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Kwak K, Hwang SS. Predicted Cervical Cancer Prevention: Impact of National HPV Vaccination Program on Young Women in South Korea. Cancer Res Treat 2024; 56:898-908. [PMID: 38228083 PMCID: PMC11261207 DOI: 10.4143/crt.2023.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024] Open
Abstract
PURPOSE This study aimed to evaluate the effectiveness of the national human papillomavirus (HPV) vaccination program of South Korea among its entire female population, particularly among younger age groups. MATERIALS AND METHODS We first predicted the incidence of cervical cancer over the next 20 years (2021-2040) using the Nordpred package based on Møller's age-period-cohort model under several scenarios for the national HPV vaccination program. We calculated the potential impact fractions and proportional differences under the current national vaccination programs, and alternative scenarios using the no-vaccination assumption as a reference. RESULTS We estimated that the current national vaccination program would prevent 4.13% of cervical cancer cases and reduce the age-standardized incidence rate (ASR) by 8.79% in the overall population by 2036-2040. Under the alternative scenario of implementing the nine-valent vaccine, 5.13% of cervical cancer cases could be prevented and the ASR reduced by 10.93% during the same period. In another scenario, expanding the vaccination age to 9-17 years could prevent 10.19% of cervical cancer cases, with the ASR reduced by 18.57% during the same period. When restricted to ages < 40 years, the prevention effect was remarkably greater. We predict that the current national HPV program will reduce its incidence by more than 30% between 2036 and 2040 in women aged < 40 years. CONCLUSION The effectiveness of the vaccination program in reducing the incidence of cervical cancer was confirmed, with a considerable impact anticipated in younger age groups.
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Affiliation(s)
- Kyeongmin Kwak
- Department of Occupational and Environmental Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Department of Environmental and Occupational Health, Korea University Graduate School of Public Health, Seoul, Korea
| | - Seung-sik Hwang
- Department of Public Health Sciences, Seoul National University Graduate School of Public Health, Seoul, Korea
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2
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Le VN, Le VNB, Hoang XS, Le VD. Distribution of human papillomavirus among Vietnamese women with cervical cancer and unusual genetic variability of HPV16. Virology 2024; 594:110058. [PMID: 38520797 DOI: 10.1016/j.virol.2024.110058] [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: 08/21/2023] [Revised: 01/21/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
HPV16, with typical mutations that differ in geographical distribution and carcinogenic potency, has implications for cervical cancer screening, clinical diagnosis, and treatment. DNASTAR and MEGA were used to identify HPV16 variants and construct a phylogenetic tree. The most prevalent HPV genotypes were HPV16 (63.9%), HPV18 (26.7%), and other HPV (6.9%). HPV16 alterations were found in all E6, E7, and L1 genes, including 15 missense and 18 synonymous mutations. Missense mutations include R10G, Q14H, D25E, H78Y, L83V (E6); M29V, R35K, L78R, L95P (E7); H73Y, T176 N, N178T, T317P, T386S, L472F/I (L1). HPV16 sublineages include A1 (17.2%), A2 (0.9%), A3 (56.0%), A4 (19.0%), D1 (4.3%), and D3 (2.6%). Although several mutations in the oncoproteins E6, E7, and L1 have been detected, mutations known to be associated with cervical cancer risk, such as D25E and L83V, occur at a relatively low frequency. This suggests that HPV16 mutations are associated with cervical cancer through a complicated mechanism.
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Affiliation(s)
- Van Nam Le
- Departments of Infectious Disease, Military Hospital 103, 261 Phung Hung, Ha Dong, Hanoi, Viet Nam
| | - Van Nguyen Bang Le
- Luong the Vinh High School, 35 Dinh Nup, Trung Hoa, Cau Giay, Hanoi, Viet Nam
| | - Xuan Son Hoang
- Departments of Obstetrics and Gynecology, Cho Moi District General Hospital, Na Mo Village, Dong Tam Town, Cho Moi District, Bac Kan Province, Viet Nam
| | - Van Duyet Le
- Micobiology and Moclecular Biology Department, National Hospital for Tropical Diseases, 78 Giai Phong, Dong Da, Hanoi, Viet Nam.
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3
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Prétet JL, Arroyo Mühr LS, Cuschieri K, Fellner MD, Correa RM, Picconi MA, Garland SM, Murray GL, Molano M, Peeters M, Van Gucht S, Lambrecht C, Broeck DV, Padalko E, Arbyn M, Lepiller Q, Brunier A, Silling S, Søreng K, Christiansen IK, Poljak M, Lagheden C, Yilmaz E, Eklund C, Thapa HR, Querec TD, Unger ER, Dillner J. Human papillomavirus negative high grade cervical lesions and cancers: Suggested guidance for HPV testing quality assurance. J Clin Virol 2024; 171:105657. [PMID: 38401369 DOI: 10.1016/j.jcv.2024.105657] [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: 09/12/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Some high-grade cervical lesions and cervical cancers (HSIL+) test negative for human papillomavirus (HPV). The HPV-negative fraction varies between 0.03 % and 15 % between different laboratories. Monitoring and extended re-analysis of HPV-negative HSIL+ could thus be helpful to monitor performance of HPV testing services. We aimed to a) provide a real-life example of a quality assurance (QA) program based on re-analysis of HPV-negative HSIL+ and b) develop international guidance for QA of HPV testing services based on standardized identification of apparently HPV-negative HSIL+ and extended re-analysis, either by the primary laboratory or by a national HPV reference laboratory (NRL). METHODS There were 116 initially HPV-negative cervical specimens (31 histopathology specimens and 85 liquid-based cytology samples) sent to the Swedish HPV Reference Laboratory for re-testing. Based on the results, an international QA guidance was developed through an iterative consensus process. RESULT Standard PCR testing detected HPV in 55.2 % (64/116) of initially "HPV-negative" samples. Whole genome sequencing of PCR-negative samples identified HPV in an additional 7 samples (overall 61.2 % HPV positivity). Reasons for failure to detect HPV in an HSIL+ lesion are listed and guidance to identify cases for extended re-testing, including which information should be included when referring samples to an NRL are presented. CONCLUSION Monitoring the proportion of and reasons for failure to detect HPV in HSIL+ will help support high performance and quality improvement of HPV testing services. We encourage implementation of QA strategies based on re-analysis of "HPV negative" HSIL+ samples.
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Affiliation(s)
- Jean Luc Prétet
- French National Papillomavirus Reference Center, CHU de Besançon, EA3181, Université of Franche-Comté, F-25000 Besançon, France
| | - Laila Sara Arroyo Mühr
- Swedish National HPV Reference Laboratory, Center for Cervical Cancer Elimination, Karolinska Institutet and Karolinska University Hospital F56, 141 86 Stockholm, Sweden
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Deptartment of Lab Medicine, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - María Dolores Fellner
- Laboratorio Nacional y Regional de Referencia de Papilomavirus Humanos, Instituto Nacional de Enfermedades Infecciosas-ANLIS "Dr Malbrán", C1282AFF Buenos Aires, Argentina
| | - Rita Mariel Correa
- Laboratorio Nacional y Regional de Referencia de Papilomavirus Humanos, Instituto Nacional de Enfermedades Infecciosas-ANLIS "Dr Malbrán", C1282AFF Buenos Aires, Argentina
| | - María Alejandra Picconi
- Laboratorio Nacional y Regional de Referencia de Papilomavirus Humanos, Instituto Nacional de Enfermedades Infecciosas-ANLIS "Dr Malbrán", C1282AFF Buenos Aires, Argentina
| | - Suzanne M Garland
- Royal Women's Hospital, Parkville 3052 VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052 VIC, Australia
| | - Gerald L Murray
- Royal Women's Hospital, Parkville 3052 VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052 VIC, Australia
| | - Monica Molano
- Royal Women's Hospital, Parkville 3052 VIC, Australia
| | - Michael Peeters
- National Reference Centre for Human Papillomaviruses, Viral Diseases, Infectious Diseases in Humans, Sciensano. Rue Juliette Wytsman 14, 1050 Brussels, Belgium
| | - Steven Van Gucht
- National Reference Centre for Human Papillomaviruses, Viral Diseases, Infectious Diseases in Humans, Sciensano. Rue Juliette Wytsman 14, 1050 Brussels, Belgium
| | - Charlotte Lambrecht
- National Reference Centre for Human Papillomaviruses, Algemeen Medisch Laboratorium. Emiel Vloorsstraat 9, 2020 Antwerp, Belgium
| | - Davy Vanden Broeck
- National Reference Centre for Human Papillomaviruses, Algemeen Medisch Laboratorium. Emiel Vloorsstraat 9, 2020 Antwerp, Belgium
| | - Elizaveta Padalko
- National Reference Centre for Human Papillomaviruses, Laboratory of Medical Microbiology, University Hospital Ghent. C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Marc Arbyn
- Unit Cancer Epidemiology, Cancer centre, Sciensano. Rue Juliette Wytsman 14, 1050 Brussels, Belgium
| | - Quentin Lepiller
- French National Papillomavirus Reference Center, CHU de Besançon, EA3181, Université of Franche-Comté, F-25000 Besançon, France
| | - Alice Brunier
- French National Papillomavirus Reference Center, CHU de Besançon, EA3181, Université of Franche-Comté, F-25000 Besançon, France
| | - Steffi Silling
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Faculty of Medicine and University Hospital of Cologne, 50935 Cologne, Germany
| | - Kristiane Søreng
- Norwegian HPV Reference Laboratory, Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
| | - Irene Kraus Christiansen
- Norwegian HPV Reference Laboratory, Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia
| | - Camilla Lagheden
- Swedish National HPV Reference Laboratory, Center for Cervical Cancer Elimination, Karolinska Institutet and Karolinska University Hospital F56, 141 86 Stockholm, Sweden
| | - Emel Yilmaz
- Swedish National HPV Reference Laboratory, Center for Cervical Cancer Elimination, Karolinska Institutet and Karolinska University Hospital F56, 141 86 Stockholm, Sweden
| | - Carina Eklund
- Swedish National HPV Reference Laboratory, Center for Cervical Cancer Elimination, Karolinska Institutet and Karolinska University Hospital F56, 141 86 Stockholm, Sweden
| | - Hem R Thapa
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Troy D Querec
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Joakim Dillner
- Swedish National HPV Reference Laboratory, Center for Cervical Cancer Elimination, Karolinska Institutet and Karolinska University Hospital F56, 141 86 Stockholm, Sweden.
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Haqshenas G, Molano M, Phillips S, Balgovind P, Garland SM, Hawkes D, Brotherton JM, Machalek DA, Murray G. Evaluation of Seegene Anyplex II Performance for Detection of Human Papillomavirus Genotypes in Formalin-Fixed, Paraffin-Embedded Cervical Cancer Specimens. Arch Pathol Lab Med 2024; 148:353-358. [PMID: 37226838 DOI: 10.5858/arpa.2022-0317-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 05/26/2023]
Abstract
CONTEXT.— Detection of human papillomavirus (HPV) in formalin-fixed, paraffin-embedded (FFPE) tissues may identify the cause of lesions and has value for the development of new diagnostic assays and epidemiologic studies. Seegene Anyplex II assays are widely used for HPV screening, but their performance using FFPE samples has not been fully explored. OBJECTIVE.— To validate Anyplex II HPV HR Detection (Anyplex II, Seegene) using FFPE samples. DESIGN.— We used 248 stored DNA extracts from cervical cancer FFPE samples collected during 2005-2015 that tested HPV positive using the RHA kit HPV SPF10-LiPA25, v1 (SPF10, Labo Biomedical Products) HPV genotyping assay, manufacturer-validated for FFPE samples. RESULTS.— Of the selected 248 samples, 243 were used in our analysis. Consistent with SPF10 genotyping results, Anyplex II detected all 12 oncogenic types and had an overall HPV detection rate of 86.4% (210 of 243 samples). Anyplex II and SPF10 showed very high agreement for the detection of the 2 most important oncogenic genotypes: HPV 16 (219 of 226; 96.9%; 95% CI, 93.7-98.75) and HPV 18 (221 of 226; 97.8%; 95% CI, 94.9-99.3). CONCLUSIONS.— Overall results showed that both platforms produced comparable HPV genotyping results, indicating the suitability of Anyplex II for FFPE samples. The Anyplex II assay has the added convenience of being an efficient, single-well semiquantitative polymerase chain reaction assay. Further optimization of Anyplex II may enhance its performance using FFPE samples by improving the detection limit.
