Figure 1
Regions of Romania from which patient population was sampled. Regions are defined by province: North (Satu Mare, Maramures, Salaj, Bistrita-Nasaud, Cluj, Bihor, Suceava), Center (Sibiu, Harghita, Mures, Alba, Brasov, Covasna), West (Munedoara, Arad), South (Oltenia [Dolj, Gorj, Valcea], Muntenia region [Calarasi, Arges], South-East [Tulcea, Braila, Constanta, Galati]).
Table 1
Demographic characteristics of the cervical cancer screened population in Romania, 2015–2017, n = 2060.
| Age groups (years) | n | % |
|---|---|---|
| ≤34 | 429 | 20,8 |
| 35–44 | 765 | 37,3 |
| 45–54 | 564 | 27,5 |
| 55+ | 297 | 14,4 |
| Missing | 5 | 0,2 |
| Ethnicity | ||
| Russian | 149 | 7,2 |
| Hungarian | 63 | 3,1 |
| Roma | 124 | 6,0 |
| Romanian | 1615 | 78,4 |
| Slovakian | 85 | 4,1 |
| Ukrainian | 24 | 1,2 |
| Region | ||
| North (Satu Mare, Maramures, Salaj, Bistrita-Nasaud, Cluj, Bihor, Suceava) | 892 | 43,3 |
| Center (Sibiu, Harghita, Mures, Alba, Brasov, Covasna) | 473 | 23,0 |
| West (Munedoara, Arad) | 186 | 9,0 |
| South [Oltenia (Dolj, Gorj, Valcea), Muntenia region (Calarasi, Arges), South-East (Tulcea, Braila, Constanta, Galati)] | 509 | 24,7 |
| hrHPV Examination location | ||
| Mobile unit | 1068 | 51,8 |
| Public hospital | 726 | 35,2 |
| Private hospital | 51 | 2,5 |
| Family physician | 215 | 10,4 |
| Rural or urban living area | ||
| Rural | 919 | 44,6 |
| Urban (cities) | 1141 | 55,4 |
| Cytology test results* | ||
| NILM | 833 | 40,4 |
| ASC-US | 58 | 2,8 |
| ASC-H | 31 | 1,5 |
| AGC-NOS | 21 | 1,0 |
| LSIL | 4 | 0,2 |
| HSIL | 5 | 0,2 |
| Unsatisfactory | 3 | 0,2 |
| Previously taken prior to study | 1105 | 53,6 |
[i] Abbreviations: ASC-US – Atypical squamous cells of undetermined significance; ASC-H – Atypical squamous cells – cannot exclude HSIL; LSIL – Low grade squamous intraepithelial lesion; HSIL – High grade squamous intraepithelial lesion; AGC – Atypical Glandular Cells not otherwise specified; NILM – negative for intraepithelial lesion or malignancy; hrHPV – high-risk Human Papillomavirus.
Table 2
HPV-positive prevalence rates by demographic characteristics in cervical cancer screening population in Romania.
| Crude | Age-adjusted* | |||||
|---|---|---|---|---|---|---|
| Prevalence (%) | 95% CI | Prevalence (%) | 95% CI | |||
| Ethnicity | ||||||
| Romanian | 15,5 | 13,8 | 17,3 | 17,9 | 15,5 | 20,7 |
| Russian | 16,8 | 11,2 | 23,8 | 15,6 | 11,3 | 21,3 |
| Slovakian | 12,9 | 6,6 | 22,0 | 13,1 | 9,0 | 18,7 |
| Hungarian | 14,3 | 6,7 | 25,4 | 16,6 | 13,1 | 20,8 |
| Roma | 6,5 | 2,8 | 12,3 | 7,8 | 4,7 | 12,5 |
| Ukrainian | 4,2 | 0,1 | 21,1 | 2,5 | 0,6 | 9,7 |
| Regions | ||||||
| North | 18,0 | 15,6 | 20,7 | 19,2 | 16,5 | 22,3 |
| Center | 12,3 | 9,4 | 15,6 | 13,0 | 9,9 | 17,0 |
| West | 14,0 | 9,3 | 19,8 | 23,0 | 18,6 | 28,0 |
| South | 11,8 | 9,1 | 14,9 | 13,2 | 10,0 | 17,3 |
| Environment | ||||||
| Rural | 14,2 | 12,0 | 16,6 | 14,8 | 12,4 | 17,7 |
| Urban | 15,2 | 13,2 | 17,5 | 20,0 | 16,8 | 23,6 |
| HPV examination location | ||||||
| Mobile unit | 12,9 | 11,0 | 15,1 | 15,1 | 12,7 | 18,0 |
| Public hospital | 17,8 | 15,1 | 20,7 | 18,6 | 15,6 | 21,9 |
| Private hospital | 19,6 | 9,8 | 33,1 | 27,4 | 22,9 | 32,4 |
| Family physician | 13,0 | 8,8 | 18,3 | 17,4 | 12,6 | 23,5 |
[i] * Adjusted for age according to WHO world standard population (2000 to 2025).
