title: Canadian oncogenic human papillomavirus cervical infection prevalence: systematic review and meta-analysis.
abstract: BACKGROUND
  Oncogenic human papillomavirus (HPV) infection prevalence is required to determine optimal vaccination strategies. We systematically reviewed the prevalence of oncogenic cervical HPV infection among Canadian females prior to immunization.
  
  
  METHODS
  We included studies reporting DNA-confirmed oncogenic HPV prevalence estimates among Canadian females identified through searching electronic databases (e.g., MEDLINE) and public health websites. Two independent reviewers screened literature results, abstracted data and appraised study quality. Prevalence estimates were meta-analyzed among routine screening populations, HPV-positive, and by cytology/histology results.
  
  
  RESULTS
  Thirty studies plus 21 companion reports were included after screening 837 citations and 120 full-text articles. Many of the studies did not address non-response bias (74%) or use a representative sampling strategy (53%). Age-specific prevalence was highest among females aged < 20 years and slowly declined with increasing age. Across all populations, the highest prevalence estimates from the meta-analyses were observed for HPV types 16 (routine screening populations, 8 studies: 8.6% [95% confidence interval 6.5-10.7%]; HPV-infected, 9 studies: 43.5% [28.7-58.2%]; confirmed cervical cancer, 3 studies: 48.8% [34.0-63.6%]) and 18 (routine screening populations, 8 studies: 3.3% [1.5-5.1%]; HPV-infected, 9 studies: 13.6% [6.1-21.1%], confirmed cervical cancer, 4 studies: 17.1% [6.4-27.9%].
  
  
  CONCLUSIONS
  Our results support vaccinating females < 20 years of age, along with targeted vaccination of some groups (e.g., under-screened populations). The highest prevalence occurred among HPV types 16 and 18, contributing a combined cervical cancer prevalence of 65.9%. Further cancer protection is expected from cross-protection of non-vaccine HPV types. Poor study quality and heterogeneity suggests that high-quality studies are needed.
authors: Li Ka Shing Knowledge Institute, St Michael's Hospital, (38 Shuter Street), Toronto, Ontario, (M5B 1T8), Canada. triccoa@smh.ca
authors: Andrea C
authors: AC
authors: Tricco
authors: Carmen H
authors: CH
authors: Ng
authors: Vladimir
authors: V
authors: Gilca
authors: Andrea
authors: A
authors: Anonychuk
authors: Ba'
authors: B
authors: Pham
authors: Shirra
authors: S
authors: Berliner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000276:immunology*; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D053918:Papillomavirus Vaccines