Oncogenic human papillomavirus infection and cervical lesions in aboriginal women of Nunavut, Canada.
BACKGROUND
The high rate of cervical cancer among aboriginal women of northern Canada has prompted the search for more aggressive methods to augment Papanicolaou (Pap) screening in this population. Nearly all cervical cancers result from oncogenic human papillomavirus (HPV) infections. This has generated interest for incorporating HPV testing into the current screening program.


OBJECTIVE
To determine the prevalence of oncogenic HPVs in Nunavut, and to assess the association between HPV and squamous intraepithelial lesions (SIL).


METHODS
A cross-sectional study was conducted on the Pap-screened populations in 19 communities of Nunavut, Canada. Liquid-based cytology was used to screen for SIL. HPV testing was performed using the Hybrid Capture II assay. Correlates of HPV infection and SIL were assessed by logistic regression with control for potential confounders.


RESULTS
In 1290 women ages 13 to 79 years, the prevalence rate was 26% for oncogenic HPV and 6.9% for SIL. The odds ratio for the association between HPV and SIL was 37.9 (95% CI, 17.7-80.8) after multivariate adjustment. This association increased markedly with increasing viral load. More than 90% of the women with squamous intraepithelial lesions had positive test results for HPV. More than 75% of the women who had positive test results for HPV but negative test results for SIL were younger than 30 years.


CONCLUSIONS
The results of this study form the basis for further evaluation of the role that liquid-based cytology and HPV testing plays and will contribute to the strategy for cervical cancer prevention in Nunavut.
Healey
S M
SM
Health Protection Unit, Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada.
Aronson
K J
KJ
Mao
Y
Y
Schlecht
N F
NF
Mery
L S
LS
Ferenczy
A
A
Franco
E L
EL
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D044467:American Indian or Alaska Native / Q000706:statistics & numerical data; D044466:Asian People / Q000235:genetics; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control / Q000821:virology; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015873:Northwest Territories / Q000453:epidemiology; D016017:Odds Ratio; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics* / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology*; D015995:Prevalence; D011795:Surveys and Questionnaires; D014412:Tumor Virus Infections / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control / Q000821:virology; D014626:Vaginal Smears / Q000706:statistics & numerical data; D016387:Women's Health; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control / Q000821:virology
D004279:DNA, Viral