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Objective To determine the prevalence of cytologie abnormalities in cervical smears from women attending the first organized screening program in Suriname and to compare the prevalences in 4 Surinamese ethnicities with different cervical carcinoma incidences. Study Design Cervicnl scrapes were taken from women with 4 different ethnicities: Maroons, Amerindians, Javanese and Hindustani. Papanicolaou staining and cytologic screening were performed on 807 cervical smears. Results Cervical cytologic abnormalities were seen in 13.4%, of which 8.1% (62 of 764) had atypical changes, 2.6% (20 of 764) had mild and 2.6% (20 of 764) bad moderate and severe dysplasia/carchtoina in situ (CIS). The cytologic abnormalities varied between the ethnicities: 42.1% (83 of 197) in the Maroons and 2.3% (4 of 176), 5.0% (9 of 183) and 3.0% (6 of 208) in the Javanese, Amerindians, and Hindustani, respectively. conclusion The high prevalence of'moderate and severe dysplasia/CIS in till ethnicities correlates with the high cervical carcinoma incidence in Suriname. A significantly higher prevalence of mild abnormalities in the Maroons as observed; it did not reflect the relatively low cervical cancer incidence in this ethnicity. However, this can be explained by the possibility that these women have a different sexual lifestyle, leading to a higher prevalence of transient HPV infection.

Objective. Human papillomavirus type 16 (HPV 16) has several intratypic variants, and some are associated with enhanced oncogenic potential. For risk determination as well as for future vaccine development, knowledge about variants is important. Regarding the geographical distribution of HPV variants and the lack of data from Indonesia and Suriname, we studied the prevalence of HPV 16 variants in cervical cancer in these high incidence countries. Data were compared with The Netherlands, a low-risk country. Methods. DNA samples from 74 formalin-fixed paraffin-embedded HPV 16-positive cervical carcinomas from Indonesia (Java, N = 22), Suriname (N = 25), and The Netherlands (N = 27) were amplified using primers specific for the E6, E7, and part of the L1 regions. Products were sequenced and analyzed. Results. A specific Javanese variant, with mutations 666A in E7 and 6826T in L1, was found in 73% of the Indonesian samples, 56% having an additional mutation in the E6 open reading frame (ORF; 276G), giving the predicted amino acid change N58S. This Javanese variant was also found in three Surinamese samples, which reflects what could be expected from migration of Javanese people to Surinam. Other non-European variants were identified in Indonesian, Surinamese, and Dutch samples in 14%, 28%, and 19%, respectively. Conclusion. The majority of the HPV 16-positive cervical cancers in Indonesia are caused by a specific intratypic variant that was rarely found before in other countries.

BACKGROUND Epidemiologic data show a high incidence of cervical cancer throughout the world and a high mortality, particularly in developing countries. The aim of this study was to describe the incidence and stages of cervical carcinoma in Surinam. Results were compared with data from The Netherlands (used as representative of western European countries) because of a medical and patient exchange program. METHODS Data for Surinamese patients analyzed in this study were based on the files from the Department of Pathology at the University of Surinam from 1989 through 1994. Cumulative and incidence rates standardized to the World Standard Population were calculated and compared with rates in other South American countries and in The Netherlands. Age distribution and stage of disease (according to the International Federation of Gynecology and Obstetrics) among Surinamese and Dutch women were compared. Furthermore, differences in incidence rates among the multiple ethnicities of the Surinamese population were evaluated. RESULTS Age standardized incidence rates for Surinam and The Netherlands were 26.7 and 6.2 per 100,000 women, respectively. The cumulative rate up to age 74 years was 2.9 in Surinam versus 0.6 in The Netherlands. Incidence in Surinam rose sharply with age. More than 40% of the Surinamese women presented with Stage IIB disease or higher compared with 12% in The Netherlands. In Surinam, low stage of disease was highest in the youngest group (48%), whereas only 18% of women 65 years or older presented with Stage I disease. Incidence rates in Surinam varied by ethnic group. Amerindians and Javanese were more likely to develop cervical cancer than were other ethnicities. CONCLUSIONS Cervical carcinoma in Surinam was characterized by high incidence rates and relatively advanced stage of disease at presentation. Moreover, incidence was not equally distributed among the different ethnic groups. This may reflect a greater exposure to risk factors and differential access to diagnostic and treatment services. Cancer 1996;77:1329-33.