1
|
Tehranian A, Ghahghaei-Nezamabadi A, Seifollahi A, Mansouri P, Maleki-Hajiagha A, Aghajani R. Concurrent anorectal and cervical cytology in women with positive and negative cervical smear test results: A cross-sectional study. Int J Gynaecol Obstet 2023; 161:100-105. [PMID: 36183298 DOI: 10.1002/ijgo.14490] [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: 05/21/2022] [Revised: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Considering the exponentially growing concerns about the increase of anal cancer rates in women with human papillomavirus (HPV) infection and cervical intraepithelial neoplasia, the authors evaluated concurrent anorectal and cervical cytology in women with positive and negative cervical smear tests. METHOD The current investigation was designed as a cross-sectional study conducted in Arash Women's Hospital, Tehran, Iran, between November 2020 and November 2021. Cervical cytology, HPV test, and anal cytology samples were prepared. Then women with abnormal cervical cytology and/or positive high-risk HPV were referred to a colposcopy clinic for further evaluation. RESULTS Five hundred and forty-three women were recruited during the study period. These women were divided into two groups of positive cervical cytology (n = 161) and negative cervical cytology (n = 382). There were no cases of anal intraepithelial neoplasia in either group. Negative anal cytology was reported in 99 (61.5%) of participants with a positive cervical cytology and 254 (66.7%) of participants with a negative cervical cytology. A total of 62 (38.5%) anal samples in the positive group and 127 (33.3%) in the negative group were unsatisfactory for further evaluation. CONCLUSION We were unable to show any correlation between abnormal cervical cytology, dysplasia, or cervical high-risk HPV with anal abnormal cytology.
Collapse
Affiliation(s)
- Afsaneh Tehranian
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Ghahghaei-Nezamabadi
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Seifollahi
- Pathology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Mansouri
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Maleki-Hajiagha
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Aghajani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Ashrafganjoei T, Sadat Hosseini M, Pirastehfar Z, Farzaneh F, Arab M, Moghaddam NA, Javadi A, Joybari AY. Evaluation of anal cytology and human papillomavirus infection in high-risk women: a cross-sectional study. MEDICAL JOURNAL OF INDONESIA 2023. [DOI: 10.13181/mji.oa.236375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Anal cancer incidence has been on the rise over the past few decades. This study aimed to assess anal Papanicolaou (Pap) smear changes in women with high risk for dysplasia and human papillomavirus (HPV) infection.
METHODS This cross-sectional study was conducted on 121 patients referred to the Gynecology Oncology Clinic of Imam Hossein Medical Center between 2020 and 2021 in Tehran, Iran, who had cervical and vulvar dysplasia, cervical HPV infection, and abnormal cervical cytology results and were over 21 years old. Data analysis was performed using SPSS software version 21 (IBM Corp., USA) at a significance level of 0.05.
RESULTS 121 women, with a mean age of 39.69 years, were included in this study. Overall, 23.1% of women had positive anal HPV results, and 35.5% were over 40 years old. Younger age was associated with an increased risk of anal HPV (p = 0.045). 33.9% of women were single and had a higher risk of anal HPV. Multiple sexual partnerships and anal sex were the significant risk factors for anal cancer (p<0.001). Women with positive anal HPV results had significantly more genital warts (p<0.001). No significant difference was observed in smoking, educational level, and cervical Pap smear results between women with negative and positive rectal HPV results.
CONCLUSIONS Younger age at diagnosis, being single, having multiple sexual partnerships, having anal sex, and having genital warts were associated with anal HPV infection in women. Abnormal anal cytology was only associated with being single and having multiple sexual partners.
Collapse
|
3
|
DUYMUŞ ME, BAYRAMOĞLU Z, AYİK H, BAG YM. The analysis of anal cytology positivity in women with pathological cervical cytology. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1142816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: Cervical cytology (CC) is a routine screening method used to reduce cervical cancer. Although anal cancer and cervical cancer have similar etiological factors the opinion about the anal cancer screening program is unclear. We aimed to determine the features of women with abnormal anal cytology (AC) who had screened via CC for cervical neoplasia.
Methods: Two hundred and five females' CC results were investigated. The patients with normal CC were excluded, finally 87 participants were included. The demographics, medical, sexual, and reproductive features, CC and AC results were analyzed.
