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Master thesis defence 6th June 2013

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Kim Brogaard

on 3 May 2015

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Transcript of Master thesis defence 6th June 2013

A study within the HPV cohort
Detection of high risk genital human papillomavirus (HPV) among HPV negative older and younger women after 7 years of follow-up
Kim Agerholm Brogaard
Master's Thesis Defence 6th June 2013
Academic Advisor: Susanne Krüger Kjaer

The prevalence of HPV is highest in the period after sexual onset after which it gradually decreases.

Studies have observed an increase in the prevalence of HPV infections in older women, the so-called ”second peak”.

The knowledge about risk factors for detection of HPV infections in older women is sparse.
Aim and Objectives
To estimate the occurrence of women testing high risk HPV DNA positive among initially HPV negative women.

To examine the risk factors that influence the detection of high risk HPV infections in older women in Denmark.

For comparison we report results from a younger cohort of women from whom data were collected in the same time period and study setting as the older women.
Material and Methods
Based on the HPV cohort study - a Danish population-based prospective cohort study.

Randomly selected women from the Copenhagen area.

Underwent a structured interview, had a Pap smear taken and cervical cells obtained for HPV DNA testing.

Baseline defined as older women aged 40-50 years and younger women aged 22-32 years tested HR HPV negative in October 1993 - January 1995.

The women were re-examined approximately 7 years later in November 2001 - June 2002.
HR HPV negative
n = 922
n = 59
n = 863
Material and Methods
The highest incidence was observed among the younger women with decreasing incidence rates with age.
(22 years 19.8%; 95% CI: 12.0 – 27.6)
(31 years 9.8%; 95% CI: 3.9 – 6.8)

Among the older women the HR HPV incidence showed little variations across age groups.
(40-41 years 6.7%; 95% CI: 2.9 – 10.6)
HR HPV negative
n = 2,057
n = 8,656
n = 207
n = 1,850
Younger cohort
Older cohort
Highlights from the design of the study
Material and Methods

Potential risk factors were examined individually in an age-adjusted logistic regression model.

Associations are presented as odds ratios (OR) with 95% confidence intervals (CI).
The role of sexual behavior
Menopausal women
The role of sexual behavior
No increase in the incidence of genital HR HPV among older Danish women observed

The risk of detecting a HR HPV infection among older women is strongly related to lifetime number of sexual partner

However, recent sexual behavior also seems to play a role.

In young women both recent and lifetime number of partners were important predictors of the risk of testing HR HPV positive

A tendency towards an increased risk of detection of HR HPV infections in relation to menopause
The absence of a "second peak" may partly be explained by the presence of cervical cancer screening with a high coverage rate in Denmark.

Reactivation of latent HPV infections may occur among women around menopause, maybe because of weakened immune response.

Further studies are needed to estimate the absolute risk of developing cervical abnormalities caused by newly detected HR HPV infections among older women.
Random sample
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