Abstract
BackgroundThere have been no published studies of carcinogenic human papillomavirus (HPV)--the necessary cause of cervical cancer--in Haiti, a nation that has one of the greatest burdens of cervical cancer globally.ObjectiveCharacterize prevalence of carcinogenic HPV and the prevalence of individual carcinogenic HPV genotypes in women with cervical precancer or cancer, cervical intraepithelial neoplasia grade 2 (CIN2) or more severe (CIN2+).MethodsWomen (n=9,769; aged 25-60 years) were screened for carcinogenic HPV by Hybrid Capture 2 (HC2; Qiagen, Gaithersburg, MD). Carcinogenic HPV positives underwent colposcopy and visible lesions were biopsied. A subset of carcinogenic HPV positives was tested for individual HPV genotypes using a GP5+/6+ assay.ResultsThe prevalence of carcinogenic HPV was 19.0% (95% confidence interval: 18.4%-19.9%) and decreased with increasing age (ptrend < 0.001). Women with 3 or more sexual partners and who started sex before the age of 18 years had twice the age-adjusted prevalence of carcinogenic HPV of women with one partner and who started sex after the age of 21 (24.3% vs. 12.9%, respectively). HPV16 and HPV35 were the most common HPV genotypes detected in CIN2+ and more common in women with CIN2+ than those without CIN2+. HPV16 and/or HPV18 were detected in 21.0% of CIN2 (n = 42), 46.2% of CIN3 (n = 52), and 80% of cancers (n = 5).ConclusionsThe prevalence of carcinogenic HPV in Haiti was much greater than the prevalence in other Latin American countries. High carcinogenic HPV prevalence and a lack of cervical cancer screening may explain the high burden of cervical cancer in Haiti.
Highlights
Cervical cancer is a major cause of cancer mortality in women of Haiti
The prevalence of carcinogenic human papillomavirus (HPV) in Haiti was much greater than the prevalence in other Latin American countries
High carcinogenic HPV prevalence and a lack of cervical cancer screening may explain the high burden of cervical cancer in Haiti
Summary
Cervical cancer is a major cause of cancer mortality in women of Haiti. Some estimates have put the cervical cancer annual incidence (93 per 100,000) and mortality (61.1 per 100,000) to be among the highest in the world [2] and perhaps the highest in Latin America [3], estimates may be imprecise due to the quality of data collected there [3]. Regardless of the exact estimate, it is generally accepted that in Haiti incidence and mortality due to cervical cancer is very high. Among the reasons for high incidence of and mortality from cervical cancer in Haiti is a lack of widespread screening for cervical precancer, cervical intraepithelial neoplasia grade 2 (CIN2) or CIN3, by cervical cytology (Papanicolaou test) or visual inspection with acetic acid with or without magnification (VIAM or VIA). There have been no published studies of carcinogenic human papillomavirus (HPV)--the necessary cause of cervical cancer--in Haiti, a nation that has one of the greatest burdens of cervical cancer globally
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