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Shih YW, Chang CW, Chang HCR, Tsai JR, Wang WJ, Fang HF, Lin CL, Rias YA, Tsai HT. Mediating Effect of White Blood Cells and Tobacco Exposure on Cervical Neoplasm Risk Among Taiwanese Women. Biol Res Nurs 2024; 26:380-389. [PMID: 38271218 DOI: 10.1177/10998004241229069] [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] [Indexed: 01/27/2024]
Abstract
Background: Both the high-risk human papillomavirus (HR-HPV) infection and tobacco exposure are significantly associated with cervical neoplasm risk. Immune cells play important roles in carcinogenesis. However, it is still unclear whether immune cells have a mediating effect on the HR-HPV infection and tobacco exposure with cervical neoplasm development. Aim: The aim of this study was to determine how the increased white blood cell (WBC) count affects the relationship between HR-HPV DNA load and tobacco exposure in the development of cervical neoplasia. Methods: A hospital-based case-control study design was conducted with a total of 108 cases of Taiwanese women with ≥ cervical intraepithelial neoplasia (CIN) I confirmed by biopsy, and 222 healthy Taiwanese female subjects with negative findings on a Pap smear were assigned to the control group. The study evaluated HR-HPV status and immune cell counts (WBCs, natural killer (NK) cells) and tobacco exposure by a self-construct questionnaire. Results: Both HR-HPV DNA load and tobacco exposure significantly independently increased cervical neoplasm risk (AORs: 1.28 and 1.42, respectively). Similar significant results were found for WBCs and NK cells, with respective AORs of 1.20 and 1.00. Moreover, increased WBCs (β = 0.04, 95% CI corrected: 0.01-0.07) and tobacco exposure (β = 0.02, 95% CI corrected: 0.01-0.04) mediated the relationship between the high-risk HPV DNA load and cervical neoplasm risk. Conclusions: Elevated WBC count acts as both predictor and mediator in cervical neoplasm development linked to HR-HPV DNA load. Monitoring and maintaining WBC levels within the normal range could be a preventive strategy for cervical neoplasm development.
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Affiliation(s)
- Ya Wen Shih
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post‑Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Ching Wen Chang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | | | - Jia Ruey Tsai
- Department of Medical Oncology, Taipei Medical University Taipei Cancer Center/Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Jun Wang
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan
- Proton Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui Fen Fang
- Department of Nursing, Taipei Medical University Taipei Cancer Center/Taipei Medical University Hospital, Taipei, Taiwan
| | - Chia Ling Lin
- Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yohanes Andy Rias
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Faculty of Health, College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata Kediri, Kediri, Indonesia
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post‑Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Tsima BM, Motlhatlhedi K, Sharma K, Rantshabeng P, Ndlovu A, Gaolathe T, Kyokunda LT. The association between smoking and cervical human papillomavirus infection among women from indigenous communities in western Botswana. PLoS One 2024; 19:e0302153. [PMID: 38848414 PMCID: PMC11161041 DOI: 10.1371/journal.pone.0302153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Cervical cancer, a malignancy caused by infection with oncogenic human papillomavirus, disproportionally affects women from low resource settings. Persistence of human papillomavirus infection may mediate an association between tobacco use and cervical cancer. In limited resource settings, women from indigenous communities are often marginalized and do not benefit from evidence-based interventions to prevent tobacco use or cervical cancer due to the limited reach of mainstream healthcare services to these communities. This study determined the association between smoking and high-risk human papillomavirus infection among women from indigenous communities in western Botswana. METHODS A cross-sectional study of women in indigenous communities was conducted between June and October 2022. Demographic, clinical and self-reported smoking data were collected. Cervical cytology and HPV DNA testing for high-risk human papillomavirus genotypes were performed. Multilevel multivariable logistic regression models were fit to evaluate the association between smoking and high-risk human papillomavirus infection while adjusting for potential confounders. RESULTS A total of 171 participants with a median (interquartile range) age of 40 (31-50) years from three settlements and two villages were recruited for the study. Of these, 17% were current smokers, 32.8% were living with HIV and high-risk human papillomavirus DNA was detected in 32.8% of the cervical specimens. Women who were current smokers, were nearly twice as likely to have cervical high-risk human papillomavirus infection compared to non-smokers (Adjusted Odds Ratio (95% CI); 1.74(1.09, 2.79)) after controlling for confounders. CONCLUSION These data underscore the need for effective tobacco control to help mitigate cervical cancer risk in this setting. These findings can help inform decisions about targeted cervical cancer prevention and tobacco cessation interventions for women from indigenous communities.
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Affiliation(s)
- Billy M. Tsima
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | | | - Andrew Ndlovu
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Khoo A, Boyer M, Jafri Z, Makeham T, Pham T, Khachigian LM, Floros P, Dowling E, Fedder K, Shonka D, Garneau J, O'Meara CH. Human Papilloma Virus Positive Oropharyngeal Squamous Cell Carcinoma and the Immune System: Pathogenesis, Immunotherapy and Future Perspectives. Int J Mol Sci 2024; 25:2798. [PMID: 38474047 DOI: 10.3390/ijms25052798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC), a subset of head and neck squamous cell carcinoma (HNSCC), involves the palatine tonsils, soft palate, base of tongue, and uvula, with the ability to spread to adjacent subsites. Personalized treatment strategies for Human Papillomavirus-associated squamous cell carcinoma of the oropharynx (HPV+OPSCC) are yet to be established. In this article, we summarise our current understanding of the pathogenesis of HPV+OPSCC, the intrinsic role of the immune system, current ICI clinical trials, and the potential role of small molecule immunotherapy in HPV+OPSCC.
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Affiliation(s)
- A Khoo
- Department of Otolaryngology, Head & Neck Surgery, Canberra Health Services, Canberra, ACT 2601, Australia
| | - M Boyer
- Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Z Jafri
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - T Makeham
- Department of Otolaryngology, Head & Neck Surgery, Canberra Health Services, Canberra, ACT 2601, Australia
- ANU School of Medicine & Psychology, Australian National University, Canberra, ACT 0200, Australia
| | - T Pham
- Department of Otolaryngology, Head & Neck Surgery, Canberra Health Services, Canberra, ACT 2601, Australia
- ANU School of Medicine & Psychology, Australian National University, Canberra, ACT 0200, Australia
| | - L M Khachigian
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - P Floros
- St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - E Dowling
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - K Fedder
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - D Shonka
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - J Garneau
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - C H O'Meara
- Department of Otolaryngology, Head & Neck Surgery, Canberra Health Services, Canberra, ACT 2601, Australia
- ANU School of Medicine & Psychology, Australian National University, Canberra, ACT 0200, Australia
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
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Ullah MI, Mikhailova MV, Alkhathami AG, Carbajal NC, Zuta MEC, Rasulova I, Najm MAA, Abosoda M, Alsalamy A, Deorari M. Molecular pathways in the development of HPV-induced oropharyngeal cancer. Cell Commun Signal 2023; 21:351. [PMID: 38098017 PMCID: PMC10722793 DOI: 10.1186/s12964-023-01365-0] [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: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023] Open
Abstract
Oropharyngeal cancer, a subset of head and neck cancer, is increasingly recognized as a unique clinical entity primarily influenced by high-risk human papillomavirus (HPV) infections, particularly HPV-16. This review delves into the viral life cycle of HPV-16 and its interactions with host cells, with a specific focus on the crucial roles played by the viral oncoproteins E6 and E7. These oncoproteins drive cellular proliferation by targeting critical tumor suppressor proteins like p53 and Rb, resulting in uncontrolled cell growth and genomic instability. Furthermore, the significance of epigenetic modifications induced by HPV-16 and their implications is important for cancer progression. This comprehensive review provides valuable insights into the intricate molecular landscape of HPV-induced oropharyngeal cancer, shedding light on the development of targeted therapies and preventive strategies for this emerging global health concern. Video Abstract.
