic and 11% Asian women. Among Hispanic and Asian women, 74% were foreign-born (FB). For the entire population, 70% were squamous cell carcinoma (SCC), 19% adenocarcinoma and 11% other histologies. Compared to NHW, there was a higher incidence of CCa in United States born Hispanics and FB Hispanics, Japanese, Filipino and Korean women (Incidence rate ratio [IRR]; 95% CI: 1.6 [1.5-1.7], 2.6 [2.5-2.7], 1.4 [1.2-1.7], 1.5 [1.4-1.6],and 1.8 [1.6-2.1], respectively). However, FB-South Asian, FB-Chinese and US-born Japanese had lower rates than NHW (IRR (95% CI): 0.8 (0.7-1.0), 0.9 (0.8-1.0), 0.6 (0.5-0.7), respectively). From 1990 to 2004, the incidence of CCa declined significantly for all groups of women except for United States-born Asian for whom the incidence remained stable (average percent of change [APC] were 2.44, 1.40 [1990-2002], 4.64 and 7.32 [1994-2004] for NHW, United States and FB-Hispanics and FBAsians, respectively). There was a reduction of the SCC incidence for all groups of women (APC: 6.37 [1990-1994] and 5.03 [1997-2004], 5.15 [1990-1995] and 9.84 [2000-2004], 5.07, 3.62, 8.07 [19932004] for NHW, United States-and FB-Hispanics, United States and FBAsian, respectively). The incidence of adenocarcinoma did not show a significant decrease with the exception of FB-Asian women, which showed a significant decrease for adenocarcinoma (APC: 3.95 [1990 -2004]). Local and regional disease declined significantly over the 14 years period for NHW, FB-and United States-born Hispanics and FB-Asian (APC: 2.58, 4.39, 12.42 [2000-2004], 5.62 for local disease and 2.06, 3.96, 2.27 and 6.73 for regional disease respectively). The incidence of distant disease has only decreased significantly in FBHispanics and FB-Asian (APC: 5.71 and 4.40, respectively). Conclusions: The incidence of CCa declined in NHW, Hispanics and Asian women in California from 1990 through 2004. The SCC incidence declined and the adenocarcinoma incidence remained stable. This difference between these histologies could be caused by less sensitivity for detecting endocervical glandular dysplasia and adenocarcinoma than for detecting squamous malignancy with pap smear. Author Disclosure: M. Froment: None. A. Roux: None. M.C. DeRouen: None. S.L. Gomez: None. E.A. Kidd: None.

Cost-effectiveness of the vaccine against human papillomavirus in the Brazilian Amazon region

ObjectiveTo assess the cost-utility of the human papillomavirus (HPV) vaccination on the prevention of cervical cancer in the Brazilian Amazon region. MethodsA Markov cohort model was developed to simulate the natural evolution of HPV and its progress to cervical cancer, considering the current preventive programs and treatment costs. The one-year transition probabilities were mainly based on empirical data of local and national studies. The model evaluated the addition of the vaccine to three cervical cancer-screening scenarios (0, 3 or 10 exams throughout life). ResultsThe scenario of three Pap tests resulted in satisfactory calibration (base case). The addition of HPV vaccination would reduce by 35% the incidence of cervical cancer (70% vaccination coverage). The incremental cost-effectiveness ratio was US$ 825 for each quality-adjusted life year gained. The sensitivity analysis confirms the robustness of this result, and duration of immunity was the parameter with greater variation in incremental cost-effectiveness ratio. ConclusionVaccination has a favorable profile in terms of cost-utility, and its inclusion in the immunization schedule would result in a substantial reduction in incidence and mortality of invasive cervical cancer in the Brazilian Amazon region.