Prevalence of oncogenic human papillomavirus infection in an organised screening population in Finland

Abstract

A persistent high-risk human papillomavirus (hrHPV) infection is a necessary condition for developing a cervical intraepithelial neoplasia and cervical cancer. The viral aetiology in cervical carcinogenesis has stimulated attempts to use HPV DNA detection in cervical cancer screening. In Finland there is an ongoing study assessing the benefits of primary HPV DNA testing in the setting of centrally organised mass screening for cervical cancer. Here we present the age-specific prevalence of hrHPV infection and associated sociodemographic factors of 16,895 women aged 25-65 years attending the 5-yearly cervical cancer screening between years 2003 and 2004. The overall hrHPV prevalence rate was 7.5%. The peak prevalence at the age group of 25-29 was 24.1% decreasing steadily thereafter to approximately 2.9% in women aged 65 years. Young age and marital status were the main determinants for oncogenic HPV types. Our study confirms the inverse relationship between age and hrHPV prevalence reported in many developed countries. As our prevalence rates and hence background risk for cervical cancer are not lower than in other European countries, it is likely that our lowest cervical cancer burden in Europe is due to health care actions justifying the organised cervical cancer screening. ' 2008 Wiley-Liss, Inc.Key words: high-risk HPV; prevalence; age; cervical cancer; screeningIn Finland an organised nationwide screening programme has been running over 40 years, reducing the age-adjusted incidence and mortality of cervical cancer by 80%, 1 incidence rate being about 4 cases per 100,000 woman-years nowadays. Nevertheless, there are still about 160 new cancer cases every year making the cervical cancer the third most common gynaecological cancer, but 20th of all female cancers, in Finland. 2 However, during the last 10 years, the cervical cancer incidence rate has been increasing among young target ages of the screening programme which is mainly due to inadequate attendance rates to the screening programme. 1 Cohort effects related to changes in exposure to risk factors such as sexual behaviour and smoking habits may also partly explain the increase.Despite the enormous impacts of cytology based screening on cervical cancer incidence and mortality rates in Finland, the Pap test has its limitations as errors in sample taking and in interpretation. As it is known that a persistent high-risk human papillomavirus (hrHPV) infection is a necessary condition for developing a cervical intraepithelial neoplasia (CIN) and cervical cancer 3 and moreover, hrHPV DNA is found in virtually all cases of cervical cancer, 4,5 HPV DNA detection has been suggested for cervical cancer screening as the primary test.To find out whether using HPV DNA detection can bring increase into the routine population-based screening programme effectiveness in Finland, a commercial hrHPV detection test, Hybrid Capture 2 (HC 2, Digene Corporation, Gaithersburg, MD), has been implemented into cervical cancer screening programme as the primary screening test sinc...

Population-based Cervical Cancer Screening Using High-risk HPV DNA Test and Liquid-based Cytology in Northern Thailand

“…In the present study, the prevalence of positive hrHPV test or cytology peaked in the age group 35-39 years, which is rather different from several other studies in which hrHPV prevalence gradually decline after the age of 25 to 30 years (Cuzick et al, 2003;Leinonen et al, 2008;Arbyn et al, 2009;Swangvaree et al, 2010;Zorzi et al, 2013). However, studies in China have shown a "two peak" pattern of hrHPV prevalence, with the first peak in the age group 15-24 years (prevalence 16.2-18.7%) and the second peak in the age group 35-39 years (prevalence 16.0-18.6%) (Li et al, 2013).…”

“…Considering population-based studies in which HC2 testing was used, the HC2-positive prevalence of 7.1% in our study is comparable to the reported prevalence from countries in Europe and North America (6.3-8.1%) (Cuzick et al, 2003;Leinonen et al, 2008;Castle et al, 2009;Ogilvie et al, 2012;Zorzi et al, 2013), while it is higher than the prevalence in the Netherlands (4.5%) (Bulkmans et al, 2007) but is lower than that in India (10.3-16.2%) (Sankaranarayanan et al, 2009;Pandey et al, 2012;Rai et al, 2014) and China (9.9-27.5%) (Zhao et al, 2010;Li et al, 2013). Population-based studies for HPV detection by PCR techniques also have demonstrated high overall HPV prevalence in Latin America and Africa, where cervical cancer incidence is high (Herrero et al, 2000;Franceschi et al, 2006).…”

“…The prevalence of positive hrHPV testing appears to be variable depending on geographic regions and the types of HPV test (Franceschi et al, 2006;Leinonen et al, 2008;Arbyn et al, 2009;Sharma et al, 2013). Considering population-based studies in which HC2 testing was used, the HC2-positive prevalence of 7.1% in our study is comparable to the reported prevalence from countries in Europe and North America (6.3-8.1%) (Cuzick et al, 2003;Leinonen et al, 2008;Castle et al, 2009;Ogilvie et al, 2012;Zorzi et al, 2013), while it is higher than the prevalence in the Netherlands (4.5%) (Bulkmans et al, 2007) but is lower than that in India (10.3-16.2%) (Sankaranarayanan et al, 2009;Pandey et al, 2012;Rai et al, 2014) and China (9.9-27.5%) (Zhao et al, 2010;Li et al, 2013).…”

Age distribution of human papillomavirus infection and cervical neoplasia reflects caveats of cervical screening policies

“…[2][3][4] This could reflect a difference in culture and sexual behavior. Such a lower prevalence rate would favor a higher positive predictive value for HPV-based screening assays.…”

“…2,3 Finally, the second peak may be a reflection of population-specific cohort effects as it is not consistently observed across the world. 2,4 The underlying reason for this second minor peak is still obscure, and its potential importance has not been fully investigated. It has been shown that a3/a15 HPV types, including HPV61, 71, 72, 81, 83, 84 and 89, are more commonly found in cervical scrape samples collected from older women and these samples also contain more squamous cells.…”