HPV prevalence in women with normal cervical cytology HPV type distribution among women with normal cervical cytology, precancerous cer-

4.1.1 HPV prevalence in women with normal cervical cytology

Figure 25: Crude age-specific HPV prevalence and 95 confidence interval in women with normal cervical cytology in Indonesia 20 40 60 25 25−34 35−44 45−54 55−64 65+ Age group years HPV pr e v alence Data updated on 15 Dec 2016 data as of 30 Jun 2015. Data sources: Based on systematic reviews and meta-analysis performed by ICO. The ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Bruni L, J Infect Dis 2010; 202: 1789. 2 De Sanjosé S, Lancet Infect Dis 2007; 7: 453 de Boer MA, Int J Gynecol Cancer 2006; 16: 1809 Figure 26: HPV prevalence among women with normal cervical cytology in Indonesia, by study Study Vet 2008 Tasikmalaya Vet 2008 Bali Vet 2008 Jakarta a de Boer 2006 Jakarta Rachmadi 2012 b Age 12−70 12−70 12−70 21−75 18−60 N 919 887 880 200 101 95 CI 8.8 7.1−10.8 11.5 9.6−13.8 13.9 11.7−16.3 31.0 25.0−37.7 16.8 10.8−25.3 10 20 30 40 Data updated on 15 Dec 2016 data as of 30 Jun 2015. 95 CI: 95 Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens freshfixed biopsies or exfoliated cells. a Women from the general population, including some with cytological cervical abnormalities b Jakarta, Tasikmalaya and Bali Data sources: Based on systematic reviews and meta-analysis performed by ICO. The ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Bruni L, J Infect Dis 2010; 202: 1789. 2 De Sanjosé S, Lancet Infect Dis 2007; 7: 453 de Boer MA, Int J Gynecol Cancer 2006; 16: 1809 | Rachmadi L, Acta Cytol 2012; 56: 171 | Vet JN, Br J Cancer 2008; 99: 214 ICO HPV Information Centre

4.1.2 HPV type distribution among women with normal cervical cytology, precancerous cer-

vical lesions and cervical cancer Table 14: Prevalence of HPV16 and HPV18 by cytology in Indonesia HPV 1618 Prevalence No. tested 95 CI Normal cytology 1 ,2 200 4.0 2.0-7.7 Low-grade lesions 3 - - - High-grade lesions 4 - - - Cervical cancer 5 ,6 230 87.0 82.0-90.7 Data updated on 19 May 2017 data as of 30 Jun 2015 30 Jun 2015. 95 CI: 95 Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; Low-grade lesions: LSIL or CIN-1; The samples for HPV testing come from cervical specimens fresh fixed biopsies or exfoliated cells Data sources: 1Based on systematic reviews and meta-analysis performed by ICO. The ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Bruni L, J Infect Dis 2010; 202: 1789. 2 De Sanjosé S, Lancet Infect Dis 2007; 7: 453 2de Boer MA, Int J Gynecol Cancer 2006; 16: 1809 3Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Clifford GM, Cancer Epidemiol Biomarkers Prev 2005;14:1157 4Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Smith JS, Int J Cancer 2007;121:621 3 Clifford GM, Br J Cancer 2003;89:101. 5Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Li N, Int J Cancer 2011;128:927 3 Smith JS, Int J Cancer 2007;121:621 4 Clifford GM, Br J Cancer 2003;88:63 5 Clifford GM, Br J Cancer 2003;89:101. 