Human papillomavirus prevalence among indigenous and non-indigenous Australian women prior to a national HPV vaccination program

Abstract

BackgroundIndigenous women in Australia have a disproportionate burden of cervical cancer despite a national cervical screening program. Prior to introduction of a national human papilloma virus (HPV) vaccination program, we determined HPV genotype prevalence by Indigenous status and residence in remote areas.MethodsWe recruited women aged 17 to 40 years presenting to community-based primary health services for routine Pap screening across Australia. A liquid-based cytology (LBC) cervical specimen was tested for HPV DNA using the AMPLICOR HPV-DNA test and a PGMY09/11-based HPV consensus PCR; positive specimens were typed by reverse hybridization. We calculated age-adjusted prevalence by weighting to relevant population data, and determined predictors of HPV-DNA positivity by age, Indigenous status and area of residence using logistic regression.ResultsOf 2152 women (655 Indigenous), prevalence of the high-risk HPV genotypes was similar for Indigenous and non-Indigenous women (HPV 16 was 9.4% and 10.5%, respectively; HPV 18 was 4.1% and 3.8%, respectively), and did not differ by age group. In younger age groups, the prevalence of other genotypes also did not differ, but in those aged 31 to 40 years, HPV prevalence was higher for Indigenous women (35% versus 22.5%; P < 0.001), specifically HPV clades α5 (OR = 2.1, 95% CI 1.1 to 4.3) and α7, excluding type 18 (OR 1.9, 95% CI 1.1 to 3.3). In multivariate analysis, detection of any HPV genotype was strongly associated with smoking and Pap-test abnormalities, with both risk factors more common among Indigenous women.ConclusionAlthough we found no difference in the prevalence of HPV16/18 among Australian women by Indigenous status or, for Indigenous women, residence in remote regions, differences were found in the prevalence of risk factors and some other HPV genotypes. This reinforces the importance of cervical screening as a complement to vaccination for all women, and the value of baseline data on HPV genotype prevalence by Indigenous status and residence for the monitoring of vaccine impact.

High-Throughput Monitoring of Human Papillomavirus Type Distribution

“…This agrees only in part with a recent meta-analysis where HPV 16, 31, 18, 39, 33, and 66 were the most common types among European women (19). Our finding that HPV 51 was the second most common HPV type after HPV 16 is in accordance with the Australian survey (10). HPV-type distributions among men have been variable, with HPV 59, 16, 52, and 51 being most common among Mexican men (20), and HPV 6, 16 and 59, 52, and 39 among men from the United States (21).…”

“…Female high-risk HPV prevalence in cervicovaginal swab samples in the United States among 20-to 24-year-olds has been estimated to be 43.4% (9), slightly lower than what we found in the corresponding age group (56.9%). In Australia, the age-adjusted baseline high-risk HPV prevalence in cervical swab samples among 15-to 40-year-old women was 30.0% and 31.3% for nonindigenous and indigenous Australian women, respectively (10). This is also slightly lower than what we found in the corresponding age group (45.2%).…”

Prevalence of Cervical Human Papillomavirus (HPV) Infection in Vanuatu

“…12) and among non-Indigenous and Indigenous women in Australia (41.5% and 47.5%, respectively; ref. 13). Similarly to our survey, the highest HPV prevalences were detected in women younger than 25 years, but findings must be compared with caution due to the use of a PCR assay (PGMY09/ PGMY11) that has higher analytic sensitivity than GP5 .…”

Risk Factors for Cervical Cancer in Northeastern Thailand: Detailed Analyses of Sexual and Smoking Behavior

“…Smoking exposure-a welldocumented environmental factor-is a leading cause of many types of cancer such as lung, esophageal, gastric, bladder, liver and cervical cancers (Tredaniel et al, 1997;Kinjo et al, 1998;Gallus et al, 2001;Sobue et al, 2002 ;Settheetham-Ishida et al, 2004;Samanic et al, 2006;Settheetham-Ishida et al, 2006;Syrjanen et al, 2007;Pesch et al, 2011). An increased risk of cervical cancer associated with tobacco smoking has been found in many studies (Haverkos et al, 2003;SettheethamIshida et al, 2004;Garland et al, 2011;Yetimalar et al, 2011). Among HPV-positive women, an increased risk of cervical cancer was demonstrated among smokers than non-smokers (Kapeu et al, 2009;Plummer et al, 2003).…”