Risk factors for HPV infection and cervical cancer among unscreened women in a high-risk rural area of China

Abstract

We report a prevalence rate of 23.6% human papillomavirus (HPV) infection with oncogenic subtypes and 2.4% cervical intraepithelial neoplasia (CIN) III and cervical cancer (CC) in rural middle-aged women in 2 counties with the highest CC mortality in Shanxi Province, China. We examined the association of risk factors to HPV infection and to CIN III and CC in 8,798 unscreened women aged 35-50 years. Multivariate odds ratios (OR) and 95% confidence intervals (CI) for each endpoint were obtained for risk factors after adjustment for covariates. The OR of oncogenic HPV were: 1.41 (95% CI 5 1.25-1.60) and 1.42 (95% CI 5 1.24-1.61) for the participant and her husband having multiple sexual partners, respectively; 1.67 (95% CI 5 1.37-2.04), 1.15 (95% CI 5 1.04-1.26), and 0.82 (95% CI 5 0.72-0.94) for ever (vs. never) diagnosed with tuberculosis, cervical inflammation and vaginal trichomoniasis, respectively; while bathing in a public (v. private) facility had an OR of 1.23 (95% CI 51.11-1.35). Seasonal fluctuations in HPV infection, but not CC, appeared in Xiangyuan County, with OR of 1.23 (95% CI 5 1.14-1.33) and 1.51 (95% CI 5 1.35-1.67) in Spring and Winter compared to Summer, respectively. The OR of CIN III and CC in the HPV positives were: 2.03 (95% CI 5 1.63-2.53) for ages 45 years (vs. <40); and 4.01 (95% CI 5 1.46-11.0) for 3 (vs. no) home births. Public health interventions and control strategies for improving the reproductive health of women in these rural populations need to be developed to reduce risk of HPV and subsequent CC. ' 2005 Wiley-Liss, Inc.Key words: cervical cancer; human papillomavirus; tuberculosis; trichomoniasis Wide disparities in cervical cancer (CC) incidence and mortality throughout the world are mainly attributable to differences in access to programs that detect and treat pre-invasive disease of the cervix.1 Although the CC mortality rate in China has declined markedly from 14.6 to 4.3/100,000 in the past 20 years, 2 some medically underserved rural areas without access to CC screening continue to experience high mortality. A prime example is Yangcheng County with a mortality rate of 52/100,000 in Shanxi Province, which has the highest CC mortality rate in China.2 Cervical cancer represents a major health burden in poor rural areas like Shanxi Province located in the middle of China.Although infection with oncogenic subtypes of human papillomavirus (HPV) has been clearly established as a necessary cause of CC, 3,4 the low incidence of CC in contrast with the extremely high lifetime cumulative incidence of cervical infection with HPV suggests additional etiologic co-factors are involved in CC pathogenesis. 5,6 Research on risk factors for CC or HPV infection has been carried out in many countries, 7-10 but only 2 earlier studies have examined risk factors for CC in China.11,12 State-of-the-art techniques for detecting HPV DNA and biopsy-based diagnoses have changed since earlier reports in China, with the potential for changes in previous prevalence estimates of HPV infection and the ide...

The Prevalence of Human Papilloma Virus (HPV) in Women using Liquid Base Pap Smear in Rasht, Northern of Iran

“…Also, the prevalence of HPV infection in different age's group of women is 4% to 19.3% in different countries [12][13][14][15]. Other studies in Asia, reported the prevalence of HPV infections approximately 10%, 10.9%, 6.3% and 23.6% in South Korea, Southern Vietnam, Thailand and China respectively [8,9,16]. Given that similar work was performed in Tehran University of Medical Sciences and abnormal Pap specimens has been reported in 5 to 6 percent [17].…”

“…Shin HR and colleagues have reported that the prevalence of HPV infection in sexually active women 20-74 y old in South Korea was 10.4% [8]. On the other hand, Zhao et al, in China, found oncogenic subtypes in 23.6% of middle-aged women [9]. Epidemiological data shows that High-risk oncogenic genital HPV-16 and 18 are the most frequently detected types in CCs worldwide [10].…”

Prevalence of HPV infection and cervical intraepithelial neoplasia and attitudes towards HPV vaccination among Chinese women aged 18–25 in Jiangsu Province

“…Few population-based studies exist describing the epidemiology of HPV and cervical cancer among Chinese women younger than 25 years old as well as their knowledge of HPV and attitudes towards HPV vaccination [7][8][9][10][11][12][13] . Our study bridged this gap, demonstrating the high cervical cancer disease burden of sampled Chinese women aged 18-25.…”

“…Multiple studies have demonstrated that the prevalence of CIN and HPV infection varies by age [4][5][6] . Though several population-based screening studies reported the prevalence of HPV infection and CIN in China [7][8][9][10][11][12][13] , most studies focused on women older than 30 or 35. Very few data exist describing HPV and CIN prevalence among Chinese women younger than 25 years old.…”

Human papillomavirus infection in Shanxi Province, People's Republic of China: a population-based study

“…Furthermore, while cervical cancer mortality appears to have declined considerably in urban China between 1987 and 1999, this is less marked in rural areas (Yang et al, 2003b). A recent study in one such high-risk rural area, Shanxi Province, revealed that 23.6% of women aged 35 -50 years were infected with high-risk HPV types (Zhao et al, 2006). However, at present no population-based data are available on HPV prevalence across a broader age range of Chinese women, nor on the relative frequency of individual HPV types.…”