State-level progress in reducing cervical cancer incidence among US young women between the pre- and post-human papillomavirus vaccination eras

BACKGROUND: Despite well-documented national declines in cervical cancer incidence among young women following human papillomavirus (HPV) vaccine implementation, state-level data remain limited. METHODS: Using the US Cancer Statistics Database, differences in cervical cancer incidence rates for women aged 20-31 between the pre-vaccination (2000-2005) and vaccination era (2016-2021) were estimated using rate ratios (RRs) across 47 states and the District of Columbia (DC). Associations between HPV vaccination rates from the National Immunization Survey-Teen and RRs were examined using Spearman's rank test and linear regression models, adjusted for screening rates from the Behavioral Risk Factor Surveillance System. RESULTS: Nationwide, cervical cancer incidence rates declined by 27% (RR = 0.73, 95% CI = 0.70 to 0.75) during the vaccination era, from 5.1 to 3.7 per 100 000. Reductions exceeded 50% in DC (RR = 0.48, 95% CI = 0.15 to 0.81), Rhode Island (RR = 0.48, 95% CI = 0.21 to 0.76), Michigan (RR = 0.48, 95% CI = 0.38 to 0.57), and Hawaii (RR = 0.49, 95% CI = 0.21 to 0.78), with 28 additional states achieving statistically significant reductions of 15%-50%. Ten states showed slower decreases (