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Canadian oncogenic human papillomavirus cervical infection prevalence: Systematic review and meta-analysis

Andrea C Tricco1*, Carmen H Ng2, Vladimir Gilca3, Andrea Anonychuk4, Ba' Pham56 and Shirra Berliner7

Author Affiliations

1 Li Ka Shing Knowledge Institute, St Michael's Hospital, (38 Shuter Street), Toronto, Ontario, (M5B 1T8), Canada

2 School of Population and Public Health, University of British Columbia, (2206 East Mall), Vancouver, British Columbia, (V6T 1Z3), Canada

3 Centre de Recherche du CHUL (CHUQ), l'Université Laval, (2705 boulevard Laurier), Québec, Québec, (G1V 4G2), Canada

4 GlaxoSmithKline Biologicals, (Avenue Fleming 20), Wavre (1300), Belgium

5 Health Policy Management and Evaluation, University of Toronto, (155 College Street), Toronto, Ontario, (M5T 3MT), Canada

6 Toronto Health Economics and Technology Assessment, University of Toronto, (144 College Street), Toronto, Ontario, (M5S 3M2), Canada

7 Department of Epidemiology, University of Western Ontario, (Kresge Building), London, Ontario, (N6A 5C1), Canada

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BMC Infectious Diseases 2011, 11:235  doi:10.1186/1471-2334-11-235

Published: 5 September 2011



Oncogenic human papillomavirus (HPV) infection prevalence is required to determine optimal vaccination strategies. We systematically reviewed the prevalence of oncogenic cervical HPV infection among Canadian females prior to immunization.


We included studies reporting DNA-confirmed oncogenic HPV prevalence estimates among Canadian females identified through searching electronic databases (e.g., MEDLINE) and public health websites. Two independent reviewers screened literature results, abstracted data and appraised study quality. Prevalence estimates were meta-analyzed among routine screening populations, HPV-positive, and by cytology/histology results.


Thirty studies plus 21 companion reports were included after screening 837 citations and 120 full-text articles. Many of the studies did not address non-response bias (74%) or use a representative sampling strategy (53%).

Age-specific prevalence was highest among females aged < 20 years and slowly declined with increasing age. Across all populations, the highest prevalence estimates from the meta-analyses were observed for HPV types 16 (routine screening populations, 8 studies: 8.6% [95% confidence interval 6.5-10.7%]; HPV-infected, 9 studies: 43.5% [28.7-58.2%]; confirmed cervical cancer, 3 studies: 48.8% [34.0-63.6%]) and 18 (routine screening populations, 8 studies: 3.3% [1.5-5.1%]; HPV-infected, 9 studies: 13.6% [6.1-21.1%], confirmed cervical cancer, 4 studies: 17.1% [6.4-27.9%].


Our results support vaccinating females < 20 years of age, along with targeted vaccination of some groups (e.g., under-screened populations). The highest prevalence occurred among HPV types 16 and 18, contributing a combined cervical cancer prevalence of 65.9%. Further cancer protection is expected from cross-protection of non-vaccine HPV types. Poor study quality and heterogeneity suggests that high-quality studies are needed.

human papillomavirus; systematic review; meta-analysis; Bethesda system; cervical cancer