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Affiliation(s)
- Gholamreza Haqshenas
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
| | - Monica Molano
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
| | - Samuel Phillips
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- Murdoch Children's Research Institute, Melbourne, Australia (Haqshenas, Phillips, Balgovind, Garland, Murray)
| | - Prisha Balgovind
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- Murdoch Children's Research Institute, Melbourne, Australia (Haqshenas, Phillips, Balgovind, Garland, Murray)
| | - Suzanne M Garland
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- Murdoch Children's Research Institute, Melbourne, Australia (Haqshenas, Phillips, Balgovind, Garland, Murray)
| | - David Hawkes
- Biochemistry and Pharmacology (Hawkes)
- the Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia (Hawkes, Brotherton)
- the Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia (Hawkes)
| | - Julia Ml Brotherton
- the School of Population and Global Health (Brotherton), University of Melbourne, Melbourne, Australia
| | - Dorothy A Machalek
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- The Kirby Institute, University of New South Wales, Sydney, Australia (Machalek)
| | - Gerald Murray
- From the Departments of Obstetrics and Gynaecology (Haqshenas, Phillips, Balgovind, Garland, Murray)
- the Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia (Haqshenas, Molano, Phillips, Balgovind, Garland, Machalek, Murray)
- Murdoch Children's Research Institute, Melbourne, Australia (Haqshenas, Phillips, Balgovind, Garland, Murray)
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5
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Lawton B, MacDonald EJ, Storey F, Stanton JA, Adcock A, Gibson M, Parag V, Sparkes NK, Kaimoana B, King F, Terry M, Watson H, Bennett M, Lambert CS, Geller S, Paasi I, Hibma M, Sykes P, Hawkes D, Saville M. A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a Cluster Randomized Crossover Trial. JMIR Res Protoc 2023; 12:e51643. [PMID: 37707939 PMCID: PMC10540018 DOI: 10.2196/51643] [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: 08/07/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Māori are the Indigenous people of Aotearoa (New Zealand). Despite global acceptance that cervical cancer is almost entirely preventable through vaccination and screening, wāhine Māori (Māori women) are more likely to have cervical cancer and 2.5 times more likely to die from it than non-Māori women. Rural Māori residents diagnosed with cervical cancer have worse outcomes than urban residents. Living in rural Aotearoa means experiencing barriers to appropriate and timely health care, resulting from distance, the lack of community resourcing, and low prioritization of rural needs by the health system and government. These barriers are compounded by the current screening processes and referral pathways that create delays at each step. Screening for high-risk human papillomavirus (hrHPV) and point-of-care (POC) testing are scientific advances used globally to prevent cervical cancer. OBJECTIVE This study aims to compare acceptability, feasibility, timeliness, referral to, and attendance for colposcopy following hrHPV detection between a community-controlled pathway and standard care. METHODS This is a cluster randomized crossover trial, with 2 primary care practices (study sites) as clusters. Each site was randomized to implement either pathway 1 or 2, with crossover occurring at 15 months. Pathway 1 (community-controlled pathway) comprises HPV self-testing, 1-hour POC results, face-to-face information, support, and immediate referral to colposcopy for women with a positive test result. Pathway 2 (standard care) comprises HPV self-testing, laboratory analysis, usual results giving, information, support, and standard referral pathways for women with a positive test result. The primary outcome is the proportion of women with hrHPV-positive results having a colposcopy within 20 working days of the HPV test (national performance indicator). Qualitative research will analyze successes and challenges of both pathways from the perspectives of governance groups, clinical staff, women, and their family. This information will directly inform the new National Cervical Screening Program. RESULTS In the first 15-month period, 743 eligible HPV self-tests were performed: 370 in pathway 1 with POC testing and 373 in pathway 2 with laboratory testing. The positivity rate for hrHPV was 7.3% (54/743). Data collection for the second period, qualitative interviews, and analyses are ongoing. CONCLUSIONS This Māori-centered study combines quantitative and qualitative research to compare 2 clinical pathways from detection of hrHPV to colposcopy. This protocol draws on rural community practices strengths, successfully engaging Māori from a whānau ora (family wellness) approach including kanohi ki te kanohi (face-to-face), kaiāwhina (nonclinical community health workers), and multiple venues for interventions. It will inform the theory and practice of rural models of the use of innovative technology, addressing Māori cervical cancer inequities and facilitating Māori wellness. The findings are anticipated to be applicable to other Indigenous and rural people in high-income countries. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000553875; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000553875. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51643.
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Affiliation(s)
- Beverley Lawton
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Evelyn Jane MacDonald
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Francesca Storey
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Jo-Ann Stanton
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Anna Adcock
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Melanie Gibson
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ngaire Kereru Sparkes
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | | | | | | | - Matthew Bennett
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Charles Seymour Lambert
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Stacie Geller
- Center for Research on Women and Gender, College of Medicine, University of Illinois, Chicago, IL, United States
| | - Isitokia Paasi
- National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Merilyn Hibma
- Pathology Department, Otago University, Dunedin, New Zealand
| | - Peter Sykes
- Department of Obstetrics &Gynaecology, Christchurch Medical School, Otago University, Christchurch, New Zealand
| | - David Hawkes
- Department of Biochemistry and Pharmacology, The University of Melbourne, Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
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Yang Y, Liao Y, Qing Y, Li H, Du J. Electrochemical DNA Biosensors with Dual-Signal Amplification Strategy for Highly Sensitive HPV 16 Detection. SENSORS (BASEL, SWITZERLAND) 2023; 23:7380. [PMID: 37687836 PMCID: PMC10490446 DOI: 10.3390/s23177380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
Cervical cancer is an important topic in the study of global health issues, ranking fourth among women's cancer cases in the world. It is one of the nine major cancers that China is focusing on preventing and treating, and it is the only cancer that can be prevented through vaccination. Systematic and effective screening for human papilloma (HPV) infection, which is closely linked to the development of cervical cancer, can reduce cervical cancer incidence and mortality. In this paper, an electrochemical sensor was designed to detect HPV 16 using dual-signal amplification. An APTES-modified glassy carbon electrode was used for improved stability. Gold nanoparticles and a chain amplification reaction were combined for signal amplification. The limit of detection (LOD) of this electrochemical sensor was 1.731 × 10-16 mol/L, and the linear response of the target detector range was from 1.0 × 10-13 mol/L to 1.0 × 10-5 mol/L (R2 = 0.99232). The test of serum sample recovery showed that it has good anti-interference, and the performance of all aspects was improved to different degrees compared with the previous research from the team. The designed sensor is centered around the principles of low cost, high sensitivity and stability, which provides new ideas for the future development of cervical cancer prevention and electrochemical biosensors.
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Affiliation(s)
| | | | | | | | - Jie Du
- College of Materials Science and Engineering, Hainan University, Haikou 570228, China; (Y.Y.); (Y.L.); (Y.Q.); (H.L.)
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7
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Netfa F, King C, Davies C, Rashid H, Tashani M, Booy R, Rachel Skinner S. Perceived facilitators and barriers to the uptake of the human papillomavirus (HPV) vaccine among adolescents of Arabic-speaking mothers in NSW, Australia: A qualitative study. Vaccine X 2023; 14:100335. [PMID: 37409191 PMCID: PMC10318426 DOI: 10.1016/j.jvacx.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/16/2023] [Indexed: 07/07/2023] Open
Abstract
Background Australia has a large immigrant population but there is little data regarding whether human papillomavirus (HPV) vaccination coverage in adolescents varies according to parents' cultural or ethnic background. This work aims to identify facilitators and barriers to HPV vaccination of adolescents as perceived by Arabic-speaking mothers in Western Sydney, South Western Sydney and Wollongong, NSW, Australia. Methods A purposive sampling approach was applied to recruit mothers of adolescents from Arabic speaking backgrounds who had at least one child eligible for the HPV school-based vaccination program. Face-to-face semi-structured well as online interviews were conducted in Arabic between April 2021 and July 2021. The interviews were audio-recorded, transcribed, and translated into English and examined using thematic analysis. Results Sixteen mothers of adolescents from Arabic backgrounds described facilitators and barriers to HPV vaccination. A) Facilitators of HPV vaccination included: knowledge of HPV disease, trust in the school vaccination program, opportunistic recommendations from healthcare workers, information from friends. B) Barriers to accessing HPV vaccination included communication gaps: breakdown in school-parent information flow, lack of access to the Arabic language version of the information sheet, mother - GP communication barriers, mother-child communication gap; and health system gaps: missed opportunities for vaccination. C) Mothers' suggestions to improve HPV vaccination acceptance: to involve religious and cultural leadership, encourage engagement with GPs, and provide school-based education for parents and students. Conclusion Parents could benefit from assistance with HPV vaccination decision making. Interventions via schools, health professionals and religious and cultural organisations could play important roles in HPV vaccination acceptance for Arabic speaking immigrant families and in introducing their adolescent children to this vaccine.
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Affiliation(s)
- Faeza Netfa
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Catherine King
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Harunor Rashid
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Mohamed Tashani
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Faculty of Medicine, University of Tripoli, Tripoli 13275, Libya
| | - Robert Booy
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
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8
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Kaba G, Stevenson A, Sakyi SA, Konney TO, Bhatia R, Titiloye NA, Oppong SA, Agyemang-Yeboah F, Cuschieri K, Graham SV. Diversity of cervicovaginal human papillomavirus (HPV) genotypes and naturally occurring E6/E7 DNA polymorphisms of HPV-16 in Ghana. Tumour Virus Res 2023; 15:200261. [PMID: 37179021 PMCID: PMC10209332 DOI: 10.1016/j.tvr.2023.200261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/12/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023] Open
Abstract
Human papillomavirus (HPV) E6 and E7 oncogene expression is essential for cervical carcinogenesis. Evidence exists that E6/E7 variants may have different transforming activities while the risk of HPV-16 variants (A/D) differs by race/ethnicity. We determined the type-specific diversity of HPV infection in women with high grade cervical disease or cervical cancer in Ghana and investigated naturally occurring E6/E7 DNA variants in this population. HPV genotyping was carried out on 207 cervical swab samples collected from women referred to a gynaecology clinic at two teaching hospitals in Ghana. HPV-16, HPV-18 and HPV-45 were detected in 41.9%, 23.3% and 16.3% of cases respectively. HPV-16 E6/E7 DNA sequencing was performed in 36 samples. Thirty samples contained E6/E7 variants of the HPV-16-B/C lineage. 21/36 samples were of the HPV-16C1 sublineage variant and all contained the E7 A647G(N29S) single nucleotide polymorphism (SNP). This study reveals the diversity of E6/E7 DNA and the dominance of HPV16 B/C variants in cervicovaginal HPV infection in Ghana. Type-specific HPV diversity analysis indicates that most Ghanaian cervical disease cases are vaccine preventable. The study provides an important baseline from which for the impact of vaccine and antivirals on clinically relevant HPV infection and associated disease can be measured.
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Affiliation(s)
- Gladys Kaba
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Andrew Stevenson
- Centre for Virus Research, School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, Garscube Estate, University of Glasgow, Scotland, G61 1QH, UK
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas Okpoti Konney
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ramya Bhatia
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, University of Edinburgh, Scotland, EH16 4SA, UK
| | - Nicholas A Titiloye
- Department of Pathology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology Kumasi, Ghana
| | - Samuel A Oppong
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital and University of Ghana Medical School, Accra, Ghana
| | - Francis Agyemang-Yeboah
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, University of Edinburgh, Scotland, EH16 4SA, UK
| | - Sheila V Graham
- Centre for Virus Research, School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, Garscube Estate, University of Glasgow, Scotland, G61 1QH, UK.