Results: The study group had a mean age of 40.77 ± 9.50 years. AC was pathological in six patients (6.9%). Four of these (66.7%) were high-grade squamous intraepithelial lesions (HSIL) and two (33.3%) were low-grade squamous intraepithelial lesions (LSIL). The CC results of these patients were all HSIL, all of them were human papillomavirus (HPV) positive, with the most common type being 16 (83.3%).
Conclusion: Women with HSIL in CC (especially with concomitant HPV) may be riskier for AC positivity. The others are most likely to have negative AC results. The use of AC for early diagnosis of risky anal intraepithelial lesions (such as a screening tool) may be considered for this group of patients.
Collapse
|
4
|
Svidler López L, La Rosa L. Human Papilloma Virus Infection and Anal Squamous Intraepithelial Lesions. Clin Colon Rectal Surg 2019; 32:347-357. [PMID: 31507344 DOI: 10.1055/s-0039-1687830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article addresses the natural history of the human papilloma virus (HPV) infection to anal squamous intraepithelial lesions, and onto squamous cell carcinoma of the anus. This article provides overviews of the virology, pathophysiology, nomenclature, classification, historical terms, risk factors, clinical evaluation, differential diagnosis, and treatment of HPV infection and its sequelae.
Collapse
Affiliation(s)
- Laura Svidler López
- Department of Surgery, Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina
| | - Luciana La Rosa
- Department of Surgery, Centro de Educación Médica e Investigaciones clínicas, Buenos Aires, Argentina.,Centro Privado de Cirugía y Coloproctología, Buenos Aires, Argentina
| |
Collapse
|
5
|
Fokom Domgue J, Messick C, Milbourne A, Guo M, Salcedo MP, Dahlstrom KR, Chiao EY, Deshmukh AA, Sturgis EM, Schmeler KM. Prevalence of high-grade anal dysplasia among women with high-grade lower genital tract dysplasia or cancer: Results of a pilot study. Gynecol Oncol 2019; 153:266-270. [PMID: 30827725 DOI: 10.1016/j.ygyno.2019.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate the prevalence of high-grade anal dysplasia in women with high-grade dysplasia or carcinoma of the cervix, vagina or vulva. METHODS In this cross-sectional study, participants underwent anal cytology, anal HPV testing with Cervista HPV16/18 and high-resolution anoscopy (HRA). Patients with HSIL (high-grade squamous cell intraepithelial lesion) or greater on anal cytology or anal biopsy were referred to a colorectal surgery specialist for further evaluation. RESULTS Seventy-five women were enrolled in the study, including 47 with cervical (cervix group), 10 with vaginal (vagina group), 15 with vulvar (vulva group), 1 with cervical and vaginal, and 2 with vulvar and vaginal disease. The median age in the cervix group (40 years (range 26-69)) was substantially younger than in the vagina (60 years (38-69)) and the vulva (59 years (36-75)) groups. Anal HSIL based on composite endpoints of the most severe cytology or histology result was diagnosed in 6 patients (8.0%). Anal cytology revealed HSIL in 2 (2.7%), atypical squamous cells of undetermined significance (ASCUS) in 12 (16.0%), low-grade squamous cell intraepithelial lesion (LSIL) in 2 (2.7%), and was normal in 59 (78.7%) patients. Anal HPV16/18 test was positive in 15 (20.0%), negative in 48 (64.0%) and insufficient in 12 (16.0%) patients. Of the 6 women with high-grade anal dysplasia, three (50%) had a positive anal HPV16/18 test. No case of anal cancer was observed. CONCLUSION Our results suggest that the prevalence of anal HSIL is elevated among women with HPV-related lower genital tract dysplasia or cancer. To further support the inclusion of this high-risk group into screening guidelines for anal dysplasia, further studies are necessary to determine what screening strategy is suited to this population.
