Prevalence of human papillomavirus and cervical intraepithelial neoplasia in China: A pooled analysis of 17 population‐based studies

Abstract

High-risk (HR) human papillomavirus (HPV) prevalence has been shown to correlate well with cervical cancer incidence rates. Our study aimed to estimate the prevalence of HR-HPV and cervical intraepithelial neoplasia (CIN) in China and indirectly inform on the cervical cancer burden in the country. 30,207 women from 17 population-based studies throughout China were included. All women received HPV DNA testing (HC2, Qiagen), visual inspection with acetic acid, and liquid-based cytology. Women positive for any test received colposcopy-directed or 4-quadrant biopsies. 29,579 women had HR-HPV testing results, of whom 28,761 had biopsy-confirmed (9019, 31.4%) or assumed (19,742, 68.6%) final diagnosis. Overall crude HR-HPV prevalence was 17.7%. HR-HPV prevalence was similar in rural and urban areas but showed dips in different age groups: at age 25–29 years (11.3%) in rural and at age 35–39 (11.3%) in urban women. In rural and urban women, age-standardized CIN2 prevalence was 1.5% (95%CI: 1.4%–1.6%) and 0.7% (95%CI: 0.7%–0.8%), and CIN3+ prevalence was 1.2% (95%CI: 1.2%–1.3%) and 0.6% (95%CI: 0.5%–0.7%), respectively. Prevalence of CIN3+ as a percentage of either all women or HR-HPV positive women steadily increased with age, peaking in 45–49 year-old women. High prevalence of HR-HPV and CIN3+ was detected in both rural and urban China. The steady rise of CIN3+ up to the age group 45–49 is attributable to lack of lesion removal through screening. Our findings document the inadequacy of current screening in China while indirectly raising the possibility that the cervical cancer burden in China is under-reported.

An Evaluation of Novel, Lower-Cost Molecular Screening Tests for Human Papillomavirus in Rural China

“…2). As previously reported, the prevalence (percent-positive) of HR-HPV DNA by both tests on both specimens (clinician-and self-collected) remained high (!12%) at all ages, as previously reported for China (18) and the highest percent positive was in women aged 50 years and older ( Fig. 2A).…”

“…The biopsied tissues diagnosed as CIN2 þ underwent HPV genotyping for HPV genotype-specific attribution by PCR using SPF 10 primers, which amplify a 65 bp region in L1, as previously described (17,18). After PCR, 10 mL of the amplimers that were positive for HPV DNA in the DNA immunoassay were used in the reverse hybridization line probe assay (LiPA 25 ; version 1, Laboratory Biomedical Products).…”

Elevated Expression of Human Papillomavirus-16/18 E6 Oncoprotein Associates with Persistence of Viral Infection: A 3-Year Prospective Study in China

“…Although the prevalence of HR-HPV infections among women is very high in China [about 17% in rural China; ref. 8], most of these infections are transient and only a small proportion will progress and develop to ICC; persistent HR-HPV infection has been shown to constitute the single most important risk factor for development of cervical precancers-cervical intraepithelial neoplasia (CIN) grade 2 and 3 (9,10). A single HPV test, however, cannot distinguish between transient and persistent infection, and it appears thus as an important clinical priority to identify clinical tests and markers that allow to better evaluate whether or not a given HPV infection detected at any time has a higher likelihood of being persistent.…”

HPV Vaccines? Still Needed

“…The hpv vaccinations stimulate immunomodulation and contribute to the prevention and lowered prevalence of hpv-positive head-andneck squamous cell carcinomas and urogenital cancers. Accordingly, vaccination is now advised for all boys and girls before their sexual debut [15][16][17] . Transmission of hpv can occur during sexual activity or orogenital contact, and even during social kissing or inhalation of spray from sneezes or coughs by hpv carriers 18,19 .…”