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Affiliation(s)
- Muhammad Ikram Ullah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka-72388, Aljouf, Saudi Arabia
| | - Maria V Mikhailova
- Department of Prosthetic Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Ali G Alkhathami
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Nestor Cuba Carbajal
- Doctor en Gestión Pública y Gobernabilidad, Docente en La Universidad Norbert Wiener, Lima, Perú.
| | | | - Irodakhon Rasulova
- School of Humanities, Natural & Social Sciences, New Uzbekistan University, 54 Mustaqillik Ave, 100007, Tashkent, Uzbekistan
- Department of Public Health, Tashkent Pediatric Medical Institute, Bogishamol Street 223, Tashkent, Uzbekistan
| | - Mazin A A Najm
- Pharmaceutical Chemistry Department, College of Pharmacy, Al-Ayen University, Thi-Qar, Nasiriyah, Iraq
| | - Munther Abosoda
- College of Pharmacy, the Islamic University, Najaf, Iraq
- College of Pharmacy, the Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq
- College of Pharmacy, the Islamic University of Babylon, Hillah, Iraq
| | - Ali Alsalamy
- College of Pharmacy, Imam Ja'afar Al-Sadiq University, Al-Muthanna, 66002, Iraq
| | - Mahamedha Deorari
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, India
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Yokoji K, Giguère K, Malagón T, Rönn MM, Mayaud P, Kelly H, Delany-Moretlwe S, Drolet M, Brisson M, Boily MC, Maheu-Giroux M. Association of naturally acquired type-specific HPV antibodies and subsequent HPV re-detection: systematic review and meta-analysis. Infect Agent Cancer 2023; 18:70. [PMID: 37941016 PMCID: PMC10631102 DOI: 10.1186/s13027-023-00546-3] [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: 08/11/2022] [Accepted: 10/13/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Understanding the role of naturally acquired (i.e., infection-induced) human papillomavirus (HPV) antibodies against reinfection is important given the high incidence of this sexually transmitted infection. However, the protective effect of naturally acquired antibodies in terms of the level of protection, duration, and differential effect by sex remains incompletely understood. We conducted a systematic review and a meta-analysis to (1) strengthen the evidence on the association between HPV antibodies acquired through past infection and subsequent type-specific HPV detection, (2) investigate the potential influence of type-specific HPV antibody levels, and (3) assess differential effects by HIV status. METHODS We searched Embase and Medline databases to identify studies which prospectively assessed the risk of type-specific HPV detection by baseline homologous HPV serostatus among unvaccinated individuals. Random-effect models were used to pool the measures of association of naturally acquired HPV antibodies against subsequent incident detection and persistent HPV positivity. Sources of heterogeneity for each type were assessed through subgroup analyses stratified by sex, anatomical site of infection, male sexual orientation, age group, and length of follow-up period. Evidence of a dose-response relationship of the association between levels of baseline HPV antibodies and type-specific HPV detection was assessed. Finally, we pooled estimates from publications reporting associations between HPV serostatus and type-specific HPV detection by baseline HIV status. RESULTS We identified 26 publications (16 independent studies, with 62,363 participants) reporting associations between baseline HPV serostatus and incident HPV detection, mainly for HPV-16 and HPV-18, the most detected HPV type. We found evidence of protective effects of baseline HPV seropositivity and subsequent detection of HPV DNA (0.70, 95% CI 0.61-0.80, NE = 11) and persistent HPV positivity (0.65, 95% CI 0.42-1.01, NE = 5) mainly for HPV-16 among females, but not among males, nor for HPV-18. Estimates from 8 studies suggested a negative dose-response relationship between HPV antibody level and subsequent detection among females. Finally, we did not observe any differential effect by baseline HIV status due to the limited number of studies available. CONCLUSION We did not find evidence that naturally acquired HPV antibodies protect against subsequent HPV positivity in males and provide only modest protection among females for HPV-16. One potential limitation to the interpretation of these findings is potential misclassification biases due to different causes.
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Affiliation(s)
- Kana Yokoji
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, 2001 Avenue McGill College, Suite 1200, Montreal, QC, H3A 1G1, Canada
| | - Katia Giguère
- Institut national de santé publique du Québec, Quebec City, Canada
| | - Talía Malagón
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - Minttu M Rönn
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Kelly
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mélanie Drolet
- Centre de recherche du CHU de Québec - Université Laval, Quebec City, Canada
| | - Marc Brisson
- Centre de recherche du CHU de Québec - Université Laval, Quebec City, Canada
| | - Marie-Claude Boily
- MRC Center for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, 2001 Avenue McGill College, Suite 1200, Montreal, QC, H3A 1G1, Canada.
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Malevolti MC, Maci C, Lugo A, Possenti I, Gallus S, Gorini G, Carreras G. Second-hand smoke exposure and cervical cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2023; 149:14353-14363. [PMID: 37516982 DOI: 10.1007/s00432-023-04841-9] [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: 04/06/2023] [Accepted: 05/04/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE The association between second-hand smoke (SHS) exposure and cervical cancer (CC) risk is still unclear. The aim of this study is to provide an accurate and updated estimate of this association. METHODS Through an original methodology to identify original publications, we conducted a systematic review and meta-analysis of all epidemiological studies published up to October 2022 evaluating the association between SHS exposure and CC risk among female non-smokers. Meta-analytic estimates were obtained using random-effects models and dose-response relationships were derived using log-linear functions. RESULTS Out of 25 eligible studies, 21 were included in the meta-analysis, providing a pooled relative risk (RR) of cervical intraepithelial neoplasia (CIN) of grade 2 or higher of 1.52 (95% confidence interval, CI 1.30-1.78, 21 studies) for overall SHS exposure versus non-exposure. When restricting the analysis to invasive CC, the pooled RR was 1.42 (95% CI 1.17-1.71, 13 studies), whereas the pooled RR for CIN was 1.50 (95% CI 1.22-1.84, 6 studies). Analyzing RR by setting or source of SHS exposure resulted in significant associations with CC risk for SHS exposure at home (RR for CIN2+ 1.49, 95% CI 1.21-1.84, 14 studies), in non-specified settings (RR for CIN2+ 1.64, 95% CI 1.20-2.23, 8 studies) and from partner (RR for CIN2+ 1.55, 95% CI 1.25-1.94, 10 studies). The risk of CIN2+ significantly increased linearly with the intensity and pack-years of SHS exposure. CONCLUSION This comprehensive review and meta-analysis confirmed the association of SHS exposure with CC, further suggesting the need to raise concern about SHS exposure in the population.
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Affiliation(s)
- Maria Chiara Malevolti
- Oncologic Network, Prevention and Research Institute (ISPRO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Caterina Maci
- Oncologic Network, Prevention and Research Institute (ISPRO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Alessandra Lugo
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Irene Possenti
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Silvano Gallus
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Via Cosimo il Vecchio 2, 50139, Florence, Italy.
