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Kajabwangu R, Ngonzi J, Izudi J, Bazira J, Ssedyabane F, Kanyesigye M, Atwine R, Kayondo M, Ankunda R, Lugobe HM, Turanzomwe S, Randall TC, Bajunirwe F. Association between metabolic syndrome and cervical cancer among women in Southwestern Uganda: A case-control study. Gynecol Oncol Rep 2024; 54:101465. [PMID: 39139577 PMCID: PMC11321433 DOI: 10.1016/j.gore.2024.101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
Objective To determine the association between MetS and its components with cervical cancer among women in South-western Uganda. Methods We conducted an unmatched case-control study on 470 participants in a 1:2 case-to-control ratio among women in southwestern Uganda. We recruited 157 women with cervical cancer as cases and 313 women without cervical cancer as controls at the Mbarara Regional Referral Hospital Cervical Cancer Clinic. We assessed for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We used a multivariable binary logistic regression analysis to determine the association between MetS and its components with cervical cancer adjusted for potential confounders. We reported the adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results Cases were significantly older than controls: 52.4 ± 13.15 versus 41.9 ± 11.9 respectively, p < 0.001. We found MetS was independently associated with cervical cancer (aOR 1.66; 95 % CI 1.07-2.57). Age ≥ 50 years (aOR-2.20; 95 % CI 1.35-3.56), HIV infection (aOR 2.51, 95 % CI 1.56-4.05), increasing parity (aOR 1.16, 95 % CI 1.06-1.26), and a lack of formal education (aOR 6.41, 95 % CI, 1.33-30.86) were also associated with cervical cancer. However, none of the components of MetS was associated with cervical cancer. Conclusion In Ugandan women, MetS was associated with a higher likelihood of cervical cancer. We, therefore recommend combined screening for MetS and cervical cancer in order to reduce morbidity and mortality from both Mets and cervical cancer.
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Affiliation(s)
- Rogers Kajabwangu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Joel Bazira
- Department of Medical Microbiology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Frank Ssedyabane
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Michael Kanyesigye
- Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Raymond Atwine
- Department of Pathology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Rogers Ankunda
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Stuart Turanzomwe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Thomas C. Randall
- Department of Obstetrics and Gynecology, Gynecological Oncology Division, Massachusetts General Hospital, Boston, MA, United States
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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Malagón T, Franco EL, Tejada R, Vaccarella S. Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination. Nat Rev Clin Oncol 2024; 21:522-538. [PMID: 38760499 DOI: 10.1038/s41571-024-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.
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Affiliation(s)
- Talía Malagón
- Department of Oncology, McGill University, Montréal, Quebec, Canada.
- St Mary's Research Centre, Montréal West Island CIUSSS, Montréal, Quebec, Canada.
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada.
| | - Eduardo L Franco
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Romina Tejada
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
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Aziz H, Sattar AA, Mahmood H, Fatima S, Khurshid M, Faheem M. Prevalence of HPV types in HIV-positive and negative females with normal cervical cytology or dysplasia. J Clin Lab Anal 2023; 37:e24851. [PMID: 36807631 PMCID: PMC10020845 DOI: 10.1002/jcla.24851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/10/2023] [Accepted: 02/05/2023] [Indexed: 02/19/2023] Open
Abstract
The burden of HPV varies by country and HIV status. The study aimed to evaluate HPV types prevalent in HIV-positive females compared with HIV-negative females in the local population of the federal capital territory in Pakistan. METHOD The selected female population consisted of 65 already diagnosed HIV-positive females and 135 HIV-negative females. Cervical scrap was collected and analyzed for HPV and cytology. RESULTS The prevalence of HPV in HIV-positive patients was 36.9%, higher than HIV-negative patients (4.4%). 12.30% had cervical cytology interpreted as "LSIL" and 87.69% had cytology interpreted as "NIL." The high-risk type was detected in 15.39% while 21.54% showed low-risk HPV types. Among the high-risk types, HPV18 (6.15%), HPV16 (4.62%), HPV45 (3.07%), HPV33 (1.53%), HPV58 (3.07%), and HPV68 (1.53%) were found. In patients with LSIL, high-risk HPV accounts for 62.5%. Risk factors, such as age, marital status, educational status, residence, parity, other STDs, and contraceptives, were analyzed to find the correlation with HPV infection Age ≤35 years (OR 1.21, 95% CI, 0.44-3.34), illiterate and incomplete secondary education (OR 1.08, 95% CI, 0.37-3.15), and those reported not to use contraceptives (OR: 1.90; 95% CI: 0.67-5.42) have an association for increased risk of HPV infection. CONCLUSION HPV18, HPV16, HPV58, HPV45, HPV68, and HPV33 were identified among high-risk HPV types. High-risk HPV was detected in 62.5% of low-grade squamous intraepithelial lesions. The data is useful for health policymakers to develop a strategy for HPV screening and prophylactic vaccination to prevent cervical cancer.
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Affiliation(s)
- Hafsa Aziz
- Nuclear Medicine, Oncology and Radiotherapy InstituteIslamabadPakistan
| | | | - Humera Mahmood
- Nuclear Medicine, Oncology and Radiotherapy InstituteIslamabadPakistan
| | - Shazia Fatima
- Nuclear Medicine, Oncology and Radiotherapy InstituteIslamabadPakistan
| | - Mona Khurshid
- Pakistan Institute of Medical SciencesIslamabadPakistan
| | - Mohammad Faheem
- Nuclear Medicine, Oncology and Radiotherapy InstituteIslamabadPakistan
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Solomon K, Tamire M, Solomon N, Bililign N, Kaba M. Misconceptions About Female Cancers Contributing to Late Presentation to Health Facilities in Ethiopia: A Qualitative Study. Int J Womens Health 2023; 15:299-309. [PMID: 36814529 PMCID: PMC9939666 DOI: 10.2147/ijwh.s395824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Morbidity and mortality from female cancers is a major public health problem in low- and middle-income countries, including Ethiopia. More than three quarters of women visiting health facilities are diagnosed with late-stage cervical and breast cancer. Evidence reveals that misconception affects timely health seeking behavior which could have averted expensive treatment and poor survival. This study aimed to explore misconceptions about female cancers that may have contributed to late presentation of the problem to health facilities in Sidama region, Ethiopia. Methods A descriptive qualitative study was carried out in June 2021. Nine focus group discussions (six with women and three with men) and 14 key informants were conducted. Data were collected using interview guide until all information get saturated. Data were inductively coded and qualitative content analysis was applied. Results A total of 63 (24 men and 39 women) people participated in this study. Nearly all (12) key informant interviewees have awareness about cervical and breast cancer, yet reported that their community members clearly lack awareness and they are working to improve misconceptions regarding cervical and breast cancer. The focus group discussion participants (15 men and 36 women) reported lack of detailed information related to cervical and breast cancer. Women believe that cervical and breast cancer mainly resulted from poor hygiene, trauma, having multiple sexual partners, early marriage, breast exposure to heat, not breast feeding, birth complication, urinating in the sun, hereditary, devil's intrusion and God's punishment. Conclusion There were misconceptions among the community on what cervical and breast cancer mean, how they could happen, what the symptoms are, why and when to screen, when to seek health care and how to use modern treatment options. Therefore, we recommended the design of social and behavioral change strategies to address the misconceptions among different population groups.
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Affiliation(s)
- Kalkidan Solomon
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Correspondence: Kalkidan Solomon, Email
| | - Mulugeta Tamire
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nahom Solomon
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Nigus Bililign
- Department of Midwifery, School of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Mirgissa Kaba
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Crippin T, Tounkara K, Squibb E, Beseme S, Barry K, Sangare K, Coulibaly S, Fané P, Bagayoko A, Koita OA, Teguété I, De Groot AS. A story-telling cloth approach to motivating cervical cancer screening in Mali. Front Public Health 2022; 10:1051536. [PMID: 36589936 PMCID: PMC9800037 DOI: 10.3389/fpubh.2022.1051536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Ninety percent of deaths from Cervical cancer (CC) caused by Human Papilloma Virus (HPV) occur in low- and middle-income countries. CC is the 2nd most common cause of cancer in women in West Africa, where 12,000 women develop cervical cancer and more than 6,000 die from the disease, annually. While HPV vaccination and CC screening have dramatically reduced the incidence of CC and mortality from CC in developed countries, prevention of CC in West Africa is often limited to visual inspection of the cervix and surgical intervention. In previous studies of CC in Mali, we demonstrated that knowledge about the link between HPV and CC is limited, and that screening for CC is often delayed until women are symptomatic. For this intervention, a story-telling cloth (West African-style printed pagne) was designed for use as a starting point for educational sessions run by community health workers. Community outreach using the cloth during 6 months of 2015 resulted in a 5-fold higher uptake of cervical cancer screening and increased awareness of the potential to vaccinate adolescents against CC. 3,271 women were motivated to visit one of five participating clinics for CC screening, where a mere 600 women had been screened during the previous year. This study shows that a comprehensive, visual, community-centered education campaign coupled with coordinated support for local clinics improves uptake of CC screening.
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Affiliation(s)
| | | | - Eliza Squibb
- GAIA Vaccine Foundation, Providence, RI, United States
| | - Sarah Beseme
- GAIA Vaccine Foundation, Providence, RI, United States
| | - Katherine Barry
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Kotou Sangare
- Laboratory of Applied Molecular Biology, University of Sciences, Techniques, and Technologies, Bamako, Mali
| | | | - Pinda Fané
- Department of Regional Health, Bamako, Mali
| | | | - Ousmane A. Koita
- Laboratory of Applied Molecular Biology, University of Sciences, Techniques, and Technologies, Bamako, Mali
| | | | - Anne S. De Groot
- GAIA Vaccine Foundation, Providence, RI, United States,*Correspondence: Anne S. De Groot
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Nõmm O, Veerus P, Orumaa M, Innos K. Effect of Pap-smear and sociodemographic factors on cervical cancer risk in Estonia: A population-based case-control study. Cancer Epidemiol 2022; 80:102231. [PMID: 35901623 DOI: 10.1016/j.canep.2022.102231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Like many Eastern-European countries, Estonia struggles with ineffective cervical cancer (CC) screening. Despite a long-term organised screening programme and high overall Pap-smear coverage, CC incidence and mortality remain very high. The aim of the study was to examine the reasons for high CC incidence in Estonia by analysing the effect of Pap-smears and sociodemographic factors on CC risk. METHODS In this population-based case-control study, women aged ≥ 25 years with an in situ/invasive CC diagnosed in Estonia in 2011-2017 were defined as cases. Using a density sampling scheme, controls were randomly selected from general population. To estimate CC risk associated with having no Pap-smears during seven years before diagnosis (cases) or index date (controls), place of residence, interruption in health insurance, and several sociodemographic factors, multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Individual-level data from three population-based registries were used. RESULTS Among 1439 cases and 4317 controls, proportion of women with no Pap-smears was 53% and 35%, respectively. Women with no Pap-smears were at higher risk for CC (OR=2.35; 95% CI: 1.85-2.98). CC risk was increased among women who were younger, living in more remote regions, lower-educated, or divorced/widowed. Interruption in health insurance was associated with a 23% risk increase. Regional differences in CC risk were observed among screened women. CONCLUSION To reduce the risk of CC in Estonia, efforts are necessary to increase screening coverage among high-risk women and ensure the quality of CC screening programme. Screening approaches and communication should be tailored to the needs of different population groups. Further studies are warranted to identify the reasons for regional differences in CC risk.