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9
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Jayasinghe YL, Tabrizi SN, Stevens M, Leong TYM, Pyman J, Grover SR, Garland SM. Pre-Vaccination Human Papillomavirus Genotypes and HPV16 Variants among Women Aged 25 Years or Less with Cervical Cancer. Pathogens 2023; 12:451. [PMID: 36986373 PMCID: PMC10051959 DOI: 10.3390/pathogens12030451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/25/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND In 2007, Australia introduced a national human papillomavirus (HPV) vaccination program. In 2017, the onset of cervical screening changed from 18 to 25 years of age, utilising human papillomavirus (HPV) nucleic acid testing. The objective of the study is to describe the HPV genotypes and HPV16 variants in biopsies from women ≤ 25 years of age with cervical carcinoma (CC) (cases), compared with those aged >25 years (controls), in a pre-vaccination cohort. METHODS HPV genotyping of archival paraffin blocks (n = 96) was performed using the INNO-LiPA HPV Genotyping assay. HPV16-positive samples were analysed for variants by type-specific PCR spanning L1, E2 and E6 regions. RESULTS HPV16 was the commonest genotype in cases (54.5%, 12/22) and controls (66.7%, 46/69) (p = 0.30), followed by HPV18 (36.3%, 8/22 vs. 17.3% 12/69, respectively) (p = 0.08). Furthermore, 90% (20/22) of cases and 84.1% (58/69) of controls were positive for HPV16 or 18 (p = 0.42); 100% (22/22) of cases and 95.7% (66/69) of controls had at least one genotype targeted by the nonavalent vaccine (p = 0.3). The majority of HPV16 variants (87.3%, 48/55) were of European lineage. The proportion of unique nucleotide substitutions was significantly higher in cases (83.3%, 10/12) compared with controls (34.1%, 15/44), (p < 0.003, χ2, OR 9.7, 95%CI 1.7-97.7). CONCLUSIONS Virological factors may account for the differences in CCs observed in younger compared with older women. All CCs in young women in this study had preventable 9vHPV types, which is important messaging for health provider adherence to new cervical screening guidelines.
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Affiliation(s)
- Yasmin L. Jayasinghe
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, The University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Gynaecology, Royal Children’s Hospital, Melbourne, VIC 3010, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Sepehr N. Tabrizi
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, The University of Melbourne, Melbourne, VIC 3010, Australia
- Women’s Centre for Infectious Diseases, Royal Women’s Hospital, Melbourne, VIC 3010, Australia
| | - Matthew Stevens
- The Australian Genome Research Facility, Melbourne, VIC 3050, Australia
| | - Trishe Y-M. Leong
- Department of Anatomical Pathology, St. Vincents Hospital, Melbourne, VIC 3000, Australia
| | - Jan Pyman
- Department of Anatomical Pathology, Royal Women’s Hospital, Melbourne, VIC 3010, Australia
| | - Sonia R. Grover
- Department of Gynaecology, Royal Children’s Hospital, Melbourne, VIC 3010, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Suzanne M. Garland
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, The University of Melbourne, Melbourne, VIC 3010, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Women’s Centre for Infectious Diseases, Royal Women’s Hospital, Melbourne, VIC 3010, Australia
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10
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Talia KL, Rahimi S, Hawkes D, McCluggage WG. HPV42-associated Seborrhoeic Keratosis-like Lesion of the Cervix: First Reported Case With High-grade Morphology. Int J Gynecol Pathol 2022; 41:649-654. [PMID: 35072991 DOI: 10.1097/pgp.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Seborrheic keratosis-like lesion (SKLL) is an extremely rare, morphologically distinct lesion occurring in the cervix and vagina that differs histologically from usual squamous intraepithelial lesions in these sites, by bearing close resemblance to cutaneous seborrheic keratosis and lacking koilocytosis. Like many vulvar seborrheic keratoses, which are associated with low-risk human papillomavirus (HPV), an association between SKLL and low-risk HPV is suggested based on the identification of HPV42, regarded as a low-risk genotype, in 4 of 8 reported cases. We report a further HPV42-associated SKLL of the cervix which differs from the previously reported cases by the presence of high-grade morphology and block-type p16 immunoreactivity. This novel finding challenges the classification of HPV42 as a low-risk genotype and expands the reported morphologic spectrum of SKLL, suggesting that they may not always be clinically indolent.
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11
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High Prevalence of HPV 51 in an Unvaccinated Population and Implications for HPV Vaccines. Vaccines (Basel) 2022; 10:vaccines10101754. [PMID: 36298619 PMCID: PMC9611345 DOI: 10.3390/vaccines10101754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
Human papillomavirus (HPV) is detected in 99.7% of cervical cancers. Current vaccines target types 16 and 18. Prior to vaccination implementation, a prospective cohort study was conducted to determine baseline HPV prevalence in unvaccinated women in Wales; after HPV16 and HPV18, HPV 51 was found to be most prevalent. This study aimed to re-assess the unexpected high prevalence of HPV 51 and consider its potential for type-replacement. Two hundred HPV 51 positive samples underwent re-analysis by repeating the original methodology using HPV 51 GP5+/6+ PCR-enzyme immunoassay, and additionally a novel assay of HPV 51 E7 PCR. Data were correlated with age, social deprivation and cytology. Direct repeat of HPV 51 PCR-EIA identified 146/195 (75.0%) samples as HPV 51 positive; E7 PCR identified 166/195 (85.1%) samples as HPV 51 positive. HPV 51 prevalence increased with cytological grade. The prevalence of HPV 51 in the pre-vaccinated population was truly high. E7 DNA assays may offer increased specificity for HPV genotyping. Cross-protection of current vaccines against less-prevalent HPV types warrants further study. This study highlights the need for longitudinal investigation into the prevalence of non-vaccine HPV types, especially those phylogenetically different to vaccine types for potential type-replacement. Ongoing surveillance will inform future vaccines.
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12
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Nagaraja M, Narendra H, Venkataramana B, Kalawat U. HPV genotype prevalence in Indian women with cervical disease and estimation of the potential impact of HPV vaccines on prevention of cervical cancer. Indian J Med Microbiol 2022; 43:73-78. [PMID: 36241529 DOI: 10.1016/j.ijmmb.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Human papillomavirus (HPV) causes genital and oropharyngeal cancers worldwide. There are significant gaps exist in the data on HPV genotype prevalence in this part of the country. HPV vaccination is one of the best preventive methods available currently. HPV genotyping plays an important role in the selection of appropriate vaccines and monitoring vaccine efficacy and coverage. The present study aimed to determine the HPV genotype prevalence and to estimate the potential impact of HPV vaccines on invasive cervical cancer. MATERIALS AND METHODS A total of 204 cervical biopsy samples collected from symptomatic women were subjected to an in-house designed and standardised nested multiplex PCR (NM-PCR) assay. The NM-PCR was designed to detect 38 Mucosal HPV types as a pooled result and genotyping of 15 HPV types. Further, the HPV genotype data was used to estimate the HPV vaccine bivalent, quadrivalent and nonavalent impact on the population using a mathematical formula. RESULTS Out of 204 samples 188 were subjected to HPV-nested PCR. A total of 163 (86.7%) samples were positive for at least one HPV type. Multiple genotypes were identified in 30% of samples processed. HPV-16 (85.3%) was the most frequently detected genotype followed by HPV-18 (13.5%) and HPV-33 (11.0%). Other genotypes were observed less frequently. Based on the HPV prevalence observed in the study a mathematical model estimated the efficacy of bivalent, quadrivalent and nonavalent vaccines were 76.1%, 76.7%, and 91.1% (average) respectively. CONCLUSIONS HPV-16 was the most prevalent (>85%) genotype detected in this study. Multiple infections observed in 30% of samples were quite high as compared to the majority of national, and global reference (15-25.4%) data. The Mathematical model showed that a nonavalent vaccine would give better protection.
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Affiliation(s)
- Mudhigeti Nagaraja
- Department of Clinical Virology, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - Hulikal Narendra
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - Banda Venkataramana
- Department of Microbiology, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - Usha Kalawat
- Department of Clinical Virology, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India.
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13
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Jo S, Pituch KA, Howe N. The Relationships Between Social Media and Human Papillomavirus Awareness and Knowledge: Cross-sectional Study. JMIR Public Health Surveill 2022; 8:e37274. [PMID: 36125858 PMCID: PMC9533211 DOI: 10.2196/37274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/12/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV can infect both females and males, and it can cause many cancers, including anal, cervical, vaginal, vulvar, and penile cancers. HPV vaccination rates are lower than vaccination rates within other national vaccination programs, despite its importance. Research literature indicates that people obtain health-related information from internet sources and social media; however, the association between such health-seeking behavior on social media and HPV-related behaviors has not been consistently demonstrated in the literature. OBJECTIVE This study aims to examine the association between social media usage and HPV knowledge and HPV awareness. METHODS This study analyzed public health data collected through the Health Information National Trends Survey (HINTS) conducted by the US National Cancer Institute. The analysis used data collected in 2020; in total, 2948 responses were included in the analysis. Six HPV-related questions were used to identify HPV awareness, HPV vaccine awareness, and HPV knowledge about HPV-related cancers. Four questions about social media usage and one question about online health information-seeking behavior were used to analyze the associations between social media usage and HPV-related behaviors. Initially, six logistic regressions were conducted using replicate weights. Based on the results, significant factors were included in a second set of regression analyses that also included demographic variables. RESULTS About half of the respondents were aware of HPV (68.40%), the HPV vaccine (64.04%), and the relationship between HPV and cervical cancer (48.00%). However, fewer respondents were knowledgeable about the relationships between HPV and penile cancer (19.18%), anal cancer (18.33%), and oral cancer (19.86%). Although social media usage is associated with HPV awareness, HPV vaccine awareness, and knowledge of cervical cancer, these associations were not significant after adjusting for demographic variables. Those less likely to report HPV awareness and knowledge included older participants, males, those with a household income of less than US $20,000, those with a formal education equal to or less than high school, or those who resided in a household where adults are not fluent in English. CONCLUSIONS After adjusting for demographic variables, social media use was not related to HPV knowledge and awareness, and survey respondents were generally not aware that HPV can lead to specific types of cancer, other than cervical cancer. These results suggest that perhaps a lack of high-quality information on social media may impede HPV awareness and knowledge. Efforts to educate the public about HPV via social media might be improved by using techniques like storytelling or infographics, especially targeting vulnerable populations, such as older participants, males, those with low incomes, those with less formal education, or those who reside in the United States but are not fluent in English.
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Affiliation(s)
- Soojung Jo
- School of Nursing, Purdue University, West Lafayette, IN, United States
| | - Keenan A Pituch
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Nancy Howe
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
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14
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Chen H, Xiong W, Dong X, Liu Y, Tan X. Infection status and survival impact of high-risk human papillomavirus in cervical adenocarcinomas: A systematic review and meta-analysis. Gynecol Oncol 2022; 167:129-136. [PMID: 35973872 DOI: 10.1016/j.ygyno.2022.08.007] [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: 07/01/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cervical adenocarcinoma (CAC) comprises a heterogeneous group of tumors that are not universally associated with HPV infection. As has been shown in other organs, it is becoming increasingly apparent that HPV status significantly affects the prognosis of adenocarcinoma. We conducted a systematic review and meta-analysis to investigate the infection status of high-risk Human papillomavirus (hrHPV) in CAC and evaluate its impact on the survival of patients. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), and Clinical Trials.gov were searched from inception to May 1st, 2022. Data on HPV infection status and survival outcomes were evaluated using STATA 16.0. RESULTS Seventy-one studies with 11,278 participants were included in HPV infection analysis and eight studies with 1099 participants were included in prognosis analysis. The HPV infection rate (including high-risk and low-risk) and hrHPV infection rate in CAC were 75% (95% CI 0.70-0.80, 6978 participants) and 75% (95% CI 0.70-0.81, 4906 participants), respectively. HPV-16 and -18 were the most common HPVs in CAC, with pooled infection rates of 37% (95% CI 0.33-0.41, 7848 participants) and 34% (95% CI 0.30-0.38, 7730 participants), respectively. hrHPV infection was associated with better overall survival (HR 0.23, 95% CI 0.11-0.47, 1013 participants), better disease-free survival (HR 0.18, 95% CI 0.07-0.43, 292 participants), better progression-free survival (HR 0.20, 95% CI 0.08-0.47, 271 participants) and less recurrence (RR 0.30, 95% CI 0.07-0.43, 181 participants). CONCLUSION HPV infection rates were high in CAC. HPV-16 and -18 had the highest infection rates in CAC. However, hrHPV infection was associated with better survival and less recurrence. Future studies should clarify the relationship between hrHPV infection and other prognostic factors and make reasonable treatment strategies for CAC with different HPV status. PROTOCOL REGISTRATION CRD42022319390.
