The Prevalence of HPV Infection and Other Cervical Cancer Risk Factors in a Fijian Population

Brewer (presenting author), Naomi

INTRODUCTION:

Cervical cancer is the most common cancer among women in Fiji, and the age-standardised incidence rate of 51 per 100,000 is among the highest in the world. There have been no studies of the population prevalence of human papillomavirus (HPV) in Fiji, and only one elsewhere in the Pacific – in Vanuatu. We therefore conducted a population-based study to determine the prevalence of HPV infection, cervical abnormalities, and other cervical cancer risk factors among women in Suva, the Fijian capital.

METHODS:

Participants were recruited through community meetings, church leaders, and public health outreach. Public health nurses explained the study, sort informed consent, took the specimens and administered a standardised questionnaire.

Pap smears were read at the main tertiary hospital laboratory, and abnormalities were managed according to local protocols. A general primer GP5+/6+ mediated polymerase chain reaction assay was used for HPV DNA analysis.

Age-standardised HPV prevalence was estimated using the World standard population. Odds ratios (ORs) for HPV positivity were estimated using logistic regression. ORs were adjusted for age, and then also for variables which showed elevated risks in preliminary analyses.

RESULTS:

We included 1,244 women with an adequate HPV sample, aged 16–63 years. Crude HPV prevalence was 24.0% (95% confidence interval, 21.7–26.4%) and age-standardised prevalence was 25.5% (23.1–28.1%). Prevalence of high-risk HPV types was 13.6% (11.8–15.6%). Among 1,192 women with adequate cytological results, 13 (1.1%) showed cervical abnormalities; the majority were high-grade intraepithelial lesions or worse. After adjustment, the only variables significantly associated with HPV-positivity were age (ranging from OR 0.57 (0.36–0.89) for 16–24 year-old-women to OR 0.43 (0.20-0.89) for 55-63 year-old-women) and ‘husband’s extramarital sexual relationships’ (OR 1.69; 1.17–2.34).

CONCLUSIONS:

These findings provide key information for future policy decisions on the most appropriate methods of cervical cancer prevention in Fiji and in the Pacific region.