6Contributing studies: Bosch FX, J Natl Cancer Inst 1995; 87: 796 | De Boer MA, Int J Cancer 2005; 114: 422 | Schellekens MC, Gynecol Oncol 2004; 93: 49 | Tobing MD, Asian Pac J Cancer Prev 2014; 15: 5781 Figure 27: HPV 16 prevalence among women with normal cervical cytology in Indonesia, by study Study de Boer 2006 N 200 95 CI 2.0 0.8−5.0 10 Data updated on 15 Dec 2016 data as of 30 Jun 2015. 95 CI: 95 Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens freshfixed biopsies or exfoliated cells. Data sources: Based on systematic reviews and meta-analysis performed by ICO. The ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Bruni L, J Infect Dis 2010; 202: 1789. 2 De Sanjosé S, Lancet Infect Dis 2007; 7: 453 de Boer MA, Int J Gynecol Cancer 2006; 16: 1809 Figure 28: HPV 16 prevalence among women with low-grade cervical lesions in Indonesia, by study Study No data available Age N 10 20 30 40 50 60 70 80 90 100 Data updated on 17 Jul 2017 data as of 30 Jun 2015. 95 CI: 95 Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens freshfixed biopsies or exfoliated cells. Data sources: Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Clifford GM, Cancer Epidemiol Biomarkers Prev 2005;14:1157 ICO HPV Information Centre Figure 29: HPV 16 prevalence among women with high-grade cervical lesions in Indonesia, by study Study No data available Age N 10 20 30 40 50 60 70 80 90 100 Data updated on 17 Jul 2017 data as of 30 Jun 2015. 95 CI: 95 Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens freshfixed biopsies or exfoliated cells. Data sources: Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Smith JS, Int J Cancer 2007;121:621 3 Clifford GM, Br J Cancer 2003;89:101. Figure 30: HPV 16 prevalence among women with invasive cervical cancer in Indonesia, by study Study De Boer 2005 Schellekens 2004 Bosch 1995 Tobing 2014 N 74 74 42 40 95 CI 33.8 24.0−45.1 43.2 32.6−54.6 35.7 23.0−50.8 90.0 76.9−96.0 20 30 40 50 60 70 80 90 100 Data updated on 17 Jul 2017 data as of 30 Jun 2015. 95 CI: 95 Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens freshfixed biopsies or exfoliated cells. Data sources: Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Li N, Int J Cancer 2011;128:927 3 Smith JS, Int J Cancer 2007;121:621 4 Clifford GM, Br J Cancer 2003;88:63 5 Clifford GM, Br J Cancer 2003;89:101. Bosch FX, J Natl Cancer Inst 1995; 87: 796 | De Boer MA, Int J Cancer 2005; 114: 422 | Schellekens MC, Gynecol Oncol 2004; 93: 49 | Tobing MD, Asian Pac J Cancer Prev 2014; 15: 5781 ICO HPV Information Centre Figure 31: Comparison of the ten most frequent HPV oncogenic types in Indonesia among women with and without cervical lesions N or mal cyt ologya, b Lo w−gr ade lesionsc High−gr ade lesionsd Cer vical Cancere, f 59 66 39 45 52 53 16 56 18 51 HPV−type 0.5 0.5 0.5 0.5 1.0 1.5 2.0 2.0 2.0 4.5 10th 9th 8th 7th 6th 5th 4th 3rd 2nd 1st HPV−type No data available 10th 9th 8th 7th 6th 5th 4th 3rd 2nd 1st HPV−type No data available 10 20 30 40 50 58 31 39 33 51 35 45 52 18 16 HPV−type 0.6 1.3 1.3 1.3 1.3 1.3 12.2 13.5 40.0 47.0 Prevalence No data available. No more types than shown were tested or were positive. Data updated on 19 May 2017 data as of 30 Jun 2015 30 Jun 2015. High-grade lesions: CIN-2, CIN-3, CIS or HSIL; Low-grade lesions: LSIL or CIN-1; The samples for HPV testing come from cervical specimens fresh fixed biopsies or exfoliated cells. Data sources: a Based on systematic reviews and meta-analysis performed by ICO. The ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Bruni L, J Infect Dis 2010; 202: 1789. 