Human papillomavirus infection in women in Shenzhen City, People's Republic of China, a population typical of recent Chinese urbanisation

Abstract

Select cancer registries report that cervical cancer is relatively rare in the People's Republic of China, but may not be representative of the entire country. We carried out a survey of human papillomavirus (HPV) prevalence in 3 samples of women, i.e., general population, factory workers, and tertiary sector workers, in Shenzhen City in 2004. All participants were interviewed and offered gynaecological examination. HPV detection in exfoliated cervical cells was performed using a GP5þ/6þ PCR-based assay. Overall HPV prevalence was 18.4% among the general population (n 5 534), 11.2% among factory workers (n 5 269) and 18.8% among tertiary sector workers (n 5 224). Corresponding prevalence for high-risk HPV types was 13.5%, 8.2% and 13.8%, respectively. The most commonly found HPV types were HPV16, 52, 58, 31 and 39. HPV prevalence significantly increased with age in the general population, whereas it was highest below age 25 years in tertiary sector workers. Associations of HPV prevalence with indicators of sexual behaviour were stronger among tertiary sector workers than in the other samples of women. High HPV prevalence in all age groups and the appearance of a Ôwestern-typeÕ peak in HPV prevalence among young women employed in the tertiary sector raise important questions concerning the real cervical cancer burden, and its control, in urban China. ' 2007 Wiley-Liss, Inc.Key words: human papillomavirus; cervical neoplasia; China; epidemiology Human papillomavirus (HPV) has been established as a necessary cause of cervical cancer, and HPV prevalence in a given population correlates well with cervical cancer risk.1,2 However, as HPV is highly sexually transmissible, 3 the burden of cervical HPV infection in a given population is very sensitive to changes in sexual behaviour.The rapid industrialisation and urbanisation that have taken place over the last 3 decades in the People's Republic of China have been accompanied by marked behavioural changes. This has resulted in clear transitions in major causes of death (e.g., increases in vascular disease and cancer 4 ), and may have impacted the burden of HPV infection through increased population mobility and changes in sexual behaviour. Declines in cervical cancer incidence 5,6 and mortality 7,8 have been reported in China since the 1970s, a phenomenon thought to be linked to the banning of prostitution and the restriction of family size. However, cervical cancer mortality is apparently on the increase among younger women, particularly in urban settings. 8 Furthermore, national surveillance data show that incidence of most sexually transmitted diseases in China have increased during the 1990s. Shenzhen City, Guangdong Province, was founded in 1979, in the location of a small fishing village adjacent to Hong Kong, in Southern China. By the year 2000 the city had changed dramatically because of rapid industrialisation: the population had grown to over 7 million, almost entirely as a result of migration, with an average age of 31 years (The fifth national census in 2000...

Human papillomavirus infection in women with and without cervical cancer in Nepal

“…HPV52 and 58, however, were not as predominant as in similar surveys in China [16][17][18]. We also confirmed that the type distribution Major strengths of our present study include a large and population-based sample, the use of a standardized and well-validated HPV test allowing comparisons with similar studies around the world [9] and the presence of a concurrent series of women with ICC drawn from the same study area.…”

“…The agespecific curve of HPV prevalence in Nepal resembled the flat age curves reported previously in some low-resource countries in Asia and Africa [15][16][17][18]24], albeit at a lower level of HPV prevalence. It clearly differed, on the other hand, from the steep decrease in HPV prevalence seen by age in high-and medium-resource countries in Europe, the Americas, and Asia [23,25].…”

“…The major finding of this present study, the first undertaken in Nepal, is that the burden of HPV infection in the general population (8.6%) is somewhat lower than that observed in previous studies performed using the same HPV testing protocol in neighboring countries (e.g., 17% in Tamil Nadu, India, [15] and 15-18% range in three provinces in China [16][17][18]), and much less than in the high-risk areas in Asia and Africa (e.g., 35% in Mongolia [19] and 51% in Guinea [20]). Nevertheless, HPV prevalence remained greater than that in other areas in Asia (e.g., 2% in Hanoi, Vietnam [21], 4% in Songkla, Thailand [22]), and in Europe [23].…”

“…As in previous IARC HPV prevalence surveys in Asia [15][16][17][18], the gynecological exam was acceptable only to married women, so, the HPV prevalence estimate represents that in married women only. Nevertheless, age at first marriage (median = 17 years, intraquartile range [15][16][17][18][19] was relatively early, and 91% of participants reported an age at first sexual intercourse that was the same as, or greater than, age at first marriage, suggesting that marriage is a good proxy for sexual activity in this population.…”

“…Nevertheless, age at first marriage (median = 17 years, intraquartile range [15][16][17][18][19] was relatively early, and 91% of participants reported an age at first sexual intercourse that was the same as, or greater than, age at first marriage, suggesting that marriage is a good proxy for sexual activity in this population. HPV16/18 prevalence, however, was highest among older women.…”