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Prevalence and predictors of human papillomavirus infection in women in Ontario, Canada

John W. Sellors^*, James B. Mahony, Janusz Kaczorowski, Alice Lytwyn^¶, Helen Bangura^**, Sylvia Chong^*, Attila Lorincz, Dawn M. Dalby^*, Vladan Janjusevic^*, Jana L Keller^* and The Survey of HPV in Ontario Women (SHOW) Group

From *the Health Services Delivery Research Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Hospital, Hamilton, Ont.; the departments of Family Medicine, Clinical Epidemiology and Biostatistics, and Pathology and Molecular Medicine, McMaster University, Hamilton, Ont.; the ¶Department of Pathology, University of Toronto, Toronto, Ont.; the **Ministry of Health, Toronto, Ont.; and Digene Corporation, Silver Spring, Md. Members of the Survey of HPV in Ontario Women (SHOW) Group are listed at the end of the article. Members of the Survey of HPV in Ontario Women (SHOW) Group: John W. Sellors, James B. Mahony, Alice Lytwyn and Helen Bangura (principal investigators); Central East Region: Alice Bluemke, Debra Graham, Val Hester, Judy Lane and Jerry Workewych (Mississauga); Catherine Andrew, Peter Jacyk and Bohdan Olearczyk (Toronto); Andrea Hirscheimer and Eshrat Sayani (North York); Lucie Blouin and Peggy Wilkins (Peterborough); Heather Currie (Markham); Janice Boxall (Milton); Peter Deimling (Orillia); Sadrudin Bardai (Oshawa); Barbara Alexander (Richmond Hill). Central West Region: Cameron Duthie, Karin Euler and Bruce Silburt (Guelph); Theresa Clinton and Marilyn Robertson (Caledonia); Nancy Abram (Hamilton); Martha Taylor (Kitchener); Preston Zuliani (St. Catharines). Eastern Region: Francine Bonnet (Cornwall); Janet Dollin (Ottawa); Kathryn Lockington (Kingston). Northeastern Region: Daniel Krawczuk, William McMullen and John Mulloy (Sudbury); Jean Deslauriers and Marie-Josée Deslauriers (Timmins); David Crookston (Sault Ste. Marie). Northwestern Region: Brian Cameron and Corinna Chung (Thunder Bay); Rhonda Diamond, Sven Pedersen and John Vaudry (Kenora); Southwestern Region: Deborah Koudys and Vasiliki Papukna (London); Sharon Doyle and Andrea Steen (Windsor); Kate Bailey (Chatham); Emer Dudley (Wallaceburg)

Background: Human papillomavirus (HPV) is thought to be the primary cause of cervical intraepithelial neoplasia and cervical cancer. We determined the age-specific prevalence of HPV infection and its risk factors in Ontario women.

Methods: We obtained 2 cervical specimens from randomly selected women (in 5-year age categories, from 15 to 49 years) who were being seen in 32 family practices for cytologic screening. The specimens were tested for carcinogenic HPV by the hybrid capture II assay (Digene Corp., Silver Spring, Md.) and by polymerase chain reaction (PCR) and genotyping.

Results: Of 1004 women eligible to participate, samples were obtained from 955 (95.1%). The prevalence of HPV (as determined by the hybrid capture II method) was highest, at 24.0% (95% confidence interval [CI] 16.5% to 31.5%), among women 20 to 24 years of age and was progressively lower in older age groups, reaching 3.4% (95% CI 0.1% to 6.7%) in women 45 to 49 years old. The prevalence of HPV (any type) as determined by PCR showed a similar pattern but was significantly higher (p = 0.01) among women 45 to 49 years old than among those 40 to 44 years old (13.0% [95% CI 6.4% to 19.6%] v. 3.3% [95% CI 0.1% to 6.5%]). Risk factors for positivity with the hybrid capture II method were never-married status, divorced or separated status, more than 3 lifetime partners, more than 1 partner in the preceding year, cigarette smoking and current use of oral contraceptives. The presence of squamous intraepithelial lesions on cytologic examination was strongly associated with positivity with the hybrid capture II assay (odds ratio 96.0, 95% CI 22.3 to 413.4; p < 0.01).

Interpretation: The highest prevalence of HPV was 24.0%, in women 20 to 24 years old. Risk factors supported a sexual mode of transmission, and there was a strong association between HPV and abnormal cervical cytologic result

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