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Affiliation(s)
- Hengxi Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Wei Xiong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xue Dong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yana Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xin Tan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
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15
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Correa RM, Baena A, Valls J, Colucci MC, Mendoza L, Rol M, Wiesner C, Ferrera A, Fellner MD, González JV, Basiletti JA, Mongelos P, Rodriguez de la Peña M, Saino A, Kasamatsu E, Velarde C, Macavilca N, Martinez S, Venegas G, Calderón A, Rodriguez G, Barrios H, Herrero R, Almonte M, Picconi MA. Distribution of human papillomavirus genotypes by severity of cervical lesions in HPV screened positive women from the ESTAMPA study in Latin America. PLoS One 2022; 17:e0272205. [PMID: 35905130 PMCID: PMC9337688 DOI: 10.1371/journal.pone.0272205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
Abstract
The proportion of HPV16 and 18-associated cervical cancer (CC) appears rather constant worldwide (≥70%), but the relative importance of the other HR-HPV differs slightly by geographical region. Here, we studied the HPV genotype distribution of HPV positive Latin American (LA) women by histological grade, in a sub-cohort from the ESTAMPA study; we also explored the association of age-specific HPV genotypes in severe lesions. Cervical samples from 1,252 participants (854 ≤CIN1, 121 CIN2, 194 CIN3 and 83 CC) were genotyped by two PCRs-Reverse Blotting Hybridization strategies: i) Broad-Spectrum General Primers 5+/6+ and ii) PGMY9/11 PCRs. HPV16 was the most frequently found genotype in all histological grades, and increased with the severity of lesions from 14.5% in ≤ CIN1, 19.8% in CIN2, 51.5% in CIN3 to 65.1% in CC (p < 0.001). For the remaining HR-HPVs their frequency in CC did not increase when compared to less severe categories. The nonavalent vaccine HR-types ranked at the top in CC, the dominant ones being HPV16 and HPV45. HR-HPV single infection occurs, respectively, in 57.1% and 57.0% of ≤CIN1 and CIN2, increasing to 72.2% and 91.6% in CIN3 and CC (p<0.001). No association between age and HPV type was observed in CC, although the risk of HPV16 infection in CIN3 cases increased with age. Results confirm the relevance of HPV16 in the whole clinical spectrum, with a strong rise of its proportion in CIN3 and cancer. This information will be relevant in evaluating the impact of HPV vaccination, as a baseline against which to compare genotype changes in HPV type-specific distribution as vaccinated women participate in screening in LA region. Likewise, these data may help select the best HPV testing system for HPV-based efficient, affordable, and sustainable screening programmes.
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Affiliation(s)
- Rita Mariel Correa
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Armando Baena
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Joan Valls
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - María Celeste Colucci
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay, San Lorenzo, Paraguay
| | - Maryluz Rol
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tagucigalpa, Honduras
| | - María Dolores Fellner
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Joaquín Víctor González
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Jorge Alejandro Basiletti
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Pamela Mongelos
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay, San Lorenzo, Paraguay
| | | | - Agustina Saino
- Sección Histología, Servicio Anatomía Patológica, Hospital Nacional “Prof. Posadas”, El Palomar, Argentina
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay, San Lorenzo, Paraguay
| | - Carlos Velarde
- Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Perú
| | | | | | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social, Región Pacífico Central, San José, Costa Rica
| | | | - Hernán Barrios
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay, San Lorenzo, Paraguay
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, San José, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - María Alejandra Picconi
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
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16
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Whop LJ, Butler TL, Brotherton JML, Anderson K, Cunningham J, Tong A, Garvey G. Study protocol: Yarning about HPV Vaccination: a qualitative study of factors influencing HPV vaccination among Aboriginal and Torres Strait Islander adolescents in Australia. BMJ Open 2021; 11:e047890. [PMID: 34344679 PMCID: PMC8336189 DOI: 10.1136/bmjopen-2020-047890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander women experience a higher burden of cervical cancer than non-Indigenous women in Australia. Cervical cancer is preventable partly through human papillomavirus (HPV) vaccination; in Australia, this is delivered through the national school-based immunisation programme. While HPV vaccination uptake is high among Australian adolescents, there remain gaps in uptake and completion among Aboriginal and Torres Strait Islander adolescents. This study aims to gain a comprehensive understanding of the barriers and facilitators to HPV vaccination uptake and completion among Aboriginal and Torres Strait Islander adolescents in Queensland, Australia. METHODS AND ANALYSIS The study will be guided by an Indigenist research approach and an ecological model for health promotion. Yarning, a qualitative Indigenous research method, will be conducted in up to 10 schools. Participants will include Year 7 (12/13 years old) Aboriginal and Torres Strait Islander adolescents; parents/caregivers; and local key informants and immunisation programme partners involved in the delivery of school-based HPV immunisation programme. Participants will be recruited through school representatives and investigator networks using purposive and snowball sampling and samples of convenience. Field notes, HPV vaccination clinic observations and sequential diagramming of the HPV vaccination process will be conducted. Thematic analysis of data will be led by Aboriginal and Torres Strait Islander researchers. Synthesised sequential diagrams of the process of HPV vaccination and qualitative themes summarising key findings will be produced. ETHICS AND DISSEMINATION The Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (1646/20), the Australian National University Human Research Ethics Committee (HREC, 2020/478), the HREC of the Northern Territory Department of Health and Menzies School of Health Research (19-3484) and the Townsville Hospital and Health Service HREC (HREC/QTHS/73789) have approved the study. Dissemination will occur via conferences and peer-reviewed publications. Further dissemination will be determined in partnership with the Aboriginal and Torres Strait Islander Steering Committee, including Youth Representatives and Consultation Network.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Tamara L Butler
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
| | | | - Kate Anderson
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gail Garvey
- Menzies School of Health Research, Wellbeing and Preventable Chronic Diseases, Charles Darwin University, Casuarina, Northern Territory, Australia
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17
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Stuebs FA, Gass P, Dietl AK, Schulmeyer CE, Adler W, Geppert C, Hartmann A, Knöll A, Beckmann MW, Koch MC. Human papilloma virus genotype distribution in women with premalignant or malignant lesions of the uterine cervix. Arch Gynecol Obstet 2021; 304:751-758. [PMID: 33538863 DOI: 10.1007/s00404-021-05986-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cervical cancer is caused by persistent infection with high-risk human papillomavirus (hrHPV). Cytology-based national screening programs have reduced the incidence and mortality of cervical cancer. Different hrHPV subtypes have different carcinogenic potentials. This study evaluated the distribution of different types of hrHPV relative to age in cervical cancer and its precursor lesions. METHODS HPV testing was performed between November 2018 and February 2020 using the Abbott RealTime high-risk HPV assay on an Abbott m2000sp instrument. This assay separately detects HPV-16, HPV-18, and a pool of 12 additional hrHPV types (HPV-31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68). RESULTS The study included 652 women with HPV samples and biopsies of the cervix or histology samples obtained during surgery. In all, 30.8% (95% CI, 27.3-34.6%) were HPV-negative. Among HPV-positive women, HPV-16, HPV-18, and "HPV other" types were found in 33.5, 4.4, and 49.4%, respectively. Cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesions (HSILs) in women ≤ 34 years were positive for HPV-16 in 54.5% of cases and in those ≥ 35 years in 45.4% of cases. Among women with cervical cancer, 75.8% were infected with HPV-16 or had coinfection with HPV-16 and "HPV other". CONCLUSIONS HPV-16 is the most common type of hrHPV in HSIL + lesions. It is more common in women diagnosed with CIN 3/HSIL who are aged ≤ 35 and is decreasing with age. Therefore, women age ≥ 35 with persistent infection with this type of hrHPV need careful surveillance, as they are at high risk of progression to cervical cancer.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 6, 91054, Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Schlossgarten 4, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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18
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Sias C, Guarrasi V, Minosse C, Lapa D, Nonno FD, Capobianchi MR, Garbuglia AR, Del Porto P, Paci P. Human Papillomavirus Infections in Cervical Samples From HIV-Positive Women: Evaluation of the Presence of the Nonavalent HPV Genotypes and Genetic Diversity. Front Microbiol 2020; 11:603657. [PMID: 33324386 PMCID: PMC7723855 DOI: 10.3389/fmicb.2020.603657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/03/2020] [Indexed: 12/21/2022] Open
Abstract
Non-nonavalent vaccine (9v) Human papillomavirus (HPV) types have been shown to have high prevalence among HIV-positive women. Here, 1444 cervical samples were tested for HPV DNA positivity. Co-infections of the 9v HPV types with other HPV types were evaluated. The HPV81 L1 and L2 genes were used to investigate the genetic variability of antigenic epitopes. HPV-positive samples were genotyped using the HPVCLART2 assay. The L1 and L2 protein sequences were analyzed using a self-optimized prediction method to predict their secondary structure. Co-occurrence probabilities of the 9v HPV types were calculated. Non9v types represented 49% of the HPV infections; 31.2% of the non9v HPV types were among the low-grade squamous intraepithelial lesion samples, and 27.3% among the high-grade squamous intraepithelial lesion samples, and several genotypes were low risk. The co-occurrence of 9v HPV types with the other genotypes was not correlated with the filogenetic distance. HPV81 showed an amino-acid substitution within the BC loop (N75Q) and the FGb loop (T315N). In the L2 protein, all of the mutations were located outside antigenic sites. The weak cross-protection of the 9v types suggests the relevance of a sustainable and effective screening program, which should be implemented by HPV DNA testing that does not include only high-risk types.
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Affiliation(s)
- Catia Sias
- Laboratory of Virology, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Valerio Guarrasi
- Dipartimento di Ingegneria Informatica, Automatica e Gestionale “A. Ruberti”, Sapienza Università di Roma, Rome, Italy
| | - Claudia Minosse
- Laboratory of Virology, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Daniele Lapa
- Laboratory of Virology, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Franca Del Nonno
- Laboratory of Pathology, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, Lazzaro Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy,*Correspondence: Anna Rosa Garbuglia,
| | - Paola Del Porto
- Department of Biology and Biotechnology “C. Darwin”, Sapienza University, Rome, Italy
| | - Paola Paci
- Dipartimento di Ingegneria Informatica, Automatica e Gestionale “A. Ruberti”, Sapienza Università di Roma, Rome, Italy
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19
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Smith MA, Hall MT, Saville M, Brotherton JML, Simms KT, Lew JB, Bateson D, Skinner SR, Kelaher M, Canfell K. Could HPV Testing on Self-collected Samples Be Routinely Used in an Organized Cervical Screening Program? A Modeled Analysis. Cancer Epidemiol Biomarkers Prev 2020; 30:268-277. [PMID: 33219163 DOI: 10.1158/1055-9965.epi-20-0998] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/10/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical screening on self-collected samples has mainly been considered for targeted use in underscreened women. Updated evidence supports equivalent sensitivity of PCR-based human papillomavirus (HPV) testing on self-collected and clinician-collected samples. METHODS Using a well-established model, we compared the lifetime impact on cancer diagnoses and deaths resulting from cervical screening using self-collected samples only, with and without the existing restriction in Australia to women aged 30+ years and ≥2 years overdue, compared with the mainstream program of 5-yearly HPV screening on clinician-collected samples starting at 25 years of age. We conservatively assumed sensitivity of HPV testing on self-collected relative to clinician-collected samples was 0.98. Outcomes were estimated either in the context of HPV vaccination ("routinely vaccinated cohorts;" uptake as in Australia) or in the absence of HPV vaccination ("unvaccinated cohorts"). RESULTS In unvaccinated cohorts, the health benefits of increased participation from self-collection outweighed the worst case (2%) loss of relative test sensitivity even if only 15% of women, who would not otherwise attend, used it ("additional uptake"). In routinely vaccinated cohorts, population-wide self-collection could be marginally (0.2%-1.0%) less effective at 15% additional uptake but 6.2% to 12.4% more effective at 50% additional uptake. Most (56.6%-65.0%) of the loss in effectiveness in the restricted self-collection pathway in Australia results from the requirement to be 2 or more years overdue. CONCLUSIONS Even under pessimistic assumptions, any potential loss in test sensitivity from self-collection is likely outweighed by improved program effectiveness resulting from feasible levels of increased uptake. IMPACT Consideration could be given to offering self-collection more widely, potentially as an equal choice for women.See related commentary by Lim, p. 245.
