Abstract
ObjectivePrecise prevention is more desired for cervical cancer due to the huge population, high prevalence of human papillomavirus (HPV) infection in China and the vision of screen-and-treat strategies in low- and middle-income countries (LMICs). Considerations of combining type-specific prevalence and attribution proportion to high-grade cervical intraepithelial neoplasia are informative to more precise and effective region-specific cervical cancer prevention and control programs. The aim of the current study was to determine the genotype distribution of HPV and attribution to cervical precancerous lesions among women from rural areas in North China.MethodsA total of 9,526 women participated in the cervical cancer screening project in rural China. The samples of women who tested positive for HPV were retested with a polymerase chain reaction (PCR)-based HPV genotyping test. The attribution proportion of specific high-risk human papillomavirus (HR-HPV) types for different grades of cervical lesions was calculated by using the type contribution weighting method.ResultsA total of 22.2% (2,112/9,526) of women were HR-HPV positive and HPV52 (21.7%) was the most common HR-HPV genotype, followed by HPV58 (18.2%), HPV53 (18.2%) and HPV16 (16.2%). The top three genotypes detected in HR-HPV-positive cervical intraepithelial neoplasia (CIN)1 were HPV16 (36.7%), HPV58 (20.4%), HPV56 (15.3%). Among CIN2+, the most frequent genotypes were HPV16 (75.6%), HPV52 (17.8%), HPV58 (16.7%). HPV16, 56, 58, 53, 52, 59, 68, and 18 combined were attributed to 84.17% of all CIN1 lesions, and HPV16, 58, and 52 combined were attributed to 86.98% of all CIN2+ lesions.ConclusionsThe prevalence of HR-HPV infection among women from rural areas in North China was high and HPV16, HPV58, HPV52 had paramount attributable fraction in CIN2+. Type-specific HPV prevalence and attribution proportion to cervical precancerous lesions should be taken into consideration in the development of vaccines and strategy for screening in this population.
Highlights
Cervical cancer is the 4th most commonly diagnosed cancer in women globally, and it is the 2nd most diagnosed in women living in less-developed regions [1]
There are more than 150 human papillomavirus (HPV) types being identified and at least 13 of them are regarded as “high risk” contributing to the development of cervical cancer including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 [4]; it has been suggested that their relative carcinogenic potential varies enormously [5], which causes different attributable proportions to cervical cancer
Our study suggests that HPV16, HPV52, and HPV58 play important roles in the development of cervical lesions in rural North China, and these particular HPV carcinogenic types should be given priority in the development of new polyvalent HPV vaccines
Summary
Cervical cancer is the 4th most commonly diagnosed cancer in women globally, and it is the 2nd most diagnosed in women living in less-developed regions [1]. HPV infection rates and genotype distributions vary between different regions and countries, causing cervical cancer incidence and mortality to vary geographically as well [6,7]. Obtaining knowledge of high-risk genotype attribution to high grades of cervical lesions will benefit to risk stratification of HPV positive women and determine who deserve special attention during screening in countries that adopt the screen-and-treat programs. Both quadrivalent and nonavalent Gardasil®, as well as Cervarix®, have been used in the Chinese mainland since 2017 for the primary prevention of cervical cancer, no vaccine has been incorporated into the National Immunization Program yet. This helps provide logistical information for the development of second-generation HPV vaccine
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