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Human Papillomavirus Infection in Ulaanbaatar, Mongolia: A Population-Based Study

¹ Research Program Infection and Cancer, German Cancer Research Center; ² Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; ³ International Agency for Research on Cancer, Lyon, France; ⁴ First Maternal House; ⁵ National Cancer Center of Mongolia, Ulaanbaatar, Mongolia; ⁶ Institute of Pathology, Referral Center for Gynecopathology, Mannheim, Germany; and ⁷ Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands

Requests for reprints: Gary M. Clifford, IARC, 150 cours Albert Thomas, 69372 Lyon cedex 08, France. Phone: 33-472-73-84-25; Fax: 33-4-72-73-83-45. E-mail: clifford{at}iarc.fr

Data on human papillomavirus (HPV) and cervical cancer burden in Central Asia are scarce. To investigate HPV infection in Ulaanbaatar, the capital of Mongolia, we obtained cervical cell specimens from a population of 969 women ages 15 to 59 years. DNA of 44 HPV types was detected using a GP5+/6+ PCR-based assay. Seropositivity for L1 proteins of HPV 16, 18, 31, 33, 45, 52, and 58 was assessed using multiplex HPV serology. Cytologic abnormalities were detected in 127 women (13.1%), among whom 6 cervical intraepithelial neoplasia grade 3 and 2 invasive cervical cancers were diagnosed. Overall HPV DNA prevalence was 35.0%, being highest (48.5%) in women ages <25 years. High-risk types were detected in 24.5% of women. HPV DNA prevalence declined with age but remained >25% in all age groups. HPV seroprevalence was also very high (38.0%) and increased steadily from 33.2% to 48.9% in women ages <25 and 50 to 59 years, respectively. However, the proportion of women positive for both HPV markers of any individual HPV type was low. HPV16 was the most frequently detected type by PCR (6.1%), serology (23.0%), or both (2.1%). Lifetime number of sexual partners and induced abortions were shown to be directly associated with HPV DNA and/or seroprevalence. HPV prevalence in Ulaanbaatar was higher than that detected by similar HPV testing protocols in other populations in Asia or elsewhere and would suggest an important, yet unquantified, cervical cancer burden. Improving cervical cancer prevention, through screening and HPV vaccination, is an important public health issue for Mongolia. (Cancer Epidemiol Biomarkers Prev 2008;17(7):1731–8)