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Affiliation(s)
- Oskar Nõmm
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Piret Veerus
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Madleen Orumaa
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
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Yadav M, Kumar HS, Kumar R, Sharma N, Jakhar S. Survival pattern in cervical cancer patients in North West India: A tertiary care center study. J Cancer Res Ther 2022; 18:1530-1536. [DOI: 10.4103/jcrt.jcrt_342_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Indracanti M, Berhane N, Minyamer T. Factors Associated with Pre- and Post-Educational Intervention Knowledge Levels of HPV and Cervical Cancer Among the Male and Female University Students, Northwest Ethiopia. Cancer Manag Res 2021; 13:7149-7163. [PMID: 34548819 PMCID: PMC8449546 DOI: 10.2147/cmar.s326544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infections are sexually transmitted and most frequently associated with cervical cancer in women, but they are also a public health concern in men. There is rising evidence that HPV's role in other cancers, such as anal, vulva, vaginal, penis, head, and neck cancers. The present study aimed to understand the factors associated with HPV and cervical cancer knowledge levels of university students before and after an educational intervention. METHODS An Institutional-based cross-sectional study was conducted from October to November 2018. A total of 638 study participants were selected using a simple random multistage sampling technique. A pretested questionnaire was used, consolidated the data, and analyzed with SPSS version 23. Bivariate and multivariate logistic regression analyses were performed to identify which variables were associated with the knowledge levels. RESULTS Six hundred thirty-eight study participants with a 100% response rate, and the mean age was 21.07 years (±SD, 1.96). Initial awareness of various broad categories was 4.09, and after the intervention, it increased to 23.4, with an average increase of 19.31 at 99% CI, p≤0.001 significance level. Before the educational intervention, students with <21 years of age [6.16, 95% CI: (2.21-17.18)] and ≤2.5 CGPA [3.44, 95% CI: (1.51-7.81)] were less knowledgeable over other counterparts. After educational intervention, the year of study was significantly associated with increased knowledge of overall and different broad categories of cervical cancer and HPV. Year of study, 1st-year students [AOR: 0.27, 95% CI: (0.14-0.51)] over third years and above are less knowledgeable. First-year students and CGPA ≤2.5 were less improved awareness over others. CONCLUSION The educational intervention improved more than fourfold increase knowledge on cervical cancer and HPV, and the year of study was a key factor associated with overall improvement. This study suggests that educational intervention effectively strengthens our understanding of the spread of HPV and cervical cancer disease burden.
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Affiliation(s)
- Meera Indracanti
- Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Nega Berhane
- Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Tigist Minyamer
- Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
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Puspitasari IM, Legianawati D, Sinuraya RK, Suwantika AA. Cost-Effectiveness Analysis of Chemoradiation and Radiotherapy Treatment for Stage IIB and IIIB Cervical Cancer Patients. Int J Womens Health 2021; 13:221-229. [PMID: 33642882 PMCID: PMC7903166 DOI: 10.2147/ijwh.s289781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Cervical cancer is the second most common type of cancer and cause of death from cancer in Indonesia. In 2013, cervical cancer was the most prevalent cancer in Indonesia, with a rate of 0.8 per 1000 women. Based on the National Guidelines for Cervical Cancer Medical Services in Indonesia, the recommended therapy for stages IIB-IIIB cervical cancer is chemoradiation or radiotherapy. This study aimed to evaluate the cost-effectiveness of chemoradiation and radiotherapy for treating stage IIB-IIIB cervical cancer in a national referral hospital in Indonesia. Patients and Methods A cross-sectional study from a healthcare perspective using retrospective patient data was conducted. The included patients had stage IIB-IIIB registered cervical cancer, were in the hospital between January 1, 2015 and December 31, 2017, received chemoradiation or radiotherapy, were ≥18 years old, and had complete clinical data and detailed cost of therapy data. The incremental cost-effectiveness ratio (ICER) were calculated, and a sensitivity analysis was performed. Results The average treatment cost per patient was $2944 and $3231 for radiotherapy and chemoradiation, respectively. Despite the fact that the treatment effectiveness of chemoradiation (69.1%) was considered to be higher than that of radiotherapy (63.2%), chemoradiation had more potential side effects than radiotherapy. In a comparison with radiotherapy, the ICER of chemoradiation was $48.6 per complete response rate. Additionally, the cost of radiotherapy was the most influential parameter impacting the ICER. Conclusion Chemoradiation was considered to be more costly than radiotherapy. Additionally, the effectiveness of chemoradiation was higher than that of radiotherapy. A cost utility analysis (CUA) is required for further investigation.
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Affiliation(s)
- Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Dewi Legianawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Rano K Sinuraya
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
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Drake VE, Fakhry C, Windon MJ, Stewart CM, Akst L, Hillel A, Chien W, Ha P, Miles B, Gourin CG, Mandal R, Mydlarz WK, Rooper L, Troy T, Yavvari S, Waterboer T, Brenner N, Eisele DW, D'Souza G. Timing, number, and type of sexual partners associated with risk of oropharyngeal cancer. Cancer 2021; 127:1029-1038. [PMID: 33426652 DOI: 10.1002/cncr.33346] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Case-control studies from the early 2000s demonstrated that human papillomavirus-related oropharyngeal cancer (HPV-OPC) is a distinct entity associated with number of oral sex partners. Using contemporary data, we investigated novel risk factors (sexual debut behaviors, exposure intensity, and relationship dynamics) and serological markers on odds of HPV-OPC. METHODS HPV-OPC patients and frequency-matched controls were enrolled in a multicenter study from 2013 to 2018. Participants completed a behavioral survey. Characteristics were compared using a chi-square test for categorical variables and a t test for continuous variables. Adjusted odds ratios (aOR) were calculated using logistic regression. RESULTS A total of 163 HPV-OPC patients and 345 controls were included. Lifetime number of oral sex partners was associated with significantly increased odds of HPV-OPC (>10 partners: odds ratio [OR], 4.3 [95% CI, 2.8-6.7]). After adjustment for number of oral sex partners and smoking, younger age at first oral sex (<18 vs >20 years: aOR, 1.8 [95% CI, 1.1-3.2]) and oral sex intensity (>5 sex-years: aOR, 2.8 [95% CI, 1.1-7.5]) remained associated with significantly increased odds of HPV-OPC. Type of sexual partner such as older partners when a case was younger (OR, 1.7 [95% CI, 1.1-2.6]) or having a partner who had extramarital sex (OR, 1.6 [95% CI, 1.1-2.4]) was associated with HPV-OPC. Seropositivity for antibodies to HPV16 E6 (OR, 286 [95% CI, 122-670]) and any HPV16 E protein (E1, E2, E6, E7; OR, 163 [95% CI, 70-378]) was associated with increased odds of HPV-OPC. CONCLUSION Number of oral sex partners remains a strong risk factor for HPV-OPC; however, timing and intensity of oral sex are novel independent risk factors. These behaviors suggest additional nuances of how and why some individuals develop HPV-OPC.
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Affiliation(s)
- Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Melina J Windon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Lee Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Alexander Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Wade Chien
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Health System, New York City, New York
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Rajarsi Mandal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Lisa Rooper
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Tanya Troy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Siddhartha Yavvari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center, Heidelberg, Germany
| | - Nicole Brenner
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center, Heidelberg, Germany
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Molina-Pineda A, López-Cardona MG, Limón-Toledo LP, Cantón-Romero JC, Martínez-Silva MG, Ramos-Sánchez HV, Flores-Miramontes MG, de la Mata-González P, Jave-Suárez LF, Aguilar-Lemarroy A. High frequency of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. BMC Infect Dis 2020; 20:889. [PMID: 33238902 PMCID: PMC7690193 DOI: 10.1186/s12879-020-05627-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Human papillomavirus infection is an important factor associated with cervical cancer (CC) development. The prevalence and genotype distribution vary greatly worldwide. Examining local epidemiological data constitutes an important step towards the development of vaccines to prevent CC. In this work, we studied the prevalence of HPV genotypes in women from Western Mexico with the COBAS 4800 and/or Linear Array Genotyping Test (LA). METHODS The samples analysed in this study represent a population from Western Mexico, which includes six different states. Our approach was first to test for HPV in cervical samples from women who attended their health clinic for routine gynaecological studies (open-population, n = 3000) by utilizing COBAS 4800. Afterwards, 300 of the HPV-positive samples were randomly selected to be genotyped with LA; finally, we genotyped samples from women with cervical intraepithelial neoplasia grade 1 (CIN 1, n = 71) and CC (n = 96) with LA. Sociodemographic data of the diverse groups were also compared. RESULTS The overall HPV prevalence among the open-population of women as determined by COBAS 4800 was 12.1% (n = 364/3000). Among the HPV-positive samples, single infections (SI) with HPV16 were detected in 12.4% (n = 45/364), SI with HPV18 were detected in 1.4%, and infection with at least one of the genotypes included in the high-risk HPV pool was detected in 74.5% of the cases. LA analysis of the samples showed that in addition to HPV genotypes 16 and 18, there was a high prevalence of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. With respect to the sociodemographic data, we found statistically significant differences in the number of pregnancies, the use of hormonal contraceptives and tobacco intake. CONCLUSIONS Our data indicate that there is a high prevalence of HPV genotypes which are not covered by the vaccines currently available in Mexico; therefore, it is necessary to include HPVs 59, 66, 51, 39 and 56 in the design of future vaccines to reduce the risk of CC development. It is also essential to emphasize that the use of hormonal contraceptives and tobacco smoking are risk factors for CC development in addition to the presence of HPV.