2 De Sanjosé S, Lancet Infect Dis 2007; 7: 453 b de Boer MA, Int J Gynecol Cancer 2006; 16: 1809 c Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Clifford GM, Cancer Epidemiol Biomarkers Prev 2005;14:1157 d Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Smith JS, Int J Cancer 2007;121:621 3 Clifford GM, Br J Cancer 2003;89:101. e Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Li N, Int J Cancer 2011;128:927 3 Smith JS, Int J Cancer 2007;121:621 4 Clifford GM, Br J Cancer 2003;88:63 5 Clifford GM, Br J Cancer 2003;89:101. Continued on next page ICO HPV Information Centre Figure 31 – continued from previous page f Contributing studies: Bosch FX, J Natl Cancer Inst 1995; 87: 796 | De Boer MA, Int J Cancer 2005; 114: 422 | Schellekens MC, Gynecol Oncol 2004; 93: 49 | Tobing MD, Asian Pac J Cancer Prev 2014; 15: 5781 Figure 32: Comparison of the ten most frequent HPV oncogenic types in Indonesia among women with invasive cervical cancer by histology Cer vical Cancer Squamous cell car cinoma A denocar cinoma U nespecif ied 58 31 39 33 51 35 45 52 18 16 HPV−type 0.6 1.3 1.3 1.3 1.3 1.3 12.2 13.5 40.0 47.0 10th 35 33 56 39 31 45 52 18 16 HPV−type 0.8 1.5 1.5 2.3 3.0 6.1 9.1 25.0 50.8 10th 9th 8th 7th 58 59 45 52 16 18 HPV−type 3.4 3.4 5.2 12.1 19.0 67.2 10 20 30 40 50 60 70 10th 9th 8th 35 33 51 52 45 18 16 HPV−type 2.5 2.5 5.0 30.0 32.5 42.1 53.5 Prevalence No data available. No more types than shown were tested or were positive. Data updated on 19 May 2017 data as of 30 Jun 2015. The samples for HPV testing come from cervical specimens fresh fixed biopsies or exfoliated cells. The ranking of the ten most frequent HPV types may present less than ten types beause only a limited number of types were tested or were HPV-positive. Data sources: Continued on next page ICO HPV Information Centre Figure 32 – continued from previous page Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Li N, Int J Cancer 2011;128:927 3 Smith JS, Int J Cancer 2007;121:621 4 Clifford GM, Br J Cancer 2003;88:63 5 Clifford GM, Br J Cancer 2003;89:101. Contributing studies: Bosch FX, J Natl Cancer Inst 1995; 87: 796 | De Boer MA, Int J Cancer 2005; 114: 422 | Schellekens MC, Gynecol Oncol 2004; 93: 49 | Tobing MD, Asian Pac J Cancer Prev 2014; 15: 5781 ICO HPV Information Centre Table 15: Type-specific HPV prevalence in women with normal cervical cytology, precancerous cervical lesions and invasive cervical cancer in Indonesia Normal cytology 1 ,2 Low-grade lesions 3 High-grade lesions 4 Cervical cancer 5 ,6 HPV Type No. HPV Prev No. HPV Prev No. HPV Prev No. HPV Prev tested 95 CI tested 95 CI tested 95 CI tested 95 CI ONCOGENIC HPV TYPES High-risk HPV types 16 200 2.0 0.8-5.0 - - - - 230 47.0 40.6-53.4 18 200 2.0 0.8-5.0 - - - - 230 40.0 33.9-46.4 31 200 0.0 0.0-1.9 - - - - 156 1.3 0.4-4.6 33 200 0.0 0.0-1.9 - - - - 156 1.3 0.4-4.6 35 200 0.0 0.0-1.9 - - - - 