Abstract
ObjectiveTo estimate the prevalence and attribution of two non-vaccine-covered HPV types (HPV52 and HPV58) across the world.MethodsMeta-analysis on studies reported in English and Chinese between 1994 and 2012.ResultsThe pooled prevalence and attribution rates of HPV52 and HPV58 in invasive cervical cancers were significantly higher in Eastern Asia compared to other regions (HPV52 prevalence: 5.7% vs. 1.8–3.6%, P<0.001; HPV52 attribution: 3.7% vs. 0.2–2.0%; HPV58 prevalence: 9.8% vs. 1.1–2.5%, P<0.001; HPV58 attribution: 6.4% vs. 0.7–2.2%, P<0.001). Oceania has an insufficient number of studies to ascertain the prevalence of HPV52. Within Eastern Asia, the attribution of HPV58 to invasive cervical cancer was 1.8-fold higher than that of HPV52. Similarly, HPV52 and HPV58 shared a higher prevalence and attribution among cervical intraepithelial neoplasia in Eastern Asia. In contrast to the classical high-risk type, HPV16, the prevalence and attribution of HPV52 and HPV58 decreased with increasing lesion severity. Thus, HPV52 and HPV58 behave as an “intermediate-risk” type.ConclusionThe attribution of HPV52 and HPV58 to cervical intraepithelial neoplasia and invasive cancer in Eastern Asia were respectively 2.5–2.8 and 3.7–4.9 folds higher than elsewhere. Changes in the attributed disease fraction can serve as a surrogate marker for cross-protection or type replacement following widespread use of HPV16/18-based vaccines. This unique epidemiology should be considered when designing HPV screening assays and vaccines for Eastern Asia.
Highlights
Cervical cancer is the fourth most common cancer in women worldwide
Majority (76.7%) of these studies did not report histology data, and these cases were regarded as invasive cervical cancers (ICC) of unspecified histology (Table S1)
The current meta-analysis consolidates previous observations that the prevalence of HPV52 and HPV58 was higher, across all lesion grades ranging from CIN2 to ICC, in Asia compared to all other continents
Summary
Cervical cancer is the fourth most common cancer in women worldwide. There are more than 150 HPV types being identified and at least 15 of them are regarded as`high-risk'' contributing to the development of cervical cancer [3]. HPV16 and HPV18 account for about 70% of invasive cervical cancers (ICC) worldwide, and the proportion is quite consistent throughout the world. Among women with high-grade intraepithelial neoplasia, HPV16 is still the most prevalent type found worldwide, but greater geographical variability has been observed for other HPV types [6]. HPV31 and HPV33 have been reported to rank the second and third in Africa and Europe, respectively; whereas HPV58 and HPV52 were the second and third most common types found in Asia, respectively [7]
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