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Affiliation(s)
- Andrea Molina-Pineda
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
- Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - María Guadalupe López-Cardona
- Unidad de Medicina Genómica y Genética, Hospital Regional Dr. Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, Mexico
- Departamento de Fisiología, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Laura Patricia Limón-Toledo
- Clínica de Displasias, Unidad Médica de Alta Especialidad (UMAE), Hospital de Ginecología y Obstetricia, Centro Médico Nacional de Occidente-IMSS, Guadalajara, Jalisco, Mexico
| | - Juan Carlos Cantón-Romero
- Servicio de Ginecología Oncológica, UMAE Hospital de Ginecología y Obstetricia, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, Mexico
| | | | - Holanda Vanesa Ramos-Sánchez
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - María Guadalupe Flores-Miramontes
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Pedro de la Mata-González
- Unidad de Medicina Genómica y Genética, Hospital Regional Dr. Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, Mexico
- Departamento de Fisiología, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Luis F Jave-Suárez
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
- Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
| | - Adriana Aguilar-Lemarroy
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
- Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
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12
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Andujar M, Roura E, Torres A, Vega B, Pavcovich M, Sanchez MA, Lubrano A, Trujillo JL, Almeida L, Santana M, Hurtado R, Arencibia O, Benito V, Medina N, Carballo S, Camacho MDC, Ruiz Del Pozo A, Quesada A, Salido E, de Sanjosé S, Bruni L. Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands. BMJ Open 2020; 10:e037402. [PMID: 32973061 PMCID: PMC7517562 DOI: 10.1136/bmjopen-2020-037402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE National Spanish studies show that prevalence of cervical human papillomavirus (HPV) infection in the female population is increasingly frequent, with an overall estimate of 14% in women aged 18-65 years. The objective of this study is to know the prevalence and distribution of HPV types in the female population of the Canary Islands prior to the introduction of HPV vaccines and to investigate the associated clinical and sociodemographic factors. METHODS Based on the Primary Health Care database, a sample of adult women (aged 18-65 years) of Gran Canaria (GC) and Tenerife (TF) stratified into nine age groups was carried out between 2002 and 2007. Women were contacted by postal letter and telephone call and were visited in their primary care centre. A clinical-epidemiological survey was completed and cervical samples were taken for cytological study and HPV detection. HPV prevalence and its 95% CI were estimated, and multivariate analyses were performed using logistic regression to identify factors associated with the infection. RESULTS 6010 women participated in the study, 3847 from GC and 2163 from TF. The overall prevalence of HPV infection was 13.6% (CI 12.8%-14.5%) and 11.1% (CI 10.3%-11.9%) for high-risk types. The most frequent HPV type was 16 followed by types 51, 53, 31, 42 and 59. HPV types included in the nonavalent vaccine were detected in 54.1% of infected women. Factors associated with an increased risk of infection were: young ages (18-29 years), the number of sexual partners throughout life, not being married, being a smoker, and having had previous cervical lesions or genital warts. CONCLUSIONS It is confirmed that prevalence of HPV infection in the female population of the Canary Islands is high, but similar to that of Spain, HPV 16 being the most frequent genotype. The determinants of infection are consistent with those of other populations.
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Affiliation(s)
- Miguel Andujar
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Esther Roura
- Unit of Infections and Cancer-Information and Interventions (UNIC-I&I)-Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alejandra Torres
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Begoña Vega
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Marta Pavcovich
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Miguel Angel Sanchez
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Amina Lubrano
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Jose Luis Trujillo
- Department of Obstetrics and Gynecology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Lucia Almeida
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Milagros Santana
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Rosaura Hurtado
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Octavio Arencibia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Virginia Benito
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Norberto Medina
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Sonia Carballo
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Maria Del Carmen Camacho
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Arancha Ruiz Del Pozo
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alfoso Quesada
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Eduardo Salido
- Department of Pathology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Silvia de Sanjosé
- Reproductive Health Global Programme, PATH, Seattle, Washington, USA
- Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Laia Bruni
- Unit of Infections and Cancer-Information and Interventions (UNIC-I&I)-Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
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13
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Education Level Predicts Appropriate Follow-Up of Incidental Findings From Lung Cancer Screening. J Am Coll Radiol 2020; 17:613-619. [DOI: 10.1016/j.jacr.2019.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/11/2019] [Accepted: 12/14/2019] [Indexed: 12/16/2022]
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14
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Baskran K, Kumar PK, Santha K, Sivakamasundari II. Cofactors and Their Association with Cancer of the Uterine Cervix in Women Infected with High-Risk Human Papillomavirus in South India. Asian Pac J Cancer Prev 2019; 20:3415-3419. [PMID: 31759367 PMCID: PMC7063002 DOI: 10.31557/apjcp.2019.20.11.3415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Human papilloma viruses (HPVs) are recognized as the major etiological agents of most pre invasive and invasive cancer of the uterine cervix. Many cofactors in association with high-risk HPV (HR-HPV) trigger infection which leads to cervical carcinogenesis. The aim was to study various cofactors and their association with cervical cancer in women infected with HR-HPV. Methods: The present study screened a total of 156 subjects for the presence of HPV infection. Association of various cofactors with cervical cancer was estimated using binary logistic regression analysis. Results: The HR-HPV infection showed a very significant risk factor for cervical cancer. Among the cofactors, the education level, early sexual exposure and age at pregnancy had no significant association while low socioeconomic status (SES) and high parity showed significant association as risk factors for cervical cancer. Tobacco chewing with betel quid was not significantly associated with cervical cancer. Conclusions: The present study indicates that low SES is a major risk factor associated with cervical cancer. Bringing awareness about HPV infection and intensifying routine screening programs for cervical cancer will help reduce the risk of cervical cancer among women with low SES in this region.
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Affiliation(s)
- Krishnan Baskran
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
| | - P Kranthi Kumar
- Department of Genetics, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India
| | - K Santha
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
| | - Inmozhi I Sivakamasundari
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
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15
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Kasamatsu E, Rodríguez Riveros MI, Soilan AM, Ortega M, Mongelós P, Páez M, Castro A, Cristaldo C, Báez FR, Centurión CC, Vester J, Barrios H, Villalba G, Amarilla ML, Giménez G, Caubere E, Hernández MDLL, Baena A, Almonte M, Herrero R, Mendoza LP. Factors associated with high-risk human papillomavirus infection and high-grade cervical neoplasia: A population-based study in Paraguay. PLoS One 2019; 14:e0218016. [PMID: 31246959 PMCID: PMC6597051 DOI: 10.1371/journal.pone.0218016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/23/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer (CC) is one of the leading causes of cancer mortality among women from Paraguay, with high incidence and mortality rates (31.2 and 16 per 100 000 women, respectively). Although the risk factors associated with high-risk human papillomavirus (hrHPV) infection and preneoplastic cervical lesions are widely studied, population-based characteristics of particular settings may influence the feasibility of HPV-based CC screening implementation. This study aimed to explore factors associated with hrHPV infection and high-grade cervical neoplasia in hrHPV-positive (hrHPV+) women from Paraguay. METHODS A total of 5677 women aged 30-64 years from the Central Department of Paraguay were screened with HPV test (Hybrid Capture 2) and Pap smear. Sociodemographic and risk factor interviews were conducted. hrHPV+ women were referred to colposcopy and women with an abnormal colposcopy had a biopsy taken. The outcomes recorded were the hrHPV status and the presence of high-grade cervical intraepithelial neoplasia or worse (CIN2+) among hrHPV+ women. Associations were investigated using multivariate logistic regressions. RESULTS hrHPV prevalence was 13.8% (95%CI 13.0-14.8). This value decreased with the age of women (p-trend<0.001) and increased with the lifetime number of sexual partners (p-trend<0.001) and number of previous female partners of their current male partner if women had had one lifetime sexual partner (p-trend<0.001), increasing from 3.06 (95%CI 0.073-20.9) if partners had had one previous female partner to 9.19 (95%CI 2.36-61.1) if they had had eight or more. In hrHPV+ women, CIN2+ prevalence was 10.7% (95%CI 8.58-13.2) and increased with time since the last Pap smear (p-trend<0.001) and with the increasing number of pregnancies (p-trend = 0.05). CONCLUSION In these settings, the sexual behavior of women and their male partners is associated with hrHPV infection. In hrHPV+ women, underscreening practices and multiple pregnancies are associated with CIN2+. This knowledge can contribute to public health policies for CC prevention and control in Paraguay.
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Affiliation(s)
- Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - María Isabel Rodríguez Riveros
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Ana María Soilan
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Pamela Mongelós
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Malvina Páez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Amalia Castro
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Carmen Cristaldo
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Fátima Romina Báez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Claudia Carolina Centurión
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Jaime Vester
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Hernán Barrios
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Griselda Villalba
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - María Luisa Amarilla
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Graciela Giménez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Elodie Caubere
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | | | - Armando Baena
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Maribel Almonte
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Rolando Herrero
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Laura Patricia Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
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Years of Life Lost Due to Cervical Cancer in Poland in 2000 to 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091545. [PMID: 31052396 PMCID: PMC6539403 DOI: 10.3390/ijerph16091545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/02/2019] [Accepted: 04/30/2019] [Indexed: 12/24/2022]
Abstract
The aim of the study was an analysis of years of life lost due to cervical cancer in Poland in the period 2000 to 2015 with consideration given to differences related to education and place of residence. The study material was 28,274 death certificates of all female inhabitants of Poland, who died in 2000 to 2015 due to cervical cancer. In order to calculate years of life lost, the authors used indices: SEYLLp (Standard Expected Years of Life Lost per living person), SEYLLd (per deaths) and AAPC (Average Annual Percentage Change). The SEYLLp index (per 100,000) due to cervical cancer in Poland decreased from 394.3 in 2000 to 220.9 years of life in 2015 (AAPC = −3.6%). Women with university education lost the smallest number of years of life (SEYLLp = 139.0 in 2000 and 53.7 in 2015; AAPC = −5.4%), whereas those with elementary education had the greatest number of years of life lost (524.2 and 312.8; AAPC = −3.4%). Women living in rural areas lost on average 329.5 years in 2000 and 177.0 in 2015 (AAPC = −3.8%). In city areas, the values were 428.6 and 247.1 (AAPC = −3.4%). Many of the years of life lost could have been avoided by including more women, particularly those with elementary education, in screening examinations.
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Park HG, Wang ZE, Wang C, Huh WK, Bae S. Cervical cancer outcome by type of health care facilities: National Cancer Database, 2004-2015. CANCER HEALTH DISPARITIES 2019; 4:e1-e13. [PMID: 34027312 PMCID: PMC8136613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The National Cancer Database from 2004 to 2015 was analyzed to identify cervical cancer outcomes associated with demographic and clinical characteristics measured by types of facility. Chi-Square tests were used to compare proportions and logistic regression to determine factors associated with cervical cancer outcomes. Women treated at Academic/Research Programs (ARPs) were younger at diagnosis, more likely black, less educated and more in Stage 2, lived further away from treatment facilities, had less comorbidities and better 5-year survival, and were more likely to be alive at 30 and 90 days after surgery compared to other programs. Women treated at Community Cancer Programs were more likely 75 and older at diagnosis, more likely to receive radiation treatment and more in Stage 4, more living in rural areas and less than 10 miles from the facility, and had more comorbidities, and lower 5-year survival compared to other programs. Women treated at Comprehensive Community Cancer Programs were more likely white and educated, had more private insurance, and underwent surgery. Women treated at Integrated Network Cancer Programs were more likely to live in urban, south region, and in Stage 1B2, had more surgery and one comorbidity, and died fewer than 30 days after surgery. The type of facility and treatment had varied effects on mortality and 5-year survival. Considering the different cervical cancer outcomes from different health care facilities, further research is needed to identify what factors influence women to choose a health care facility for their treatment and how this choice can affect different health outcomes.
