Age-specific and genotype-specific carcinogenic human papillomavirus prevalence in a country with a high cervical cancer burden : results of a cross-sectional study in Estonia
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Date
2023-06-01
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Abstract
OBJECTIVES: To describe age-specific and type-specific carcinogenic human papillomavirus (HPV) prevalence prior to large-scale effect of HPV vaccines in Estonia and to analyse the risk factors associated with carcinogenic HPV. DESIGN: Cross-sectional study using self-administered questionnaire and self-collected vaginal swabs for detection of HPV infection. SETTING: Estonian Biobank database. PARTICIPANTS: Stratified random sample of women aged 30-33, 57-60 and 67-70 years living in one of the three largest counties in Estonia. Of 3065 women approached, 1347 (43.9%) returned questionnaires and specimens for HPV DNA detection. OUTCOME MEASURES: HPV prevalence and fully adjusted ORs with 95% CIs for risk factors. RESULTS: HPV prevalence was highest among women aged 30-33 years (18.7%; 95% CI 15.8 to 21.9) followed by those aged 67-70 years (16.7%; 95% CI 12.4 to 22.0) and 57-60 years (10.2%; 95% CI 7.8 to 13.3). HPV16 and HPV56 were the most common among women aged 30-33 years (both 4.0%; 95% CI 2.7 to 5.9), and HPV68 was the most common among women aged 57-60 years (2.8%; 95% CI 1.5 to 4.7) and 67-70 years (6.4%; 95% CI 3.6 to 10.4). Vaccination with nonavalent vaccine would have halved the carcinogenic HPV prevalence among women aged 30-33 years. The odds of infection with carcinogenic HPV were higher among women with six or more sexual partners among younger (OR 2.99; 95% CI 1.54 to 5.81) and older (OR 3.80; 95% CI 1.25 to 11.55) women and lower (OR 0.35; 95% CI 0.17 to 0.72) among younger married women. CONCLUSIONS: This study demonstrated U-shaped age-specific genotype profile of carcinogenic HPV prevalence, indicating that public health providers should focus on developing exit strategies for the cervical cancer screening programme in Estonia with a possible extension of HPV testing beyond the current screening age of 65 years. Generalisability of the findings of this study may be affected by the low response rate.
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© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords
Female, Humans, Uterine Cervical Neoplasms/epidemiology, Papillomavirus Infections/prevention & control, Human Papillomavirus Viruses, Cross-Sectional Studies, Estonia/epidemiology, Carcinogens, Prevalence, Early Detection of Cancer/adverse effects, Genotype, Papillomaviridae/genetics, Papillomavirus Vaccines, Age Factors, sexual medicine, epidemiology, reproductive medicine, public health, 3.2 Clinical medicine, 1.1. Scientific article indexed in Web of Science and/or Scopus database, General Medicine, SDG 3 - Good Health and Well-being
Citation
Pärna, K, Nygård, M, Tisler, A, Toompere, K, Naaber, P, Ratnik, K, Ķīvīte Urtāne, A, Zodzika, J, Stankūnas, M, Baltzer, N & Uusküla, A 2023, 'Age-specific and genotype-specific carcinogenic human papillomavirus prevalence in a country with a high cervical cancer burden : results of a cross-sectional study in Estonia', BMJ Open, vol. 13, no. 6, e069558, pp. e069558. https://doi.org/10.1136/bmjopen-2022-069558