Abstract:
In sub-Saharan Africa, invasive cervical cancer (ICC) incidence and mortality are among
the highest in the world. This cross-sectional epidemiological study assessed human
papillomavirus (HPV) prevalence and type distribution in women with ICC in Ghana,
Nigeria, and South Africa. Cervical biopsy specimens were obtained from women aged ³21
years with lesions clinically suggestive of ICC. A questionnaire was used to evaluate the HIV
status and the medical, sexual, and reproductive history of women. Histopathological
diagnosis of ICC was determined by light microscopy examination of hematoxylin and eosin
stained sections of paraffin-embedded cervical specimens; samples with a confirmed
histopathological diagnosis underwent HPV DNA testing by polymerase chain reaction. HPVpositive
specimens were typed by reverse hybridization line probe assay. Between October
2007 and March 2010, cervical specimens from 659 women were collected (167 in Ghana,
192 in Nigeria, and 300 in South Africa); 570 cases were histologically confirmed as ICC. The tumor type was identified in 551/570 women with ICC; squamous cell carcinoma was
observed in 476/570 (83.5%) cases. The HPV-positivity rate in ICC cases was 90.4%
(515/570). In ICC cases with single HPV infection (447/515 [86.8%]), the most commonly
detected HPV types were HPV16 (51.2%), HPV18 (17.2%), HPV35 (8.7%), HPV45 (7.4%),
HPV33 (4.0%), and HPV52 (2.2%). HPV type distribution appeared to differ according to
tumor type and HIV status. In conclusion, HPV16 and HPV18 were the most frequently
detected types in women with ICC in sub-Saharan Africa and implementation of HPV
vaccination may reduce the ICC disease burden in this region.