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Affiliation(s)
- HyounKyoung G Park
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Zhixin E Wang
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Chenguang Wang
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD
| | - Warner K Huh
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Sejong Bae
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
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18
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Vale DB, Sauvaget C, Muwonge R, Thuler LCS, Basu P, Zeferino LC, Sankaranarayanan R. Level of human development is associated with cervical cancer stage at diagnosis. J OBSTET GYNAECOL 2019; 39:86-90. [PMID: 30229689 DOI: 10.1080/01443615.2018.1463976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective was to describe the cervical cancer cases in Brazil by the age-group and stage at diagnosis, and to associate them with the human development index (HDI), where the women live. This was a retrospective study that used data from the Brazilian hospital-based cancer registry from 2005 to 2014. The data were accessed by 5-year age/groups and the federal units. The association between the proportion of cases at Stage I and HDI was estimated in an adjusted linear regression analysis. Among the staged cases, the proportions of cases diagnosed at FIGO Stage I, II, III and IV were 21.2%, 30.7%, 39.9% and 8.2%, respectively. The cases were diagnosed mostly in women aged 45-49 years. There was a significant increase in the proportion of Stage I cases with an increasing HDI (coefficient, 0.46; 95% confidence interval, 0.17-0.76). In conclusion, most of the cases were diagnosed at late stages. The stage at the diagnosis was associated with the human development level. Impact Statement What is already known on this subject? The stage at diagnosis varies according to the level of organisation of the cancer control programme. It is expected that in well-developed programmes there will be a shift to an early stage diagnosis. What the results of this study add? The stage at a diagnosis was associated with the human development level where the women live in Brazil, where most cases were diagnosed at the late stages. What the implications are of these findings for clinical practice and/or further research? This analysis can help with better planning strategies for cancer control. Regional strategies would improve the efficiency of cancer care interventions in countries with large socioeconomic disparities.
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Affiliation(s)
- Diama Bhadra Vale
- a Screening Group, International Agency for Research on Cancer (IARC) , Lyon , France
- b Department of Obstetrics and Gynecology , State University of Campinas (Unicamp) , Campinas , Brazil
| | - Catherine Sauvaget
- a Screening Group, International Agency for Research on Cancer (IARC) , Lyon , France
| | - Richard Muwonge
- a Screening Group, International Agency for Research on Cancer (IARC) , Lyon , France
| | | | - Partha Basu
- a Screening Group, International Agency for Research on Cancer (IARC) , Lyon , France
| | - Luiz Carlos Zeferino
- b Department of Obstetrics and Gynecology , State University of Campinas (Unicamp) , Campinas , Brazil
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Abstract
Epidemiological methods are essential for the discovery of cancer risks and prognostic factors as well as for the evaluation of cancer prevention measures. In this review, we discuss epidemiological surveillance procedures for data collection and processing to guide and evaluate the consequences of anticancer efforts for populations, assess the identification of cancer risk factors, examine barriers to cancer screening and recommended rules for early diagnosis programs. Epidemiological studies have shown that hindrances to cancer information assessment are currently encountered in developing countries. Known cancer risk factors include social determinants, lifestyle factors, occupational exposures, infectious agents, and genetic and epigenetic alterations. Challenges remain in studying the effectiveness of cancer screening; screening can have detrimental effects, and few cancers clearly benefit from screening. Currently, epidemiology faces the challenge of dealing with distinct levels of data, including factors related to social status, lifestyle and genetics, to reconstruct the causal traits of cancer. Additionally, translating epidemiological knowledge into cancer control demands more implementation studies in the population.
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Affiliation(s)
- Tatiana N Toporcov
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Victor Wünsch Filho
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Turner SA, Deharvengt SJ, Lyons KD, Espinal JAP, LaRochelle EP, Bejarano S, Kennedy L, Tsongalis GJ. Implementation of Multicolor Melt Curve Analysis for High-Risk Human Papilloma Virus Detection in Low- and Middle-Income Countries: A Pilot Study for Expanded Cervical Cancer Screening in Honduras. J Glob Oncol 2018; 4:1-8. [PMID: 30241169 PMCID: PMC6180764 DOI: 10.1200/jgo.17.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cervical cancer is a leading cause of cancer-related mortality in low- and middle-income countries (LMICs) and screening in LMICs is extremely limited. We aimed to implement on-site high-risk human papillomavirus (hrHPV) DNA testing in cohorts of women from an urban factory and from a rural village. METHODS A total of 802 women were recruited for this study in partnership with La Liga Contra el Cancer through the establishment of women's health resource fairs at two locations in Honduras: a textile factory (n = 401) in the city of San Pedro Sula and the rural village of El Rosario (n = 401) in Yoro. Participants received a routine cervical examination during which three sterile cytobrushes were used to collect cervical samples for testing. hrHPV genotyping was performed using a hrHPV genotyping assay and a real-time polymerase chain reaction instrument. RESULTS hrHPV status across all participants at both sites was 13% hrHPV positive and 67% hrHPV negative. When hrHPV status was compared across all three testing sites, hrHPV-positive rates were approximately equal among the factory (13%), village (12%), and confirmatory testing at Dartmouth-Hitchcock Medical Center (Lebanon, NH; 14%). hrHPV genotype was compared across sites, with HPV16 showing the highest infection rate (15%), followed by HPV59 (12%), and HPV68 (11%). There was a low prevalence of HPV18 observed in both populations compared with the hrHPV-positive population in the United States. CONCLUSION In collaboration with oncologists and pathologists from La Liga Contra el Cancer, we were able to provide a continuum of care once health-fair testing was performed. We established a method and implementation plan for hrHPV testing that is sustainable in LMICs.
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Affiliation(s)
- Scott A. Turner
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Sophie J. Deharvengt
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Kathleen Doyle Lyons
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Jorge Arturo Plata Espinal
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Ethan P.M. LaRochelle
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Suyapa Bejarano
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Linda Kennedy
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Gregory J. Tsongalis
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
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Level and determinants of precancerous symptoms of cervical cancer in unscreened population of Uttar Pradesh and Rajasthan, India: A pilot study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2017. [DOI: 10.1016/j.cegh.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Delory T, Ngo-Giang-Huong N, Rangdaeng S, Chotivanich N, Limtrakul A, Putiyanun C, Suriyachai P, Matanasarawut W, Jarupanich T, Liampongsabuddhi P, Heard I, Jourdain G, Lallemant M, Le Coeur S. Human Papillomavirus infection and cervical lesions in HIV infected women on antiretroviral treatment in Thailand. J Infect 2017; 74:501-511. [PMID: 28254419 DOI: 10.1016/j.jinf.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To estimate the prevalence and factors associated with Human Papillomavirus (HPV) infection, HPV genotypes and cytological/histological high-grade (HSIL+/CIN2+) lesions. METHODS We conducted a cross-sectional study within a prospective cohort of HIV-infected women on combination antiretroviral therapy (cART). Cervical specimens were collected for cytology and HPV genotyping (Papillocheck®). Any women with High-Risk-HPV (HR-HPV), and/or potentially HR-HPV (pHR-HPV) and/or ASC-US or higher (ASC-US+) lesions were referred for colposcopy. Factors associated with HR-HPV infection and with HSIL+/CIN2+ lesions were investigated using mixed-effects logistic regression models. RESULTS 829 women were enrolled: median age 40.4 years, on cART for a median of 6.9 years, median CD4 cell-count 536 cells/mm3, and 788 (96%) with HIV-viral load<50copies/mL. Of 214 (26%) infected with HPV: 159 (19%) had ≥1 HR-HPV, of whom 38 (5%) HPV52, 22 (3%) HPV16, 9 (1%) HPV18; 21 (3%) had pHR-HPV, 34 (4%) low risk-HPV infection, and 56 (26%) had multiple genotypes. Younger age, low CD4 cell-counts and low education were independently associated with HR-HPV infection. 72 women (9%) had ASC-US+ and 28 (3%) HSIL+/CIN2+ lesions. HR-HPV infection was independently associated with HSIL+/CIN2+ lesions. CONCLUSION The prevalence of HPV infection and of cervical lesions was low. The HPV genotype distribution supports the use of 9-valent vaccine in Thailand.
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Affiliation(s)
- Tristan Delory
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; APHP, Service de maladies infectieuses et tropicales, hôpital Saint Louis, F-75010, Paris, France; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France.
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Samreung Rangdaeng
- Faculty of Medicine, Department of Pathology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Aram Limtrakul
- Ministry of Public Health, Nakornping Hospital, Chiang Mai, Thailand
| | - Chaiwat Putiyanun
- Ministry of Public Health, Chiang Kham Hospital, Chiang Kham, Thailand
| | | | | | | | | | - Isabelle Heard
- HPV National Reference Center, Pasteur Institute, Paris, France; APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France; Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Jain A, Ganesh B, Bobdey SC, Sathwara JA, Saoba S. Sociodemographic and Clinical Profile of Cervical Cancer Patients Visiting in a Tertiary Care Hospital in India. Indian J Med Paediatr Oncol 2017; 38:291-295. [PMID: 29200676 PMCID: PMC5686969 DOI: 10.4103/ijmpo.ijmpo_20_16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in the developing countries. Study of the sociodemographic and clinical profile of patients is the first step in planning control measures and treatment facilities. Aims The aims of the study were to determine the sociodemographic and clinical profile of cervical cancer patients and study their association with other tumor-related factors. Settings and Design This is a record-based retrospective study from a single institution. Subjects and Methods The data on sociodemographic and clinical factors of 765 cervical cancer patients visited and treated at tertiary care cancer hospital in Mumbai in 1 year period were analyzed. Statistical Analysis Data were analyzed using descriptive statistics. Kruskal-Wallis and Chi-square test were used to assess relationship between variables. Results The median age of the cohort was 54 years and interquartile range was 16 years. Nearly 53.6% of patients were illiterate. About 88.10% of patient's had squamous cell carcinoma. Only 13% of cases had early stage disease and 77% of patient's had not taken any treatment before coming to the hospital. Of the total, about 26% patients also had concomitant comorbidities, of which hypertension was found to be the leading comorbid condition. Stage of disease was found to be significantly (P < 0.05) associated with age and educational status. Conclusion This study highlights certain important baseline characteristics of cervical cancer patients. This basic information on profile of patients can help plan and optimum utilization of hospital services, especially in resource-poor countries like India.