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Lin CW, Zheng JQ, Tzou KY, Fang YA, Kao WT, Lin HT, Liu JC, Huang YH, Lin YF, Lu KC, Dong SW, Zheng CM, Wu CC. Influenza vaccination is associated with lower risk of renal cell carcinoma among chronic kidney disease patients: a population-based cohort study. Clin Kidney J 2023; 16:1936-1946. [PMID: 37915887 PMCID: PMC10616448 DOI: 10.1093/ckj/sfad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Indexed: 11/03/2023] Open
Abstract
Background Chronic kidney disease (CKD) patients possess a higher risk for renal cell carcinoma (RCC) possibly because of related underlying inflammation and immune dysregulation. In the current population-based cohort study, we evaluate the effects of influenza vaccination on RCC among CKD patients. Methods We analysed the vaccinated and unvaccinated CKD patients (≥55 years of age) identified from the Taiwan National Health Insurance Database. Propensity score matching was used to reduce the selection bias. Subgroup analyses based on comorbid conditions, dialysis status and vaccinated dosages were also conducted. Results The incidence of RCC decreased significantly in the vaccinated compared with unvaccinated group {unadjusted hazard ratio [HR] 0.50 [95% confidence interval (CI) 0.31-0.81], P < .01; adjusted HR 0.46 [95% CI 0.28-0.75], P < .01}. Such protective effects of influenza vaccination were noted significantly among those ≥75 years of age [unadjusted HR 0.29 (95% CI 0.12-0.74), P < .01; adjusted HR 0.22 (95% CI 0.08-0.58), P < .01]. A reverse association was noted between the total number of vaccinations and RCC events in both unadjusted and adjusted models. The Kaplan-Meier estimates of the RCC events showed significantly higher free survival rates in the vaccinated as compared with the unvaccinated patients (logrank P = .005). Conclusion This population-based cohort study found a significant inverse relationship between influenza vaccination and the risk of RCC in CKD patients and the protective effects were more prominent in patients >75 years of age. A possible relation exists between the total number of vaccinations and RCC events. Future randomized clinical and basic studies will be needed to prove these findings and underlying pathophysiological mechanisms.
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Affiliation(s)
- Chia-Wei Lin
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jing-Quan Zheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kai-Yi Tzou
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Medical University Research Centre of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ann Fang
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wei-Tang Kao
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Medical University Research Centre of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Ting Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ju-Chi Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Han Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuh-Feng Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shao-Wei Dong
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cai-Mei Zheng
- Taipei Medical University Research Centre of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Medical University Research Centre of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
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Dabán-López P, Fernández-Martínez NF, Petrova D, Rodríguez-Barranco M, Jiménez-Moleón JJ, Gutierrez J, Sánchez MJ. Epidemiology of human papillomavirus-associated anogenital cancers in Granada: a three-decade population-based study. Front Public Health 2023; 11:1205170. [PMID: 37780447 PMCID: PMC10537955 DOI: 10.3389/fpubh.2023.1205170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction HPV infection is a common risk factor for all anogenital cancers. However, there are important differences in the epidemiology of anogenital cancers and these have not been compared considering diverse epidemiological indicators over a long period of time. To fill this gap, we investigated incidence, mortality, and survival trends of anogenital cancers over a period of three decades. Methods We conducted an observational registry-based study using data from the population-based cancer registry of Granada in southern Spain. We collected data on all incident cases of anogenital cancer (cervical, anal, penile, vulvar, and vaginal cancer) diagnosed between 1985 and 2017. We calculated crude and age-standardized incidence and mortality rates, and 1, 3, and 5-year overall and net survival. We further conducted time-trend analysis calculating annual percent changes (APC) for each cancer site. Results The incidence of anogenital cancers decreased slightly during the past 30 years, with the exception of vulvar cancer, where a slight increase was observed. Mortality decreased significantly for cervical cancer over the study period but increased non-significantly for the remaining cancer sites. Survival rates were similar to those reported in comparable countries and increased for cervical and vulvar cancer. Discussion Cervical cancer was the greatest contributor to the burden of anogenital cancers and showed a marked improvement in all indicators in comparison to the remaining cancer sites.
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Affiliation(s)
- Pablo Dabán-López
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, Spain
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jose Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Javier Gutierrez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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Novak J, Belleti R, da Silva Pinto GV, do Nascimento Bolpetti A, da Silva MG, Marconi C. Cervicovaginal Gardnerella sialidase-encoding gene in persistent human papillomavirus infection. Sci Rep 2023; 13:14266. [PMID: 37652960 PMCID: PMC10471596 DOI: 10.1038/s41598-023-41469-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023] Open
Abstract
Disturbed vaginal microbiota have a role in the persistence of high-oncogenic-risk human papillomavirus (hrHPV) and Gardnerella spp. is closely related with this condition. Such bacteria are the major source of cervicovaginal sialidases, important for microbiota alterations. The sialidase-encoding gene nanH3 is account for their sialidase activity. Thus, a subset of 212 women positive for hrHPV at the first visit were included in the analysis of the current study aiming to compare the loads of nanH3 in cervicovaginal fluid (CFV) of women with persistent hrHPV infection and with those cleared the infection after a year. Participants were assigned to two study groups named "persistence" (n = 124, 53.22%) or "clearance" (n = 88, 37.77%), according to the HPV status upon enrollment and follow-up. Absolute quantification of nanH3 gene was performed using quantitative real-time PCR (qPCR). Persistence and clearance group did not show statistical difference in the load of nanH3 gene (p = 0.19). When considering the subset of women with HPV16, differences in number of copies of nanh3 gene was observed between the persistent (7.39E+08 copies/μL) and clearance group (2.85E+07 copies/μL) (p = 0.007). Therefore, baseline loads of nanH3 gene is increased in women that persist with cervical HPV16 infection after 12 months.
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Affiliation(s)
- Juliano Novak
- Department of Pathology, Botucatu Medical School, UNESP, São Paulo State University, São Paulo, Brazil.
| | - Rafael Belleti
- Department of Pathology, Botucatu Medical School, UNESP, São Paulo State University, São Paulo, Brazil
| | | | | | - Márcia Guimarães da Silva
- Department of Pathology, Botucatu Medical School, UNESP, São Paulo State University, São Paulo, Brazil
| | - Camila Marconi
- Department of Pathology, Botucatu Medical School, UNESP, São Paulo State University, São Paulo, Brazil
- Department of Basic Pathology, Sector of Biologic Science, UFPR, Universidade Federal do Paraná, Curitiba, Brazil
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10
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Yang Z, Sun P, Dahlstrom KR, Gross N, Li G. Joint effect of human papillomavirus exposure, smoking and alcohol on risk of oral squamous cell carcinoma. BMC Cancer 2023; 23:457. [PMID: 37202767 DOI: 10.1186/s12885-023-10948-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Smoking, alcohol consumption, and human papillomavirus (HPV) infection are known risk factors for oral squamous cell carcinoma (OSCC) including SCC of oropharynx (SCCOP) and SCC of oral cavity (SCCOC). Researchers have examined each of these risk factors independently, but few have observed the potential risk of their interaction. This study investigated the interactions among these risk factors and risk of OSCC. METHODS Totally 377 patients with newly diagnosed SCCOP and SCCOC and 433 frequency-matched cancer-free controls by age and sex were included. Multivariable logistic regression was performed to calculate ORs and 95% CIs. RESULTS We found that overall OSCC risk was independently associated with smoking (adjusted OR(aOR), 1.4; 95%CI, 1.0-2.0), alcohol consumption (aOR, 1.6; 95%CI, 1.1-2.2), and HPV16 seropositivity (aOR, 3.3; 95%CI, 2.2-4.9), respectively. Additionally, we found that HPV16 seropositivity increased the risk of overall OSCC in ever-smokers (aOR, 6.8; 95%CI, 3.4-13.4) and ever-drinkers (aOR, 4.8; 95%CI, 2.9-8.0), while HPV16-seronegative ever-smokers and ever-drinkers had less than a twofold increase in risk of overall OSCC (aORs, 1.2; 95%CI, 0.8-1.7 and 1.8; 95%CI, 1.2-2.7, respectively). Furthermore, the increased risk was particularly high for SCCOP in HPV16-seropositive ever-smokers (aOR, 13.0; 95%CI, 6.0-27.7) and in HPV16-seropositive ever-drinkers (aOR, 10.8; 95%CI, 5.8-20.1), while the similar increased risk was not found in SCCOC. CONCLUSION These results suggest a strong combined effect of HPV16 exposure, smoking, and alcohol on overall OSCC, which may indicate a strong interaction between HPV16 infection and smoking and alcohol consumption, particularly for SCCOP.
