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Causal attribution of human papillomavirus genotypes to invasive cervical cancer worldwide: a systematic analysis of the global literature
Abstract
Background Understanding the proportion of invasive cervical cancer (ICC) caused by different human papillomavirus (HPV) genotypes can inform primary (ie, vaccination) and secondary (ie, screening) prevention efforts that target specific HPV genotypes. However, using the global literature to estimate population attributable fractions (AFs) requires a methodological framework to address HPV genotype-specific causality from aggregated data. We aimed to estimate the proportion of ICC caused by different HPV genotypes at the global, regional, and national level. Methods This systematic review identified studies reporting HPV genotype-specific prevalence in ICC or people with normal cervical cytology. We searched PubMed, Embase, Scopus, and Web of Science up to Feb 29, 2024, using the search terms "cervix" and "HPV", with no language restrictions. Odds ratios (ORs) were estimated by comparing HPV genotype-specific prevalence between HPV-positive ICC and normal cervical cytology with logistic regression models, adjusting for region, year of paper publication, and HPV primer or test. HPV genotypes with a lower bound to the 95% CI of the OR greater than 1·0 were judged as causal to ICC. Corresponding regional genotype-specific AFs were calculated as regional HPV prevalence in ICC multiplied by (1 - [1 / OR]) and were proportionally adjusted to total 100%. Global AFs were calculated from regional AFs weighted by number of regional ICC cases in 2022 (GLOBOCAN). Findings The systematic…
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Metadata
- Authors
- Wei, F., Georges, D., Man, I., Baussano, I., & Clifford, G. M.
- Affiliations
- Centre international de recherche sur le cancer (FR)
- Corresponding author
- Clifford, Gary M
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2024-08
- Volume
- 404
- Issue
- 10451
- Pages
- 435-444
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W4401206220
- Cited by
- 317
- References
- 28
- Citations by year
- 2026: 158 · 2025: 144 · 2024: 15
- FWCI
- 96.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- European Union
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
- Health Sciences › Medicine › Surgery › Genital Health and Disease
- Keywords
- human papillomavirus, HPV genotypes, invasive cervical cancer, population attributable fraction, causal attribution, HPV16, HPV 18, HPV45, HPV 33, HPV58, HPV 31, HPV52, HPV51, HPV35, HPV 59, HPV39, HPV 56, HPV73
- MeSH terms
- Human Papillomavirus Viruses, Uterine Cervical Neoplasms, Female, Genotype, Humans, Global Health, Prevalence, Papillomaviridae, Papillomavirus Infections
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