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Affiliation(s)
- Aanchal Jain
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Balasubramaniam Ganesh
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Saurabh C Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jignasa A Sathwara
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sushma Saoba
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Determinants of Patient Delay in Seeking Diagnosis and Treatment among Moroccan Women with Cervical Cancer. Obstet Gynecol Int 2016; 2016:4840762. [PMID: 27882055 PMCID: PMC5110862 DOI: 10.1155/2016/4840762] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/12/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction. This study sought to investigate potential determinants of patient delay among Moroccan women with cervical cancer. Methods. A cross-sectional study was conducted from June 2014 to June 2015 at the National Institute of Oncology in Rabat. Data were collected using questionnaire among patients with cervical cancer locally advanced or metastatic (stages IIA–IVB). Medical records were abstracted to complete clinical information. An interval longer than 90 days between discovery of initial symptoms and presentation to a provider was defined as a patient delay. Results. Four hundred and one patients with cervical cancer enrolled in this study. The mean age was 52.4 years (SD = 11.5). 53.6% were illiterate. Abnormal vaginal bleeding was identified for 65.8% of patients. 60.1% were diagnosed at stages IIA-IIB. 55.4% were found having patient delay. The regression analyses showed the association between literacy (p < 0.001), distance of the place of the first consultation (p = 0.031), abnormal vaginal bleeding as an earlier symptom (p < 0.001), stage at diagnosis (p < 0.03), knowledge of symptoms (p < 0.001), knowledge of causes (p = 0.008), and practice of gynecological exam during the last three years (p = 0.018) and the patient delay. Conclusion. Educational messages should aim at increasing awareness of cervical cancer, assisting women in symptom recognition, and encouraging earlier presentation.
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Arnold M, Rentería E, Conway DI, Bray F, Van Ourti T, Soerjomataram I. Inequalities in cancer incidence and mortality across medium to highly developed countries in the twenty-first century. Cancer Causes Control 2016; 27:999-1007. [PMID: 27329211 DOI: 10.1007/s10552-016-0777-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 06/10/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE Inequalities in the burden of cancer have been well documented, and a variety of measures exist to analyse disease disparities. While previous studies have focused on inequalities within countries, the aim of the present study was to quantify existing inequalities in cancer incidence and mortality between countries. METHODS Data on total and site-specific cancer incidence and mortality in 2003-2007 were obtained for 43 countries with medium-to-high levels of human development via Cancer Incidence in Five Continents Vol. X and the WHO Mortality Database. We calculated the concentration index as a summary measure of socioeconomic-related inequality between countries. RESULTS Inequalities in cancer burden differed markedly by site; the concentration index for all sites combined was 0.03 for incidence and 0.02 for mortality, pointing towards a slightly higher burden in countries with higher levels of the human development index (HDI). For both incidence and mortality, this pattern was most pronounced for melanoma. In contrast, the burden of cervical cancer was disproportionally high in countries with lower HDI levels. Prostate, lung and breast cancer contributed most to inequalities in overall cancer incidence in countries with higher HDI levels, while for mortality these were mostly driven by lung cancer in higher HDI countries and stomach cancer in countries with lower HDI levels. CONCLUSION Global inequalities in the burden of cancer remain evident at the beginning of the twenty-first century: with a disproportionate burden of lifestyle-related cancers in countries classified as high HDI, while infection-related cancers continue to predominate in transitioning countries with lower levels of HDI.
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Affiliation(s)
- Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France.
| | - Elisenda Rentería
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
| | - Tom Van Ourti
- Erasmus School of Economics and Tinbergen Institute, University of Rotterdam, Burgemeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
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Whop LJ, Baade P, Garvey G, Cunningham J, Brotherton JML, Lokuge K, Valery PC, O’Connell DL, Canfell K, Diaz A, Roder D, Gertig DM, Moore SP, Condon JR. Cervical Abnormalities Are More Common among Indigenous than Other Australian Women: A Retrospective Record-Linkage Study, 2000-2011. PLoS One 2016; 11:e0150473. [PMID: 27064273 PMCID: PMC4827842 DOI: 10.1371/journal.pone.0150473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
Indigenous Australian women have much higher incidence of cervical cancer compared to non-Indigenous women. Despite an organised cervical screening program introduced 25 years ago, a paucity of Indigenous-identified data in Pap Smear Registers remains. Prevalence of cervical abnormalities detected among the screened Indigenous population has not previously been reported. We conducted a retrospective cohort study of population-based linked health records for 1,334,795 female Queensland residents aged 20–69 years who had one or more Pap smears during 2000–2011; from linked hospital records 23,483 were identified as Indigenous. Prevalence was calculated separately for Indigenous and non-Indigenous women, for cytology-detected low-grade (cLGA) and high-grade abnormalities (cHGA), and histologically confirmed high-grade abnormalities (hHGA). Odds ratios (OR) were estimated from logistic regression analysis. In 2010–2011 the prevalence of hHGA among Indigenous women (16.6 per 1000 women screened, 95% confidence interval [CI] 14.6–18.9) was twice that of non-Indigenous women (7.5 per 1000 women screened, CI 7.3–7.7). Adjusted for age, area-level disadvantage and place of residence, Indigenous women had higher prevalence of cLGA (OR 1.4, CI 1.3–1.4), cHGA (OR 2.2, CI 2.1–2.3) and hHGA (OR 2.0, CI 1.9–2.1). Our findings show that Indigenous women recorded on the Pap Smear Register have much higher prevalence for cLGA, cHGA and hHGA compared to non-Indigenous women. The renewed cervical screening program, to be implemented in 2017, offers opportunities to reduce the burden of abnormalities and invasive cancer among Indigenous women and address long-standing data deficiencies.
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Affiliation(s)
- Lisa J. Whop
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
- * E-mail:
| | - Peter Baade
- Cancer Council Queensland, Brisbane, Australia
| | - Gail Garvey
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - Joan Cunningham
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - Julia M. L. Brotherton
- Victorian Cytology Service Inc, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kamalini Lokuge
- National Centre of Epidemiology and Public Health, Australian National University, Canberra, Australia
| | - Patricia C. Valery
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Abbey Diaz
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - David Roder
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Dorota M. Gertig
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Suzanne P. Moore
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - John R. Condon
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
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Mwaka AD, Garimoi CO, Were EM, Roland M, Wabinga H, Lyratzopoulos G. Social, demographic and healthcare factors associated with stage at diagnosis of cervical cancer: cross-sectional study in a tertiary hospital in Northern Uganda. BMJ Open 2016; 6:e007690. [PMID: 26801459 PMCID: PMC4735146 DOI: 10.1136/bmjopen-2015-007690] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To examine patient and primary healthcare factors and stage at diagnosis in women with cervical cancer in Northern Uganda with the intention to identify factors that are associated with advanced stages in order to inform policies to improve survival from cervical cancer in low income and middle income countries. DESIGN Cross-sectional hospital-based study. SETTING Tertiary, not-for-profit private hospital in postconflict region. PARTICIPANTS Consecutive tissue-diagnosed symptomatic patients with cervical attending care. Of 166 patients, 149 were enrolled and analysed. PRIMARY OUTCOME Cervical cancer stage at diagnosis. RESULTS Most women were diagnosed at stages III (45%) or IV (21%). After controlling for age, marital status, educational attainment and number of biological children, there was evidence for association between advanced stage at diagnosis and pre-referral diagnosis of cancer by primary healthcare professionals (adjusted OR (AOR)=13.04:95% CI 3.59 to 47.3), and financial difficulties precluding prompt help seeking (AOR=5.5:95% CI 1.58 to 20.64). After adjusting for age, marital status and educational attainment, women with 5-9 biological children (AOR=0.27:95% CI 0.08 to 0.96) were less likely to be diagnosed with advanced stage (defined as stages III/IV) cancer. In this pilot study, there was no statistical evidence for associations between stage at diagnosis, and factors such as age at diagnosis and marital status. CONCLUSIONS This study is a first attempt to understand the descriptive epidemiology of cervical cancer in rural Ugandan settings. Understanding individual patient factors, patients' behavioural characteristics and healthcare factors associated with advanced stage at diagnosis is essential for targeted effective public health interventions to promote prompt health seeking, diagnosis at early stage and improved survival from cervical cancer.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher Orach Garimoi
- Department of Community Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Martin Roland
- Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Henry Wabinga
- Department of Pathology, Kampala Cancer Registry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Georgios Lyratzopoulos
- Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
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Behnamfar F, Azadehrah M. Factors associated with delayed diagnosis of cervical cancer in Iran--a survey in Isfahan City. Asian Pac J Cancer Prev 2015; 16:635-9. [PMID: 25684499 DOI: 10.7314/apjcp.2015.16.2.635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the absence of routine screening program for cervical cancer in Iran and high rate of diagnosed cancer in its advanced stage, recognition of sociodemographic factors related to delayed diagnosis of cancer in Iran could be helpful in reducing the burden of disease in our community. The aim of this study was to determine the stage of cervical cancer at diagnosis and factors related to delayed diagnosis of cervical cancer in Isfahan, Iran. MATERIALS AND METHODS In this cross sectional study women diagnosed with cervical cancer for the first time by histo-pathological examination were enrolled. According to the clinical and paraclinical findings and staging of the cancer, they were classified into early and delayed diagnosis of cervical cancer. Sociodemographic factors were compared in the two groups. RESULTS In this study of 55 women mean age was 48.3±12.0. According to our classification 6/55 (10.9%) and 49/55 (89.1%) of them had early and delayed diagnosis of cervical cancer. Delayed diagnosis of the cancer was significantly higher in patients with lower degree of education, lower socioeconomic status, having smoker and addict husband and those who did not have a history of Pap smear test (p<0.05). CONCLUSIONS The results of this study indicated risk factors related to delayed diagnosis of cervical cancer. The affected women should be targeted for implementation of specialized educational programmes for improving knowledge and screening test.