Collapse
Affiliation(s)
- Joël Fokom Domgue
- The Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Cameroon
| | - Craig Messick
- The Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrea Milbourne
- The Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ming Guo
- The Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mila P Salcedo
- The Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The Department of Obstetrics & Gynecology, Federal University of Health Sciences/Irmandade Santa Casa de Misericordia, Porto Alegre, Brazil
| | - Kristina R Dahlstrom
- The Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Y Chiao
- Department of Medicine - Infectious Disease, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ashish A Deshmukh
- Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Erich M Sturgis
- The Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathleen M Schmeler
- The Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
6
|
Hosseini MS, Khosravi D, Farzaneh F, Ebrahimi A, Arab M, Ashraf Ganjoie T, Jamdar F, Moridi A, Chehrazi M. Evaluation of Anal Cytology in Women with History of Abnormal Pap Smear, Cervical Intraepithelial Neoplasia, Cervical Cancer and High Risk HPV for Anogenital Dysplasia. Asian Pac J Cancer Prev 2018; 19:3071-3075. [PMID: 30485943 PMCID: PMC6318392 DOI: 10.31557/apjcp.2018.19.11.3071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Anal cancer is uncommon. Although uncommon, the incidence of anal cancer has increased among
the general population of the United States and other countries over the past 30 years. We evaluated anal cytology in
women with the history of abnormal pap smear, cervical intraepithelial neoplasia, cervical cancer and high risk HPV
for anogenital dysplasia. Methods: In this cross-sectional study, 153 patients over the age of 21 years, referred to Imam
Hossein Hospital in 1395-1396 who were being monitored due to abnormal pap smear, cervical cancer, CIN and high
risk HPV, were evaluated with anal cytology for anogenital dysplasia. Results: 153 patients were enrolled in four
main groups. Among those with a history of abnormal pap smear (39 patients), only 25% of the patients with HSIL
had abnormal anal pap smear, and the rest of them had negative anal smear. Among those with a history of CIN (61
patients), patients with CIN III, 30.8% had abnormal anal smear, while the rest had a negative anal smear. Among those
with a high risk of HPV (23 patients), 50% of the patients with concurrent positive HPV 16 and 18 had anal abnormal
smear. Patients with a history of cervical cancer (30 patients) who had radiotherapy with or without surgery showed a
negative anal smear. The ratio of anal SIL positive of individuals with a sexual partner was only 1.9%, while this ratio
was 27.3% for those with more than one partner and this difference was statistically significant (P <0.0001). 15.4%
of smokers had positive anal SIL test result, while, only 2.9% non-smokers had the same result, and this difference
was statistically significant (P = 0.03). 20% of the patients who had anal intercourse showed a positive anal SIL score
result, compared to 1% for those who did not. This difference was statistically significant (P <0.0001). Conclusion:
Among people with a history of abnormal cervical pap smear, CIN, cervical cancer and high-risk HPV during the last
6 months, abnormal anal tests are most commonly seen in patients who had risk factors such as anal sex, cigarette,
multi partner etc. with high grade interepithelial squamous cervix such as HSIL, CIN III, HPV 16 and 18; more studies
in larger sample size are needed to have the better conclusion.
Collapse
Affiliation(s)
- Maryam Sadat Hosseini
- Preventative Gynecology Research Center, ShahidBeheshti University of Medical Sciences, Tehran, Iran.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Cronin B, Bregar A, Luis C, Schechter S, Disilvestro P, Pisharodi L, Sung CJ, Raker C, Clark M, Robison K. Evaluation of anal cytology and dysplasia in women with a history of lower genital tract dysplasia and malignancy. Gynecol Oncol 2016; 141:492-496. [PMID: 27095188 DOI: 10.1016/j.ygyno.2016.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/12/2016] [Accepted: 04/15/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the prevalence of abnormal anal cytology, high-risk anal HPV and biopsy proven anal dysplasia among women with a history of lower genital tract malignancy compared to those with dysplasia. METHODS A prospective cohort study was performed from December 2012 to February 2014 at outpatient clinics at an academic medical center. Women with a history of high-grade cervical, vulvar, or vaginal dysplasia, or malignancy were recruited. Anal cytology and HPV genotyping were performed. All women with abnormal anal cytology were referred for high-resolution anoscopy and biopsy. RESULTS Sixty-seven women had a lower genital tract malignancy and 123 had a history of genital dysplasia. Average age in the malignancy group was 52.6years (range 27-86) versus 43.5years (range 21-81) in the dysplasia group (p<0.0002). Similar rates of anal dysplasia were seen in both groups, 12.99% (10 cases) in the malignancy group, versus 12.20% (15) in the dysplasia group (p=1.0). Six women in the malignancy group had anal intraepithelial neoplasia (AIN2+) compared to 2 in the dysplasia group (p=0.03). CONCLUSIONS We found high rates of abnormal anal cytology and HPV in women with lower genital tract dysplasia and malignancy. We also found high rates of anal dysplasia in both groups with a trend towards increased rate in those women with history of genital malignancy. Since precancerous anal lesions are detectable and treatable, anal cancer screening may be potentially useful in both of these higher risk groups.