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Affiliation(s)
- Zheng Yang
- Department of Otolaryngology Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery of the Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Peng Sun
- Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
- Department of Otolaryngology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Kristina R Dahlstrom
- Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Neil Gross
- Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Guojun Li
- Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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11
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Ma K, Li S, Wu S, Zhu J, Yang Y. Impact of smoking exposure on human papillomavirus clearance among Chinese women: A follow-up propensity score matching study. Tob Induc Dis 2023; 21:42. [PMID: 36949733 PMCID: PMC10026377 DOI: 10.18332/tid/161026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Smoking has been proven to increase the risk of cervical cancer, but it is still controversial whether smoking reduces women's ability to clear human papillomavirus (HPV) infection. This study investigated the association between smoking behaviors during follow-up and clearance of HPV infection in women with HPV-positive and pathologically normal uterine cervix in China, using a propensity score matching (PSM) analysis. METHODS The present prospective study included data from women examined in the Gynecology Department of Shanghai General Hospital from January 2018 to June 2020. Twenty patients who smoked throughout follow-up were selected and matched with 60 patients using the 1:3 PSM method on age, marital status, and whether infected with high-risk HPV (HR-HPV). At each visit, smoking and sexual behaviors were collected. The Kaplan-Meier method and a Cox proportional hazard regression model were used to evaluate the probability of clearing HPV infection within a 2-year follow-up. RESULTS A total of 80 patients were included in the study, all of whom were infected with at least one HR-HPV type at baseline. Current smokers had a lower likelihood of clearing the HPV infection than current non-smokers, after adjusting for a history of sexually transmitted diseases (STD), HPV infection status, and sexual behaviors during follow-up (AHR=0.478; 95% CI: 0.239-0.958, p=0.037). Additionally, longer duration, higher frequency and larger doses of smoking correlated with the lower clearance possibility of HPV infection (p for trend=0.029, 0.022 and 0.026, respectively). CONCLUSIONS This study showed that the use of tobacco throughout follow-up could increase the risk of a persistent HPV infection, this risk being higher for smokers with heavier tobacco consumption. Our results should alert HPV-positive women to reiterate the advice to cut-back on or stop smoking.
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Affiliation(s)
- Kangli Ma
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shu Li
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Sufang Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jingfen Zhu
- School of Public Health, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yongbin Yang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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12
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Hashemnejad M, Mirmajidi R, Rahimzadeh M, Ataei M. The prevalence of high-risk human papillomavirus genotypes and related risk factors among Iranian women. J Med Life 2022; 15:1340-1346. [PMID: 36567834 PMCID: PMC9762374 DOI: 10.25122/jml-2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/02/2022] [Indexed: 12/27/2022] Open
Abstract
Human papillomavirus (HPV) infection, which often includes high-risk genotype infection, is one of the leading causes of cervical cancer. This cross-sectional research included 503 Iranian women referred to the gynecology clinic of Kamali Hospital in Karaj, Iran, for routine cervical cancer screening between 2020 and 2021. Cervical specimens were collected from all participants with a special brush and transported to the laboratory for cervical cytology diagnosis. Overall HPV incidence among Iranian women was 39.96%, of which 23.06% had high-risk HPV genotypes and 9.7% had low-risk HPV types. The risk associated with HR-HPV types was considerably associated with employment and marital status.
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Affiliation(s)
- Maryam Hashemnejad
- Obstetrics and Gynecology Department, School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran
| | - Roghieh Mirmajidi
- Obstetrics and Gynecology Department, School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran
| | - Mitra Rahimzadeh
- Social Determinants of Health Research Center, School of Public Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Mina Ataei
- Obstetrics and Gynecology Department, School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran,Social Determinants of Health Research Center, School of Public Health, Alborz University of Medical Sciences, Karaj, Iran,Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran,Corresponding Author: Mina Ataei, Obstetrics and Gynecology Department, School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran E-mail:
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13
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Bortolli APR, Vieira VK, Treco IC, Pascotto CR, Wendt GW, Lucio LC. GSTT1 and GSTM1 polymorphisms with human papillomavirus infection in women from southern Brazil: a case-control study. Mol Biol Rep 2022; 49:6467-6474. [PMID: 35507115 PMCID: PMC9065665 DOI: 10.1007/s11033-022-07475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Important risk factors for the most common sexually transmitted infection (STI) in the world, human papillomavirus (HPV), include early sexual activity, use of contraceptives, tobacco smoking, and immunological and genetic factors. This study aimed to investigate the relationship between GSTM1 and GSTT1 polymorphisms and HPV infection and associated risk factors in a group of women assisted in the public health system of southwestern Paraná, Brazil. METHODS AND RESULTS A case-control study was designed with 21 women with HPV matched by age in the case group and 84 women without the virus in the control group. Viral detection was conducted via polymerase chain reaction (PCR) and GSTM1 and GSTT1 genotyping by Multiplex PCR. The results showed that the GSTT1 null allele was a protective factor against infection (ORadj 0.219; 95% CI 0.078-0.618; p = 0.004). No relationship was observed for the GSTM1 gene. Smoking was defined as a risk factor (ORadj 3.678; 95% CI 1.111-12.171; p = 0.033), increasing the chances of HPV by up to 3.6 times. CONCLUSION This study showed, for the first time, the relationship between GSTM1 and GSTT1 genetic polymorphisms and HPV. We found that this relationship protected women from southern Brazil from viral infection, but not from susceptibility.
