{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T05:58:53Z","timestamp":1773295133176,"version":"3.50.1"},"reference-count":39,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013609","name":"EEA Grants\/Norway Grants","doi-asserted-by":"publisher","award":["Grant EMP416"],"award-info":[{"award-number":["Grant EMP416"]}],"id":[{"id":"10.13039\/501100013609","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,5,16]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe age-specific and type-specific carcinogenic human papillomavirus (HPV) prevalence prior to large-scale effect of HPV vaccines in Estonia and to analyse the risk factors associated with carcinogenic HPV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study using self-administered questionnaire and self-collected vaginal swabs for detection of HPV infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Estonian Biobank database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Stratified random sample of women aged 30\u201333, 57\u201360 and 67\u201370 years living in one of the three largest counties in Estonia. Of 3065\u2009women approached, 1347 (43.9%) returned questionnaires and specimens for HPV DNA detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>HPV prevalence and fully adjusted ORs with 95% CIs for risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HPV prevalence was highest among women aged 30\u201333 years (18.7%; 95%\u2009CI 15.8 to 21.9) followed by those aged 67\u201370 years (16.7%; 95%\u2009CI 12.4 to 22.0) and 57\u201360 years (10.2%; 95%\u2009CI 7.8 to 13.3). HPV16 and HPV56 were the most common among women aged 30\u201333 years (both 4.0%; 95%\u2009CI 2.7 to 5.9), and HPV68 was the most common among women aged 57\u201360 years (2.8%; 95%\u2009CI 1.5 to 4.7) and 67\u201370 years (6.4%; 95%\u2009CI 3.6 to 10.4). Vaccination with nonavalent vaccine would have halved the carcinogenic HPV prevalence among women aged 30\u201333 years. The odds of infection with carcinogenic HPV were higher among women with six or more sexual partners among younger (OR 2.99; 95%\u2009CI 1.54 to 5.81) and older (OR 3.80; 95%\u2009CI 1.25 to 11.55)\u2009women and lower (OR 0.35; 95%\u2009CI 0.17 to 0.72) among younger married women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrated U-shaped age-specific genotype profile of carcinogenic HPV prevalence, indicating that public health providers should focus on developing exit strategies for the cervical cancer screening programme in Estonia with a possible extension of HPV testing beyond the current screening age of 65 years. Generalisability of the findings of this study may be affected by the low response rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-069558","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T10:37:10Z","timestamp":1685615830000},"page":"e069558","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Age-specific and genotype-specific carcinogenic human papillomavirus prevalence in a country with a high cervical cancer burden: results of a cross-sectional study in Estonia"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7677-9493","authenticated-orcid":false,"given":"Kersti","family":"P\u00e4rna","sequence":"first","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari","family":"Nyg\u00e5rd","sequence":"additional","affiliation":[{"name":"Department of Research, Cancer Registry of Norway, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Tisler","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolin","family":"Toompere","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Naaber","sequence":"additional","affiliation":[{"name":"SYNLAB Estonia, Tallinn, Estonia"},{"name":"Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaspar","family":"Ratnik","sequence":"additional","affiliation":[{"name":"SYNLAB Estonia, Tallinn, Estonia"},{"name":"Department of Human Genetics, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anda","family":"\u0136\u012bv\u012bte Urt\u0101ne","sequence":"additional","affiliation":[{"name":"Institute of Public Health, R\u012bga Stradi\u0146\u0161 University, R\u012bga, Latvia"},{"name":"Department of Public Health and Epidemiology, R\u012bga Stradi\u0146\u0161 University, R\u012bga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana","family":"Zodzika","sequence":"additional","affiliation":[{"name":"Institute of Public Health, R\u012bga Stradi\u0146\u0161 University, R\u012bga, Latvia"},{"name":"Department of Obstetrics and Gynaecology, R\u012bga Stradi\u0146\u0161 University, R\u012bga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mindaugas","family":"Stank\u016bnas","sequence":"additional","affiliation":[{"name":"Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Baltzer","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4036-3856","authenticated-orcid":false,"given":"Anneli","family":"Uusk\u00fcla","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,1]]},"reference":[{"key":"2025121411354051000_13.6.e069558.1","unstructured":"IARC working group on the evaluation of Cancerogenic risks to human. 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