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Affiliation(s)
- Fariba Behnamfar
- Depatment of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran E-mail :
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Li J, Kang LN, Li B, Pang Y, Huang R, Qiao YL. Effect of a group educational intervention on rural Chinese women's knowledge and attitudes about human papillomavirus (HPV) and HPV vaccines. BMC Cancer 2015; 15:691. [PMID: 26467534 PMCID: PMC4606881 DOI: 10.1186/s12885-015-1682-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 10/02/2015] [Indexed: 11/23/2022] Open
Abstract
Background Statistics regarding HPV prevalence and cervical cancer rates in rural China are high, however, low levels of HPV awareness and HPV-related knowledge pose a great challenge for cervical cancer control. Methods The authors conducted an educational intervention study, which was embedded in a cervical cancer screening project in Yangcheng county, Shanxi Province, China from October to December, 2011 and was designed to assess the short-term effectiveness of a hospital-based, brief, HPV-focused session on rural Chinese women’s knowledge and attitudes. Student’s t-test was used when comparing quantitative variables. Chi-squared test or Fisher’s exact tests was used when comparing qualitative variables. Results We found that following the intervention, significant increases were detected in awareness regarding HPV (5.9 % vs. 59 %, p < 0.001) and cervical cancer (63.0 % vs. 89.2 %, p < 0.001). Changes were also observed regarding women’s intention to vaccinate themselves (82.0 % vs. 89.0 %, p = 0.001) and their daughters (82.9 % vs. 88.0 %, p = 0.011), although the impact was more modest compared with the impact on change of awareness. Among women who were aware of HPV, 60.3 % knew that cervical cancer is related to HPV, while only 5.0 % knew the relationship between HPV and genital warts after the educational intervention. Conclusions Educational campaigns, particularly those targeting women with limited education and poor access to public media or other educational channels are needed to improve knowledge regarding HPV in the general population.
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Affiliation(s)
- Jing Li
- Department of Occupational and Environmental Health, West China School of Public Health, Sichuan University, Chengdu, 610041, China.
| | - Le-Ni Kang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
| | - Bayi Li
- Department of Medical Services, Yangcheng Maternal and Child Health Hospital, Yangcheng, 048100, China.
| | - Yi Pang
- The prevention and control section for STD & AIDS, Center for disease control and prevention of Jinjiang, Chengdu, 610021, China.
| | - Rong Huang
- Department of Human Resource, The People's Hospital of Gansu Province, Lanzhou, 730060, China.
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
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Seroprevalence of human Toxocara infections in the Roma and non-Roma populations of Eastern Slovakia: a cross-sectional study. Epidemiol Infect 2015; 143:2249-58. [PMID: 25592864 DOI: 10.1017/s0950268814003665] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Socioeconomic conditions and health of the Roma population, the most numerous minority in Europe, are worse than that of the non-Roma population. Information about the occurrence of human toxocarosis and other parasitic diseases in the Roma population is scarce or completely missing. The aim of this study was to map the seroprevalence of toxocarosis in the population living in segregated Roma settlements and to compare the data with the occurrence of antibodies in the non-Roma population of Eastern Slovakia. The seropositivity to Toxocara in 429 examined Roma inhabitants of segregated settlements reached 22·1%, while only 4/394 samples of the non-Roma population were found to be positive (odds ratio 27·7, P < 0·0001). Headache, muscle pain, influenza-like symptoms and diarrhoea occurred significantly more often in seropositive persons than in seronegative individuals. In the Roma population positivity was not influenced by gender, level of education and poverty, but age, lack of sanitary facilities and heating with wood significantly increased the risk of infection. It can be assumed that besides the high prevalence of toxocarosis, other parasitic diseases and communicable diseases will also be more prevalent in the Roma population living in segregated settlements.
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Lovell B, Wetherell MA, Shepherd L. Barriers to cervical screening participation in high-risk women. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0649-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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KHODAKARAMI N, MORADI A, MIRZAEI H, FARZANEH F, YAVARI P, AKBARI ME. Frequency of Human Papillumavirus among Women with High-Grade Squamous Intraepithelial Lesions and Invasive Cervical Cancer Attending Shahid Beheshti University of Medical Sciences Clinics, Tehran, Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:1563-8. [PMID: 26060725 PMCID: PMC4449507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 09/20/2014] [Indexed: 10/27/2022]
Abstract
BACKGROUND The previous studies reported some information about prevalence release of high-risk HPV types in HSIL or cervical cancer globally and in Iran, however, this information is not enough for final judgment about vaccination against HPV or any screening program. The aim of the present study was to assess the HPV type distribution in HSIL and ICC specimens of women attending Shahid Beheshti University of Medical Sciences teaching hospitals, Tehran, Iran for treatment during 10 years. METHODS This retrospective- descriptive study evaluated the HPV type distribution of pathologic specimens of Iranian women with invasive cervical cancer (ICC) and high-grade squamous cell intraepithelial lesions (HSIL). Formalin-fixed tumor biopsies that were retrieved from women presenting with histological confirmation for ICC and 17 pathologic confirmation for HSIL specimens. RESULTS The most frequently identified HPV type 16 among both groups, women with invasive cervical cancer (4-2.18%) and women with High Grade Squamous Intraepithelial Lesion (29.41%), followed by HPV18, HPV31 and 26. HPV16 and / or 18 accounted for 82.2% of all infected samples. CONCLUSION The dominance of HPV16 over other high-risk types might be even higher than in a region with low HPV exposure. However, there was no strong evidence for any judgment that show to the policy makers; which one is cost-effectiveness and feasibility for cervical cancer prevention in Iran, vaccination, screening or both? More population based study and national meta-analysis needed for better understanding of HPV prevalence and HPV DNA patterns in Iran.
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Affiliation(s)
- Nahid KHODAKARAMI
- 1. Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin MORADI
- 2. Dept. of Pathology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza MIRZAEI
- 3. Dept. of Oncology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah FARZANEH
- 4. Dept. of Obstetrics/Gynecology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin YAVARI
- 5. Dept., of Epidemiology, Health & Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Esmaeil AKBARI
- 1. Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,* Corresponding Author:
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Shaltout MF, Sallam HN, AbouSeeda M, Moiety F, Hemeda H, Ibrahim A, Sherbini MEL, Rady H, Gopala K, DeAntonio R. Prevalence and type distribution of human papillomavirus among women older than 18 years in Egypt: a multicenter, observational study. Int J Infect Dis 2014; 29:226-31. [PMID: 25447728 DOI: 10.1016/j.ijid.2014.07.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/29/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Persistent infection with high-risk (HR) human papillomavirus (HPV) is associated with premalignant lesions and cervical cancer, the third most common cancer amongst women globally and the second most frequent in Egypt. We studied the prevalence and type distribution of HPV and documented HPV infection awareness and health-related behaviours for HPV infection. METHODS This was a multicenter, hospital-based observational study of women ≥18 years of age who attended for a gynaecological examination during October 2010-August 2011. Cervical samples were tested using Linear Array HPV genotyping. Two questionnaires on awareness and health-related behaviour were completed. RESULTS Four hundred and forty-three women with a mean age of 39.3±14.0 years were included in the analysis. HPV DNA was detected in 10.4% of women; a single HPV-type infection was found in 6.5% and multiple infections in 3.8%. The most prevalent HR types among HPV-positive women were HPV-16 (19.6%) and HPV-31 and HPV-51 (15.2% each); low-risk types included HPV-62 (17.4%) and HPV-84 (10.9%). The prevalence of HPV-18 was low (6.5%). The prevalence of any HR HPV-type was highest in women aged 45-54 years (9.2%). CONCLUSIONS The overall prevalence of HPV in Egypt was 10.4% and was highest (9.2%) amongst women aged 45-54 years. These data provide important reference information for public health authorities considering HPV prevention in Egypt.
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Affiliation(s)
| | | | | | - Fady Moiety
- University of Alexandria, Smouha, Alexandria, Egypt
| | | | | | | | - Helmy Rady
- University of Alexandria, Smouha, Alexandria, Egypt
| | - Kusuma Gopala
- GlaxoSmithKline Pharmaceuticals Ltd., Bangalore, India
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Park HM, Oh HE. Factors associated with the Intention of Human Papillomavirus Vaccination among Mothers of Junior High School Daughters. ACTA ACUST UNITED AC 2014. [DOI: 10.5392/jkca.2014.14.08.307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barbaro B, Brotherton JM. Assessing HPV vaccine coverage in Australia by geography and socioeconomic status: are we protecting those most at risk? Aust N Z J Public Health 2014; 38:419-23. [DOI: 10.1111/1753-6405.12218] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/01/2013] [Accepted: 01/01/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Bianca Barbaro
- Public Health Information Development Unit; University of Adelaide; South Australia
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Kristensson JH, Sander BB, von Euler-Chelpin M, Lynge E. Predictors of non-participation in cervical screening in Denmark. Cancer Epidemiol 2014; 38:174-80. [DOI: 10.1016/j.canep.2013.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
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Tay SK, Oon LLE. Prevalence of cervical human papillomavirus infection in healthy women is related to sexual behaviours and educational level: a cross-sectional study. Int J STD AIDS 2014; 25:1013-21. [DOI: 10.1177/0956462414528315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study reports the prevalence and risk factors of human papillomavirus (HPV) infection in healthy women in Singapore. Demography, education, sexual and reproductive history and cigarette smoking habits were obtained from a cross-sectional population of healthy women and girls aged above 12 years of age. Cervical or vaginal cytology samples were investigated for 37 known anogenital HPV subtypes using the linear array PCR method. Chi square statistics were used to test for associations of individual epidemiological factors with HPV infection. Independent risk factors were identified with binomial logistic regression analysis. Of 891 subjects, the prevalence of HPV infection was 9.31% (83/891 women) for any-type HPV and 5.05% (46/891 women) for the high-risk HPV (hrHPV). Of 30 HPV subtypes detected, the most prevalent genotypes in descending order of frequency were subtypes 51, 16, 52, 58 and 66 for hrHPV and subtypes 62, 61, 84, 72 and 53 for the low-risk HPV. This frequency distribution of HPV subtypes was different from reports from other countries within Asia. Forty-six virgins studied tested negative for HPV infection. Significant independent risk factors for any-type HPV infection were multiple sexual partners (adjusted OR 1.4) and low (≤6 years) educational level (adjusted OR 4.0). The distribution of HPV subtypes in healthy women varies between different countries within Asia. In Singapore, the prevalence of HPV infection was 9.31% and was related to penetrative sexual intercourse, multiple sexual partners and low educational level.
