Human papillomavirus infection in women with and without cervical cancer in Warsaw, Poland

https://doi.org/10.1016/j.ejca.2007.12.001Get rights and content

Abstract

Cervical cancer incidence and mortality in Poland is among the highest in Europe. To investigate infection with different human papillomaviruses (HPV) in Warsaw, Poland, we obtained cervical cell specimens from 834 women aged 18–59 years from the general population, and 88 cervical cancers. DNA of 44 HPV types was detected using a GP5+/6+-based PCR assay. HPV prevalence was 16.6% in the general female population, being highest (24.2%) in women aged 25–34 years, notably among unmarried women (37.3%). HPV prevalence fell to 8.6% at ages 55–59. High-risk HPV prevalence was 11.3%, with HPV16 being the most common type (3.7%). All but one cervical cancer were high-risk HPV-positive, although the importance of HPV16 (73%) was much greater, and multiple infections fewer (1%), than among HPV-positive women in the general female population. In summary, we report a relatively high burden of HPV infection in Warsaw, Poland, where 79% of cervical cancers are theoretically preventable by HPV16/18 vaccines.

Introduction

The incidence of cervical cancer in Eastern Europe is approximately three-fold higher than in Western European countries, with particularly elevated rates reported in Poland (14.4/100,000 women in Warsaw, 19.6/100,000 women in Cracow).1 The disparity between Eastern and Western Europe is also reflected in cervical cancer mortality rates.2 Population-based screening programmes in Poland are few and restricted to small areas, but at least in urban districts, opportunistic cytological screening is widespread.3

The establishment of genital infection with certain types of human papillomavirus (HPV) as the central cause of cervical cancer has prompted a shift in the planning of primary and secondary prevention towards HPV test-based screening4 and vaccination.5

One of the essential pieces of epidemiological data required to introduce and predict the impact of HPV test-based screening or vaccination in a given country is population-based data on age- and type-specific patterns of HPV prevalence, which is known to vary substantially across different populations.6, 7 In addition, corresponding information on women with cervical cancer is important to predict the theoretical fraction of cervical cancer preventable by current HPV16/18 vaccines.

Population-based studies on the prevalence of HPV in Eastern European countries remain limited.8, 9 Therefore, the International Agency for Research on Cancer (IARC), in collaboration with The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland, have carried out an HPV survey on a representative sample of women from Warsaw, and on a corresponding sample of locally-diagnosed cervical cancer cases.

Section snippets

Ethical approval

All participants, whether from the general female population or those with cervical cancer, signed informed consent forms according to the recommendations of the IARC and the Maria Sklodowska-Curie Memorial Institute and Cancer Center ethical review committees, which both approved the study.

General female population

The survey of HPV infection in the general female population was carried out between March and May 2006 in Warsaw, Poland. A population-based cervical screening programme, including an active call of women

General female population

Of 897 women who provided cervical cell samples, 49 had inadequate HPV results (β-globin negative), four had inadequate cytology, and 10 had undergone hysterectomy, leaving 834 women with valid cytology and HPV results. Among them, 35 (4.2%) had abnormal cytological findings, including 10 (1.2%) women with atypical squamous cells of undetermined significance, 22 (2.6%) with low-grade squamous intraepithelial lesions and three (0.4%) with high-grade squamous intraepithelial lesions. Final

Discussion

A major finding of the present study, the first carried out in Poland, is the disclosure of a relatively important burden of HPV prevalence in the general female population, particularly in women below the age of 35 years. The age-standardised HPV prevalence (17.8%) in Warsaw was higher than in previous studies using the same HPV testing protocol in Italy and the Netherlands, but similar to that found in some parts of South America and India.6 In addition, the prevalence of high-risk HPV types

Conflict of interest statement

None declared.

Acknowledgement

Source of support: The Bill & Melinda Gates Foundation (grant number 35537). The study sponsors had no role in the study design, the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. The authors did not contract any writing assistance.

References (23)

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    HPV DNA detection and typing in cervical scrapes by general primer GP5+/6+ PCR

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