BACKGROUND: Cervical cancer incidence in western Africa is among the highest in the world. METHODS: To investigate human papillomavirus (HPV) infection in Guinea, we obtained cervical specimens from 831 women aged 18 -64 years from the general population of the capital Conakry and from 77 locally diagnosed invasive cervical cancers (ICC). Human papillomavirus was detected using a GP5 þ /6 þ PCR-based assay. RESULTS: Among the general population, the prevalence of cervical abnormalities was 2.6% by visual inspection and 9.5% by liquidbased cytology. Fourteen of 15 high-grade squamous intraepithelial lesions were visual inspection-negative. Human papillomavirus prevalence was 50.8% (32.1% for high-risk types) and relatively constant across all age groups. Being single or reporting X3 sexual partners was significantly associated with HPV positivity. HPV16 was the most common type, both among the general population (7.3%) and, notably in ICC (48.6%). HPV45 (18.6%) and HPV18 (14.3%), the next most common types in ICC, were also more common in ICC than in HPV-positive women with normal cytology from the general population. CONCLUSION: The heavy burden of HPV infection and severe cervical lesions in Guinean women calls for new effective interventions. Sixty-three per cent of cervical cancers are theoretically preventable by HPV16/18 vaccines in Guinea; perhaps more if some cross-protection exists with HPV45.

We have registered 2,064 cases of cancer among the inhabitants of Conakry, Guinea, during 1992-1994, corresponding to age-standardized incidence rates (ASRs) of 83.3 per 100,000 in men and 110.5 per 100,000 in women. As elsewhere in West Africa, the principal cancer of men was liver cancer (ASR 32.6), with modest rates of stomach (ASR 6.2) and prostate (ASR 8.1) cancers. In women, cervix cancer was the dominant malignancy (ASR 46.0), followed by liver cancer (ASR 12.5) and breast cancer (ASR 10.9). In contrast to contemporary East and Central Africa, Kaposi's sarcoma remained rare (only 4 cases). In the childhood age group, relatively high incidence rates were found for Hodgkin's disease, Burkitt's lymphoma and, especially, retinoblastoma.

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