Human papillomavirus genotype distribution and socio-behavioural characteristics in women with cervical pre-cancer and cancer at the start of a human papillomavirus vaccination programme: the CIN3+ plus study

Dianne Egli-Gany, Anne Spaar Zographos, Joachim Diebold, Virginie Masserey Spicher, Brigitte Frey Tirri, Rolf Heusser, Joakim Dillner, Patrick Petignat, Roland Sahli, Nicola Low, CIN3+plus study group, Astrid Baege, Fridolin Bannwart, Clauldia Berlin, Pascal Cassinotti, Gieri Cathomas, Johanna Claass, Carina Eklund, Milo Frattini, Anne Graber, Anina Häfliger, Liza Ho, Andre Kind, Christian Kreis, Luca Mazzucchelli, Thomas McKee, Eric Megevand, Ulrike Meyer-Hamme, Francesca Molinari, Christoph Noppen, Aurelia Noske, Ines Raineri, Elisabetta Rapiti, Dominique Rubi, Niels J Rupp, Kathrin Schwedler, Thomas Stallmach, Jean-Christophe Tille, Luigi Tornillo, Alexandra Valera, Dominique Weintraub, Philip Went, Dieter Zimmermann, Dianne Egli-Gany, Anne Spaar Zographos, Joachim Diebold, Virginie Masserey Spicher, Brigitte Frey Tirri, Rolf Heusser, Joakim Dillner, Patrick Petignat, Roland Sahli, Nicola Low, CIN3+plus study group, Astrid Baege, Fridolin Bannwart, Clauldia Berlin, Pascal Cassinotti, Gieri Cathomas, Johanna Claass, Carina Eklund, Milo Frattini, Anne Graber, Anina Häfliger, Liza Ho, Andre Kind, Christian Kreis, Luca Mazzucchelli, Thomas McKee, Eric Megevand, Ulrike Meyer-Hamme, Francesca Molinari, Christoph Noppen, Aurelia Noske, Ines Raineri, Elisabetta Rapiti, Dominique Rubi, Niels J Rupp, Kathrin Schwedler, Thomas Stallmach, Jean-Christophe Tille, Luigi Tornillo, Alexandra Valera, Dominique Weintraub, Philip Went, Dieter Zimmermann

Abstract

Background: The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2008. To establish monitoring of the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to examine the distribution of oncogenic HPV genotypes in biopsies with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) at the beginning of HPV vaccination programmes and to compare sociodemographic and behavioural factors of women with CIN3+ with women in the Swiss general population.

Methods: We conducted a retrospective and prospective cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status in the CIN3 + plus group with the Swiss National Cohort in 2014 and compared risk factors for HPV infection with the Swiss Health Survey in 2012.

Results: We included 768 biopsies from 767 women. Four hundred and seventy-five (61.8%) biopsies were positive for HPV 16 and/or 18, 687 (89.5%) were positive for oncogenic HPV genotypes 16, 18, 31, 33, 45, 52, and/or 58 and five (0.7%) were HPV negative. Twenty-eight (10.3%) of the 273 women who completed the patient questionnaire reported having received at least one dose of an HPV vaccine. When compared with Swiss women in the six study cantons, fewer women in the CIN3+ plus study group were of Swiss nationality, more were born abroad and more were single. The study group also had a higher proportion of women with ≥2 partners in the last year, current smokers and was younger at age of first sexual intercourse.

Conclusions: Introduction of the nonavalent vaccine could cover approximately 90% of CIN3+ lesions in Swiss women compared with around 60% with the quadrivalent vaccine. Surveillance of HPV genotype distribution in CIN3+, together with information about vaccination and CIN3+ incidence will allow monitoring of the public health impact of vaccination programmes.

Trial registration: ClinicalTrials.gov, NCT02323997 . Registered 24 December 2014.

Keywords: Cervical cancer; Cervical dysplasia; Cervical intraepithelial neoplasia; HPV; Human papillomavirus; Vaccines.

Conflict of interest statement

Consent for publication

Not applicable.

Ethics approval and consent to participate

This study was reviewed and approved by the ethics committees in all participating Swiss cantons (Ethics Committee Bern 194–24, Ethics Committee Northwest/Central Switzerland 2014–280, Ethics Committee Geneva 14–176, Ethics Committee Zurich 2014–0363, Ethics Committee Ticino 2839). Written informed consent was obtained from participants.

Competing interests

Joakim Dillner reports previously having received funding from Merck Sharp & Dohme, a vaccine manufacturer. The other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart. Originally published in Swiss Federal Office of Public Health Bulletin (reference 19).a 11 patients were included in the study twice by different laboratories.b 10 biopsies were excluded because they were from the same patient with the same HPV result

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