Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
Federal Office of Public Health, Schwarzenburgstrasse 157, 3003, Bern, Switzerland.
BMC Cancer. 2019 Jan 30;19(1):111. doi: 10.1186/s12885-018-5248-y.
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.
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.
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.
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.
ClinicalTrials.gov, NCT02323997 . Registered 24 December 2014.
自 2008 年以来，瑞士联邦公共卫生办公室建议接种人乳头瘤病毒（HPV）疫苗，以预防宫颈癌。为了评估未来疫苗接种对公共卫生的影响，需要基于人群的基线数据。本研究的目的是研究 HPV 疫苗接种项目开始时，宫颈癌前病变 3 级及以上（CIN3+）患者中致癌 HPV 基因型的分布情况，并比较 CIN3+女性与瑞士一般人群的社会人口学和行为因素。
我们进行了一项回顾性和前瞻性的瑞士 CIN3+女性的横断面研究。来自六个州和三个语言区的 10 家病理研究所参与了这项研究。我们对 2014 年和 2015 年的福尔马林固定石蜡包埋标本进行 HPV 基因分型。2015 年入组的女性被要求填写一份问卷。我们描述了 HPV 类型的频率。我们还将 CIN3+组与 2014 年瑞士全国队列的人口统计学特征和社会经济地位进行了比较，并将 HPV 感染的危险因素与 2012 年瑞士健康调查进行了比较。
我们纳入了 767 名女性的 768 份活检。475 份（61.8%）活检 HPV16 和/或 18 阳性，687 份（89.5%）为致癌 HPV 基因型 16、18、31、33、45、52 和/或 58 阳性，5 份（0.7%）为 HPV 阴性。273 名完成患者问卷的女性中，28 名（10.3%）报告至少接种过一剂 HPV 疫苗。与瑞士六个研究州的女性相比，CIN3+组的瑞士女性较少，更多的人出生在国外，更多的人是单身。该研究组中，在过去一年中有≥2 个性伴侣、当前吸烟者以及初次性行为年龄较小的女性比例也更高。
与四价疫苗相比，九价疫苗可能覆盖瑞士女性 CIN3+病变的 90%左右。对 CIN3+中 HPV 基因型分布的监测，结合疫苗接种和 CIN3+发病率的信息，将能够监测疫苗接种计划对公共卫生的影响。
ClinicalTrials.gov，NCT02323997。2014 年 12 月 24 日注册。
