Using HPV prevalence to predict cervical cancer incidence. Issue 8 (11th October 2012)

• Record Type: Journal Article
• Authors: Sharma, Monisha; Bruni, Laia; Diaz, Mireia; Castellsagué, Xavier; Sanjosé, Silvia de; Bosch, F. Xavier; Kim, Jane J.
• Is Part Of: International journal of cancer. Volume 132:Issue 8(2013:Apr. 15)
• Page Start: 1895
• Page End: 1900
• Publication Date: 2012-10-11
• Subjects: human papilloma virus -- cervical cancer -- prediction modeling; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.27835
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: Knowledge of a country's cervical cancer (CC) burden is critical to informing decisions about resource allocation to combat the disease; however, many countries lack cancer registries to provide such data. We developed a prognostic model to estimate CC incidence rates in countries without cancer registries, leveraging information on human papilloma virus (HPV) prevalence, screening, and other country‐level factors. We used multivariate linear regression models to identify predictors of CC incidence in 40 countries. We extracted age‐specific HPV prevalence (10‐year age groups) by country from a meta‐analysis in women with normal cytology ( N = 40) and matched to most recent CC incidence rates from Cancer Incidence in Five Continents when available ( N = 36), or Globocan 2008 ( N = 4). We evaluated country‐level behavioral, economic, and public health indicators. CC incidence was significantly associated with age‐specific HPV prevalence in women aged 35–64 (adjusted R ‐squared 0.41) ("base model"). Adding geographic region to the base model increased the adjusted R ‐squared to 0.77, but the further addition of screening was not statistically significant. Similarly, country‐level macro‐indicators did not improve predictive validity. Age‐specific HPV prevalence at older ages was found to be a better predictor of CC incidence than prevalence in women under 35. However, HPV prevalence could not explain the entire CC burden as many factors modify women's risk of progression to cancer. Geographic region seemed to serve as a proxy for these country‐level indicators. Our analysis supports the assertion that conducting a population‐based HPV survey targeting women over age 35 can be valuable in approximating the CC risk in a given country. Abstract : What's new? Quantifying a country's cervical cancer burden is critical for guiding policies on prevention activities. The vast majority of cervical cancer cases occur in developing countries where few population‐based cancer registries exist. The authors developed a prediction model to estimate country‐level cervical cancer incidence using HPV prevalence as a proxy. This is the first study to assess the value of using HPV prevalence in the general female population to predict country‐level cervical cancer incidence.