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Affiliation(s)
- Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia. .,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michaela T Hall
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Mathematics and Statistics, UNSW, Sydney, New South Wales, Australia
| | - Marion Saville
- VCS Foundation, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology & Neonatology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - S Rachel Skinner
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Children's Hospital Westmead, Westmead, New South Wales, Australia
| | - Margaret Kelaher
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia
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20
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Icardi G, Costantino C, Guido M, Zizza A, Restivo V, Amicizia D, Tassinari F, Piazza MF, Paganino C, Casuccio A, Vitale F, Ansaldi F, Trucchi C. Burden and Prevention of HPV. Knowledge, Practices and Attitude Assessment Among Pre-Adolescents and their Parents in Italy. Curr Pharm Des 2020; 26:326-342. [PMID: 31942852 PMCID: PMC7527545 DOI: 10.2174/1381612826666200114100553] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/08/2020] [Indexed: 12/24/2022]
Abstract
Despite infections due to HPV nowadays represent the most common sexually transmitted diseases worldwide with recognized effective and safe preventive strategies, knowledge, attitudes; however, awareness on HPV is considerably low. The present study has two main objectives: 1. To conduct a literature review to analyze the evolution of preventive tools, the complexity of the vaccine choice process, and the challenges posed by HPV vaccine hesitancy and refusal among pre-adolescents and their parents; 2. To assess knowledge, practices and attitudes toward HPV infection and vaccination in a sample of Italian pre-adolescents and their parents. The observational study was carried out through the use of two anonymous and self-administered pre- and post-intervention questionnaires dedicated to the target populations. Between the administrations of the pre- and post-intervention questionnaires, an educational intervention on HPV infection and related diseases, and prevention strategies was conducted. All participants demonstrated suboptimal knowledge and positive attitudes in the pre-intervention questionnaire. Higher levels of knowledge and attitudes were observed among pre-adolescents thatused social networks and had heard of sexually transmitted diseases at home/school/physician and from parents and also who had heard of HPV from General Practitioners, Gynecologists, family members and newspapers. A significant increase in HPV vaccination awareness was observed among pre-adolescents after the educational sessions. Health education programs aimed at increasing knowledge, attitudes and awareness on HPV are needed to implement the outcomes of HPV immunization programs, especially if supported by the physicians involved in counselling and recommendation processes.
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Affiliation(s)
- Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy.,IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties (PROMISE), University of Palermo, Italy
| | - Marcello Guido
- Department of Biological and Environmental Sciences and Technologies, Laboratory of Hygiene, University of the Salento, Lecce, Italy.,Inter-University Centre for Research of Influenza and other Transmissible Infections (C.I.R.I.- I.T.), Genova Italy
| | - Antonella Zizza
- National Research Council, Institute of Clinical Physiology, Campus Ecotekne, Lecce, Italy
| | - Vincenzo Restivo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties (PROMISE), University of Palermo, Italy
| | - Daniela Amicizia
- Department of Health Sciences, University of Genoa, Genoa, Italy.,IRCCS San Martino Policlinic Hospital, Genoa, Italy.,Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Genova, Italy
| | | | - Maria Francesca Piazza
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Genova, Italy
| | - Chiara Paganino
- Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Genova, Italy
| | - Alessandra Casuccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties (PROMISE), University of Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties (PROMISE), University of Palermo, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy.,IRCCS San Martino Policlinic Hospital, Genoa, Italy.,Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Genova, Italy
| | - Cecilia Trucchi
- IRCCS San Martino Policlinic Hospital, Genoa, Italy.,Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Genova, Italy
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21
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Zhou FY, Zhou Q, Zhu ZY, Hua KQ, Chen LM, Ding JX. Types and viral load of human papillomavirus, and vaginal microbiota in vaginal intraepithelial neoplasia: a cross-sectional study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1408. [PMID: 33313153 PMCID: PMC7723660 DOI: 10.21037/atm-20-622] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Human papilloma virus (HPV) infection is an important risk factor for vaginal intraepithelial neoplasia (VAIN). Recent studies have suggested that the microbiome may play a potential role in cervicovaginal diseases. This study aimed to explore the characteristics of the types and viral load of HPV in VAIN, as well as the association between vaginal microbiota and VAIN. Methods A total of 176 women, either with VAIN, or without VAIN but with HPV infection were enrolled in the study. Among them, 109 HPV positive cases were qualified for viral load assay. The vaginal microbiota of 122 HPV positive women, who were matched by severity of cervical lesions and menopause status, was determined by 16S ribosomal RNA (16S rRNA) sequencing. Results The top 5 types of HPV-associated vaginal lesions were HPV16 (24.2%), HPV52 (24.2%), HPV53 (16.1%), HPV58 (14.5%) and HPV66 (14.5%). The viral load of HPV types 16, 52, and 58 appeared higher in separate vaginal lesions than in histopathologically normal cases (P=0.026, 0.002, and 0.013, respectively). The vaginal microbiota of HPV-positive patients with VAIN did not exhibit a large change in diversity. Vaginal microbiota of VAIN was characterized by an increased abundance of Atopobium, Gardnerella, Allobaculum and Clostridium, as well as decreased abundance of Finegoldia, Actinobaculum and Blautia. A higher level of Enterococcus and some specific Clostridium spp. might be associated with an elevated risk of VAIN2/3. Conclusions A higher level of viral load of HPV16, 52, and 58 may indicate VAIN. The composition of vaginal microbiota changes during the progression of VAIN and specific bacteria such as Atopobium, Gardnerella, Allobaculum, Enterococcus and Clostridium, may help to promote its development.
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Affiliation(s)
- Fang-Yue Zhou
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Qi Zhou
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhong-Yi Zhu
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ke-Qin Hua
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Li-Mei Chen
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing-Xin Ding
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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22
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Mai Q, Yang X, Cheng H, Wu G, Wu Z. Prevalence and genotype distribution of human papillomavirus among women with cervical lesions in Shenzhen city, China. Hum Vaccin Immunother 2020; 17:965-971. [PMID: 32961080 DOI: 10.1080/21645515.2020.1805993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
There is currently a lack of sufficient data on human papillomavirus (HPV)-attributable cervical carcinoma in China. Accordingly, we aimed to determine the prevalence and genotype distribution of HPV among women with cervical lesions in Shenzhen, in order to evaluate the potential benefit of HPV vaccination programs and inform cervical cancer control policies. We enrolled 5,255 patients who were admitted to the University of Chinese Academy of Sciences Shenzhen Hospital from January 2017 to December 2019. The HPV prevalence and genotype distribution were analyzed using the 21 HPV GenoArray diagnostic assay. A total of 937/5,255 patients showed HPV-positivity (prevalence rate 17.83%), of whom 85.81% (804/937) had high-risk HPV infection. HPV52 was the most prevalent genotype (4.72%, 248/5,255), followed by HPV58 (3.04%, 160/5,255), and HPV16 (2.72%, 143/5,255). The HPV prevalence rates among women with a normal cervix, low-grade intraepithelial lesions, high-grade intraepithelial lesions, invasive cervical cancer, and other characteristics were 15.63% (50/320), 58.65% (61/104), 80.00% (44/55), 88.57% (31/35), and 15.84% (751/4,741), respectively. HPV16, HPV18, and HPV52 accounted for the majority of cervical lesions, and the infection rates of HPV16 and HPV18 gradually increased with intraepithelial lesion progression (both P < .001). Our study found that HPV16, HPV52, and HPV18 played important roles in the occurrence and development of cervical lesions. This finding has the potential to guide the formulation of HPV screening and vaccination programs and preventive strategies for HPV-attributable cancer in this region.
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Affiliation(s)
- Qingfeng Mai
- Department of Clinical Laboratory, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Xiaohan Yang
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, People's Republic of China
| | - Huan Cheng
- Department of Clinical Laboratory, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Genghang Wu
- Medical Genetic Centre, Guangdong Women and Children's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, People's Republic of China
| | - Zikun Wu
- Department of Clinical Laboratory, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, People's Republic of China
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23
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Cornall AM, Brotherton JML, Callegari ET, Tan FH, Saville M, Pyman J, Phillips S, Malloy MJ, Tabrizi SN, Garland SM. Assessment of attribution algorithms for resolving CIN3-related HPV genotype prevalence in mixed-genotype biopsy specimens using laser capture microdissection as the reference standard. Vaccine 2020; 38:6312-6319. [PMID: 32736939 DOI: 10.1016/j.vaccine.2020.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
To make accurate determinations regarding potential and actual impact of HPV vaccine programs, precise estimates of genotype-specific contributions to disease are required for pre- and post-vaccine populations. Definitive determination of lesion-specific genotypes, particularly where multiple genotypes are detected in a sample, can be technically demanding and resource intensive; therefore, most prevalence studies use mathematical algorithms to adjust for multiple genotype detections. There are currently several algorithms, which can produce genotype estimates within a wide range of variability. The use of these for cervical cytology samples has recently been assessed for accuracy against a definitive reference standard, but none have yet been assessed for multiple-genotype-containing whole biopsy specimens. Using laser capture microdissection (LCM) on biopsy samples, lesion-specific genotype prevalence data were generated for a cohort of 516 young Australian women (aged 18-32 years) with cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ. Using whole tissue section genotype data from the same cohort, including 71 (13.7%) with multiple genotypes, lesion-associated genotype prevalence was estimated using four different attribution algorithms. The proportion of lesions attributable to HPV16 and HPV18 by LCM were 58.4% and 5%, respectively; hierarchical, proportional, single type/minimum and any type/maximum attribution estimates were comparable across genotypes. For analyses utilising whole tissue biopsy cervical specimens, attribution estimates are appropriate for estimating the proportional contribution of individual genotypes to lesions in a population.
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Affiliation(s)
- Alyssa M Cornall
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Emma T Callegari
- Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Parkville 3052, Victoria, Australia
| | - Fiona H Tan
- Department of Surgery, University of Melbourne, The Royal Melbourne Hospital, Parkville 3052, Victoria, Australia.
| | - Marion Saville
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia; VCS Pathology, Carlton, Victoria, Australia.
| | - Jan Pyman
- Department of Anatomical Pathology, Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Samuel Phillips
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Michael J Malloy
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville 3052, Victoria, Australia
| | - Sepehr N Tabrizi
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Suzanne M Garland
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia.
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24
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Wnukowski-Mtonga P, Jayasinghe S, Chiu C, Macartney K, Brotherton J, Donovan B, Hall M, Smith DW, Peterson K, Campbell-Lloyd S, Selvey C, Giles M, Kaldor J, Marshall H. Scientific evidence supporting recommendations on the use of the 9-valent HPV vaccine in a 2-dose vaccine schedule in Australia. ACTA ACUST UNITED AC 2020; 44. [PMID: 32299331 DOI: 10.33321/cdi.2020.44.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Australian Technical Advisory Group on Immunisation (ATAGI) updated recommendations on the use of human papillomavirus (HPV) vaccines in the Australian Immunisation Handbook in 2018, regarding the use of the recently available 9-valent (9vHPV) vaccine, Gardasil 9, and a 2-dose schedule for young adolescents for HPV vaccines. This report provides an overview of the relevant scientific evidence that underpinned these updated recommendations. The 9vHPV vaccine includes 5 HPV types (HPV 31, 33, 45, 52 and 58) additional to the 4 that are also covered by the 4vHPV (Gardasil) vaccine (HPV 6,11,16,18). Accordingly, the 9vHPV vaccine is expected to prevent an additional 15% of cervical cancers and up to 20% of other HPV-related cancers. Non-inferior antibody responses after two 9vHPV vaccine doses given 6-12 months apart in girls and boys aged 9-14 years compared to women aged 16-26 years after three doses support the 2-dose schedule for adolescents of this age group. In clinical trials 9vHPV vaccine was well-tolerated with a similar safety profile to 4vHPV vaccine. The switch to 9vHPV vaccine and a 2-dose schedule is anticipated to improve public acceptability of the program and reduce HPV-related disease in the long-term.
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Affiliation(s)
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales
| | - Julia Brotherton
- Victorian Cytology Service Population Health, VCS Foundation and School of Population and Global Health, University of Melbourne, Melbourne, Victoria
| | - Basil Donovan
- The Kirby Institute, University of New South Wales and Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales
| | - Madeline Hall
- Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Queensland
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine WA and Faculty of Health and Medical Sciences, University of Western Australia, Nedlands, Western Australia
| | - Karen Peterson
- Immunisation Program, Queensland Health, Brisbane, Queensland
| | - Sue Campbell-Lloyd
- Immunisation Unit, Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, New South Wales
| | - Christine Selvey
- Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, New South Wales
| | - Michelle Giles
- The Alfred Hospital and Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital and Robinson Research Institute and Adelaide Medical School, University of Adelaide, North Adelaide, South Australia
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25
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Brotherton JM, Budd AC, Saville M. Understanding the proportion of cervical cancers attributable to HPV. Med J Aust 2020; 212:63-64.e1. [PMID: 31909481 DOI: 10.5694/mja2.50477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Alison C Budd
- Australian Institute of Health and Welfare, Canberra, ACT
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26
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Sturrock S, Griffiths A, Jobling T. CIN III and cervical SCC with negative oncogenic HPV PCR: A case series. Aust N Z J Obstet Gynaecol 2019; 60:154-157. [PMID: 31724153 DOI: 10.1111/ajo.13092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/14/2019] [Indexed: 11/28/2022]
Abstract
With the recent introduction of the renewed National Cervical Screening Program (NCSP) in Australia, utilising primary human papillomavirus (HPV) nucleic acid testing (NAT) for known oncogenic HPV types rather than cervical cytology, we reflect on three asymptomatic women with negative oncogenic HPV test results and high-grade cervical abnormalities including cervical intraepithelial neoplasia (CIN) III and cervical squamous cell carcinoma (SCC). The two cases with CIN III had a 'probable' oncogenic subtype (HPV 53) identified on further testing, while the case of SCC had no HPV virus identified. These cases serve as a reminder of the need for ongoing diligence despite low-risk screening under the new program.
