Association of HPV35 with cervical carcinogenesis among women of African ancestry: Evidence of viral-host interaction with implications for disease intervention

Maisa Pinheiro, Julia C. Gage, Gary M. Clifford, Maria Demarco, Li C. Cheung, Zigui Chen, Meredith Yeager, Michael Cullen, Joseph F. Boland, Xiaojian Chen, Tina Raine-Bennett, Mia Steinberg, Sara Bass, Brian Befano, Yanzi Xiao, Vanessa Tenet, Joan Walker, Rosemary Zuna, Nancy E. Poitras, Michael A. GoldTerence Dunn, Kai Yu, Bin Zhu, Laurie Burdett, Sevilay Turan, Thomas Lorey, Philip E. Castle, Nicolas Wentzensen, Robert D. Burk, Mark Schiffman, Lisa Mirabello

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


HPV35 has been found in only ∼2% of invasive cervical cancers (ICC) worldwide but up to 10% in Sub-Saharan Africa, warranting further investigation and consideration of impact on preventive strategies. We studied HPV35 and ethnicity, in relation to the known steps in cervical carcinogenesis, using multiple large epidemiologic studies in the U.S. and internationally. Combining five U.S. studies, we measured HPV35 positivity and, in Northern California, observed HPV35 type-specific population prevalence and estimated 5-year risk of developing precancer when HPV35-positive. HPV35 genetic variation was examined for differences in carcinogenicity in 1053 HPV35+ cervical specimens from a U.S. cohort and an international collection. African-American women had more HPV35 (12.1% vs 5.1%, P '.001) and more HPV35-associated precancers (7.4% vs 2.1%, P '.001) compared to other ethnicities. Precancer risks after HPV35 infection did not vary by ethnicity (global P =.52). The HPV35 A2 sublineage showed an increased association with precancer/cancer in African-Americans (OR = 5.6 vs A1, 95% CI = 1.3-24.8) and A2 was more prevalent among ICC in Africa than other world regions (41.9% vs 10.4%, P '.01). Our analyses support a strong link between HPV35 and cervical carcinogenesis in women of African ancestry. Current HPV vaccines cover the majority of cervical precancer/cancer across all ethnic groups; additional analyses are required to determine whether the addition of HPV35 to the already highly effective nine-valent HPV vaccine would provide better protection for women in Africa or of African ancestry.

Original languageEnglish (US)
Pages (from-to)2677-2686
Number of pages10
JournalInternational Journal of Cancer
Issue number10
StatePublished - Nov 15 2020


  • African ancestry women
  • HPV35
  • cervical cancer
  • epidemiology
  • genetics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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