Research Article

Does HPV type 16 or 18 prevalence in cervical intraepithelial neoplasia grade 3 lesions vary by age? An important issue for postvaccination surveillance

* Author for correspondence

Registries, Victorian Cytology Service, PO Box 310, East Melbourne, Victoria 8002, Australia.

Email the corresponding author at jbrother@vcs.org.au

Regional WHO Human Papillomavirus Laboratory Network, Department of Microbiology & Infectious Diseases, The Royal Women’s Hospital, Locked Bag 300, Parkville, Victoria 3052, Australia

Department of Obstetrics & Gynecology, University of Melbourne, Parkville, Victoria 3052, Australia

Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia

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Suzanne M Garland

Regional WHO Human Papillomavirus Laboratory Network, Department of Microbiology & Infectious Diseases, The Royal Women’s Hospital, Locked Bag 300, Parkville, Victoria 3052, Australia

Department of Obstetrics & Gynecology, University of Melbourne, Parkville, Victoria 3052, Australia

Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia

Department of Microbiology, Royal Children’s Hospital, Locked Bag 300, Parkville, Victoria 3052, Australia

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Published Online:10 Feb 2012https://doi.org/10.2217/fmb.11.161

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Abstract

Aim: We used existing data to investigate whether prevalence of HPV16/18 in cervical intraepithelial neoplasia 3 (CIN3) varies by age, in order to determine whether age specific baseline data is required as the prevaccination comparator for type-specific surveillance following HPV vaccination programs. Materials & Methods: We analyzed available Australian HPV typing data from 317 cervical smears from women with concurrent CIN3 on biopsy and conducted a review and analysis of the international literature. Results: Among 317 women with CIN3, HPV16 was detected in 70% of those 16–25 years old, 59% of 26–35-year-olds and 48% of >36-year-olds (p = 0.025). This association took the form of a trend with decreasing HPV16 prevalence with increasing age (p = 0.007). That HPV16 is commoner in younger women with high-grade cervical lesions was consistent with all but one study of 18 identified in the literature. Conclusion: In screened populations, younger women with CIN3 are more likely to have HPV16 detected. To make valid pre- and post-vaccination comparisons, surveillance specimens for HPV typing should be both age stratified and lesion specific.

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Papers of special note have been highlighted as: ▪ of interest

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Acknowledgements

The authors acknowledge the work of the investigators who collected the dataset we have analyzed in this paper (M Stevens, S Garland, E Rudland, J Tan, M Quinn and S Tabrizi). We sincerely thank L Bruni, Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, for her review of the typing studies included in the HPV information center’s current update of the international meta-analysis. We also thank G Clifford and R Howell-Jones at IARC for their assistance, W Chen at the Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, for providing additional data and helpful insights regarding the Chinese study data, C Hunt and C Wheeler at the University of New Mexico for providing additional data analyses from their study, and P Allen and B Barbaro for administrative and research assistance. We would also like to thank the reviewers for their helpful comments.

Financial & competing interests disclosure

All authors were chief investigators on the WHINURS study, a study of HPV prevalence in Australian women, which was funded by a grant from the Cooperative Research Centre for Aboriginal Health, as well as education grants in aid from GlaxoSmithKline and CSL Limited. SM Garland has received advisory board fees and grant support from CSL and GSK, and lecture fees from Merck and GSK. SM Garland has received funding through her institution to conduct Phase III clinical trials of HPV vaccine studies for MSD and GSK. SM Garland is a member of the Merck Global Advisory Board, the Merck Scientific Advisory Committee for HPV prophylactic vaccines, as well as being on the Australian Advisory Boards on cervical cancer for GSK and CSL. JML Brotherton and SM Garland are investigators on an Australian Research Council Linkage Grant, for which CSL Biotherapies is a partner organisation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

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