Regions are defined by province: North: (Satu Mare, Maramures, Salaj, Bistrita-Nasaud, Cluj, Bihor, Suceava), Center (Sibiu, Harghita, Mures, Alba, Brasov, Covasna), West (Munedoara, Arad), South [Oltenia (Dolj, Gorj, Valcea), Muntenia region (Calarasi, Arges), South-East (Tulcea, Braila, Constanta, Galati)].
CI, confidence interval.
Table 3
Correlates of hrHPV positivity for cervical cancer screened population in Romania.
| hrHPV positive | hrHPV negative | Age-adjusted | Adjusted for age and prior cervical cytology test | |||||
|---|---|---|---|---|---|---|---|---|
| n | n | OR | 95% CI | OR | 95% CI | |||
| Ethnicity | ||||||||
| Romanian | 251 | 1364 | 1 | |||||
| Russian | 9 | 54 | 0,81 | 0,39 | 1,68 | 0,72 | 0,35 | 1,48 |
| Hungarian | 8 | 116 | 0,37 | 0,18 | 0,77 | 0,44 | 0,21 | 0,91 |
| Roma | 25 | 124 | 1,10 | 0,70 | 1,74 | 1,06 | 0,67 | 1,68 |
| Slovakian | 11 | 74 | 0,83 | 0,43 | 1,60 | 1,15 | 0,59 | 2,24 |
| Ukrainian | 1 | 23 | 0,22 | 0,03 | 1,65 | 0,30 | 0,04 | 2,24 |
| Regionsa | ||||||||
| North | 161 | 731 | 1 | 1 | ||||
| Center | 58 | 415 | 0,65 | 0,47 | 0,89 | 0,81 | 0,57 | 1,13 |
| West | 26 | 160 | 0,76 | 0,49 | 1,19 | 1,18 | 0,72 | 1,95 |
| South | 60 | 449 | 0,62 | 0,45 | 0,86 | 0,85 | 0,60 | 1,21 |
| Rural vs urban living area | ||||||||
| Rural | 131 | 788 | 1 | 1 | ||||
| Urban | 174 | 967 | 1,11 | 0,86 | 1,42 | 0,96 | 0,74 | 1,24 |
| hrHPV examination locations | ||||||||
| Mobile unit | 138 | 930 | 1 | |||||
| Public Hospital | 129 | 597 | 1,36 | 1,04 | 1,77 | 1,38 | 1,05 | 1,80 |
| Private Hospital | 10 | 41 | 1,62 | 0,79 | 3,32 | 1,66 | 0,81 | 3,44 |
| Family Doctors | 28 | 187 | 1,00 | 0,64 | 1,55 | 1,47 | 0,92 | 2,34 |
| Cervical cytology resultb | ||||||||
| NILM | 66 | 767 | 1 | – | – | – | ||
| Low-grade | 14 | 49 | 3,17 | 1,65 | 6,08 | |||
| High-grade | 16 | 40 | 5,18 | 2,74 | 9,79 | |||
| Prior cervical cytology screening | 209 | 897 | 2,54 | 1,89 | 3,41 | |||
[i] a North (Satu Mare, Maramures, Salaj, Bistrita-Nasaud, Cluj, Bihor, Suceava); Center (Sibiu, Harghita, Mures, Alba, Brasov, Covasna); West (Munedoara, Arad); South Oltenia (Dolj, Gorj, Valcea), Muntenia region (Calarasi, Arges), South-East (Tulcea, Braila, Constanta, Galati).
b Low-grade includes ASC-US and LSIL cytology. High-grade includes AGC, ASC-H, and HSIL cytology.
Abbreviations: ASC-US – Atypical squamous cells of undetermined significance; ASC-H – Atypical squamous cells – cannot exclude HSIL; LSIL – Low grade squamous intraepithelial lesion; HSIL – High grade squamous intraepithelial lesion; AGC – Atypical Glandular Cells not otherwise specified; NILM – negative for intraepithelial lesion or malignancy; hrHPV – high-risk Human papillomavirus.