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Affiliation(s)
- Sam Sturrock
- Monash Women's Service, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Andrew Griffiths
- Obstetrics and Gynaecology, Peninsular Health, Melbourne, Victoria, Australia
| | - Thomas Jobling
- Monash Women's Service, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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27
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Mahumud RA, Alam K, Dunn J, Gow J. The cost-effectiveness of controlling cervical cancer using a new 9-valent human papillomavirus vaccine among school-aged girls in Australia. PLoS One 2019; 14:e0223658. [PMID: 31596899 PMCID: PMC6785120 DOI: 10.1371/journal.pone.0223658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Cervical cancer imposes a substantial health burden worldwide including in Australia and is caused by persistent infection with one of 13 sexually transmitted high-risk human papillomavirus (HPV) types. The objective of this study was to assess the cost-effectiveness of adding a nonavalent new Gardasil-9® (9vHPV) vaccine to the national immunisation schedule in Australia across three different delivery strategies. MATERIALS AND METHODS The Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model was used to examine the cost-effectiveness of 9vHPV vaccine introduction to prevent HPV infection. Academic literature and anecdotal evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, and vaccine delivery costs. The incremental cost-effectiveness ratios (ICERs) were measured per disability-adjusted life years (DALYs) averted, using the heuristic cost-effectiveness threshold defined by the World Health Organisation (WHO). Analyses and data from international agencies were used in scenario analysis from the health system and societal perspectives. RESULTS The 9vHPV vaccination was estimated to prevent 113 new cases of cervical cancer (discounted) during a 20-year period. From the health system and societal perspectives, the 9vHPV vaccination was very cost-effective in comparison with the status quo, with an ICER of A$47,008 and A$44,678 per DALY averted, respectively, using the heuristic cost-effectiveness threshold level. Considering delivery strategies, the ICERs per DALY averted were A$47,605, A$46,682, and A$46,738 for school, health facilities, and outreach-based vaccination programs from the health system perspective, wherein, from the societal perspective, the ICERs per DALY averted were A$46,378, A$43,729, A$43,930, respectively. All estimates of ICERs fell below the threshold level (A$73,267). CONCLUSIONS This cost-effectiveness evaluation suggests that the routine two-dose 9vHPV vaccination strategy of preadolescent girls against HPV is very cost-effective in Australia from both the health system and societal perspectives. If equally priced, the 9vHPV option is the most economically viable vaccine. Overall, this analysis seeks to contribute to an evidence-based recommendation about the new 9vHPV vaccination in the national immunisation program in Australia.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, QLD Australia
- Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Health and Epidemiology Research, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, QLD Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia
- Prostate Cancer Foundation of Australia, St Leonards NSW, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, QLD Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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28
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Patel C, Brotherton JM, Pillsbury A, Jayasinghe S, Donovan B, Macartney K, Marshall H. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? ACTA ACUST UNITED AC 2019; 23. [PMID: 30326995 PMCID: PMC6194907 DOI: 10.2807/1560-7917.es.2018.23.41.1700737] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: A National human papilloma virus (HPV) Vaccination Programme for the prevention of HPV infection and associated disease using the quadrivalent HPV vaccine (4vHPV) has been funded and implemented in Australia since 2007, initially for girls only and extended to boys in 2013, with uptake rates among the highest observed worldwide. Aim: We report on the impact of this national programme on HPV prevalence and associated disease burden and estimate the potential impact of adopting a nonavalent HPV (9vHPV) vaccine. Methods: We performed a non-systematic literature review of studies measuring the burden of HPV-associated disease and infection in Australia before and after introduction of HPV vaccination. We also included key national reports with estimates of HPV-related disease burden. Results: Substantial declines in high-grade cervical disease and genital warts among vaccine-eligible women have been observed. Reductions in genital warts incidence and HPV prevalence among heterosexual men of similar age were observed before introduction of the male vaccination programme, indicating a substantial herd effect. 9vHPV vaccine is expected to prevent up to 90% of cervical and 96% of anal cancers. Of an estimated 1,544 HPV-associated cancers in 2012, 1,242 would have been preventable by the 4vHPV vaccine and an additional 187 anogenital cancers by the 9vHPV vaccine. Conclusions: Vaccination using 4vHPV vaccine has had a large demonstrable impact on HPV-related disease in Australia. A switch to 9vHPV could further reduce the HPV-associated cancer burden. With continued high coverage among both males and females, elimination of vaccine-type HPV disease seems achievable in Australia.
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Affiliation(s)
- Cyra Patel
- National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Julia Ml Brotherton
- School of Population and Global Health, University of Melbourne, Parkville, Australia.,VCS Population Health, VCS Foundation, East Melbourne, Australia
| | - Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Sanjay Jayasinghe
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Basil Donovan
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia.,The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kristine Macartney
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Helen Marshall
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, North Adelaide, Australia.,Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, North Adelaide, Australia
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29
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Espinosa JR, Galván M, Quiñones AS, Ayala JL, Durón SM. DNA Biosensor Based on Double-Layer Discharge for the Detection of HPV Type 16. SENSORS 2019; 19:s19183956. [PMID: 31540232 PMCID: PMC6767228 DOI: 10.3390/s19183956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/29/2022]
Abstract
DNA electrochemical biosensors represent a feasible alternative for the diagnosis of different pathologies. In this work, the development of an electrochemical method for Human Papillomavirus-16 (HPV-16) sensing is reported based on potential relaxation measurements related to the discharge of a complex double layer of a DNA-modified gold electrode. The method used allows us to propose an equivalent circuit (EC) for a DNA/Au electrode, which was corroborated by electrochemical impedance spectroscopy (EIS) measurement. This model differs from the Randles circuit that is commonly used in double-layer simulations. The change in the potential relaxation and associated charge transfer resistance were used for sensing the DNA hybridization by using the redox pair Fe(CN)64-/Fe(CN)63+ as an electrochemical indicator. In order to determinate only the potential relaxation of the composed double layer, the faradic and double-layer current contributions were separated using a rectifier diode arrangement. A detection limit of 0.38 nM was obtained for the target HPV-16 DNA sequences. The biosensor showed a qualitative discrimination between a single-base mismatched sequence and the fully complementary HPV-16 DNA target. The results indicate that the discharge of the double-layer detection method can be used to develop an HPV DNA biosensor.
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Affiliation(s)
- José R. Espinosa
- Electrical Engineering Department, Autonomous University of Zacatecas, Col. Centro, Av. Ramón López Velarde 801. Zacatecas, Zacatecas C.P. 98000, Mexico;
| | - Marisol Galván
- Chemistry Department, Autonomous University of Zacatecas, Campus Siglo XXI, Edif. 6, Km 6 carr. Zacatecas-Guadalajara, Zacatecas C.P. 98160, Mexico; (M.G.); (A.S.Q.); (J.L.A.)
| | - Arturo S. Quiñones
- Chemistry Department, Autonomous University of Zacatecas, Campus Siglo XXI, Edif. 6, Km 6 carr. Zacatecas-Guadalajara, Zacatecas C.P. 98160, Mexico; (M.G.); (A.S.Q.); (J.L.A.)
| | - Jorge L. Ayala
- Chemistry Department, Autonomous University of Zacatecas, Campus Siglo XXI, Edif. 6, Km 6 carr. Zacatecas-Guadalajara, Zacatecas C.P. 98160, Mexico; (M.G.); (A.S.Q.); (J.L.A.)
| | - Sergio M. Durón
- Chemistry Department, Autonomous University of Zacatecas, Campus Siglo XXI, Edif. 6, Km 6 carr. Zacatecas-Guadalajara, Zacatecas C.P. 98160, Mexico; (M.G.); (A.S.Q.); (J.L.A.)
- Correspondence: ; Tel.: +52-49-2925-6690 (ext. 4655)
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30
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Garland SM, Pitisuttithum P, Ngan HYS, Cho CH, Lee CY, Chen CA, Yang YC, Chu TY, Twu NF, Samakoses R, Takeuchi Y, Cheung TH, Kim SC, Huang LM, Kim BG, Kim YT, Kim KH, Song YS, Lalwani S, Kang JH, Sakamoto M, Ryu HS, Bhatla N, Yoshikawa H, Ellison MC, Han SR, Moeller E, Murata S, Ritter M, Sawata M, Shields C, Walia A, Perez G, Luxembourg A. Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries. J Infect Dis 2019; 218:95-108. [PMID: 29767739 PMCID: PMC5989602 DOI: 10.1093/infdis/jiy133] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/16/2018] [Indexed: 01/17/2023] Open
Abstract
Background A 9-valent human papillomavirus-6/11/16/18/31/33/45/52/58 (9vHPV) vaccine extends coverage to 5 next most common oncogenic types (31/33/45/52/58) in cervical cancer versus quadrivalent HPV (qHPV) vaccine. We describe efficacy, immunogenicity, and safety in Asian participants (India, Hong Kong, South Korea, Japan, Taiwan, and Thailand) from 2 international studies: a randomized, double-blinded, qHPV vaccine-controlled efficacy study (young women aged 16–26 years; NCT00543543; Study 001); and an immunogenicity study (girls and boys aged 9–15 years; NCT00943722; Study 002). Methods Participants (N = 2519) were vaccinated at day 1 and months 2 and 6. Gynecological samples (Study 001 only) and serum were collected for HPV DNA and antibody assessments, respectively. Injection-site and systemic adverse events (AEs) were monitored. Data were analyzed by country and vaccination group. Results 9vHPV vaccine prevented HPV-31/33/45/52/58–related persistent infection with 90.4%–100% efficacy across included countries. At month 7, ≥97.9% of participants seroconverted for each HPV type. Injection-site AEs occurred in 77.7%–83.1% and 81.9%–87.5% of qHPV and 9vHPV vaccine recipients in Study 001, respectively, and 62.4%–85.7% of girls/boys in Study 002; most were mild to moderate. Conclusions The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Asian participants. Data support 9vHPV vaccination programs in Asia. Clinical Trials Registration NCT00543543; NCT00943722.
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Affiliation(s)
- S M Garland
- Western Pacific Regional HPV Labnet Reference Laboratory, Department of Infectious Disease and Microbiology, Royal Women's Hospital, Murdoch Children's Research Institute, Royal Children's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | | | - H Y S Ngan
- Department of Obstetrics and Gynaecology, the University of Hong Kong, China
| | - C-H Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - C-Y Lee
- Department of Gynecology, Chang Gung Memorial Hospital, Chiayi Branch, Taipei
| | - C-A Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei
| | - Y C Yang
- MacKay Memorial Hospital, Taipei
| | - T-Y Chu
- Tzu Chi Medical Center, Hualien
| | - N-F Twu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - R Samakoses
- Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | | | - T H Cheung
- Department of Obstetric and Gynaecology, Chinese University of Hong Kong, China
| | - S C Kim
- Division of Gynecologic Oncology, Ewha Womans University Mokdong Hospital, School of Medicine Ewha Womans University, Seoul, South Korea
| | - L-M Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - B-G Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Y-T Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asian Medical Center, Seoul, South Korea
| | - K-H Kim
- Department of Pediatrics and Center for Vaccine Evaluation and Study, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Y-S Song
- Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, South Korea
| | - S Lalwani
- Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, India
| | - J-H Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, South Korea
| | - M Sakamoto
- Department of Gynaecology, Sasaki Foundation Kyoundo Hospital and Department of Obstetrics and Gynaecology, School of Medicine, the Jikei University, Tokyo, Japan
| | - H-S Ryu
- Department of Obstetrics and Gynecology, School of Medicine, Ajou University, Suwon, South Korea
| | - N Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - H Yoshikawa
- Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | | | | | - E Moeller
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - M Ritter
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - C Shields
- Merck & Co., Inc., Kenilworth, New Jersey
| | - A Walia
- Merck & Co., Inc., Kenilworth, New Jersey
| | - G Perez
- Merck & Co., Inc., Kenilworth, New Jersey
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31
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Zhu C, Hu A, Cui J, Yang K, Zhu X, Liu Y, Deng G, Zhu L. A Lab-on-a-Chip Device Integrated DNA Extraction and Solid Phase PCR Array for the Genotyping of High-Risk HPV in Clinical Samples. MICROMACHINES 2019; 10:mi10080537. [PMID: 31443221 PMCID: PMC6722547 DOI: 10.3390/mi10080537] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 02/01/2023]
Abstract
Point-of-care (POC) molecular diagnostics play a crucial role in the prevention and treatment of infectious diseases. It is necessary to develop portable, easy-to-use, inexpensive and rapid molecular diagnostic tools. In this study, we proposed a lab-on-a-chip device that integrated DNA extraction, solid-phase PCR and genotyping detection. The ingenious design of the pneumatic microvalves enabled the fluid mixing and reagent storage to be organically combined, significantly reducing the size of the chip. The solid oligonucleotide array incorporated into the chip allowed the spatial separation of the primers and minimized undesirable interactions in multiplex amplification. As a proof-of-concept for POC molecular diagnostics on the device, five genotypes of high-risk human papillomavirus (HPV) (HPV16/HPV18/HPV31/HPV33/HPV58) were examined. Positive quality control samples and HPV patient cervical swab specimens were analyzed on the integrated microdevice. The platform was capable of detection approximately 50 copies of HPV virus per reaction during a single step, including DNA extraction, solid-phase PCR and genotype detection, in 1 h from samples being added to the chip. This simple and inexpensive microdevice provided great utility for the screening and monitoring of HPV genotypes. The sample-to-result platform will pave the way for wider application of POC molecular testing in the fields of clinical diagnostics, food safety, and environmental monitoring.