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Affiliation(s)
- Sun Kuie Tay
- Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore
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Gyenwali D, Pariyar J, Onta SR. Factors associated with late diagnosis of cervical cancer in Nepal. Asian Pac J Cancer Prev 2014; 14:4373-7. [PMID: 23992006 DOI: 10.7314/apjcp.2013.14.7.4373] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The majority of cervical cancers, the most prevalent cancer among Nepali women, are diagnosed in advanced stage leading to high mortality in Nepal. The present study explored factors associated with late diagnosis. MATERIALS AND METHODS A cross-sectional study was carried out in two specialized cancer hospitals of Nepal from August 12 to October 12, 2012. Randomly selected 110 cervical cancer patients were interviewed and their medical records were reviewed. Multivariate logistic regression analysis was performed to predict associations. RESULTS Mean age of patients was 52.7years (SD=10.6), 66% were illiterate and 77% were rural inhabitants. Medical shops (33.6%) and private hospitals (31%) were major first contact points of patients with health care providers (HCP). There was no cervical/per-speculum examination (78.2%) and symptoms misinterpretation (90%) of patients occurred in initial consultation with HCP. Four in every five cases (80.9%) of cervical cancer had late diagnosis. Literate women (adjusted OR=0.121, CI: 0.030-0.482) and women having abnormal vaginal bleeding as early symptom (adjusted OR=0.160, CI: 0.035-0.741) were less likely to suffer late diagnosis. Women who shared their symptoms late (adjusted OR=4.272, CI: 1.110-16.440) and did so with people other than their husband (adjusted OR=12.701, CI: 1.132-142.55) were more likely for late diagnosis. CONCLUSIONS High level of illiteracy among women and their problematic health seeking behavior for gynecological symptoms are responsible for late diagnosis of cervical cancer in Nepal. In the absence of a routine screening program, prevention interventions should be focused on raising awareness of gynecological symptoms and improving health seeking behavior of women for such symptoms.
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Affiliation(s)
- Deepak Gyenwali
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
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Kim SY, Choi SY. Knowledge and Health Beliefs about Cervical Cancer among Husbands Married to Immigrant Women. ASIAN ONCOLOGY NURSING 2014. [DOI: 10.5388/aon.2014.14.3.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- So Young Kim
- Department of Nursing, Graduate School of Gyeongsang National University, Jinju, Korea
| | - So Young Choi
- College of Nursing, Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Brun-Micaleff E, Coffy A, Rey V, Didelot MN, Combecal J, Doutre S, Daurès JP, Segondy M, Boulle N. Cervical cancer screening by cytology and human papillomavirus testing during pregnancy in French women with poor adhesion to regular cervical screening. J Med Virol 2013; 86:536-45. [PMID: 24114972 DOI: 10.1002/jmv.23764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2013] [Indexed: 11/08/2022]
Abstract
In France, cervical screening is opportunistic and approximately 40% of women do not attend regular screening programs. The aim of this study was (1) to assess the prevalence of human papillomavirus (HPV) cervical infection and of cytological abnormalities in a population of young pregnant women with poor adherence to cervical cancer screening and (2) to evaluate the adherence to a screening strategy combining HPV testing and cytology during pregnancy. For this purpose, pregnant women benefited from a cervical smear associated with HPV DNA detection. High-risk HPV types were detected and identified using the HC2 assay and the INNO-LiPA HPV genotyping Extra assay. Two hundred forty-seven women (mean age 26.6 ± 5.1 years) were enrolled. Among them, 76.8% did not attend regular cervical cancer screening programs. High-risk HPV types were detected in 50 (20.2%) samples, HPV 16 being the most frequent (N = 12; 14.5%), with multiple HPV infection in 17 samples (27%). Nine (3.6%) abnormal cervical smears were diagnosed. Follow-up of women with abnormal cytology and/or infection with high-risk HPV was obtained in 29 cases (55.8%), showing 12 persistent high-risk HPV infections. Nine women had colposcopy with a final diagnosis of four normal cervixes, three cervical intraepithelial neoplasia grade 1 and two cervical intraepithelial neoplasia grade 2. Overall, women adherence to the free post-partum follow-up visit was 53.5%. This study suggests that a screening program combining HPV testing with cervical cytology during pregnancy may be one option to target young women with poor adhesion to regular cervical cancer screening.
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Affiliation(s)
- Elisabeth Brun-Micaleff
- Prenatal Care Center (PMI), Montpellier, France; Department of Gynecology and Obstetrics, CHRU de Montpellier, Montpellier, France
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Huang WH, Lin JL, Lin-Tan DT, Chen KH, Hsu CW, Yen TH. Education level is associated with mortality in male patients undergoing maintenance hemodialysis. Blood Purif 2013; 35:316-26. [PMID: 23920269 DOI: 10.1159/000351613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of the correlation between education levels and mortality in hemodialysis (HD) patients are rare. The aim of this multi-center study was to investigate the relationship between education levels and 3-year mortality rates in HD patients. METHODS A total of 935 HD patients from 3 HD centers participated in this 3-year prospective observational study. Education levels were categorized as either less than senior high school and above or equal to senior high school. The causes of death and mortality rates were also analyzed for each subgroup. RESULTS At the end of the 3-year follow-up period, 164 patients had died. In the male group, forward stepwise Cox regression analysis revealed that age, HD duration, hypertension, creatinine level, serum albumin level ≥3.6 g/dl, anuria, Kt/Vurea, and high education level were significant predictive factors for 3-year mortality rates. CONCLUSION This prospective observational study demonstrated that education level was associated with mortality in men undergoing HD.
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Affiliation(s)
- Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei and Lin-Kou Medical Center, Taoyuan, and Chang Gung University and School of Medicine, Taipei, Taiwan, ROC
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Das D, Rai AK, Kataki AC, Barmon D, Deka P, Sharma JD, Sarma A, Shrivastava S, Bhattacharyya M, Kalita AK, Sharma M, Ahmed S. Nested Multiplex PCR Based Detection of Human Papillomavirus in Cervical Carcinoma Patients of North- East India. Asian Pac J Cancer Prev 2013; 14:785-90. [DOI: 10.7314/apjcp.2013.14.2.785] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Marlow LAV, Sangha A, Patnick J, Waller J. The Jade Goody Effect: whose cervical screening decisions were influenced by her story? J Med Screen 2012; 19:184-8. [PMID: 23271834 DOI: 10.1258/jms.2012.012095] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES In 2009 more women attended cervical screening in England and Wales than in the previous year. Described as the 'Jade Goody Effect' this was attributed to the death from cervical cancer of a UK celebrity. The present study aimed to establish which sociodemographic characteristics were associated with being influenced by Jade Goody's story. METHODS Data were collected as part of a Taylor Nelson Sofres (TNS) omnibus survey using random location sampling. Women in England aged 26-64 years were asked to report whether they felt Jade Goody's story had influenced their decisions about cervical screening over the 18 months between her death and the time of the survey. RESULTS Data from 890 participants was included in analysis. Over a third of women felt Goody's story had influenced their decisions about cervical screening (40%). Younger women (aged 26-35 years) were more likely to have been influenced by Goody's story than older women (56-64 year olds). There was also evidence of socioeconomic variation with women from lower socioeconomic class groups and those with fewer educational qualifications more likely to say they had been influenced by Goody's story. CONCLUSIONS The 'Jade Goody Effect', as acknowledged by women themselves, was more pronounced among young women and influenced screening decisions more markedly among those from lower socioeconomic backgrounds. Narrative communication may be an effective way to encourage attendance at cervical cancer screening and reach groups of the population that are difficult to reach using traditional intervention methods.
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Affiliation(s)
- Laura A V Marlow
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK.
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Charbotel B, Massardier-Pilonchery A, Fort E, Dananché B, Févotte J, Confavreux-Romestaing C, Bergeret A. Occupational trichloroethylene exposure and cervical pathology: a case-control study. ACTA ACUST UNITED AC 2012; 57:407-16. [PMID: 23091111 DOI: 10.1093/annhyg/mes075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Trichloroethylene (TCE) is suspected of association with elevated risk of cervical cancer. A case-control study was performed in a geographical area in which occupational TCE exposure is high. The study objective was to analyze the correlation between occupational TCE exposure and cervical cancer (including precancerous conditions). METHODS Case and control subjects were recruited by gynecologists. General and occupational data were collected by telephonic interviews. An industrial hygienist assessed occupational TCE exposure on a task-exposure matrix. Analysis focused on occupational TCE exposure at various levels and on cumulative dose. Multivariate analysis was performed to take account of the various risk factors. RESULTS In total, 67 case and 67 age-matched control subjects were included. Mean age was 36 years in both groups. Five of the possible general risk factors correlated significantly with cervical dysplasia or cancer: number of partners, history of genital or anal wart, interval between first period and first sexual relation, parity, and body mass index, the last three showing inverse correlation. Elevated risk was found in women who had had jobs as manual workers according to the PCS French classification (professions and socioprofessional categories), and production and related workers according to ISCO classification (International Standard Classification of Occupations), with odds ratios (ORs), adjusted on general and medical risk factors, of 7.68 [95% confidence interval (CI): 1.39-42.54] and 7.48 (1.30-43.24), respectively, among skilled service sector workers; the adjusted OR was close to significance, at 4.67 (95% CI: 0.92-23.67). No occupational sectors were significantly associated with elevated risk. In all, 17 (25.4%) case and 15 (22.4%) control subjects were exposed to TCE: raw OR = 1.17 (95% CI: 0.54-2.52), adjusted OR = 1.51 (95% CI: 0.42-5.41). There was no significant correlation between cumulative dose and exposure time. CONCLUSIONS The study found no significantly increased risk of cervical dysplasia or cancer associated with occupational TCE exposure.
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Nascimento MID, Silva GAE, Monteiro GTR. História prévia de realização de teste de Papanicolaou e câncer do colo do útero: estudo caso-controle na Baixada Fluminense, Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2012; 28:1841-53. [DOI: 10.1590/s0102-311x2012001000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 05/28/2012] [Indexed: 11/22/2022] Open
Abstract
Este estudo caso-controle hospitalar foi realizado de 2007 a 2010 para estimar a associação de história prévia de colpocitologia e câncer do colo do útero na Baixada Fluminense, Rio de Janeiro, Brasil. A amostra consistiu de 152 casos histologicamente confirmados e 169 controles selecionados no mesmo hospital dos casos. A análise foi feita de acordo com um modelo em três níveis hierárquicos; considerando as variáveis sociodemográficas (nível distal), sexual/reprodutivas e de estilo de vida (nível intermediário) e a história prévia de colpocitologia (nível proximal). Odds ratios (OR) e respectivos intervalos de 95% de confiança (IC95%) foram calculados pela regressão logística não condicional. Ter história prévia de três ou mais colpocitologias conferiu uma proteção de 84% (OR = 0,16; IC95%: 0,074; 0,384) após ajuste pelas variáveis selecionadas. Os resultados acentuam a importância do exame preventivo ginecológico no risco desse câncer e fortalecem a necessidade de aumentar a aderência às normas do programa brasileiro, bem como de identificar e capturar mulheres relutantes para o rastreamento da doença.
