title: Against which human papillomavirus types shall we vaccinate and screen? The international perspective.
abstract: At least 15 types of HPV have been associated with cervical cancer, but current HPV vaccines confer only type-specific immunity. To determine geographic variations in the HPV type distribution in cervical cancer, we carried out a pooled analysis of data from an international survey of HPV types in cervical cancer and from a multicenter case-control study, both co-coordinated by the IARC. Study cases were 3,607 women with incident, histologically confirmed cervical cancer recruited in 25 countries. HPV DNA detection and typing in cervical cells or biopsies were centrally done using PCR assays. Estimates of the potential number of cases prevented by HPV type-specific vaccines and changes in the validity of different HPV screening cocktails were calculated. HPV DNA was detected in 96% of specimens, and 30 different types were detected. The 15 most common types were, in descending order of frequency, 16, 18, 45, 31, 33, 52, 58, 35, 59, 56, 39, 51, 73, 68 and 66. Higher than average proportions of type 16 were found in northern Africa, of type 18 in south Asia, of type 45 in sub-Saharan Africa and of type 31 in Central/South America. A vaccine including types 16 and 18 could potentially prevent 71% of cervical cancers worldwide, but its impact with regard to the percentage of cases potentially prevented would be higher in Asia and Europe/North America. In contrast, a vaccine containing the 7 most common HPV types would prevent about 87% of cervical cancers worldwide, with little regional variation. The impact of modifying the number of types in the screening cocktail tests would be small and probably irrelevant for screening programs.
authors.affiliation: International Agency for Research on Cancer, Lyon, France. cris@ico.scs.es
authors.forename: Nubia
authors.initials: N
authors.lastname: Muñoz
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Bosch
authors.forename: Xavier
authors.initials: X
authors.lastname: Castellsagué
authors.forename: Mireia
authors.initials: M
authors.lastname: Díaz
authors.forename: Silvia
authors.initials: S
authors.lastname: de Sanjose
authors.forename: Doudja
authors.initials: D
authors.lastname: Hammouda
authors.forename: Keerti V
authors.initials: KV
authors.lastname: Shah
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
mesh_terms: D000349:Africa; D016022:Case-Control Studies; D004279:DNA, Viral / Q000032:analysis* / Q000145:classification; D005060:Europe; D005260:Female; D005843:Geography; D006306:Health Surveys; D006801:Humans; D007391:International Cooperation; D008403:Mass Screening; D009656:North America; D027383:Papillomaviridae / Q000276:immunology / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D013020:South America; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology*; D014765:Viral Vaccines
chemical_list: D004279:DNA, Viral; D014765:Viral Vaccines