156 1.3 0.4-4.6 39 200 0.5 0.1-2.8 - - - - 156 1.3 0.4-4.6 45 200 0.5 0.1-2.8 - - - - 156 12.2 7.9-18.2 51 200 4.5 2.4-8.3 - - - - 156 1.3 0.4-4.6 52 200 1.0 0.3-3.6 - - - - 156 13.5 9.0-19.7 56 200 2.0 0.8-5.0 - - - - 156 0.6 0.1-3.5 58 200 0.0 0.0-1.9 - - - - 156 0.6 0.1-3.5 59 200 0.5 0.1-2.8 - - - - 156 0.0 0.0-2.4 Probablepossible carcinogen 26 - - - - - - 82 0.0 0.0-4.5 30 - - - - - - - - 34 200 0.0 0.0-1.9 - - - - 114 0.0 0.0-3.3 53 200 1.5 0.5-4.3 - - - - 156 0.0 0.0-2.4 66 200 0.5 0.1-2.8 - - - - 156 0.0 0.0-2.4 67 - - - - - - 40 0.0 0.0-8.8 68 200 0.0 0.0-1.9 - - - - 156 0.0 0.0-2.4 69 - - - - - - 40 0.0 0.0-8.8 70 200 0.0 0.0-1.9 - - - - 156 0.0 0.0-2.4 73 - - - - - - 82 0.0 0.0-4.5 82 - - - - - - 82 0.0 0.0-4.5 85 - - - - - - - - 97 - - - - - - - - NON-ONCOGENIC HPV TYPES 6 200 1.0 0.3-3.6 - - - - 156 0.0 0.0-2.4 11 200 0.0 0.0-1.9 - - - - 156 0.6 0.1-3.5 32 - - - - - - - - 40 200 0.5 0.1-2.8 - - - - 114 0.0 0.0-3.3 42 200 0.0 0.0-1.9 - - - - 114 0.0 0.0-3.3 43 200 1.0 0.3-3.6 - - - - 74 0.0 0.0-4.9 44 200 2.0 0.8-5.0 - - - - 114 0.0 0.0-3.3 54 200 2.0 0.8-5.0 - - - - 114 0.0 0.0-3.3 55 - - - - - - - - 57 - - - - - - - - 61 - - - - - - 40 2.5 0.4-12.9 62 - - - - - - 40 0.0 0.0-8.8 64 - - - - - - - - 71 - - - - - - 40 0.0 0.0-8.8 72 - - - - - - 40 0.0 0.0-8.8 74 200 2.5 1.1-5.7 - - - - 74 0.0 0.0-4.9 81 - - - - - - 40 0.0 0.0-8.8 83 - - - - - - 40 0.0 0.0-8.8 84 - - - - - - 40 0.0 0.0-8.8 86 - - - - - - - - 87 - - - - - - - - 89 - - - - - - - - 90 - - - - - - - - 91 - - - - - - - - Data updated on 19 May 2017 data as of 30 Jun 2015 30 Jun 2015. 95 CI: 95 Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; Low-grade lesions: LSIL or CIN-1; The samples for HPV testing come from cervical specimens fresh fixed biopsies or exfoliated cells. Data sources: 1Based on systematic reviews and meta-analysis performed by ICO. The ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Bruni L, J Infect Dis 2010; 202: 1789. 2 De Sanjosé S, Lancet Infect Dis 2007; 7: 453 2de Boer MA, Int J Gynecol Cancer 2006; 16: 1809 3Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Clifford GM, Cancer Epidemiol Biomarkers Prev 2005;14:1157 4Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2015. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Smith JS, Int J Cancer 2007;121:621 3 Clifford GM, Br J Cancer 2003;89:101. Continued on next page ICO HPV Information Centre Table 15 – continued from previous page 5Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Li N, Int J Cancer 2011;128:927 3 Smith JS, Int J Cancer 2007;121:621 4 Clifford GM, Br J Cancer 2003;88:63 5 Clifford GM, Br J Cancer 2003;89:101. 6Contributing studies: Bosch FX, J Natl Cancer Inst 1995; 87: 796 | De Boer MA, Int J Cancer 2005; 114: 422 | Schellekens MC, Gynecol Oncol 2004; 93: 49 | Tobing MD, Asian Pac J Cancer Prev 2014; 15: 5781 ICO HPV Information Centre Table 16: Type-specific HPV prevalence among invasive cervical cancer cases in Indonesia by histology Any Histology Squamous cell carcinoma Adenocarcinoma Unespecified HPV Type No. HPV Prev No. HPV Prev No. HPV Prev No. HPV Prev tested 95 CI tested 95 CI tested 95 CI tested 95 CI ONCOGENIC