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Nationwide comprehensive human papillomavirus (HPV) genotyping of invasive cervical cancer

British Journal of Cancervolume 118pages13771381 (2018) | Download Citation



The Swedish National Cervical Screening Registry collects and evaluates comprehensive, nationwide health data to optimise organised cervical cancer prevention. Since all cervical cancer specimens are saved in biobanks, population-based data from the specimens should be available for analysis and linkage with other health information.


We identified all cervical cancers diagnosed in Sweden during 2002–2011 (4254 confirmed cases) and requested the tissue blocks to retrieve human papillomavirus (HPV) genotype data using general primer PCR with Luminex genotyping and real-time PCR targeting the E6/E7 regions of HPV16/18.


We obtained blocks from 2932/4254 (69%) of cases. Valid HPV genotyping data was retrieved for 2850 cases (97%). The most common type was HPV16 (60%), followed by HPV18 (19%), HPV45 (7%), HPV31 (3%), HPV33 (2%), HPV52 (2%), HPV39 (1%), HPV70 (1%), HPV56 (1%), HPV35 (1%), HPV58 (1%) and HPV59 (1%). Ninety-six percent of all HPV-positive cases had a single infection. Eighty-nine cases were HPV-positive only when testing for the HPV16/18-E6/E7 region.


We present one of the largest series of HPV-genotyped cervical cancers to date. The systematic collection of cervical cancer HPV genotyping data by the screening registry will facilitate prevention and monitoring of HPV type-specific disease burden.

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We thank Pouran Almstedt for database management, Walter Ryd for histopathological review and Anna Söderlund Strand for advice and support. We also thank all members of the Advancing Cervical Cancer Eradication Strategies group ( for many inspiring scientific discussions. This study was supported by the Swedish Foundation for Strategic Research (grant numbers KF10-0046 and RB13-0011).

Author contributions

C.L. performed the laboratory work, drafted and coordinated the revision of the paper. C.E. assisted with the planning of the work and performed laboratory work. H.L. performed laboratory work. S.N.K. collected all the blocks and slides, and performed data management. J.L. performed all statistics. B.A. reviewed all medical charts. B.A., K.S., P.S. and J.D. designed the study and provided supervision. K.M.E. provided supervision and all authors significantly contributed to the critical revision of the manuscript.

Author information


  1. Department of Laboratory Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden

    • Camilla Lagheden
    • , Carina Eklund
    • , Sara Nordqvist Kleppe
    • , K. Miriam Elfström
    • , Karin Sundström
    •  & Joakim Dillner
  2. Karolinska University Laboratory, Karolinska University Hospital, 171 76, Stockholm, Sweden

    • Helena Lamin
    • , Karin Sundström
    •  & Joakim Dillner
  3. Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden

    • Jiayao Lei
    • , Bengt Andrae
    •  & Pär Sparén


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Competing interests

J.D. has obtained grants to his institution from Roche & Genomica research on HPV tests. J.D. and K.S. have obtained grants to their institution for research on HPV vaccines from Merck, a manufacturer of HPV vaccines. The remaining authors declare no competing interests.

Ethical approval

for this study was granted by the Regional ethical review board of Stockholm, Sweden (decision numbers: 2011/1026-31/4 and 2012/1028-32), which decided that informed consent from the participants was not required.

Availability of data and material

Individual-level data will be shared on request, to be sent to the corresponding author, given that all ethical and legal requirements of such a transfer are met.

Corresponding author

Correspondence to Joakim Dillner.

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