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Detection of Human Papillomavirus Infection of the Cervix in Very Elderly Women Using PCR

Authors' Affiliations: ¹ Human Tissue Research Group, Tokyo Metropolitan Institute of Gerontology; ² Department of Pathology, Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan; ³ Department of Pathology, Sekishinkai Sayama Hospital, Saitama-ken, Japan; and ⁴ Department of Histopathology and Cytopathology, School of Health Science, Faculty of Medicine, Gunma University; ⁵ Department of Tumor Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan

Requests for reprints: Kaiyo Takubo, Human Tissue Research Group, Tokyo Metropolitan Institute of Gerontology, Sakaecho 35-2, Itabashi-ku, Tokyo 173-0015, Japan. Phone: 81-3-3964-3241; Fax: 81-3-3579-4776; E-mail: takubo{at}tmig.or.jp.

Purpose: To determine the incidence of human papillomavirus (HPV) infection and the morphologic lesions induced by HPV infection of the uterine cervix in elderly Japanese women (including very elderly women) and to clarify the natural history and outcome of HPV infection.

Experimental Design: We detected squamous intraepithelial lesions (SIL) by cytology and the presence of HPV infection by PCR on cervical smears obtained at autopsy from 335 women ages 60 to 105 years (mean, 82.7 years). Two primers were used for PCR, one for low-risk HPV subtypes and one for high-risk HPV subtypes.

Results: SILs were observed in 20 (6.0%) of the women autopsied; 18 (5.4%) had low-grade SIL and 2 (0.6%) had high-grade SIL. HPV-DNA was not detected in any of the women with normal cervical cytology but was found in 9 (45.0%) of the 20 with SIL (2.7% of all subjects). Of these 9 women, 2 (22%) were positive for low-risk types of HPV and 7 (78%) were positive for high-risk types. All 9 had spent their last days in hospitals or nursing homes, the duration of institutional care ranging from 17 days to 10 years 2 months.

Conclusions: Our results suggest that HPV infection of the cervix may occasionally persist for long periods of time (the maximum duration noted in this study being 10 years 2 months). It is also possible that HPV infection in young women with normal cervical cytology will not persist into advanced age.

Key Words: cervical carcinoma • natural history • intraepithelial squamous neoplasia • advanced age