HPV TYPES High-risk HPV types 16 230 47.0 40.6-53.4 132 50.8 42.3-59.1 58 19.0 10.9-30.9 114 53.5 44.4-62.4 18 230 40.0 33.9-46.4 132 25.0 18.4-33.0 58 67.2 54.4-77.9 114 42.1 33.4-51.3 31 156 1.3 0.4-4.6 132 3.0 1.2-7.5 58 0.0 0.0-6.2 40 0.0 0.0-8.8 33 156 1.3 0.4-4.6 132 1.5 0.4-5.4 58 0.0 0.0-6.2 40 2.5 0.4-12.9 35 156 1.3 0.4-4.6 132 0.8 0.1-4.2 58 0.0 0.0-6.2 40 2.5 0.4-12.9 39 156 1.3 0.4-4.6 132 2.3 0.8-6.5 58 0.0 0.0-6.2 40 0.0 0.0-8.8 45 156 12.2 7.9-18.2 132 6.1 3.1-11.5 58 5.2 1.8-14.1 40 32.5 20.1-48.0 51 156 1.3 0.4-4.6 132 0.0 0.0-2.8 58 0.0 0.0-6.2 40 5.0 1.4-16.5 52 156 13.5 9.0-19.7 132 9.1 5.3-15.2 58 12.1 6.0-22.9 40 30.0 18.1-45.4 56 156 0.6 0.1-3.5 132 1.5 0.4-5.4 58 0.0 0.0-6.2 40 0.0 0.0-8.8 58 156 0.6 0.1-3.5 132 0.0 0.0-2.8 58 3.4 1.0-11.7 40 0.0 0.0-8.8 59 156 0.0 0.0-2.4 132 0.0 0.0-2.8 58 3.4 1.0-11.7 40 0.0 0.0-8.8 Probablepossible carcinogen 26 82 0.0 0.0-4.5 - - - - - - 30 - - - - - - - - 34 114 0.0 0.0-3.3 90 0.0 0.0-4.1 58 0.0 0.0-6.2 40 0.0 0.0-8.8 53 156 0.0 0.0-2.4 - - - - - - 66 156 0.0 0.0-2.4 132 0.0 0.0-2.8 58 0.0 0.0-6.2 40 0.0 0.0-8.8 67 40 0.0 0.0-8.8 - - - - 40 0.0 0.0-8.8 68 156 0.0 0.0-2.4 132 0.0 0.0-2.8 58 0.0 0.0-6.2 40 0.0 0.0-8.8 69 40 0.0 0.0-8.8 - - - - - - 70 156 0.0 0.0-2.4 - - - - - - 73 82 0.0 0.0-4.5 - - - - - - 82 82 0.0 0.0-4.5 42 0.0 0.0-8.4 - - 40 0.0 0.0-8.8 85 - - - - - - - - 97 - - - - - - - - NON-ONCOGENIC HPV TYPES 6 156 0.0 0.0-2.4 - - - - - - 11 156 0.6 0.1-3.5 - - - - - - 27 - - - - - - - - 32 - - - - - - - - 40 114 0.0 0.0-3.3 - - - - - - 42 114 0.0 0.0-3.3 90 0.0 0.0-4.1 58 0.0 0.0-6.2 40 0.0 0.0-8.8 43 74 0.0 0.0-4.9 - - - - - - 44 114 0.0 0.0-3.3 90 0.0 0.0-4.1 58 0.0 0.0-6.2 40 0.0 0.0-8.8 54 114 0.0 0.0-3.3 - - - - - - 55 - - - - - - - - 57 - - - - - - - - 60 - - - - - - - - 61 40 2.5 0.4-12.9 - - - - - - 62 40 0.0 0.0-8.8 - - - - - - 64 - - - - - - - - 71 40 0.0 0.0-8.8 - - - - - - 72 40 0.0 0.0-8.8 - - - - - - 74 74 0.0 0.0-4.9 - - - - - - 76 - - - - - - - - 81 40 0.0 0.0-8.8 - - - - - - 83 40 0.0 0.0-8.8 - - - - - - 84 40 0.0 0.0-8.8 - - - - - - 86 - - - - - - - - 87 - - - - - - - - 89 - - - - - - - - 90 - - - - - - - - 91 - - - - - - - - No Data Available - - - - - - - - - - - - Data updated on 19 May 2017 data as of 30 Jun 2015. 95 CI: 95 Confidence Interval; The samples for HPV testing come from cervical specimens fresh fixed biopsies or exfoliated cells. Data sources: Based on meta-analysis performed by IARC’s Infections and Cancer Epidemiology Group up to November 2011, the ICO HPV Information Centre has updated data until June 2014. Reference publications: 1 Guan P, Int J Cancer 2012;131:2349 2 Li N, Int J Cancer 2011;128:927 3 Smith JS, Int J Cancer 2007;121:621 4 Clifford GM, Br J Cancer 2003;88:63 5 Clifford GM, Br J Cancer 2003;89:101. Contributing studies: Bosch FX, J Natl Cancer Inst 1995; 87: 796 | De Boer MA, Int J Cancer 2005; 114: 422 | Schellekens MC, Gynecol Oncol 2004; 93: 49 | Tobing MD, Asian Pac J Cancer Prev 2014; 15: 5781 Continued on next page ICO HPV Information Centre Table 16 – continued from previous page ICO HPV Information Centre 4.1.3 HPV type distribution among HIV+ women with normal cervical cytology