Risk factors and human papillomavirus genotypes: Investigating their interplay in cervical cancer

Abstract

Introduction: Cervical cancer continues to pose a substantial worldwide health challenge, primarily linked to human papillomavirus (HPV) infection. In regions like Indonesia, understanding local genotype distribution is critical for refining screening and vaccination efforts.

Objective: This research explores the complex relationship between various risk factors and the types of HPV detected in cervical cancer patients at a national referral center in Indonesia.

Methods: Ninety-one women diagnosed with cervical cancer were recruited for this cross-sectional study at Cipto Mangunkusumo National Hospital, Jakarta-the top-tier referral facility in Indonesia. This setting provides a diverse patient demographic representing various geographical regions across the archipelago. Cervical swabs were collected for HPV genotyping using dot blot hybridization. Various clinical risk factors, including age, age at marriage, age at first pregnancy, parity, smoking habits, hormonal contraceptive history, and the stage of cervical cancer diagnosis, were assessed. Statistical analysis was conducted using Fisher’s exact test to accommodate the distribution of the data.

Results: High-risk (HR) HPV was detected in 62.6% of participants. HPV type 18 was the most prevalent (15.4%), followed by types 52 (14.3%) and 16 (12.1%). Statistically significant associations were observed between HR-HPV presence and both early age at marriage (p = 0.004) and the use of hormonal contraception (p = 0.002). No significant correlations were observed between some patient characteristics (age, parity, and smoking habits) and HPV genotypes (p > 0.05). A total of 35.2% of samples were HPV-negative, potentially reflecting technical challenges or viral integration in advanced-stage cases.

Conclusion: These findings suggest that early marriage and hormonal contraceptive use are significant clinical markers for HR-HPV in this Indonesian population. The dominance of HPV 18 and 52 highlights the need for locally relevant diagnostic tools and the potential transition to nonavalent vaccines. These data are essential for developing locally relevant diagnostic tools and optimizing cervical cancer prevention strategies tailored to the Indonesian demographic.

Keywords

Cervical cancer / HPV genotypes / Hormonal contraception / Age at marriage / Indonesia

Acknowledgements

The authors would like to thank the Center for Biomedical Research, Organization for Health, National Research and Innovation (BRIN), and the Biomolecular Laboratory, Faculty of Medicine, Universitas Trisakti, for supporting this research.

Funding

This research was supported by the RIIM LPDP Grant and BRIN (grant number 51/IV/KS/06/2022).

Conflict of interest

The authors declare they have no competing interests.

Author contributions

Conceptualization: Raditya Wratsangka, Monica D. Hartanti

Formal analysis: Raditya Wratsangka, Monica D. Hartanti, Lily M. Surjadi

Investigation: Monica D. Hartanti, Gatot Purwoto, Miranti P. Aulia, Alvionita Kogoya

Methodology: Monica D. Hartanti, Gatot Purwoto, Miranti P. Aulia

Writing–original draft: Raditya Wratsangka, Monica D. Hartanti, Miranti P. Aulia

Writing–review & editing: All authors

Ethics approval and consent to participate

This study was approved by the ethical clearance committee of the Faculty of Medicine, Universitas Indonesia, with ethical clearance number KET-1262/UN2.F1/ETIK/PPM.00.02/2022.

Consent for publication

Written informed consent was obtained from participants before enrolment. Written informed consent was obtained from all participants for the publication of this study. All data have been anonymized to ensure participant confidentiality.

Availability of data

All data generated or analyzed during this study are included in this published article.

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