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Affiliation(s)
- Cancan Zhu
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, 2221 Changjiang Road, Hefei 230000, China
- Science Island Branch, University of Science and Technology of China, No. 96, JinZhai Road Baohe District, Hefei 230000, China
| | - Anzhong Hu
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, 2221 Changjiang Road, Hefei 230000, China
| | - Junsheng Cui
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, 2221 Changjiang Road, Hefei 230000, China
| | - Ke Yang
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, 2221 Changjiang Road, Hefei 230000, China
| | - Xinchao Zhu
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, 2221 Changjiang Road, Hefei 230000, China
- Science Island Branch, University of Science and Technology of China, No. 96, JinZhai Road Baohe District, Hefei 230000, China
| | - Yong Liu
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, 2221 Changjiang Road, Hefei 230000, China
| | - Guoqing Deng
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, 2221 Changjiang Road, Hefei 230000, China
| | - Ling Zhu
- Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, 2221 Changjiang Road, Hefei 230000, China.
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32
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Toh ZQ, Kosasih J, Russell FM, Garland SM, Mulholland EK, Licciardi PV. Recombinant human papillomavirus nonavalent vaccine in the prevention of cancers caused by human papillomavirus. Infect Drug Resist 2019; 12:1951-1967. [PMID: 31308715 PMCID: PMC6613616 DOI: 10.2147/idr.s178381] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/26/2019] [Indexed: 12/26/2022] Open
Abstract
Human papillomavirus (HPV) types 16 and 18 cause 70% of cervical cancer cases globally. The nonavalent HPV vaccine (9vHPV) was licensed in 2014 and protects against the next five most common cancer-causing HPV types (HPV 31/33/45/52/58) after HPV 16/18. Phase III clinical studies have demonstrated high vaccine efficacy (>90%) against cervical, vulvar, and vaginal precancers caused by these additional types, and have shown comparable immunogenicity to the shared genotypes to quadrivalent HPV vaccine (4vHPV). Vaccine efficacy and antibody responses for 9vHPV are found to persist for at least five years while longer-term observational studies are ongoing to monitor long-term vaccine effectiveness. The implementation of 9vHPV has the potential to prevent up to 93% of cervical cancer cases, as well as a significant proportion of other HPV-related anogenital cancers. This review article summarizes the current evidence for 9vHPV in terms of vaccine efficacy against HPV infection and related anogenital precancers, safety, and immunogenicity, as well as discussing the potential impact of this vaccine on the cervical cancer burden globally.
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Affiliation(s)
- Zheng Quan Toh
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennie Kosasih
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Regional WHO HPV Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Edward K Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, University of London, London WC1E7HT, UK
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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33
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Machalek DA, Roberts JM, Garland SM, Thurloe J, Richards A, Chambers I, Sivertsen T, Farnsworth A. Routine cervical screening by primary HPV testing: early findings in the renewed National Cervical Screening Program. Med J Aust 2019; 211:113-119. [PMID: 31168828 DOI: 10.5694/mja2.50223] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/05/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To report human papillomavirus (HPV) testing patterns and rates of oncogenic HPV-positivity for specimens submitted during the first 6 months after the National Cervical Screening Program switched from cytology- to primary HPV-based screening. DESIGN, PARTICIPANTS Retrospective cross-sectional review of 195 606 specimens submitted for HPV testing, 1 December 2017 - 31 May 2018. SETTING Large community-based general pathology laboratory in metropolitan Sydney. MAIN OUTCOME MEASURES Prevalence of oncogenic HPV types (all, HPV16/18, non-HPV16/18) by reason for HPV test (primary screening, non-screening); for oncogenic HPV-positive women in the age band recommended for primary HPV screening (25-74 years), prevalence of cytologic abnormality and rates of 12-month follow-up and colposcopy recommendations. RESULTS 195 606 samples were received: 157 700 (80.6%) for primary screening, 37 906 (19.4%) for non-screening tests. Oncogenic HPV was detected in 8.1% of screening tests (95% CI, 7.9-8.2%) and 20.9% of non-screening tests (95% CI, 20.5-21.3%); 35.5% (95% CI, 34.7-36.4%) of women of recommended screening age with positive oncogenic HPV screening test results also had a cytologic abnormality. The proportion of HPV16/18-positive samples with high grade abnormality was 15.3% (95% CI, 14.2-16.6%); for samples positive for other oncogenic HPV types, the proportion was 6.3% (95% CI, 5.8-6.8%). Repeat HPV testing after 12 months was recommended for 5.4% (95% CI, 5.3-5.5%) and direct colposcopy for 2.6% (95% CI, 2.5-2.7%) of screened women aged 25-74 years. CONCLUSIONS High grade cytologic abnormalities were more common in women positive for HPV16/18, supporting their higher risk classification. Colposcopy referral rates were higher than during primary cytology-based testing, as predicted by clinical trial and modelling data. The prevalence of HPV was much higher in non-screening than in primary screening samples. Our findings indicate the renewed program is performing as expected during the initial HPV screening round.
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Affiliation(s)
- Dorothy A Machalek
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Suzanne M Garland
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | | | | | | | - Annabelle Farnsworth
- Douglass Hanly Moir Pathology, Sydney, NSW.,University of Notre Dame, Sydney, NSW
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34
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Aro K, Nieminen P, Louvanto K, Jakobsson M, Virtanen S, Lehtinen M, Dillner J, Kalliala I. Age-specific HPV type distribution in high-grade cervical disease in screened and unvaccinated women. Gynecol Oncol 2019; 154:354-359. [PMID: 31176553 DOI: 10.1016/j.ygyno.2019.05.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Age-specific type-distribution of high-risk human papillomavirus (hrHPV) in cervical precancerous lesions is subject to change in the HPV vaccination era. Knowing the pre-vaccination type-distribution helps to anticipate changes induced by mass vaccination and optimize screening. METHODS We recruited 1279 women referred to colposcopy for abnormal cytology into a population-based study on HPV type distribution in diagnostic cervical samples (ISRCTN10933736). The HPV genotyping findings were grouped as: HPV16/18+, other hrHPV+ (HPV31/33/35/39/45/51/52/56/58/59/66/68), non-vaccine targeted hrHPV+ (HPV35/39/51/56/59/66/68), low-risk HPV, and HPV negative. We estimated the HPV group-specific prevalence rates according to diagnostic histopathological findings in the age groups of <30 (n = 339), 30-44.9 (n = 614), and ≥45 (n = 326). RESULTS Altogether 503 cases with high grade squamous intraepithelial lesion or worse (HSIL+) were diagnosed. More than half, 285 (56.7%) of HSIL+ cases were associated with HPV16/18: 64.3% (101/157) in women <30 years (reference group), 58.4% (157/269) in women 30-44.9 years (risk ratio (RR) 0.91, 95% confidence interval (95% CI) 0.78-1.06), and 35.1% (27/77) in women ≥45 years of age (RR 0.55, 95% CI 0.39-0.75). Conversely, other hrHPV's were associated with 191 (38.0%) of HSIL+: 31.9% (50/157) in women <30, 36.8% (99/269) in women 30-44.9 years, 54.6% (42/77) and in women ≥45 (RR 1.71, 95% CI 1.26-2.33). The proportion of non-vaccine targeted hrHPV and HPV negative HSIL+ increased with advancing age. CONCLUSIONS Pre-vaccination HPV type distribution in HSIL+ was distinctly polarised by age with HPV16/18 attributed disease being markedly more prevalent in women aged <30. In the older women the other hrHPV types, however, dominated suggesting a need for more age-dependent screening strategies.
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Affiliation(s)
- Karoliina Aro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Karolina Louvanto
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Seppo Virtanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, SE-171 77 Stockholm, Sweden.
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, SE-171 77 Stockholm, Sweden.
| | - Ilkka Kalliala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
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Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia. Gynecol Oncol 2019; 152:465-471. [PMID: 30876490 DOI: 10.1016/j.ygyno.2018.12.019] [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: 08/06/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Australia's HPV vaccination and HPV-based cervical screening programs are changing the landscape in cervical cancer prevention. We aim to identify areas which can make the biggest further impact on cervical cancer burden. This protocol describes the first stage of a program of work called Pathways-Cervix that aims to generate evidence from modelled evaluations of interventions across the cervical cancer spectrum. METHODS Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified. RESULTS Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level; vaccinating older women; increasing screening participation; methods for triaging HPV-positive women; improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer; treating cervical abnormalities and cancer; and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes. CONCLUSIONS Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
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Egli-Gany D, Spaar Zographos A, Diebold J, Masserey Spicher V, Frey Tirri B, Heusser R, Dillner J, Petignat P, Sahli R, Low N. Human papillomavirus genotype distribution and socio-behavioural characteristics in women with cervical pre-cancer and cancer at the start of a human papillomavirus vaccination programme: the CIN3+ plus study. BMC Cancer 2019; 19:111. [PMID: 30700274 PMCID: PMC6354352 DOI: 10.1186/s12885-018-5248-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/26/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2008. To establish monitoring of the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to examine the distribution of oncogenic HPV genotypes in biopsies with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) at the beginning of HPV vaccination programmes and to compare sociodemographic and behavioural factors of women with CIN3+ with women in the Swiss general population. METHODS We conducted a retrospective and prospective cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status in the CIN3 + plus group with the Swiss National Cohort in 2014 and compared risk factors for HPV infection with the Swiss Health Survey in 2012. RESULTS We included 768 biopsies from 767 women. Four hundred and seventy-five (61.8%) biopsies were positive for HPV 16 and/or 18, 687 (89.5%) were positive for oncogenic HPV genotypes 16, 18, 31, 33, 45, 52, and/or 58 and five (0.7%) were HPV negative. Twenty-eight (10.3%) of the 273 women who completed the patient questionnaire reported having received at least one dose of an HPV vaccine. When compared with Swiss women in the six study cantons, fewer women in the CIN3+ plus study group were of Swiss nationality, more were born abroad and more were single. The study group also had a higher proportion of women with ≥2 partners in the last year, current smokers and was younger at age of first sexual intercourse. CONCLUSIONS Introduction of the nonavalent vaccine could cover approximately 90% of CIN3+ lesions in Swiss women compared with around 60% with the quadrivalent vaccine. Surveillance of HPV genotype distribution in CIN3+, together with information about vaccination and CIN3+ incidence will allow monitoring of the public health impact of vaccination programmes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02323997 . Registered 24 December 2014.
