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Original article
High prevalence of high-risk HPV genotypes other than 16 and 18 in cervical cancers of Curaçao: implications for choice of prophylactic HPV vaccine
  1. Desiree J Hooi1,2,
  2. Birgit I Lissenberg-Witte3,
  3. Maurits N C de Koning4,
  4. Herbert M Pinedo1,
  5. Gemma G Kenter5,
  6. Chris JLM Meijer2,
  7. Wim G Quint4
  1. 1 Fundashon Prevenshon, Willemstad, Curaçao
  2. 2 Department of Pathology, VU University Medical Centre, Amsterdam, the Netherlands
  3. 3 Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
  4. 4 DDL Diagnostic Laboratory, Rijswijk, the Netherlands
  5. 5 Department of Gynaecology and Oncology, VU University Medical Centre, Amsterdam, the Netherlands
  1. Correspondence to Dr Chris JLM Meijer, VUmc Cancer Centre Amsterdam, De Boelelaan, Amsterdam 1118, The Netherlands; cjlm.meijer{at}


Background Curaçao is a Dutch-Caribbean Island located in a high-risk area for cervical cancer.

Prior to introduction of a prophylactic human papillomavirus (HPV) vaccine, knowledge of the prevalence of high-risk HPV vaccine genotypes (HPV16, 18, 31, 33, 45, 52 and 58) in cervical (pre)cancer is required.

Objective To investigate the prevalence of HPV genotypes in invasive cervical cancers (ICC) and cervical intraepithelial neoplasia (CIN) grade 1, 2 and 3 in Curaçao.

Methods Paraffin-embedded blocks of 104 cervical cancers (89 squamous, 15 adenocarcinoma), 41 CIN3, 39 CIN2 and 40 CIN1 lesions were analysed for the presence of HPV. Sections were stained by H&E for histopathological evaluation, and DNA was extracted using proteinase K. HPV genotypes were detected using Short PCR Fragment (SPF10) PCR DNA enzyme immunoassay and a Line Probe Assay (LiPA25) .

Results HPV was found in 92 (88.5%) ICC; 87 (94.6%) had a single HPV infection and 86 (93.5%) were high-risk human papillomavirus (hrHPV)-type positive.

The three most common HPV types in ICC were 16 (38.5%), 18 (13.5%) and 45 (6.7%), covering 58.7%.

HrHPV vaccine genotypes 16, 18, 31, 35, 45, 52 and 58 were responsible for 73.1% of ICC. For precancerous lesions, the HPV attribution was 85.4% for CIN3, 66.7% for CIN2% and 42.5% for CIN1.

Conclusions Our study, the largest in the Caribbean region in (pre)cancer, shows that the prevalence of HPV-type 16 and 18 in cervical cancer is lower compared with the world population but no differences in prevalence of these two HPV types are seen in precancerous lesions.

When considering HPV vaccination in Curaçao, the relatively high contribution of non-HPV 16/18 genotypes in ICC should be taken into account.

  • HPV prevalence
  • HPV genotypes
  • Cervical cancer
  • HPV vaccination
  • Cervical intraepithelial neoplasia(CIN)
  • Curaçao

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Handling editor Jackie A Cassell

  • Contributors Design of the study: Hooi, Witte, Kenter,Meijer, Quint. Data collection: Hooi, Pinedo. HPV detection and genotyping: de Koning, Quint, Hooi. Statistics: Hooi, Witte, Meijer, de Koning, Quint. Writing: Hooi, Meijer, Kenter, Witte, Quint. All authors critically commented on all versions of the manuscript.

  • Funding This work was financially supported by Fundashon Prevenshon grant number 1.

  • Competing interests Desiree J. Hooi, no COI Birgit Lissenberg-Witte: no COI Maurits de Koning: no COI Herbert Micheal Pinedo: no COI Gemma Kenter: no COI Chris J.L.M. Meijer has received speakers fee from GSK, Qiagen, SPMSD/Merck, Roche, Menarini and Seegene, served occasionally on the scientific advisory board (expert meeting) of GSK, Qiagen, SPMSD/Merck., Roche and Genticel and by occasion as consultant for Qiagen and Genticel. He is minority stock holder Self-Screen b.v. , a spin off company of VUMC. Until April 2016 he was minority stock holder of Diassay b.v. Until 2014 he had a small number of certificates of shares in Delphi Biosciences, which went into receivership in 2014. Wim Quint has obtained projects from GSK and Qiagen and is stockholder of DDL Diagnostic Laboratory.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The institutional review board of Fundashon Prevenshon, Curaçao, approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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