Cervical and vaginal high-grade cancer precursors : age dependence of human papillomavirus genotypes and alternative management strategies

Karoliina Aro

Research output: ThesisDoctoral ThesisCollection of Articles


Nearly all humans acquire a human papillomavirus (HPV) infection during their lifetime. The vast majority of HPV infections regress spontaneously, even the precancerous lesions (intraepithelial neoplasias) of the female genital tract that HPV causes. Precancerous cervical lesions are treated with local excision, because the progressive or regressive nature of an individual lesion remains unknown. These procedures have a 90% initial cure rate but may predispose to preterm birth. Prophylactic HPV vaccines targeting the two most common HPV types in cervical cancer (HPV 16 and 18) have been available for a little over a decade. A near eradication of HPV infections and precancerous lesions has been demonstrated a decade after vaccination in adolescence; however, the full effect of mass vaccination, especially on cancer rates, will only be seen decades later. Characterising the prevaccination era HPV-type distribution can aid the assessment of the effect of vaccinations and refine screening strategies. Our study of 1279 women assessed for abnormal cytology found a distinct, age-related polarisation of HPV types. Histological high-grade cervical disease was diagnosed in 503 women, and two thirds of cases in young women were attributed to HPV16/18, whereas it was only found in one third of women ≥45. Other high-risk types and even HPV negativity were more common than HPV16/18 in the older women. We performed a meta-analysis on the outcomes of untreated cervical intraepithelial neoplasia grade 2 (CIN2). Summary estimates from 36 studies showed the overall regression rate at two years to be 50% and the progression rate 18%. The two-year regression rate was 60% and the progression rate was 11% in a subgroup analysis of women
Original languageEnglish
  • Nieminen, Pekka, Supervisor
  • Jakobsson, Maija, Supervisor
Place of PublicationHelsinki
Print ISBNs978-951-51-5486-6
Electronic ISBNs978-951-51-5487-3
Publication statusPublished - 2019
MoE publication typeG5 Doctoral dissertation (article)

Bibliographical note

M1 - 125 s. + liitteet

Fields of Science

  • Papillomavirus Infections
  • Cervical Intraepithelial Neoplasia
  • Precancerous Conditions
  • Squamous Intraepithelial Lesions
  • Uterine Cervical Neoplasms
  • +prevention & control
  • +therapy
  • Vagina
  • +pathology
  • Imiquimod
  • Mass Vaccination
  • Papillomavirus Vaccines
  • Papillomaviridae
  • +genetics
  • Human papillomavirus 16
  • Human papillomavirus 18
  • DNA Methylation
  • Age Factors
  • Neoplasm Grading
  • Female
  • Laser Therapy
  • Watchful Waiting
  • 3123 Gynaecology and paediatrics

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