D8c Prevalence of High-Risk Human Papillomavirus Types and Abnormal Cervical Cytology Among American Indian and Alaska Native Women in a US Cervical Screening Population, 2003-2005

Thursday, March 11, 2010: 9:00 AM
Grand Ballroom A (M4) (Omni Hotel)
Grace Alfonsi, MD, Denver Public Health, Denver Health Authority, Denver, CO, S. Deblina Datta, MD, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, Theresa Mickiewicz, MSPH, Public Health Informatics, Denver Public Health, Denver, CO, Laura Koutsky, PhD, HPV Research Group, University of Washington, Seattle, WA, Seattle, WA, Khalil Ghanem, MD, PhD, Department of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, Michael Hagensee, MD, PhD, Department of Microbiology, Louisiana State University Health Science Center, New Orleans, LA, Peter Kerndt, MD, MPH, STD Program, Los Angeles County Department of Public Health, Los Angeles, CA, Katherine Hsu, MD, MPH, Sylvie Ratelle STD/HIV Prevention Training Center of New England, Massachusetts Department of Public Health, Jamaica Plain, MA, Hillard Weinstock, MD, MPH, Division of STD Prevention, CDC, Atlanta, GA and Judith Shlay, MD, MSPH, Denver Public Health, Denver Health, Denver, CO

Background: Although efficacy of the human papillomavirus (HPV) vaccine is well documented, American Indian and Alaska natives (AI/AN) attending focus groups have expressed doubt about its effectiveness in AI/AN. The belief that vaccine types (HPV16/18) may not be as prevalent in the AI/AN population could decrease their confidence in the vaccine. In addition, cervical cancer rates are 30% higher among AI/AN women than non-Hispanic white (NHW) women with more advanced disease at diagnosis. Differences in prevalence of high-risk human papillomavirus (HR-HPV) could contribute to this disparity.

Objectives: Explore differences in prevalence estimates of HR-HPV among AI/AN women and other racial/ethnic groups.

Methods: Women presenting for cervical screening in a sentinel network of 26 clinics (STD, family planning, primary care) received Pap and HR-HPV genotyping tests. Prevalence estimates for abnormal Pap tests and detection of HR-HPV DNA were compared (adjusted for potential confounding) between 291 women self-identified as AI/AN and 3717 NHW women.

Results: Although  age- and clinic- adjusted prevalence of HR-HPV among AI/AN was slightly higher than among NHW (29.1%; 95% CI: 23.9%-34.3% versus 25.8%; CI 24.4%-27.2%), the difference was not statistically significant. Furthermore, prevalence of HPV types 16/18 (6.7 %; 95%CI: 3.9-9.6% versus 8.8%; 95%CI: 7.9%-9.7%) and abnormal Pap tests (16%; 95%CI: 11.7%-20.3% versus 14.9%; 95%CI: 13.7%-16%) were  similar for AI/AN and NHW.  HPV16 was the most prevalent HR-HPV type detected in AI/AN and NHW.

Conclusions: No differences in  prevalence of HR-HPV, HPV 16/18 or abnormal Pap tests between AI/AN and NHW women were identified that could explain reports of higher cervical cancer rates in AI/AN.  Similar prevalence of HR-HPV 16/18 among AI/AN and NHW reinforces the importance of providing similar levels of HPV vaccine coverage in both populations and should improve confidence in its use among AI/AN groups.

Implications for Programs, Policy, and/or Research:This supports programs that promote widespread availability of  HPV vaccine to AI/AN women to reduce rates of cervical dysplasia.

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