Human Papillomavirus Infection in relation to

the Development of Precancerous Cervical

Lesions across Age Groups in Hong Kong
Andre Ma1, Stephanie Yu1, Corey Nelson2, Hebe Law2, Cassandra Lee1
The University of Hong Kong, 2The Chinese University of Hong Kong

Asian Medical Students Association Hong Kong

Outline

1.

Introduction

2. Study Design and Methods

3. Results and Discussion
Limitations
Role of Medical Students
4. Future Directions

Outline

1.

Introduction

2. Study Design and Methods

3. Results and Discussion
Limitations
Role of Medical Students
4. Future Directions

Introduction

Cervical Cancer: 8th most common cancer-related

death in HK women
Sexually transmitted HPV infection is necessary

and preventable cause

Study

of HPV in Hong Kong valuable for

guidelines on screening and vaccination

Intro: Cervical Cytology

Intro (contd)

Previous literature in HK: first large-scale surveys

of lesion development
Data from 1988-1999

Our aim: update and expand previous trends

Data from 2005-2011
Develop timeline of HPV progression

Outline

1.

Introduction

2. Methodology
3. Results and Discussion
Limitations
Role of Medical Students
4. Future Directions

Methodology
Participants Excluded
Total LBC samples (453,460)
Normal
(435,712)
Diagnosed
(17,748)

with

cytology

ASC-US
Undetermined HPV
status (9,038)

Tested for HPV (8,710)

Failed to follow up
(3441)
Followed up after 2 years
(5,269)

Methodology

Lesion development across age groups

Correlation of HPV status and age with lesion

development

Outline

1.

Introduction

2. Study Design and Methods

3. Results and Discussion
Limitations
Role of Medical Students
4. Future Directions

Results and Discussion

Significant chisquared result for all

age groups

Results and Discussion

HPV and LSIL prevalence among
screening population

HPV+
LSIL

HPV and LSIL prevalence are highest in 21-25 y.o. group

Results and Discussion

HSIL prevalence among screening population

HPV and LSIL prevalence are highest in 21-25 y.o. group

HSIL prevalence is highest in 31-35 y.o. group

Results and Discussion

Average number of cervical cancer cases diagnosed per year between 2002 and 2011

HPV and LSIL prevalence are highest in 21-25 y.o. group

HSIL prevalence is highest in 31-35 y.o. group
Cervical cancer incidence peaks in 41-55 y.o. group

Results and Discussion

HPV and LSIL prevalence are highest in 21-25 y.o. group
HSIL prevalence is highest in 31-35 y.o. group
Cervical cancer incidence peaks in 41-55 y.o. group

HPV
infection

<5
years
(Moscicki et
al. 2001)

LSIL

~7-9
years

HSIL

(Schlecht et al.
2003,
Khan et al. 2005)

~10
years
(Holowaty et al.
1999,
Schiffman and
Rodriguez 2008)

Cervical
cancer

Results and Discussion

HSIL prevalence among HPV positive samples in screening population The relative odds of developing HSIL in HPV
positive patients

31-40 y.o. age group has a significantly higher odd of

HPV-related HSIL development

Results and Discussion

HSIL prevalence among different groups
HPV
positive
population
Screening
population

Development of HSIL:
Overall confirmed risk of HSIL from HPV infection
Increased likelihood across all age groups

Results and Discussion

Recommendations based on results:
Education programs:

HPV prevention, targeted at young individuals

HPV screening, targeted at women under 30

Guidelines:

Begin HPV screening as early as 20

More aggressive screening 31-40

Colposcopy and followup, 31-40

Results and Discussion

Subsidize Vaccination as Early as Possible

Outline

1.

Introduction

2. Study Design and Methods

3. Results and Discussion
Limitations
Role of Medical Students
4. Future Directions

Limitations

Sample size
Women <20
Women >60
Limited genotype testing
Prevents individual subtype trend analysis
Other risk factors
Sexual activity patterns, smoking

Outline

1.

Introduction

2. Study Design and Methods

3. Results and Discussions
Limitations
Role of Medical Students
4. Future Directions

Role of Medical Students

Educational
Events

Health
Campaigns

Mass Media
Campaigns
Accurate
public
knowledge
about HPV
infections

Reduce burden
on Hong Kongs
medical costs

Protocols for
infections,
screening &
vaccination

Outline

1.

Introduction

2. Study Design and Methods

3. Results and Discussions
Limitations
Role of Medical Students
4. Future Directions

Future Directions

1. Identify Hong Kong-specific HPV types that are

high risk
2. Investigate consequences of HPV infections in

males
3. Efficacy of providing HPV vaccines to both

genders

Thank you!

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