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British Journal of Cancer (2008) 98, 646-651.
doi:10.1038/sj.bjc.6604162 www.bjcancer.com Published online 8 January 2008
Age-dependent prevalence of 14 high-risk HPV types in the Netherlands: implications for prophylactic vaccination and screening
V M H Coupé1, J Berkhof1, N W J Bulkmans2, P J F Snijders2 and C J L M Meijer2
1Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, PO Box 7057, Amsterdam 1007 MB, The Netherlands
2Department of Pathology, VU University Medical Centre, PO Box 7057, Amsterdam 1007 MB, The Netherlands
Correspondence to: Dr VMH Coupé, E-mail: v.coupe@vumc.nl
Received 23 August 2007; revised 16 November 2007; accepted 28 November 2007; published online 8 January 2008
We determined the prevalence of type-specific hrHPV infections in the Netherlands on cervical scrapes of 45 362 women aged 18-65 years. The overall hrHPV prevalence peaked at the age of 22 with peak prevalence of 24%. Each of the 14 hrHPV types decreased significantly with age (P-values between 0.0009 and 0.03). The proportion of HPV16 in hrHPV-positive infections also decreased with age (OR=0.76 (10-year scale), 95% CI=0.67-0.85), and a similar trend was observed for HPV16 when selecting hrHPV-positive women with cervical intraepithelial neoplasia grade 2 or worse (CIN2+) (OR=0.76, 95% CI=0.56-1.01). In women eligible for routine screening (age 29-61 years) with confirmed CIN2+, 65% was infected with HPV16 and/or HPV18. When HPV16/18-positive infections in women eligible for routine screening were discarded, the positive predictive value of cytology for the detection of CIN2+ decreased from 27 to 15%, the positive predictive value of hrHPV testing decreased from 26 to 15%, and the predictive value of a double-positive test (positive HPV test and a positive cytology) decreased from 54 to 41%. In women vaccinated against HPV16/18, screening remains important to detect cervical lesions caused by non-HPV16/18 types. To maintain a high-positive predictive value, screening algorithms must be carefully re-evaluated with regard to the screening modalities and length of the screening interval.
Keywords: human papillomavirus; age-dependent prevalence; vaccination; screening
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