Abstract
BackgroundIndigenous women in Australia have a disproportionate burden of cervical cancer despite a national cervical screening program. Prior to introduction of a national human papilloma virus (HPV) vaccination program, we determined HPV genotype prevalence by Indigenous status and residence in remote areas.MethodsWe recruited women aged 17 to 40 years presenting to community-based primary health services for routine Pap screening across Australia. A liquid-based cytology (LBC) cervical specimen was tested for HPV DNA using the AMPLICOR HPV-DNA test and a PGMY09/11-based HPV consensus PCR; positive specimens were typed by reverse hybridization. We calculated age-adjusted prevalence by weighting to relevant population data, and determined predictors of HPV-DNA positivity by age, Indigenous status and area of residence using logistic regression.ResultsOf 2152 women (655 Indigenous), prevalence of the high-risk HPV genotypes was similar for Indigenous and non-Indigenous women (HPV 16 was 9.4% and 10.5%, respectively; HPV 18 was 4.1% and 3.8%, respectively), and did not differ by age group. In younger age groups, the prevalence of other genotypes also did not differ, but in those aged 31 to 40 years, HPV prevalence was higher for Indigenous women (35% versus 22.5%; P < 0.001), specifically HPV clades α5 (OR = 2.1, 95% CI 1.1 to 4.3) and α7, excluding type 18 (OR 1.9, 95% CI 1.1 to 3.3). In multivariate analysis, detection of any HPV genotype was strongly associated with smoking and Pap-test abnormalities, with both risk factors more common among Indigenous women.ConclusionAlthough we found no difference in the prevalence of HPV16/18 among Australian women by Indigenous status or, for Indigenous women, residence in remote regions, differences were found in the prevalence of risk factors and some other HPV genotypes. This reinforces the importance of cervical screening as a complement to vaccination for all women, and the value of baseline data on HPV genotype prevalence by Indigenous status and residence for the monitoring of vaccine impact.
Highlights
Indigenous women in Australia have a disproportionate burden of cervical cancer despite a national cervical screening program
Consultation, ethics, pilot site, and development of culturally appropriate materials In recognition of the need for research to benefit Indigenous communities, and for Indigenous people to be involved in the design, planning, undertaking and dissemination of Indigenous research, we identified collaborative research partners involved in frontline community care and service provision in the area of cervical cancer prevention in Indigenous communities
A pilot study was conducted in central Australia between April and July 2005 to examine feasibility, communication materials and protocols, and laboratory techniques: it was endorsed by the Central Australian Human Research Ethics Committee
Summary
Indigenous women in Australia have a disproportionate burden of cervical cancer despite a national cervical screening program. Since the introduction of a comprehensive, organized, cervical cytology (Pap) screening program in 1991, Australia has seen a marked reduction in incidence of cervical cancer from 13.2 per 100,000 in the early 1990s to a current stable rate of around 6.9 per 100,000 since the early 2000s. This has been matched by a mortality reduction from 4 to. This was based on precedents in which such differences were present for other infectious diseases [7,8,9,10] in these groups, as well as some limited data from small surveys suggesting similar differences for HPV [11]
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