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Affiliation(s)
- Ana Paula Reolon Bortolli
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Valquíria Kulig Vieira
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Indianara Carlotto Treco
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Claudicéia Risso Pascotto
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Guilherme Welter Wendt
- Centro de Ciências da Saúde, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Léia Carolina Lucio
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
- Department of Health Sciences, Universidade Estadual do Oeste do Paraná, PR-182 Km 02, Bairro Água Branca, Francisco Beltrão, Paraná, Brazil
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14
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Spencer JC, Brewer NT, Coyne-Beasley T, Trogdon JG, Weinberger M, Wheeler SB. Reducing Poverty-Related Disparities in Cervical Cancer: The Role of HPV Vaccination. Cancer Epidemiol Biomarkers Prev 2021; 30:1895-1903. [PMID: 34503948 PMCID: PMC8492489 DOI: 10.1158/1055-9965.epi-21-0307] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/21/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Near elimination of cervical cancer in the United States is possible in coming decades, yet inequities will delay this achievement for some populations. We sought to explore the effects of human papillomavirus (HPV) vaccination on disparities in cervical cancer incidence between high- and low-poverty U.S. counties. METHODS We calibrated a dynamic simulation model of HPV infection to reflect average counties in the highest and lowest quartile of poverty (percent of population below federal poverty level), incorporating data on HPV prevalence, cervical cancer screening, and HPV vaccination. We projected cervical cancer incidence through 2070, estimated absolute and relative disparities in incident cervical cancer for high- versus low-poverty counties, and compared incidence with the near-elimination target (4 cases/100,000 women annually). RESULTS We estimated that, on average, low-poverty counties will achieve near-elimination targets 14 years earlier than high-poverty counties (2029 vs. 2043). Absolute disparities by county poverty will decrease, but relative differences are estimated to increase. We estimate 21,604 cumulative excess cervical cancer cases in high-poverty counties over the next 50 years. Increasing HPV vaccine coverage nationally to the Healthy People 2020 goal (80%) would reduce excess cancer cases, but not alter estimated time to reach the near-elimination threshold. CONCLUSIONS High-poverty U.S. counties will likely be delayed in achieving near-elimination targets for cervical cancer and as a result will experience thousands of potentially preventable cancers. IMPACT Alongside vaccination efforts, it is important to address the role of social determinants and health care access in driving persistent inequities by area poverty.
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Affiliation(s)
- Jennifer C Spencer
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tamera Coyne-Beasley
- Departments of Pediatrics and Internal Medicine, Division of Adolescent Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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15
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Shin MB, Liu G, Mugo N, Garcia PJ, Rao DW, Bayer CJ, Eckert LO, Pinder LF, Wasserheit JN, Barnabas RV. A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities. Front Public Health 2021; 9:670032. [PMID: 34277540 PMCID: PMC8281011 DOI: 10.3389/fpubh.2021.670032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.
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Affiliation(s)
- Michelle B. Shin
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Gui Liu
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patricia J. Garcia
- Department of Global Health, University of Washington, Seattle, WA, United States
- School of Public Health, Cayetano Heredia University, Lima, Peru
| | - Darcy W. Rao
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Cara J. Bayer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Linda O. Eckert
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Leeya F. Pinder
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Judith N. Wasserheit
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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Iravani K, Bakhshi F, Doostkam A, Malekmakan L, Tale M, Jafari P, Dowran R. Detection of human papillomavirus (HPV) DNA in benign laryngeal lesions and role of cigarette smoking as an inducing factor. Virusdisease 2021; 32:255-259. [PMID: 34350316 PMCID: PMC8324672 DOI: 10.1007/s13337-021-00661-y] [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: 10/06/2020] [Accepted: 01/26/2021] [Indexed: 11/28/2022] Open
Abstract
The association of human papillomavirus (HPV) in laryngeal malignancies is largely known. This study evaluated the association between HPV and benign laryngeal lesions and also the role of smoking and alcohol consumption in increasing the prevalence of HPV in such benign lesions. Seventy-eight specimens of benign laryngeal lesions including 26 polyps, 26 dysplasia, and 26 other lesions such as nodules and cysts were enrolled in this study. Polymerase chain reaction (PCR) technique was used to detect HPV DNA in the tissues. The role of smoking and alcohol consumption in the prevalence of HPV was also evaluated through appropriate statistical tests. This study showed that the prevalence of HPV in benign laryngeal lesions was not statistically significant. The Cohen's effect size for comparing polyps vs. other lesions was nearly 0.7, indicating that HPV prevalence in laryngeal polyps may be clinically meaningful. Another finding in our study is the role of smoking in increasing the HPV prevalence in laryngeal polyps (P = 0.034). In benign laryngeal polyps, HPV prevalence may be clinically important. Smoking acts as a co-factor to induce HPV infection in laryngeal polyps in our study.
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Affiliation(s)
- Kamyar Iravani
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariba Bakhshi
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Doostkam
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masih Tale
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Dowran
- Department of Bacteriology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran
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17
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Distribution of HPV Genotypes Differs Depending on Behavioural Factors among Young Women. Microorganisms 2021; 9:microorganisms9040750. [PMID: 33918429 PMCID: PMC8066411 DOI: 10.3390/microorganisms9040750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Risk factors for the different human papillomavirus (HPV) genotypes are not well understood, although the risk of cancer is known to vary among them. Our aim was to evaluate the association of diverse behavioral and reproductive factors with genotype-specific HPV prevalence among 879 unvaccinated women aged 18–75 years referred to the colposcopy clinic at Helsinki University Hospital in Finland. Cervical swabs for HPV genotyping were collected in the first visit and assessed for 34 high-risk (hr) and low-risk (lr) HPV genotypes. Participants completed a questionnaire on behavioral, reproductive, and lifestyle factors. Differences in genotype-specific HPV prevalence were analyzed overall and in age groups using binary logistic regression. Smoking was associated with higher prevalence in HPV16 compared with other hrHPV genotypes together with decreasing age, being highest among younger women <30 years old, odds ratio (OR) 3.74 (95% CI 1.42–9.88). The later the sexual debut, the more it seemed to protect from HPV16 infection. The best protection was achieved when the sexual debut took place at >20 years of age, with an OR of 0.43 (95% CI 0.23–0.83). This association was not seen with other hrHPV genotypes. Methods of contraception seemed not to have an effect on hrHPV positivity, regardless of the HPV genotype. The genotype specific hrHPV prevalence differs, depending on behavioral factors, especially among younger women referred to colposcopy.
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Plisko O, Zodzika J, Jermakova I, Pcolkina K, Prusakevica A, Liepniece-Karele I, Donders GGG, Rezeberga D. Aerobic Vaginitis-Underestimated Risk Factor for Cervical Intraepithelial Neoplasia. Diagnostics (Basel) 2021; 11:diagnostics11010097. [PMID: 33435407 PMCID: PMC7827831 DOI: 10.3390/diagnostics11010097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 01/10/2023] Open
Abstract
The aim of this study is to analyse the association between vaginal microbiota and the histological finding of CIN. From July 2016 until June 2017, we included 110 consecutive patients with abnormal cervical cytology results referred for colposcopy to Riga East Clinical University Hospital Outpatient department in the study group. 118 women without cervical pathology were chosen as controls. Certified colposcopists performed interviews, gynaecological examinations and colposcopies for all participants. Material from the upper vaginal fornix was taken for pH measurement and wet-mount microscopy. Cervical biopsy samples were taken from all subjects in the study group and in case of a visual suspicion for CIN in the control group. Cervical pathology was more often associated with smoking (34.6% vs. 11.0%, p < 0.0001), low education level (47.2% vs. 25.5%, p = 0.001), increased vaginal pH (48.2% vs. 25.4%, p < 0.0001), abnormal vaginal microbiota (50% vs. 31.4%, p = 0.004) and moderate to severe aerobic vaginitis (msAV) (13.6% vs. 5.9%, p = 0.049) compared to controls. The most important independent risk factors associated with CIN2+ were smoking (OR 3.04 (95% CI 1.37–6.76), p = 0.006) and msAV (OR 3.18 (95% CI 1.13–8.93), p = 0.028). Bacterial vaginosis (BV) was found more often in CIN1 patients (8/31, 25.8%, p = 0.009) compared with healthy controls (8/118, 6.8%), or CIN2+ cases (8/79, 10.1%). In the current study msAV and smoking were the most significant factors in the development of CIN in HPV-infected women, especially high grade CIN. We suggest that AV changes are probably more important than the presence of BV in the pathogenesis of CIN and progression to cervix cancer and should not be ignored during the evaluation of the vaginal microbiota.
