ORIGINAL ARTICLES 635 19 2017 Background: Invasive cervical cancer is caused by human papillomavirus (HPV). Objectives: To describe the prevalence and genotype distribu- tion of HPV types in women at risk for cervical neoplasia. Methods: Our study summarized HPV types detected in 6654 samples that were sent to the serology laboratory from cervical clinics in northern Israel between 2006–2014. The HPV test was performed during investigation of atypical squamous cells of undetermined significance (ASCUS) results on Pap tests or due to complaints suggestive of cervical neoplasia. HPV types were classified as high risk (HPV-HR) and low risk (HPV-LR). Results: Of the samples, 46.4% (3085/6654) were HPV-HR positive. Of women with cervical intraepithelial neoplasia 2-3 (CIN 2-3) or cancer, 292/318 (91.8%) and 137/145 (94.5%), respectively, were HPV-HR positive. HPV 16 and HPV 18 were detected in 11.8% of the total samples and in 48.2% and 64.9% of the women with CIN 2-3 and with cancer, respectively. HPV was negative in 8/145 (5.5%) and 26/318 (8.2%) of women with cervical cancer and CIN 2-3, respectively. Conclusions: This study shows the prevalence of HPV types in women at risk for cervical neoplasia. The sensitivity of all HPV types for CIN 2-3 and cervical cancer was 91.8% and 94.5%, respectively; and of HPV-HR types, 89% and 92.4%, respectively. Triage of HPV-HR types should be considered in women with ASCUS because HPV-HR types were discovered in only 36.7%. The distribution of HPV types in our population is similar to that reported for other developed countries. IMAJ 2017; 19: 635–639 human papillomavirus (HPV), cervical carcinoma, atypical squamous cells of undetermined significance (ASCUS), cervical intraepithelial neoplasia 1 (CIN 1), cervical intraepithelial neoplasia 2-3 (CIN 2-3) Prevalence and Genotype Distribution of HPV Types in Women at Risk for Cervical Neoplasia in Israel Efraim Siegler MD 1,4 * , Maayan Shiner PhD 2 * , Yakir Segev MD 1,4 , Lena Mackuli MD 1 , Nitza Lahat MD 3,4 and Ofer Lavie MD 1,4 1 Department of Gynecology and Obstetrics, 2 Blood Bank Laboratory and 3 Serology Laboratory, Carmel Medical Center, Haifa, Israel 4 Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel ABSTRACT: KEY WORDS: *The first and second authors contributed equally to this study I nvasive cervical cancer is caused by human papillomavirus (HPV). HPV is classifed as a biologic carcinogen, and HPV infection was reported as detected in 99.9% of cervical cancer cases [1]. In epidemiological studies conducted throughout the world, HPV has been detected in 85–93% of women with cervical cancer [2,3]. HPV 16 and 18 are the most common types and have been reported in 70% of HPV positive cases of cervical cancer, in 50% of cervical intraepithelial neoplasia 2-3 (CIN 2-3), and in 25% of CIN 1 patients [4]. Te introduction of the Papanicolau (Pap) smear and orga- nized cervical cytological screening has greatly contributed to decreased mortality by cervical cancer, and is considered the most cost-efective cancer screening test developed [5]. However, cervical cytology has signifcant drawbacks, includ- ing both false positive and false negative results. A number of developed countries are currently examining the possible implementation of HPV screening due to its greater efciency for women over age 30 years and its provision of 60–70% more protection against cervical cancer compared to Pap-based screening programs [6]. Te introduction of vaccines against HPV 16 and HPV 18 and against HPV 6/11/16/18 may poten- tially change the attitude toward cervical cancer prevention. Te prevalence of cervical cancer in Israel is relatively low (5.6 of 100,000 women), but mortality due to cervical cancer is 2.1 of 100,000 [7], similar to that reported in France and the United Kingdom, 1.8 and 2.0 of 100,000, respectively. A few studies have reported the prevalence of HPV types in cervi- cal cancer or CIN in Israel [8-10] but there are no studies that describe the prevalence of HPV in the general population. In Israel screening is only opportunistic and voluntary; therefore, accessing data of HPV prevalence in the general population is difcult. Te present study was conducted to determine the prevalence of HPV types in samples sent to a central laboratory from women at risk of cervical neoplasia in northern Israel. Tose cases were investigated because of atypical squamous cells of undetermined signifcance (ASCUS) results on their Pap test or due to complaints suggestive of cervical neoplasia. Te collected data are important to determine the HPV types in the Israeli population, evaluate the benefts of HPV screening, and highlight the limitations of HPV screening. PATIENTS AND METHODS STUDY POPULATION Samples for HPV typing (6654) were sent to the central serology laboratory at Carmel Medical Center from cervical clinics in Haifa, northern Israel, and the Sharon area between For Editorial see page 644