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Risk Factors for High-Risk Human Papillomavirus Infection and Cofactors for High-Grade Cervical Disease in Peru
  1. Maribel Almonte, PhD*,
  2. Catterina Ferreccio, MD,
  3. Miguel Gonzales, MD,§,
  4. Jose Manuel Delgado, MPH§,
  5. C. Hilary Buckley, FRCPath,
  6. Silvana Luciani, MHSc§,
  7. Sylvia C. Robles, MD§,
  8. Jennifer L. Winkler, MPH#,
  9. Vivien D. Tsu, PhD#,
  10. Jose Jeronimo, MD#,
  11. Jack Cuzick, PhD* and
  12. Peter Sasieni, PhD*
  1. * Centre for Cancer Prevention, Queen Mary University of London Wolfson Institute of Preventive Medicine, London, UK;
  2. Pontificia Universidad Católica de Chile, Santiago, Chile;
  3. Dirección Regional de Salud (DIRES) San Martin, Tarapoto, Peru;
  4. § Pan American Health Organization, Washington DC;
  5. Universidad Nacional de San Martin, Tarapoto, Peru;
  6. Department of Pathology, St Mary’s Hospital, Manchester, UK; and
  7. # PATH, Seattle, WA.
  1. Address correspondence and reprint requests to Maribel Almonte, PhD, Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ. E-mail: m.almonte{at}


Objective To evaluate the association between potential risk factors for high-risk human papillomavirus (HR-HPV) infection and cofactors for cervical intraepithelial lesions grade 2 or worse (CIN2+) in women attending cervical screening in Amazonian Peru.

Materials and Methods Participants completed a risk factor questionnaire before screening. High-risk human papillomavirus infection was determined by Hybrid Capture II. Logistic regression was used to evaluate associations between potential risk factors for HR-HPV infection and between cofactors and risk of CIN2+ among women with HR-HPV infection.

Results Screening and questionnaires were completed by 5435 women aged 25 to 49 years. The prevalence of HR-HPV was 12.6% (95% confidence interval [CI], 11.8%–13.6%) and decreased by age. Early age at first sexual intercourse and several lifetime sexual partners increased the risk of having HR-HPV (age-adjusted odds ratio [AOR] of age at first sexual intercourse <18 vs ≥20, 1.5; 95% CI, 1.2–2.0; AOR of ≥5 lifetime sexual partners vs 1, 2.1; 95% CI, 1.4–3.2). Among women with HR-HPV infection, those with no schooling (AOR relative to 1–5 years of schooling, 3.2; 95% CI, 1.3–8.3) and those with parity ≥3 (AOR relative to parity <3, 2.6; 95% CI, 1.4–4.9) were at increased risk of CIN2+. The effect of parity was stronger for cancer (AOR of parity ≥3 vs <3, 8.3; 95% CI, 1.0–65.6). Further analysis showed that the association between parity and CIN2+ was restricted to women younger than 40. Most women (83%) had previously been screened. Sixty-four percent of CIN2+ cases detected in this study occurred in women who reported having had a Papanicolaou test in the previous 3 years. Only 4 of 20 cancers were detected in women never screened before. Having had a previous abnormal Papanicolaou test increased the risk of CIN2+ (OR, 16.1; 95% CI, 6.2–41.9).

Conclusion Among women with HR-HPV, high parity (in young women), no schooling, lack of good-quality screening and of adequate follow-up care are the main risk factors for high-grade cervical disease in Peru.

  • Human papillomavirus
  • Cervical cancer
  • Cervical screening
  • Risk factors

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