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Affiliation(s)
- Olga Plisko
- Department of Obstetrics and Gynecology, Riga Stradins University, LV-1007 Riga, Latvia; (J.Z.); (I.J.); (D.R.)
- Correspondence:
| | - Jana Zodzika
- Department of Obstetrics and Gynecology, Riga Stradins University, LV-1007 Riga, Latvia; (J.Z.); (I.J.); (D.R.)
- Gynecological Clinic, Riga East Clinical University Hospital, LV-1038 Riga, Latvia;
| | - Irina Jermakova
- Department of Obstetrics and Gynecology, Riga Stradins University, LV-1007 Riga, Latvia; (J.Z.); (I.J.); (D.R.)
- Gynecological Clinic, Riga East Clinical University Hospital, LV-1038 Riga, Latvia;
| | - Kristine Pcolkina
- Gynecological Clinic, Riga East Clinical University Hospital, LV-1038 Riga, Latvia;
| | | | | | - Gilbert G. G. Donders
- Femicare Clinical Research for Women, 3300 Tienen, Belgium;
- Department of Obstetrics and Gynecology, University of Antwerp, 2550 Antwerp-Edegem, Belgium
- Department of Obstetrics and Gynecology, Regional Hospital, 3300 Tienen, Belgium
| | - Dace Rezeberga
- Department of Obstetrics and Gynecology, Riga Stradins University, LV-1007 Riga, Latvia; (J.Z.); (I.J.); (D.R.)
- Gynecological Clinic, Riga East Clinical University Hospital, LV-1038 Riga, Latvia;
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White CM, Bakhiet S, Bates M, Ruttle C, Pilkington LJ, Keegan H, O'Toole SA, Sharp L, O'Kelly R, Tewari P, Flannelly G, Martin CM, O'Leary JJ. Exposure to tobacco smoke measured by urinary nicotine metabolites increases risk of p16/Ki-67 co-expression and high-grade cervical neoplasia in HPV positive women: A two year prospective study. Cancer Epidemiol 2020; 68:101793. [PMID: 32841926 DOI: 10.1016/j.canep.2020.101793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) is considered the strongest epidemiologic risk factor for cervical cancer. However, it is not a sufficient cause given the high prevalence of transient infections. We examined the relationship between exposure to tobacco smoke, measured using urinary nicotine metabolite concentrations, and p16/Ki-67 co-expression in cervical smears and subsequent risk of developing CIN2+/CIN3+ lesions in HPV positive women. METHODS This prospective longitudinal study enrolled women presenting to colposcopy with cytological abnormalities LSIL/ASCUS at the National Maternity Hospital, Dublin. Women gave a urine sample which was used to perform the Nicotine Metabolite Assay (Siemens). HPV positive (HC2) cervical smears were stained by immunocytochemistry for p16/Ki-67 (CINtec PLUS, Roche). Two year follow-up data, including histological diagnosis, was collected for each woman. Crude and adjusted odds ratios were calculated using logistic regression to investigate associations between tobacco smoke, p16/Ki-67 positivity and CIN2+/CIN3 + . RESULTS In total, 275 HPV positive women were included. Women with nicotine metabolite concentrations above 500 ng/mL, indicative of smoking, were classified as smokers. Smokers were at an increased risk of testing positive for p16/Ki-67 (OR 1.678; 1.027-2.740) and CIN2+ and CIN3+ (OR 1.816; 1.107-2.977 and OR 2.453; 1.200-5.013) in compared to non-smokers. In p16/Ki-67 positive women, smoking further increased their risk of CIN2+/CIN3+ (OR 2.290; 1.017-5.159 and OR 3.506 (1.534-8.017). CONCLUSION HPV positive women exposed to tobacco smoke are at a higher risk of testing positive for p16/Ki-67 co-expression. Risk of high-grade disease is almost doubled in women who are exposed to tobacco smoke.
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Affiliation(s)
- Christine M White
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland.
| | - Salih Bakhiet
- Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Mark Bates
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Carmel Ruttle
- Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | | | - Helen Keegan
- Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Sharon A O'Toole
- Dept. Obstetrics and Gynaecology, Trinity College Dublin, Dublin 2, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, UK
| | - Ruth O'Kelly
- Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Prerna Tewari
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | | | - Cara M Martin
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - John J O'Leary
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
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Liang Z, Xu C, Ji AL, Liang S, Kan HD, Chen RJ, Lei J, Li YF, Liang ZQ, Cai TJ. Effects of short-term ambient air pollution exposure on HPV infections: A five-year hospital-based study. CHEMOSPHERE 2020; 252:126615. [PMID: 32443276 DOI: 10.1016/j.chemosphere.2020.126615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Human papillomavirus (HPV) infections are common sexually-transmitted diseases among reproductive-aged women with increasing concern. Until now, there are no prior study about the association between HPV infections and ambient air pollution. This study aimed to explore the relationship between short-term exposure to ambient pollutants and daily outpatient visits for HPV infections in China. Data of daily outpatient visits for HPV infections were obtained from January 1, 2014 to December 31, 2018 (1826 days). Over-dispersed Poisson generalized additive models were applied by adjusting weather conditions and day of the week. We identified a total of 39,746 cases for HPV infections. A 10 μg/m3 increase of PM10, PM2.5, SO2, and NO2 or a 0.1 mg/m3 rise of CO in concurrent day (lag 0) concentrations was related to an elevation of 0.822% (95% Cl: 0.282%, 1.36%), 1.05% (95% Cl: 0.280%, 1.81%), 5.72% (95% Cl: 1.79%, 9.65%), 5.02% (95% Cl: 3.45%, 6.60%), and 2.40% (95% Cl: 1.43%, 3.37%) in daily outpatient-visits for HPV infections, respectively. The association was more significant in those women aged 41 or over. As for 10 μg/m3 increase of O3, a -1.33% (95% Cl: -2.13%, -0.530%) change was observed on the lag 03 and such effects appeared to be more obvious in the aged 18-40 group. Our results provided the first evidence that short-term exposure to ambient pollutants was related to, which may be indirectly, the increased risk of HPV infections while O3 may act as a "protective" factor.
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Affiliation(s)
- Zhen Liang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China; Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Chen Xu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China; Troop 94498 of PLA, Nanyang, 474350, China
| | - Ai-Ling Ji
- Department of Preventive Medicine & Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China
| | - Shi Liang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China; Brigham Young University Provo, UT 84602, 801-422-4636, USA
| | - Hai-Dong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Ren-Jie Chen
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Jie Lei
- Department of Internal Medicine, Hui Long-Ba Town Hospital, Chongqing, 401335, China
| | - Ya-Fei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Zhi-Qing Liang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Tong-Jian Cai
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Jiang C, Chen Q, Xie M. Smoking increases the risk of infectious diseases: A narrative review. Tob Induc Dis 2020; 18:60. [PMID: 32765200 PMCID: PMC7398598 DOI: 10.18332/tid/123845] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023] Open
Abstract
Smoking is relevant to infectious diseases resulting in increased prevalence and mortality. In this article, we aim to provide an overview of the effects of smoking in various infections and to explain the potential mechanisms. We searched PubMed and other relevant databases for scientific studies that explored the relationship between smoking and infection. The mechanisms of susceptibility to infection in smokers may include alteration of the structural, functional and immunologic host defences. Smoking is one of the main risk factors for infections in the respiratory tract, digestive tract, reproductive tract, and other systems in humans, increasing the prevalence of HIV, tuberculosis, SARS-CoV, and the current SARS-CoV-2. Smoking cessation can reduce the risk of infection. Smoking increases the incidence of infections and aggravates the progress and prognosis of infectious diseases in a dose-dependent manner. Smoking cessation promotion and education are the most practical and economical preventive measures to reduce aggravation of disease infection owing to tobacco use.