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Pista A, de Oliveira CF, Cunha MJ, Paixao MT, Real O. Risk factors for human papillomavirus infection among women in Portugal: the CLEOPATRE Portugal Study. Int J Gynaecol Obstet 2012; 118:112-6. [PMID: 22608026 DOI: 10.1016/j.ijgo.2012.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 03/02/2012] [Accepted: 04/12/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate demographic, socioeconomic, lifestyle, and medical factors that might predispose women to cervical human papillomavirus (HPV) infection. METHOD A cross-sectional population-based study was performed. Women aged 18-64 years who attended selected obstetrics and gynecology or sexually transmitted disease (STD) clinics in mainland Portugal between February 2008 and March 2009 were recruited, according to an age-stratified sampling strategy. Liquid-based cytology samples were analyzed centrally for HPV genotype and for cytologic features. Univariate and multivariate logistic regression analyses identified risk factors for HPV infection. RESULTS Among the 2326 women evaluated, the crude prevalence of HPV infection was 19.4%. Lifetime number of sexual partners was a strong predictor of HPV infection (odds ratio 5.44 for 5-10 partners versus 1 partner; P<0.001). Other risk factors were young age (particularly among women aged 20-24 years; P<0.001); country of birth other than mainland Portugal (P=0.002); education up to secondary school level (P=0.010); smoking history (≤ 10 years; P=0.004); and any STD in the past 12 months (P=0.052). CONCLUSION Data from the present study may aid identification of women at increased risk of HPV infection and target prevention strategies. TRIAL REGISTRATION National Commission of Data Protection (CNPD) registration number 5346/2007; Sanofi Pasteur MSD study number HPV-E05.
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Affiliation(s)
- Angela Pista
- Department of Infectious Diseases, National Institute of Health, Lisbon, Portugal.
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Risk factors for high-risk human papillomavirus infection and cofactors for high-grade cervical disease in Peru. Int J Gynecol Cancer 2012; 21:1654-63. [PMID: 21892094 DOI: 10.1097/igc.0b013e3182288104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the association between potential risk factors for high-risk human papillomavirus (HR-HPV) infection and cofactors for cervical intraepithelial lesions grade 2 or worse (CIN2+) in women attending cervical screening in Amazonian Peru. MATERIALS AND METHODS Participants completed a risk factor questionnaire before screening. High-risk human papillomavirus infection was determined by Hybrid Capture II. Logistic regression was used to evaluate associations between potential risk factors for HR-HPV infection and between cofactors and risk of CIN2+ among women with HR-HPV infection. RESULTS Screening and questionnaires were completed by 5435 women aged 25 to 49 years. The prevalence of HR-HPV was 12.6% (95% confidence interval [CI], 11.8%-13.6%) and decreased by age. Early age at first sexual intercourse and several lifetime sexual partners increased the risk of having HR-HPV (age-adjusted odds ratio [AOR] of age at first sexual intercourse <18 vs ≥20, 1.5; 95% CI, 1.2-2.0; AOR of ≥5 lifetime sexual partners vs 1, 2.1; 95% CI, 1.4-3.2). Among women with HR-HPV infection, those with no schooling (AOR relative to 1-5 years of schooling, 3.2; 95% CI, 1.3-8.3) and those with parity ≥3 (AOR relative to parity <3, 2.6; 95% CI, 1.4-4.9) were at increased risk of CIN2+. The effect of parity was stronger for cancer (AOR of parity ≥3 vs <3, 8.3; 95% CI, 1.0-65.6). Further analysis showed that the association between parity and CIN2+ was restricted to women younger than 40. Most women (83%) had previously been screened. Sixty-four percent of CIN2+ cases detected in this study occurred in women who reported having had a Papanicolaou test in the previous 3 years. Only 4 of 20 cancers were detected in women never screened before. Having had a previous abnormal Papanicolaou test increased the risk of CIN2+ (OR, 16.1; 95% CI, 6.2-41.9). CONCLUSION Among women with HR-HPV, high parity (in young women), no schooling, lack of good-quality screening and of adequate follow-up care are the main risk factors for high-grade cervical disease in Peru.
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Rinaldi S, Plummer M, Biessy C, Castellsagué X, Overvad K, Krüger Kjær S, Tjønneland A, Clavel-Chapelon F, Chabbert-Buffet N, Mesrine S, Lukanova A, Kaaks R, Weikert C, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Agnoli C, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita B, van Kranen HJ, Peeters PH, Bakken K, Lund E, Gram IT, Rodríguez L, Bosch FX, Sánchez MJ, Dorronsoro M, Navarro C, Gurrea AB, Kjellberg L, Dillner J, Manjer J, Butt S, Khaw KT, Wareham N, Allen NE, Travis R, Romieu I, Ferrari P, Riboli E, Franceschi S. Endogenous sex steroids and risk of cervical carcinoma: results from the EPIC study. Cancer Epidemiol Biomarkers Prev 2011; 20:2532-40. [PMID: 21994406 DOI: 10.1158/1055-9965.epi-11-0753] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Epidemiologic data and animal models suggest that, despite the predominant role of human papillomavirus infection, sex steroid hormones are also involved in the etiology of invasive cervical carcinoma (ICC). METHODS Ninety-nine ICC cases, 121 cervical intraepithelial neoplasia grade 3 (CIN3) cases and 2 control women matched with each case for center, age, menopausal status and blood collection-related variables, were identified in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Circulating levels of testosterone (T) and estradiol (E(2)); dehydroepiandrosterone sulfate (DHEAS); progesterone (premenopausal women); and sex hormone-binding globulin (SHBG) were measured using immunoassays. Levels of free (f) T and E(2) were calculated from absolute concentrations of T, E(2), and SHBG. Odds ratios (ORs) and 95% confidence intervals (CI) were computed using regularized conditional logistic regression. RESULTS Among premenopausal women, associations with ICC were observed for fT (OR for highest vs. lowest tertile = 5.16, 95% CI, 1.50-20.1). SHBG level was associated with a significant downward trend in ICC risk. T, E(2), fE(2), and DHEAS showed nonsignificant positive association with ICC. Progesterone was uninfluential. Among postmenopausal women, associations with ICC were found for T (OR = 3.14; 95% CI, 1.21-9.37), whereas E(2) and fT showed nonsignificant positive association. SHBG level was unrelated to ICC risk in postmenopausal women. No associations between any hormone and CIN3 were detected in either pre- or postmenopausal women. CONCLUSIONS Our findings suggest for the first time that T and possibly E(2) may be involved in the etiology of ICC. IMPACT The responsiveness of cervical tumors to hormone modulators is worth exploring.
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Affiliation(s)
- Sabina Rinaldi
- International Agency for Research on Cancer, Lyon, France
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Alibegashvili T, Clifford GM, Vaccarella S, Baidoshvili A, Gogiashvili L, Tsagareli Z, Kureli I, Snijders PJF, Heideman DAM, van Kemenade FJ, Meijer CJLM, Kordzaia D, Franceschi S. Human papillomavirus infection in women with and without cervical cancer in Tbilisi, Georgia. Cancer Epidemiol 2011; 35:465-70. [PMID: 21292583 DOI: 10.1016/j.canep.2010.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 12/15/2010] [Accepted: 12/20/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND No accurate estimates of cervical cancer incidence or mortality currently exist in Georgia. Nor are there any data on the population-based prevalence of high-risk (HR) human papillomavirus (HPV) infection, which, in the absence of good-quality screening, is known to correlate with cervical cancer incidence. METHODS We obtained cervical cell specimens from 1309 women aged 18-59 years from the general population of Tbilisi, and also from 91 locally diagnosed invasive cervical cancers (ICC). DNA of 44 HPV types was tested for using a GP5+/6+-based PCR assay. RESULTS In the general population (of whom 2% reported a previous Pap smear) HPV prevalence was 13.5% (95% CI: 11.6-15.9), being highest in women aged 25-34 years (18.7%) and falling to between 8.6% and 9.5% for all age groups above 34 years. HR HPV prevalence was 8.6% overall, being 6.8% and 38.9% among women with normal and abnormal cytology, respectively. HPV45 (1.6%) was the most common type in women with normal cytology, whereas HPV16 predominated among women with cervical abnormalities (including 7 of 10 histologically confirmed cervical intraepithelial neoplasia 2/3) and among ICC (57.6%). The next most common types in ICC in Georgia were HPV45 and 18 (13.2 and 11.0%, respectively). CONCLUSIONS We report a relatively high burden of HPV infection in Tbilisi, Georgia. Improving cervical cancer prevention, through screening and/or HPV vaccination, is an important public health issue in Georgia, where 70% of ICC are theoretically preventable by HPV16/18 vaccines.
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Affiliation(s)
- Tamar Alibegashvili
- Alexandre Natishvili Institute of Morphology, 2 Chiaureli St., Tbilisi 0159, Georgia
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Garland SM, Brotherton JML, Condon JR, McIntyre PB, Stevens MP, Smith DW, Tabrizi SN. Human papillomavirus prevalence among indigenous and non-indigenous Australian women prior to a national HPV vaccination program. BMC Med 2011; 9:104. [PMID: 21910918 PMCID: PMC3182900 DOI: 10.1186/1741-7015-9-104] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 09/13/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Indigenous women in Australia have a disproportionate burden of cervical cancer despite a national cervical screening program. Prior to introduction of a national human papilloma virus (HPV) vaccination program, we determined HPV genotype prevalence by Indigenous status and residence in remote areas. METHODS We recruited women aged 17 to 40 years presenting to community-based primary health services for routine Pap screening across Australia. A liquid-based cytology (LBC) cervical specimen was tested for HPV DNA using the AMPLICOR HPV-DNA test and a PGMY09/11-based HPV consensus PCR; positive specimens were typed by reverse hybridization. We calculated age-adjusted prevalence by weighting to relevant population data, and determined predictors of HPV-DNA positivity by age, Indigenous status and area of residence using logistic regression. RESULTS Of 2152 women (655 Indigenous), prevalence of the high-risk HPV genotypes was similar for Indigenous and non-Indigenous women (HPV 16 was 9.4% and 10.5%, respectively; HPV 18 was 4.1% and 3.8%, respectively), and did not differ by age group. In younger age groups, the prevalence of other genotypes also did not differ, but in those aged 31 to 40 years, HPV prevalence was higher for Indigenous women (35% versus 22.5%; P < 0.001), specifically HPV clades α5 (OR = 2.1, 95% CI 1.1 to 4.3) and α7, excluding type 18 (OR 1.9, 95% CI 1.1 to 3.3). In multivariate analysis, detection of any HPV genotype was strongly associated with smoking and Pap-test abnormalities, with both risk factors more common among Indigenous women. CONCLUSION Although we found no difference in the prevalence of HPV16/18 among Australian women by Indigenous status or, for Indigenous women, residence in remote regions, differences were found in the prevalence of risk factors and some other HPV genotypes. This reinforces the importance of cervical screening as a complement to vaccination for all women, and the value of baseline data on HPV genotype prevalence by Indigenous status and residence for the monitoring of vaccine impact.
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Affiliation(s)
- Suzanne M Garland
- Regional World Health Organisation Human Papillomavirus Laboratory Network, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Locked Bag 300, Parkville, Victoria 3052, Australia.
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