The burden of 14 hr-HPV genotypes in women attending routine cervical cancer screening in 20 states of Mexico: a cross-sectional study

Abstract

In Mexico, HPV vaccines available immunize against genotypes 16/18 and 16/18/6/11; however, there is limited surveillance about carcinogenic subtypes in different states of the country that allow evaluating the effectiveness of vaccination and cervical cancer screening programs. Here, we report the regional and age-specific prevalence of 14 hr-HPV genotypes as well as their prevalence in abnormal cytology (from ASCUS to cervical cancer) among Mexican women which were undergoing from cervical cancer screening in the Salud Digna clinics in 20 states of the country. This study includes women with social security from the majority of public health institutions (IMSS, ISSSTE, SEMAR, and PEMEX), and women without social security. For cervical cancer screening, we used the SurePath liquid-based cytology and the BD Onclarity HPV Assay. From December 1, 2016, to August 2, 2018, the hr-HPV prevalence among 60,135 women was 24.78%, the most prevalent types were HPV 16 (4.13%), HPV 31 (4.12%) and HPV 51 (3.39%), while HPV 18 (1.70%) was less prevalent among infected women. Interestingly, the genotypes not covered by current vaccines in Mexico were commonly found in precancerous lesions, evidencing their carcinogenic potential, so it is necessary to increase their surveillance and inclusion in cervical cancer screening triage.

Figure 1

Prevalence of hr-HPV infections in 60,135 women from 20 states of Mexico. Coropletic histogram (A) and map (B) shows the prevalence of hr-HPV infections in 20 states of Mexico. The color red indicates the states with the highest prevalence of infections, while yellow shows the states with the lowest prevalence. Gray color (in the map) shows the states that are not included in this work. (C) The 5-year prevalence of hr-HPV infections in 60,135 women screened in 20 states of Mexico, the trend of age-specific prevalence was evaluated with the chi-squared (χ²) test for trend. The confidence intervals of the prevalence in each state are shown in Table 2.