Population‐based prevalence, type‐ and age‐specific distribution of HPV in women before introduction of an HPV‐vaccination program in Denmark

Abstract

Knowledge about the prevalence of human papillomavirus (HPV) on a population level is important. We conducted a large population-based study in Denmark to determine the overall and agespecific HPV prevalence, and HPV type distribution in women. Liquid-based cytology samples (SurePath 1 ) were collected consecutively. HPV testing was performed with Hybrid Capture 2 (HC2; Digene) (high-risk and low-risk probes), and LiPA (Innogenetics) was used for genotyping. We analyzed samples from 11,617 women; 94.0% had normal cytology, 4.3% atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion and 1.6% had high-grade squamous intraepithelial lesion (HSIL). The HPV prevalence was 26.4% with a peak in women 20-24 years (50.2%) and then decreased without a second peak in older women. Among the youngest women (15-19 years), 14% had HPV 16/18 and 16% had HPV 6/11. Prevalence of highrisk HPV types increased from 19.2% in women with normal cytology to 100% in women with cervical intraepithelial neoplasia grade 3 (CIN3)/cervical cancer. HPV 16 was the most prevalent type (6.0% of all women), and was also the most prevalent in women with HSIL (35.1%) and CIN3 (53.2%). Other common HPV types in women with CIN3 included HPV 52, 51, 31, 33 and 18. HPV 16/18 alone was present in 23% of CIN3 lesions and 67% of cervical cancers, and HPV 16/18 together with other high-risk HPV types was present in 41% of CIN3 lesions. This suggests that an efficacious HPV 16/18 vaccine will have a substantial preventive potential in the general female population. ' 2008 Wiley-Liss, Inc.Key words: HPV; genotyping; prevalence; population-based; cervical intraepithelial neoplasia; cervical cancer Cervical cancer is the second most common cancer in women worldwide; more than 490,000 women are diagnosed with invasive cervical cancer each year.1 There is a strong causal relationship between human papillomavirus (HPV) infection, which is sexually transmitted, 2 and the development of cervical cancer, with 99.7% of cervical cancers containing HPV DNA.3 The lifetime risk of acquiring HPV infection is high as the majority of sexually active individuals will be infected at some time in their lives.4 HPV infections are usually transient, but HPV infection can persist and can progress to high-grade cervical intraepithelial neoplasia, and, in the worst situation, to cervical cancer. 5Approximately 40 HPV types are known to infect the anogenital tract, of which more than 15 are thought to be associated with the development of cervical cancer (high-risk (HR) HPV types).6 It has been estimated that 2 of these types, HPV 16 and 18, are associated with 70-75% of invasive squamous cell cervical cancers and 80% of adenocarcinomas of the cervix.7,8 HPV 16 and 18 are also associated with the development of other neoplasias of the genital tract such as vulvar and vaginal cancers and the preceding precancerous lesions. 9 The low-risk (LR) HPV types 6 and 11 are mainly associated with low-grade cervical lesions and the majority of genital...

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