Collapse
Affiliation(s)
- Beth Cronin
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States.
| | - Amy Bregar
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States
| | - Christine Luis
- Program in Women's Oncology, Division of Research, Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States
| | - Steven Schechter
- University Surgical Associates, Alpert Medical School of Brown University, Providence, RI 02905, United States
| | - Paul Disilvestro
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States
| | - Latha Pisharodi
- Department of Pathology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States
| | - C James Sung
- Department of Pathology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States
| | - Christina Raker
- Division of Research, Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States
| | - Melissa Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01605, United States
| | - Katina Robison
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States
| |
Collapse
|
8
|
|
9
|
Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: a systematic review. Am J Obstet Gynecol 2015; 213:278-309. [PMID: 25797230 DOI: 10.1016/j.ajog.2015.03.034] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 02/07/2023]
Abstract
The aim of this study was to systematically review the findings of publications addressing the epidemiology of anal human papillomavirus (HPV) infection, anal intraepithelial neoplasia, and anal cancer in women. We conducted a systematic review among publications published from Jan. 1, 1997, to Sept. 30, 2013, to limit to publications from the combined antiretroviral therapy era. Three searches were performed of the National Library of Medicine PubMed database using the following search terms: women and anal HPV, women anal intraepithelial neoplasia, and women and anal cancer. Publications were included in the review if they addressed any of the following outcomes: (1) prevalence, incidence, or clearance of anal HPV infection, (2) prevalence of anal cytological or histological neoplastic abnormalities, or (3) incidence or risk of anal cancer. Thirty-seven publications addressing anal HPV infection and anal cytology remained after applying selection criteria, and 23 anal cancer publications met the selection criteria. Among HIV-positive women, the prevalence of high-risk (HR)-HPV in the anus was 16-85%. Among HIV-negative women, the prevalence of anal HR-HPV infection ranged from 4% to 86%. The prevalence of anal HR-HPV in HIV-negative women with HPV-related pathology of the vulva, vagina, and cervix compared with women with no known HPV-related pathology, varied from 23% to 86% and from 5% to 22%, respectively. Histological anal high-grade squamous intraepithelial lesions (anal intraepithelial neoplasia 2 or greater) was found in 3-26% of the women living with HIV, 0-9% among women with lower genital tract pathology, and 0-3% for women who are HIV negative without known lower genital tract pathology. The incidence of anal cancer among HIV-infected women ranged from 3.9 to 30 per 100,000. Among women with a history of cervical cancer or cervical intraepithelial neoplasia 3, the incidence rates of anal cancer ranged from 0.8 to 63.8 per 100,000 person-years, and in the general population, the incidence rates ranged from 0.55 to 2.4 per 100,000 person-years. This review provides evidence that anal HPV infection and dysplasia are common in women, especially in those who are HIV positive or have a history of HPV-related lower genital tract pathology. The incidence of anal cancer continues to grow in all women, especially those living with HIV, despite the widespread use of combined antiretroviral therapy.
Collapse
|
10
|
Eleutério J, Benício GC, Giraldo PC, Gonçalves AKS, Eleutério RMN, Oliveira DN, Jacyntho C. Liquid-based cytology and HPV DNA testing using intra-anal specimens from HIV-negative women with and without genital HPV-induced lesions. Diagn Cytopathol 2014; 43:360-5. [PMID: 25421882 DOI: 10.1002/dc.23238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 11/09/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Screening for anal cancer using cytology has not been considered in immunocompetent women. The aim of this study was to identify cytological atypia and human papillomavirus (HPV) DNA in intra-anal specimens from human immunodeficiency virus (HIV)-negative women with and without genital HPV lesions. METHODS This study was a cross-sectional analysis of 142 women who were negative for the HIV: 80 with genital lesions that were associated with HPV and 62 without HPV-induced lesions. The women were evaluated at the Federal University of Ceará from October 2011 to June 2012. The statistical analysis included the Fisher exact test and the odds ratio (CI 95%). RESULTS Atypical anal cytology was observed in 24 (29.3%) patients in the study group and in 11 (17.8%) patients in the control group. In cases with at least two sites of HPV-associated lesions, 12 (41.4%) presented atypical cytology (P = 0.0220; OR = 2.7621, 1.1579-6.5889). When the practice of anal sex was evaluated, atypical cytology was observed in 22/43 (34%) [P = 0.0214; OR = 2.519, 1.146-5.534]. HPV DNA was detected in 17/27 (63%) cases with at least two sites of lesions (P = 0.0293, OR = 2.4855, 1.0960-5.6367). In the 33 cases who presented positive HPV DNA test results, the liquid-based cytology results were atypical (P = 0.0212, OR = 2.8, 1.1665-6.7208). CONCLUSION Based on the results, liquid-based cytology may be used to detect intra-anal lesions, especially among women who have a history of anal intercourse or who have genital HPV-associated lesions at multiple sites.
