OBJECTIVES : Cervical cancer ranks second in terms of cancer incidence and mortality among women aged 15-44 years in Europe. Epidemiological data on HPV-related cervical lesions are important for planning public health interventions, including screening and treatment, and monitoring impact of vaccination programs. We reviewed recent literature on epidemiology of HPV-related high-grade cervical lesions among European mid-adult women (age 25-45 years).

METHODS : PubMed/EMBASE were systematically searched for full-text articles (published January 2013–March 2018) reporting on population-based incidence or prevalence of histologically confirmed high-grade cervical lesions or cytological abnormalities among general European mid-adult female populations. Key exclusion criteria were high-risk population, age <25 or >45 years or median/mean outside 30-40-years, small study (N<1,000) and language not English. Data extracted included screening history, year of data collection, setting and population type.

RESULTS : Nineteen studies met the inclusion criteria, reporting on Western (n=2), Southern (n=4), Northern (n=12) and mixed European populations (n=1). Incidence of cervical intraepithelial neoplasia grade 3 (CIN3) per 100,000 women-years ranged, depending on age subgroup, between 80-86 in Estonia and 1,000-1,200 in Greenland across 5 studies from Northern Europe, while incidence of CIN2 ranged between 73-216 per 100,000 women-years across 2 studies, declining in older age groups. Reported incidence of cervical adenocarcinoma in situ was 2-4 cases per 100,000 women-years in Finland and the Netherlands and 10-23 cases in Denmark. CIN3 prevalence ranged from 0.3-1.9% across 7 studies. Two studies from Northern Europe reported declining CIN3 frequency by age group, from 3.0-4.1% among 25-29 year-olds to 0.6-0.7% among 40-45-year-olds. CIN2 prevalence ranged from 0.3-1.9% across 8 studies. Reported prevalence of HSIL cytology ranged between 0.2-2.0% across 8 studies.

CONCLUSIONS : Most evidence on high-grade cervical lesions in Europe originates from Northern Europe. Peak prevalence of CIN2/CIN3 was reported in Scotland (women 25-29 years old), and peak CIN1 was reported in Greece.