Osmani Vanesa, Rossiter Michael, Hörner Lucy, Nkurunziza Theoneste, Rank Sophia, Tanaka Luana Fiengo, Klug Stefanie J
Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
BMJ Glob Health. 2025 Apr 2;10(4):e017309. doi: 10.1136/bmjgh-2024-017309.
More than half of global cervical cancer cases occur among women older than 50. However, global estimates regarding the human papillomavirus (HPV) prevalence among this population are lacking, especially for women with abnormal cytology. Therefore, we conducted a systematic review and meta-analysis to estimate the worldwide HPV prevalence in women aged 50 and older with abnormal cytology.
We searched PubMed, Scopus and Web of Science for quantitative studies reporting any or high-risk (HR)-HPV prevalence for women 50 years and older with abnormal cytology (atypical squamous cells of undetermined significance and higher). We extracted data on world region, subregion, cervical lesion type, recruitment setting, HPV test, year of study conduct and HPV prevalence from the included studies. We assessed the risk of bias of the included studies using a modified Newcastle-Ottawa scale. We estimated the pooled prevalence and 95% CIs of any-HPV and HR-HPV using random-effects models, considering the world regions. Additionally, we estimated the prevalence by HPV type, lesion type and age groups.
Overall, 113 studies met the inclusion criteria, of which 104 were included in the meta-analysis. Among women aged 50 and older with abnormal cytology, the estimated global pooled prevalence of any-HPV from 53 studies, including 14 585 women, was 54.5% (95%CI, 46.0 to 62.8%), and the HR-HPV prevalence from 85 studies, covering 33 672 women, was 43.0% (95%CI, 36.6 to 49.5%). There was a higher HR-HPV prevalence among women with high-grade lesions and women living in the African continent. No major differences in HR-HPV prevalence between the age groups of women over 50 years were found. The most common single HPV types worldwide were 16 and 52, with pooled prevalence estimates of 12.0% (95%CI, 8.0% to 17.7%) and 8.4% (95%CI, 4.4% to 15.4%), respectively.
Our findings highlight the relevance of targeted screening interventions among women 50 years and older. To achieve the elimination of cervical cancer, age-inclusive screening strategies should be considered.
CRD42021241365.
全球超过一半的宫颈癌病例发生在50岁以上的女性中。然而，目前缺乏关于该人群中人乳头瘤病毒（HPV）流行率的全球估计数据，尤其是针对细胞学异常的女性。因此，我们进行了一项系统评价和荟萃分析，以估计全球50岁及以上细胞学异常女性的HPV流行率。
我们在PubMed、Scopus和Web of Science数据库中检索了关于50岁及以上细胞学异常（意义不明确的非典型鳞状细胞及更高级别病变）女性的任何HPV或高危（HR）-HPV流行率的定量研究。我们从纳入的研究中提取了关于世界区域、次区域、宫颈病变类型、招募地点、HPV检测方法、研究开展年份和HPV流行率的数据。我们使用改良的纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。我们使用随机效应模型，考虑世界区域，估计了任何-HPV和HR-HPV的合并流行率及95%置信区间。此外，我们还按HPV类型、病变类型和年龄组估计了流行率。
总体而言，113项研究符合纳入标准，其中104项纳入了荟萃分析。在50岁及以上细胞学异常的女性中，来自53项研究（包括14585名女性）的任何-HPV估计全球合并流行率为54.5%（95%置信区间，46.0%至62.8%），来自85项研究（涵盖33672名女性）的HR-HPV流行率为43.0%（95%置信区间，36.6%至49.5%）。高级别病变女性和居住在非洲大陆的女性中HR-HPV流行率较高。未发现50岁以上不同年龄组女性的HR-HPV流行率有重大差异。全球最常见的单一HPV类型是16型和52型，合并流行率估计分别为12.0%（95%置信区间，8.0%至17.7%）和8.4%（95%置信区间，4.4%至15.4%）。
我们的研究结果凸显了针对50岁及以上女性进行靶向筛查干预的重要性。为实现消除宫颈癌的目标，应考虑采用涵盖各年龄段的筛查策略。
PROSPERO注册号：CRD42021241365。