Collapse
Affiliation(s)
- José Eleutério
- Department of Maternal and Child Health, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil; Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | | | | | | | | | | |
Collapse
|
11
|
Concurrent anal human papillomavirus and abnormal anal cytology in women with known cervical dysplasia. Obstet Gynecol 2014; 124:242-248. [PMID: 25004339 DOI: 10.1097/aog.0000000000000370] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the relationship between anal human papillomavirus (HPV) and dysplasia in women with HPV+-related cervical abnormalities. METHODS A prospective cohort study was performed on patients referred to the dysplasia clinic for atypical squamous cells of undetermined significance with HPV, atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions, low-grade squamous intraepithelial lesions, or high-grade squamous intraepithelial lesions. Exclusion criteria include age younger than 21 years, pregnancy, atypical glandular cells on cytology, or prior total hysterectomy. All patients underwent standard colposcopy with possible biopsy and cervical HPV testing as well as anal swab testing for anal HPV and anal cytology. Patients with abnormal anal cytology were referred to colorectal surgery. Histology was not validated in this study. RESULTS One hundred ninety-six patients were evaluable. The prevalence of anal HPV was 32.5%. The prevalence of abnormal anal cytology was 17.6%. Women with high-risk cervical HPV were more likely to have high-risk anal HPV (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.19-10.77, P<.024). Women with high-risk anal HPV were more likely to have abnormal anal cytology (OR 6.5, 95% CI 2.74-15.6, P<.001). CONCLUSION High-risk cervical HPV is associated with high-risk anal HPV and abnormal anal cytology. LEVEL OF EVIDENCE II.
Collapse
|
12
|
Crosignani P, De Stefani A, Fara GM, Isidori AM, Lenzi A, Liverani CA, Lombardi A, Mennini FS, Palu’ G, Pecorelli S, Peracino AP, Signorelli C, Zuccotti GV. Towards the eradication of HPV infection through universal specific vaccination. BMC Public Health 2013; 13:642. [PMID: 23845195 PMCID: PMC3751659 DOI: 10.1186/1471-2458-13-642] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/22/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Human Papillomavirus (HPV) is generally recognized to be the direct cause of cervical cancer. The development of effective anti-HPV vaccines, included in the portfolio of recommended vaccinations for any given community, led to the consolidation in many countries of immunization programs to prevent HPV-related cervical cancers. In recent years, increasing evidence in epidemiology and molecular biology have supported the oncogenic role of HPV in the development of other neoplasm including condylomas and penile, anal, vulvar, vaginal, and oro-pharyngeal cancers. Men play a key role in the paradigm of HPV infection: both as patients and as part of the mechanisms of transmission. Data show they are affected almost as often as women. Moreover, no screening procedures for HPV-related disease prevention are applied in men, who fail to undergo routine medical testing by any medical specialist at all. They also do not benefit from government prevention strategies. DISCUSSION A panel of experts convened to focus on scientific, medical, and economic studies, and on the achievements from health organizations' intervention programs on the matter. One of the goals was to discuss on the critical issues emerging from the ongoing global implementation of HPV vaccination. A second goal was to identify contributions which could overcome the barriers that impede or delay effective vaccination programs whose purpose is to eradicate the HPV infection both in women and men. SUMMARY The reviewed studies on the natural history of HPV infection and related diseases in women and men, the increasing experience of HPV vaccination in women, the analysis of clinical effectiveness vs economic efficacy of HPV vaccination, are even more supportive of the economic sustainability of vaccination programs both in women and men. Those achievements address increasing and needed attention to the issue of social equity in healthcare for both genders.
