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Meta-Analysis
. 2011 Sep 5:11:235.
doi: 10.1186/1471-2334-11-235.

Canadian oncogenic human papillomavirus cervical infection prevalence: systematic review and meta-analysis

Andrea C Tricco  1 , Carmen H Ng, Vladimir Gilca, Andrea Anonychuk, Ba' Pham, Shirra Berliner
Affiliations
Meta-Analysis

Canadian oncogenic human papillomavirus cervical infection prevalence: systematic review and meta-analysis

Andrea C Tricco et al. BMC Infect Dis. .

Abstract

Background: Oncogenic human papillomavirus (HPV) infection prevalence is required to determine optimal vaccination strategies. We systematically reviewed the prevalence of oncogenic cervical HPV infection among Canadian females prior to immunization.

Methods: We included studies reporting DNA-confirmed oncogenic HPV prevalence estimates among Canadian females identified through searching electronic databases (e.g., MEDLINE) and public health websites. Two independent reviewers screened literature results, abstracted data and appraised study quality. Prevalence estimates were meta-analyzed among routine screening populations, HPV-positive, and by cytology/histology results.

Results: Thirty studies plus 21 companion reports were included after screening 837 citations and 120 full-text articles. Many of the studies did not address non-response bias (74%) or use a representative sampling strategy (53%). Age-specific prevalence was highest among females aged < 20 years and slowly declined with increasing age. Across all populations, the highest prevalence estimates from the meta-analyses were observed for HPV types 16 (routine screening populations, 8 studies: 8.6% [95% confidence interval 6.5-10.7%]; HPV-infected, 9 studies: 43.5% [28.7-58.2%]; confirmed cervical cancer, 3 studies: 48.8% [34.0-63.6%]) and 18 (routine screening populations, 8 studies: 3.3% [1.5-5.1%]; HPV-infected, 9 studies: 13.6% [6.1-21.1%], confirmed cervical cancer, 4 studies: 17.1% [6.4-27.9%].

Conclusion: Our results support vaccinating females < 20 years of age, along with targeted vaccination of some groups (e.g., under-screened populations). The highest prevalence occurred among HPV types 16 and 18, contributing a combined cervical cancer prevalence of 65.9%. Further cancer protection is expected from cross-protection of non-vaccine HPV types. Poor study quality and heterogeneity suggests that high-quality studies are needed.

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Figures

Figure 1
Figure 1
Study flow.
Figure 2
Figure 2
Age-specific HPV prevalence. Abbreviations: Coll collection, NUN Nunavit, HC hybrid capture, n total sample size, ON Ontario, QC Quebec, PCR polymerase chain reaction, NFLD Newfoundland.
Figure 3
Figure 3
HPV prevalence meta-analyses among all participants. Note: Each point estimate and 95% confidence interval is a separate meta-analysis. Abbreviations: HR high risk, HPV human papillomavirus, CI confidence interval.
Figure 4
Figure 4
HPV prevalence meta-analyses among HPV-infected participants. Notes: Each point estimate and 95% confidence interval is a separate meta-analysis. One study (Aho 2003) included in the HPV prevalence among all participants was not included here because only one HPV type was examined (HPV-52). Abbreviations: HPV human papillomavirus, CI confidence interval.
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