# Distribution of Human Papillomavirus Genotypes in Real‐World Cervical Self‐Collected Scrapings From the Dutch Cervical Cancer Screening Program

## TL;DR

This study analyzes HPV genotype distribution in cervical samples from Dutch women to assess vaccine coverage and effectiveness in preventing cervical cancer and lesions.

## Contribution

The study provides updated prevalence data of hrHPV genotypes in a non-vaccinated cohort, emphasizing the importance of broader vaccine coverage.

## Key findings

- HPV16 was the most common genotype (33%), followed by HPV31 and HPV52.
- 9vHPV genotypes were present in all cervical cancer cases and most high-grade lesions.
- Non-9vHPV genotypes were prevalent in 19% of cases, mostly in low-grade lesions.

## Abstract

High‐risk HPV (hrHPV) is the necessary cause of cervical cancer with HPV16/18 accounting for around 70% of the cases worldwide, while other non‐HPV16/18 hrHPV genotypes prevail in ~95% of high‐grade lesions. Understanding regional genotype distribution of hrHPV types not covered by the nonavalent vaccine is crucial for evaluating vaccine effectiveness and enhancing population‐based screening (PBS). The objective of the present study is to update hrHPV genotype prevalence in a non‐vaccinated cohort of 1200 hrHPV‐positive women from the Dutch PBS using INNO‐LiPA HPV Genotyping Extra‐II to identify 32 individual HPV genotypes in self‐sampled material. HrHPV prevalence for all 32 genotypes, also grouped by bivalent, quadrivalent, and nonavalent vaccine types (2vHPV, 4vHPV, and 9vHPV), was reported by histologic diagnosis and age. The most common genotypes were HPV16 (394,33%), especially in younger women, followed by HPV31 (216,18%) and HPV52 (199,17%). 2vHPV genotypes were found in 23% (n = 90) of NILM cases, 27% (n = 84) of CIN0/CIN1, 45% (n = 74) of CIN2, 71% (n = 219) of CIN3, and 92% (n = 12) of cervical cancers. In comparison, 9vHPV genotypes appeared in 60% (n = 240) of NILM, 69% (n = 218) of CIN0/CIN1, 88% (n = 145) of CIN2, 94% (n = 289) of CIN3, and all cervical cancers (n = 13). HrHPV types not included in 9vHPV had an overall prevalence of 19% (n = 225), with 88% (197/225) found in NILM or CIN0/CIN1. This study highlights vaccine‐type HPV in all cancer cases and many high‐grade lesions, reinforcing the need for improved vaccination efforts and broader protection.