Collapse
Affiliation(s)
| | | | - Gaetano Maria Fara
- Department of Public Health and Infectious Diseases, Sapienza Università di Roma, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza Università di Roma, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza Università di Roma, Rome, Italy
| | - Carlo Antonio Liverani
- Preventive Gynecologic Oncology Unit - Department of Mother and Infant Sciences, Università di Milano, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Lombardi
- Fondazione Giovanni Lorenzini Medical Science Foundation, Milan, Italy
| | - Francesco Saverio Mennini
- CEIS Sanità - Centre for Health Economics and Management (CHEM) Faculty of Economics and Faculty of Science, University of Rome “Tor Vergata”, Rome, Italy
- Faculty of Statistics, University of Rome La Sapienza, Rome, Italy
- Institute of Leadership and Management in Healths, Kingston University, London, UK
| | - Giorgio Palu’
- Department of Molecular Medicine, Università di Padova, Padua, Italy
| | - Sergio Pecorelli
- Department of Mother and Infant Sciences and Biomedical Technologies - Rector, Università di Brescia, Brescia, Italy
| | - Andrea P Peracino
- Fondazione Giovanni Lorenzini Medical Science Foundation, Milan, Italy
- Giovanni Lorenzini Medical Science Foundation, Houston, TX, USA
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Università degli Studi di Milano - Luigi Sacco Hospital, Milan, Italy
| |
Collapse
|
13
|
Coutlée F, de Pokomandy A, Franco EL. Epidemiology, natural history and risk factors for anal intraepithelial neoplasia. Sex Health 2013; 9:547-55. [PMID: 22954036 DOI: 10.1071/sh11167] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 02/07/2012] [Indexed: 01/02/2023]
Abstract
Studies conducted in HIV-seropositive individuals have enhanced our understanding of the natural history of anal intraepithelial neoplasia (AIN) and of factors predictive of progression to high-grade AIN, the immediate precursor to anal cancer. AIN is frequently detected in HIV-seropositive individuals. Factors that increase the risk for AIN include HIV infection, low current or nadir blood CD4+ cell counts, receptive anal intercourse, oncogenic human papillomavirus (HPV) infection, persistent anal HPV infection, multiple HPV type infections and high anal HPV viral load. This review confirms the importance of high-grade AIN in HIV-seropositive individuals and HIV-seronegative men having sex with men.
Collapse
Affiliation(s)
- François Coutlée
- Départements de Microbiologie et Infectiologie, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
| | | | | |
Collapse
|
14
|
Pierangeli A, Scagnolari C, Selvaggi C, Cannella F, Riva E, Impagnatiello A, Bernardi G, Ciardi A, Moschella CM, Antonelli G, Indinnimeo M. High detection rate of human papillomavirus in anal brushings from women attending a proctology clinic. J Infect 2012; 65:255-61. [PMID: 22609230 DOI: 10.1016/j.jinf.2012.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/21/2012] [Accepted: 05/09/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To study human papillomavirus (HPV) anal infection in anal brushings from women attending a proctology clinic, and compare results with those obtained from paired cervical brushings. METHODS Women attending a university hospital proctology clinic for anal conditions or as part of a screening campaign, were enrolled consecutively, excluding those reporting previous HPV-related pathologies. HPV genotypes in anal and cervical brushings were determined by sequencing and, in most cases, type-specific viral loads were measured. RESULTS HPV DNA was detected in 28.3% of anal brushings, with 47.4% of HPV genotypes being high risk. Cervical HPV detection was at almost the same rate but HPV status was discordant in about half those women with at least one positive specimen. Abnormal cytological findings were more common in anal than in cervical samples, in particular in the proctology outpatients. Viral load measurements excluded the existence of a multiple infection with genotypes detected in discordant anal- and cervical-paired samples and showed a significant correlation between anal and cervical paired concordant samples. CONCLUSIONS The high rate of HPV detection in anal brushings that is not usually related to HPV positivity in cervical brushings could provide support for offering HPV DNA tests to women attending proctology clinics.
Collapse
Affiliation(s)
- Alessandra Pierangeli
- Laboratory of Virology, Department of Molecular Medicine, Sapienza University, Viale di Porta Tiburtina 28, 00185 Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|