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Affiliation(s)
- Dianne Egli-Gany
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Anne Spaar Zographos
- Federal Office of Public Health, Schwarzenburgstrasse 157, 3003 Bern, Switzerland
| | - Joachim Diebold
- Institute of Pathology, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
| | | | - Brigitte Frey Tirri
- Department of Gynaecology and Obstetrics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Rolf Heusser
- National Institute for Cancer Epidemiology and Registration, Hirschengraben 82, 8001 Zurich, Switzerland
| | - Joakim Dillner
- WHO HPV LabNet Global Reference Laboratory, Department of Clinical Microbiology, Center for Cervical Cancer Prevention, Skåne University Hospital, Malmö, Karolinska Institute and Hospital, SE-171, 77 Stockholm, Sweden
| | - Patrick Petignat
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Genève, Switzerland
| | - Roland Sahli
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 48, 1011 Lausanne, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
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Hall MT, Simms KT, Lew JB, Smith MA, Brotherton JML, Saville M, Frazer IH, Canfell K. The projected timeframe until cervical cancer elimination in Australia: a modelling study. LANCET PUBLIC HEALTH 2019; 4:e19-e27. [DOI: 10.1016/s2468-2667(18)30183-x] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/15/2018] [Accepted: 09/03/2018] [Indexed: 02/03/2023]
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Dong B, Sun P, Ruan G, Huang W, Mao X, Kang Y, Pan D, Lin F. Type-specific high-risk human papillomavirus viral load as a viable triage indicator for high-grade squamous intraepithelial lesion: a nested case- control study. Cancer Manag Res 2018; 10:4839-4851. [PMID: 30425576 PMCID: PMC6205532 DOI: 10.2147/cmar.s179724] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Currently, the associations between type-specific high-risk human papillomavirus (HR-HPV) viral loads and cervical lesions are still inconsistent. We aimed to assess the type-specific HR-HPV viral load as a risk triage indicator for development of high-grade squamous intraepithelial lesion or worse (≥HSIL). Patients and methods A total of 19,446 women who underwent primary screening for cervical cancer using Cervista® HR-HPV and cytology assays were enrolled. The viral loads of 1,396 HR-HPV-positive specimens confirmed by Cervista® assay were detected by BioPerfectus Multiplex Real-Time PCR assay. The correlation between viral loads and cervical lesions was analyzed. The optimal cutoffs of individual HR-HPV viral loads used to predict ≥HSIL were determined from the receiver operating characteristic curve. A logistic regression model was used to analyze the relationship between covariates and the probability of ≥HSIL. Results The viral loads of HPV-16, -31, -33, -52, and -58 were positively correlated with the severity of the cervical lesion, which was significantly elevated in patients with ≥HSIL, whereas those of HPV-18, -45, -56, -59, and other types were not. The optimal cutoffs of the log10-transformed viral loads for HPV-16, -31, -33, -52, and -58 in identifying ≥HSIL were 4.26, 4.46, 4.48, 4.36, and 4.26 copies per 10,000 cells, respectively. Furthermore, multivariate analysis indicated that type-specific viral loads of HPV-16, -31, -33, -52, and -58 exceeding the cutoffs could be independent risk factors for the incidence of ≥HSIL. Conclusion The BioPerfectus Multiplex Real-Time PCR viral load assay provides viable triage for ≥HSIL when using appropriate cutoff levels.
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Affiliation(s)
- Binhua Dong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China,
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China, .,Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China,
| | - Guanyu Ruan
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China,
| | - Weiyi Huang
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China,
| | - Xiaodan Mao
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China,
| | - Yafang Kang
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China,
| | - Diling Pan
- Department of Pathology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China
| | - Fen Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, Fujian, P.R. China,
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Saville M, McNally O. ‘Lest we forget’
as we move forward with cervical screening. Aust N Z J Obstet Gynaecol 2018; 58:265-266. [DOI: 10.1111/ajo.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marion Saville
- Victorian Cytology Service Ltd; Carlton South Australia
- Department of Obstetrics and Gynaecology; University of Melbourne; Melbourne Australia
- Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Orla McNally
- Department of Obstetrics and Gynaecology; University of Melbourne; Melbourne Australia
- Royal Women's Hospital; Parkville VIC Australia
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Final analysis of a study assessing genital human papillomavirus genoprevalence in young Australian women, following eight years of a national vaccination program. Vaccine 2018; 36:3221-3230. [PMID: 29724506 DOI: 10.1016/j.vaccine.2018.04.080] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The VACCINE [Vaccine Against Cervical Cancer Impact and Effectiveness] study evaluated the prevalence of quadrivalent vaccine-targeted human papillomavirus (HPV) genotypes (HPV 6, 11, 16, 18) amongst young women of vaccine-eligible age. METHODS Between October 2011 - June 2015, women aged 18-25 years from Victoria, Australia, were recruited through targeted advertising on the social networking website Facebook. Participants completed an online questionnaire and provided a self-collected vaginal swab for HPV DNA detection and genotyping (Linear Array HPV genotyping assay). Self-reported HPV vaccination details were verified with the National HPV Vaccination Program Register (NHVPR). RESULTS Of 1223 who agreed to participate, 916 (74.9%) completed the survey and, for 1007 (82.3%) sexually-active participants, 744 (73.9%) returned the self-collected swab, of which 737 contained detectable DNA. 184/737 (25.0%) were positive for HPV. Vaccine-targeted HPV genotypes were detected in only 13 (1.7%) women: 11 HPV 16 (six vaccinated after sexual debut, five unvaccinated) and two HPV 6. Prevalence of any of HPV 31/33/45 collectively was 2.9%, varying significantly by vaccination status (fully 2.0%, unvaccinated 6.8%; p = 0.01). Vaccination rates among the sexually-active cohort were high, with 65.6%, 71.6% and 74.2% of participants having received three, at least two or at least one dose of vaccine, respectively. Of women self-reporting HPV vaccination, the NHVPR confirmed one or more doses were received in 90%. Strong associations were observed between vaccination status, age, language spoken at home and country of birth, as well as between HPV detection and the number of male sexual partners. CONCLUSION Surveillance five to eight years' post-initiation of a national HPV vaccination program demonstrated a consistent and very low prevalence of vaccine-related HPV genotypes and some evidence of cross protection against related types amongst vaccine-eligible women from Victoria, Australia.
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Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017-2035: Example from Australia. PLoS One 2018; 13:e0185332. [PMID: 29444073 PMCID: PMC5812553 DOI: 10.1371/journal.pone.0185332] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
Background Many countries are transitioning from cytology-based to longer-interval HPV screening. Trials comparing HPV-based screening to cytology report an increase in CIN2/3 detection at the first screen, and longer-term reductions in CIN3+; however, population level year-to-year transitional impacts are poorly understood. We undertook a comprehensive evaluation of switching to longer-interval primary HPV screening in the context of HPV vaccination. We used Australia as an example setting, since Australia will make this transition in December 2017. Methods Using a model of HPV vaccination, transmission, natural history and cervical screening, Policy1-Cervix, we simulated the planned transition from recommending cytology every two years for sexually-active women aged 18–20 to 69, to recommending HPV screening every five years for women aged 25–74 years. We estimated rates of CIN2/3, cervical cancer incidence, and mortality for each year from 2005 to 2035, considering ranges for HPV test accuracy and screening compliance in the context of HPV vaccination (current coverage ~82% in females; ~76% in males). Findings Transient increases are predicted to occur in rates of CIN2/3 detection and invasive cervical cancer in the first two to three years following the screening transition (of 16–24% and 11–14% in respectively, compared to 2017 rates). However, by 2035, CIN2/3 and invasive cervical cancer rates are predicted to fall by 40–44% and 42–51%, respectively, compared to 2017 rates. Cervical cancer mortality rates are predicted to remain unchanged until ~2020, then decline by 34–45% by 2035. Over the period 2018–2035, switching to primary HPV screening in Australia is expected to avert 2,006 cases of invasive cervical cancer and save 587 lives. Conclusions Transient increases in detected CIN2/3 and invasive cancer, which may be detectable at the population level, are predicted following a change to primary HPV screening. This is due to improved test sensitivity bringing forward diagnoses, resulting in longer term reductions in both cervical cancer incidence and mortality. Fluctuations in health outcomes due to the transition to a longer screening interval are predicted to occur for 10–15 years, but cervical cancer rates will be significantly reduced thereafter due to the impact of HPV vaccination and HPV screening. In order to maintain confidence in primary HPV screening through the transitional phase, it is important to widely communicate that an initial increase in CIN2/3 and perhaps even invasive cervical cancer is expected after a national transition to primary HPV screening, that this phenomenon is due to increased prevalent disease detection, and that this effect represents a marker of screening success.
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Dong L, Wang MZ, Zhao XL, Feng RM, Hu SY, Zhang Q, Smith JS, Qiao YL, Zhao FH. Human papillomavirus viral load as a useful triage tool for non-16/18 high-risk human papillomavirus positive women: A prospective screening cohort study. Gynecol Oncol 2017; 148:103-110. [PMID: 29169614 DOI: 10.1016/j.ygyno.2017.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/06/2017] [Accepted: 11/10/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE ASCCP cervical cancer screening guidelines recommend triaging high-risk human papillomavirus (hrHPV) positive women with cytology and genotyping, but cytology is often unavailable in resource-limited areas. We compared the long-term risk of cervical cancer and precancers among type-specific hrHPV-positive women triaged by viral load to cytology and visual inspection with acetic acid (VIA). METHODS A cohort of 1742 Chinese women was screened with cytology, VIA, and Hybrid Capture 2 (HC2) test and followed for ten years. All HC2-positive samples were genotyped. Viral load was measured by HC2 relative light units/cutoff (RLU/CO). Ten-year cumulative incidence rate (CIR) of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) for type-specific hrHPV viral load was estimated using Kaplan-Meier methods. RESULTS Baseline hrHPV viral load stratified by specific genotypes was positively correlated with prevalent cytological lesions. Ten-year CIR of CIN2+ was associated with cytological lesions and viral load. Among HPV 16/18-positive women, ten-year CIR of CIN2+ was high, even with normal cytology (15.3%), normal VIA (32.4%), viral load with RLU/CO<10 (23.6%) or RLU/CO<100 (33.8%). Among non-16/18 hrHPV positive women, ten-year CIR of CIN2+ was significantly stratified by cytology grade of atypical squamous cell of undetermined significance or higher (2.0% VS. 34.6%), viral load cutoffs at 10 RLU/CO (5.1% VS. 27.2%), at 100 RLU/CO (11.0% VS. 35.5%), but not by VIA (19.1% VS. 19.0%). CONCLUSIONS Our findings support the guidelines in referring all HPV16/18 positive women to colposcopy and suggest triaging non-16/18 hrHPV positive women using viral loads in resource-limited areas where cytology screening was inaccessible.
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Affiliation(s)
- Li Dong
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China; Institutes of Biomedical Sciences, Shanxi University, Taiyuan, China
| | - Margaret Z Wang
- Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA; UJMT Fogarty Consortium, NIH Fogarty International Center, Bethesda, MD, USA
| | - Xue-Lian Zhao
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Rui-Mei Feng
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Shang-Ying Hu
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Qian Zhang
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - You-Lin Qiao
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Fang-Hui Zhao
- Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
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Smith MA, Canfell K. Projected impact of HPV vaccination and primary HPV screening on cervical adenocarcinoma: Example from Australia. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:134-141. [PMID: 28720447 PMCID: PMC5883242 DOI: 10.1016/j.pvr.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 01/26/2023]
Abstract
Cytology-based cervical screening appears to have had a limited effect on the incidence of adenocarcinoma, however HPV vaccination and HPV-based screening will likely play a role in reducing future burden. Using Australia as an example, we estimated the future burden (2015-2040) of adenocarcinoma in the absence of other interventions; and the impact of HPV vaccination (introduced 2007) and HPV-based screening (commencing 2017). Future burden was estimated considering underlying trends in adenocarcinoma, using national data (1982-2010). The relative reduction in adenocarcinoma due to HPV vaccination and HPV-based screening was derived from observed clinical data. Adenocarcinoma incidence rates have been increasing since the early-mid 2000s (average annual increases from 3.0%(25-49 years) -8.1%(20-24 years)). If these trends continue, rates would increase from 1.4 to 2.4/100,000 in <50 years and from 2.2 to 4.4/100,000 in 50+ years by 2040. Taking into account coverage, HPV vaccination will reduce 2040 incidence by 36-39%, mainly in women <50 years (61% reduction). Taking into account uncertainties in trends and screening effectiveness, HPV-based screening will reduce incidence by an additional 19-43%, mainly in women 50+ years (additional 30-68% reduction). Together, these interventions will reduce incidence by 55-81%.
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Affiliation(s)
- Megan A Smith
- School of Public Health, University of Sydney, NSW 2006, Australia; Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.
| | - Karen Canfell
- School of Public Health, University of Sydney, NSW 2006, Australia; Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.
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