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Affiliation(s)
- Chen Jiang
- Department of Gerontology and Respirology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiong Chen
- National Clinical Research Centre for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxuan Xie
- Department of Gerontology and Respirology, Xiangya Hospital, Central South University, Changsha, China
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22
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IL-10 c.-592C>A (rs1800872) polymorphism is associated with cervical cancer. J Cancer Res Clin Oncol 2020; 146:1971-1978. [PMID: 32447484 DOI: 10.1007/s00432-020-03256-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/12/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Interleukin-10 (IL-10) is an immunoregulatory cytokine and its cervical and serum concentrations have been associated with a poor prognosis of cervical cancer. The rs1800872 polymorphism (c.-592C>A) in the promotor region of the IL-10 gene affects the production and expression of IL-10 and thus is able to determine the immune response profile in the cervix. Therefore, the aim of this work is to state the association between IL-10 c.-592C>A polymorphism and cervical cancer. METHODS Genomic DNA was extracted from patient's peripheral blood and tumor biopsy. Socio-demographic, sexual behavior and reproductive characteristics data were collected using a questionnaire. RESULTS Co-dominant model in logistic binary regression adjusted for confounders, showed that patients presenting with C/A genotype had 2.15 times more chances for developing cervical cancer (OR 2.15; CI95% 1.02-4.56). The dominant model, C/A + A/A, was also independently associated with 2.71 times more chances for cervical cancer development when compared to control patients (OR 2.71; CI95% 1.05-4.47). CONCLUSION Our study analyses show the association between cervical cancer and IL-10 c.-592C>A polymorphism, demonstrating that the allele A presence was independently associated with higher risks of cervical cancer development.
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Inaida S, Matsuno S. Previous Infection Positively Correlates to the Tumor Incidence Rate of Patients with Cancer. Cancer Immunol Res 2020; 8:580-586. [DOI: 10.1158/2326-6066.cir-19-0510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/11/2019] [Accepted: 03/12/2020] [Indexed: 11/16/2022]
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Łaniewski P, Ilhan ZE, Herbst-Kralovetz MM. The microbiome and gynaecological cancer development, prevention and therapy. Nat Rev Urol 2020; 17:232-250. [PMID: 32071434 PMCID: PMC9977514 DOI: 10.1038/s41585-020-0286-z] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/16/2022]
Abstract
The female reproductive tract (FRT), similar to other mucosal sites, harbours a site-specific microbiome, which has an essential role in maintaining health and homeostasis. In the majority of women of reproductive age, the microbiota of the lower FRT (vagina and cervix) microenvironment is dominated by Lactobacillus species, which benefit the host through symbiotic relationships. By contrast, the upper FRT (uterus, Fallopian tubes and ovaries) might be sterile in healthy individuals or contain a low-biomass microbiome with a diverse mixture of microorganisms. When dysbiosis occurs, altered immune and metabolic signalling can affect hallmarks of cancer, including chronic inflammation, epithelial barrier breach, changes in cellular proliferation and apoptosis, genome instability, angiogenesis and metabolic dysregulation. These pathophysiological changes might lead to gynaecological cancer. Emerging evidence shows that genital dysbiosis and/or specific bacteria might have an active role in the development and/or progression and metastasis of gynaecological malignancies, such as cervical, endometrial and ovarian cancers, through direct and indirect mechanisms, including modulation of oestrogen metabolism. Cancer therapies might also alter microbiota at sites throughout the body. Reciprocally, microbiota composition can influence the efficacy and toxic effects of cancer therapies, as well as quality of life following cancer treatment. Modulation of the microbiome via probiotics or microbiota transplant might prove useful in improving responsiveness to cancer treatment and quality of life. Elucidating these complex host-microbiome interactions, including the crosstalk between distal and local sites, will translate into interventions for prevention, therapeutic efficacy and toxic effects to enhance health outcomes for women with gynaecological cancers.
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Affiliation(s)
- Paweł Łaniewski
- Department of Basic Medical Sciences, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Zehra Esra Ilhan
- Department of Obstetrics and Gynecology, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Melissa M. Herbst-Kralovetz
- Department of Basic Medical Sciences, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA,Department of Obstetrics and Gynecology, College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, USA,UA Cancer Center, University of Arizona, Phoenix/Tucson, AZ, USA,Correspondence:
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25
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Usyk M, Zolnik CP, Castle PE, Porras C, Herrero R, Gradissimo A, Gonzalez P, Safaeian M, Schiffman M, Burk RD. Cervicovaginal microbiome and natural history of HPV in a longitudinal study. PLoS Pathog 2020; 16:e1008376. [PMID: 32214382 PMCID: PMC7098574 DOI: 10.1371/journal.ppat.1008376] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections. However, only a small percentage of high-risk (HR) HPV infections progress to cervical precancer and cancer. In this study, we investigated the role of the cervicovaginal microbiome (CVM) in the natural history of HR-HPV. METHODS This study was nested within the placebo arm of the Costa Rica HPV Vaccine Trial that included women aged 18-25 years of age. Cervical samples from two visits of women with an incident HR-HPV infection (n = 273 women) were used to evaluate the prospective role of the CVM on the natural history of HR-HPV. We focus specifically on infection clearance, persistence, and progression to cervical intraepithelial neoplasia grade 2 and 3 (CIN2+). The CVM was characterized by amplification and sequencing the bacterial 16S V4 rRNA gene region and the fungal ITS1 region using an Illumina MiSeq platform. OTU clustering was performed using QIIME2. Functional groups were imputed using PICRUSt and statistical analyses were performed using R. RESULTS At Visit 1 (V1) abundance of Lactobacillus iners was associated with clearance of incident HR-HPV infections (Linear Discriminant Analysis (LDA)>4.0), whereas V1 Gardnerella was the dominant biomarker for HR-HPV progression (LDA>4.0). At visit 2 (V2), increased microbial Shannon diversity was significantly associated with progression to CIN2+ (p = 0.027). Multivariate mediation analysis revealed that the positive association of V1 Gardnerella with CIN2+ progression was due to the increased cervicovaginal diversity at V2 (p = 0.040). A full multivariate model of key components of the CVM showed significant protective effects via V1 genus Lactobacillus, OR = 0.41 (0.22-0.79), V1 fungal diversity, OR = 0.90 (0.82-1.00) and V1 functional Cell Motility pathway, OR = 0.75 (0.62-0.92), whereas V2 bacterial diversity, OR = 1.19 (1.03-1.38) was shown to be predictive of progression to CIN2+. CONCLUSION This study demonstrates that features of the cervicovaginal microbiome are associated with HR-HPV progression in a prospective longitudinal cohort. The analyses indicated that the association of Gardnerella and progression to CIN2+ may actually be mediated by subsequent elevation of microbial diversity. Identified features of the microbiome associated with HR-HPV progression may be targets for therapeutic manipulation to prevent CIN2+. TRIAL REGISTRATION ClinicalTrials.gov NCT00128661.
