HPV16 is associated with younger age in women with cervical intraepithelial neoplasia grade 2 and 3.
OBJECTIVE
To evaluate if women with HPV16 positive CIN2 and CIN3 are diagnosed at a younger age.


METHODS
We conducted a population-based cohort study including more than 40,000 women having a liquid based cervical cytology sample taken as part of routine screening. HPV analysis was performed using Hybrid Capture 2 and LiPAv2. The study population was linked to the Danish Pathology Data Bank to retrieve information on subsequent cervical histology. We included HR HPV positive CIN2/3 samples, comprising 173 CIN2 and 467 CIN3 lesions. Due to a high number of multiple concurrent HPV infections, the causative HPV type was assigned to a hierarchically group.


RESULTS
In CIN3, the estimated proportion of lesions positive for HPV16 was 68.1% among women aged 20 years and decreased to 38.9% among women aged 50 years. A decrease in HPV16 positivity with increasing age was also observed in CIN2. In a multinomial logistic regression analysis, young age was strongly associated with HPV16 positivity in CIN3 lesions (OR=0.46 per 10 year increase in age, 95% CI: 0.32-0.65). The proportion of HPV16 and/or 18 positive lesions among women diagnosed with CIN2 and CIN3 below 30 years of age was 44% and 75%, respectively.


CONCLUSIONS
HPV16 positivity was significantly associated with younger age at diagnosis of CIN3. In a population vaccinated against HPV16 and 18, we will experience a shift to older ages in cervical precancerous lesions. These findings may imply that cervical cancer screening programs could start at an older age in HPV vaccinated populations.
Department of Virus, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
L
L
Baandrup
C
C
Munk
K K
KK
Andersen
J
J
Junge
T
T
Iftner
S K
SK
Kjær
D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D016015:Logistic Models; D060787:Neoplasm Grading; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*