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Affiliation(s)
- Mykhaylo Usyk
- Department of Pediatrics (Genetic Medicine), Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Epidemiology and Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Christine P. Zolnik
- Department of Pediatrics (Genetic Medicine), Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Biology, Long Island University, Brooklyn, New York, United States of America
| | - Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Ana Gradissimo
- Department of Pediatrics (Genetic Medicine), Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Paula Gonzalez
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Mahboobeh Safaeian
- Roche Molecular Diagnostics, Pleasanton, California, United States of America
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Robert D. Burk
- Department of Pediatrics (Genetic Medicine), Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Departments of Microbiology and Immunology, and Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
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Dhar JP, Essenmacher L, Dhar R, Ragina N, Sokol RJ. Lack of Uptake of Prophylactic Human Papilloma Virus Vaccine Among Women With Systemic Lupus Erythematosus Seen at a Regional Medical Center. J Clin Rheumatol 2019; 25:348-350. [PMID: 31764496 DOI: 10.1097/rhu.0000000000000866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Women with systemic lupus erythematosus (SLE) are at increased risk for cervical neoplasia likely due to infection with high-risk human papillomavirus (HR-HPV) and should be considered for HPV vaccination. We sought to determine the frequency of HR-HPV infection and uptake of HPV vaccination in our regional female lupus population. METHODS For this medical records review study, data were analyzed from our electronic health records EPIC for women with International Classification of Diseases-10 or International Classification of Diseases -9 billing codes for SLE seen June 6, 2007, to May 1, 2017. This study was approved by the Central Michigan University/Covenant Medical Center institutional review board. Statistical analyses consisted of Student t test, χ, and Z test for proportions using SPSS v. 24 software. RESULTS A total of 1349 women with SLE were identified, mean age of 53 years, 70.8% white, 20.8% African American, with 49% exposed to cigarette smoke. High-risk HPV testing performed in 195 (14.5%; mean age, 50 years) showed 16.9% (33/195) were positive, with those testing positive for HR-HPV being slightly younger (p < 0.05).Comparing our proportion testing positive for HR-HPV (0.169) versus National Health and Nutrition Examination Survey (0.088), we calculated a Z = 3.99 (p < 0.001) indicating HPV infection is significantly higher (2×) in our female SLE cohort. Only 16.0% (38/238) of the 238 women eligible to receive an HPV vaccine were tested for HR-HPV with 9 being positive and only 4.6% (11/238) vaccinated. CONCLUSIONS Human papillomavirus infection is a serious health issue in women with SLE, but HPV testing and vaccination rates remain low. Efforts should be directed to promote awareness of the importance of HPV vaccination in this high-risk population.
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Affiliation(s)
| | | | - Renee Dhar
- Central Michigan University College of Medicine, Mt Pleasant, MI
| | - Neli Ragina
- Central Michigan University College of Medicine, Mt Pleasant, MI
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27
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Origoni M, Cristoforoni P, Mariani L, Costa S, Preti M, Sandri MT, Preti EP, Ghelardi A, Perino A. [HPV vaccination: not only female adolescents and not only prophylactic. Review and position paper of the Italian HPV Study Group (IHSG)]. ACTA ACUST UNITED AC 2019; 71:442-459. [PMID: 31741364 DOI: 10.23736/s0026-4784.19.04443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
HPV vaccination has been introduced in clinical practice in recent years and represents the most effective strategy of primary prevention of cervical carcinoma and of female genital preneoplastic conditions. One of the major issues of the subject is represented by vaccination coverage of the target population. Since its introduction, HPV vaccine efficacy has been progressively demonstrated also towards extragenital HPV-correlated conditions and in males too. Moreover, even subjects of older age groups or subjects who already had HPV infections have been demonstrated to received benefits from vaccination, due to improvements of their immunological response. Recently, vaccine efficacy has also been investigated in terms of adjuvant administration after treatments of preneoplastic or benign conditions of the female lower genital tract caused by HPVs; preliminary results indicate an interesting and promising field of application. On this basis, in this article an analysis of the state of the art has been performed, with specific regard to the Italian scenario and with the focus of future perspectives of implementation of the HPV vaccination policy. From the available evidences, the Italian HPV Study Group recommends the extension of systematic HPV vaccination to males too, to adult subjects and also after conservative treatment of genital HPV correlated conditions.
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Affiliation(s)
- Massimo Origoni
- Dipartimento di Ginecologia e Ostetricia, Università Vita Salute San Raffaele, Milano, Italia -
| | | | | | | | - Mario Preti
- Dipartimento di Ginecologia e Ostetricia, Università di Torino, Torino, Italia
| | | | | | | | - Antonio Perino
- Dipartimento di Ginecologia e Ostetricia, Università di Palermo, Palermo, Italia
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Chatzistamatiou K, Moysiadis T, Vryzas D, Chatzaki E, Kaufmann AM, Koch I, Soutschek E, Boecher O, Tsertanidou A, Maglaveras N, Jansen-Duerr P, Agorastos T. Cigarette Smoking Promotes Infection of Cervical Cells by High-Risk Human Papillomaviruses, but not Subsequent E7 Oncoprotein Expression. Int J Mol Sci 2018; 19:ijms19020422. [PMID: 29385075 PMCID: PMC5855644 DOI: 10.3390/ijms19020422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 12/21/2022] Open
Abstract
Persistent cervical infection with high-risk human papillomaviruses (hrHPVs) is a necessary, but not sufficient, condition for the development of cervical cancer. Therefore, there are other co-factors facilitating the hrHPV carcinogenic process, one of which is smoking. To assess the effect of smoking on high-risk (hr) HPV DNA positivity and on the expression of HPV E7 oncoprotein, as a surrogate of persistent hrHPV infection, we used data from women recruited for the PIPAVIR project, which examined the role of E7 protein detection in cervical cancer screening. Women were tested for hrHPV DNA, using Multiplex Genotyping (MPG), and E7 protein, using a novel sandwich ELISA method, and gave information on their smoking habits. Among 1473 women, hrHPV prevalence was 19.1%. The odds ratio (OR) for hrHPV positivity of smokers compared to non-smokers was 1.785 (95% confidence intervals (CI): 1.365–2.332, p < 0.001). The ORs for E7 positivity, concerning hrHPV positive women, ranged from 0.720 to 1.360 depending on the E7 detection assay used, but this was not statistically significant. Smoking increases the probability of hrHPV infection, and smoking intensity is positively associated to this increase. Smoking is not related to an increased probability of E7 protein positivity for hrHPV positive women.
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Affiliation(s)
- Kimon Chatzistamatiou
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, 54642 Thessaloniki, Greece.
| | - Theodoros Moysiadis
- Institute of Applied Biosciences, Centre for Research & Technology-Hellas, 57001 Thessaloniki, Greece.
| | - Dimos Vryzas
- Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Ekaterini Chatzaki
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Andreas M Kaufmann
- Department of Gynecology, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, 10117 Berlin, Germany.
| | | | | | | | - Athena Tsertanidou
- 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, 54642 Thessaloniki, Greece.
| | - Nikolaos Maglaveras
- Lab of Computing and Medical Informatics, Department of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
| | - Pidder Jansen-Duerr
- Research Institute for Biomedical Aging Research, University of Innsbruck, A-6020 Innsbruck, Austria.
| | - Theodoros Agorastos
- 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, 54642 Thessaloniki, Greece.
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