1
|
Singini MG, Muchengeti M, Sitas F, Chen WC, Combes JD, Waterboer T, Clifford GM. Antibodies against high-risk human papillomavirus proteins as markers for noncervical HPV-related cancers in a Black South African population, according to HIV status. Int J Cancer 2024; 155:251-260. [PMID: 38577820 DOI: 10.1002/ijc.34919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 04/06/2024]
Abstract
Human papillomavirus (HPV) proteins may elicit antibody responses in the process toward HPV-related malignancy. However, HPV seroepidemiology in noncervical HPV-related cancers remains poorly understood, particularly in populations with a high prevalence of human immunodeficiency virus (HIV). Using a glutathione S-transferase-based multiplex serology assay, antibodies against E6, E7 and L1 proteins of HPV16 and HPV18 were measured in sera of 535 cases of noncervical HPV-related cancers (anal (n = 104), vulval (n = 211), vaginal (n = 49), penile (n = 37) and oropharyngeal (n = 134)) and 6651 non-infection-related cancer controls, from the Johannesburg Cancer Study that recruited Black South African with newly diagnosed cancer between 1995 and 2016. Logistic and Poisson regression models were used to calculate adjusted odds ratios (aOR) and prevalence ratios (aPR) and 95% confidence intervals (CI) in cases versus controls. HPV16 E6 was more strongly associated with noncervical HPV-related cancers than HPV16 L1 or E7, or HPV18 proteins: anal (females (HPV16 E6 aOR = 11.50;95%CI:6.0-22.2), males (aOR = 10.12;95%CI:4.9-20.8), vulval (aOR = 11.69;95%CI:7.9-17.2), vaginal (aOR = 10.26;95%CI:5.0-21), penile (aOR = 18.95;95%CI:8.9-40), and oropharyngeal (females (aOR = 8.95;95%CI:2.9-27.5), males (aOR = 3.49;95%CI:1.8-7.0)) cancers. HPV16-E6 seropositivity ranged from 24.0% to 35.1% in anal, vulval, vaginal and penile cancer but was significantly lower (11.2%) in oropharyngeal cancer. After adjustment for HIV, prevalence of which increased from 22.2% in 1995-2005 to 54.1% in 2010-2016, HPV16 E6 seropositivity increased by period of diagnosis (aPR for 2010-2016 vs. 1995-2006 = 1.84;95%CI:1.1-3.0). Assuming HPV16 E6 seroprevalence reflects HPV attributable fraction, the proportion of certain noncervical-HPV-related cancers caused by HPV is increasing over time in South Africa. This is expected to be driven by the increasing influence of HIV.
Collapse
Affiliation(s)
- Mwiza Gideon Singini
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mazvita Muchengeti
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Freddy Sitas
- Center for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Menzies Center of Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wenlong Carl Chen
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean-Damien Combes
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gary M Clifford
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| |
Collapse
|
2
|
Dietz A, Wichmann G, Wiegand S, Waterboer T, Budach W, Klußmann JP. [Update: Epidemiology and Prevention of Oropharyngeal Cancer]. Laryngorhinootologie 2024; 103:296-313. [PMID: 38565110 DOI: 10.1055/a-2133-2348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Due to the association with the causal HPV-16 infection, the oropharyngeal carcinoma spreads into two separate entities depending on HPV-16 positivity. More recent data show a diversified picture of the importance and prevalence of the surrogate parameter p16 (discordance) for a definitive HPV-16 association, which varies worldwide. In the context of prevention options, vaccination is of major and HPV screening of healthy people only of little importance.
Collapse
|
3
|
Sichero L, Gonçalves MG, Bettoni F, Coser EM, Mota G, Nunes RAL, Mercante AMDC, Natalino R, Uno M, Ferreira Alves MJ, Matos LL, Kowalski LP, Kulcsar MAV, de Alvarenga GF, Höfler D, Schroeder L, Waterboer T, Tommasino M, Villa LL. Detection of serum biomarkers of HPV-16 driven oropharynx and oral cavity cancer in Brazil. Oral Oncol 2024; 149:106676. [PMID: 38150987 DOI: 10.1016/j.oraloncology.2023.106676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND HPV-16 driven oropharynx/oral cavity squamous cell carcinomas prevalence varies globally. We evaluated the presence of HPV-16 ctDNA and HPV-16 E6 antibodies in samples obtained from participants treated at the Instituto do Cancer do Estado de Sao Paulo, ICESP, and from whom tumoral HPV DNA, HPV-16 E6*I mRNA, and p16INK4a status was also accessed. METHODS HPV was genotyped by PCR-hybridization. All HPV DNA positive and ∼10 % HPV DNA negative cases underwent p16INK4a immunohistochemistry and E6*I RNA testing using a multiplex bead based protocol. HPV-16 ctDNA and anti-E6 antibodies were assessed by ddPCR (digital droplet PCR) and multiplex serology, respectively. RESULTS The prevalence of HPV-16 in oropharynx carcinoma (OPC) cases was low (8.7 %) when considering solely HPV-16 DNA detection, and even lower (5.2 %) when taken into consideration the concomitant detection of HPV-16 E6*I RNA and/or p16INK4 (HPV-16 attributable fraction - AF). None of the oral cavity cancer (OCC) cases were detected with HPV-16 DNA. HPV-16 ctDNA was more commonly detected than HPV-16 E6 antibodies (29.8 % versus 10.6 %). Both serum biomarkers attained 100 % sensitivity of detecting HPV-16 AF OPC, however the specificity of the HPV-16 anti-E6 biomarker was higher compared to ctDNA (93.2 % versus 75.0 %). Finally, when both HPV-16 ctDNA and anti-E6 biomarkers were considered together, the sensitivity and specificity for HPV-16 OPC detection was 100 % and about 70 %, respectively, independently of analyzing HPV-16 DNA positive or HPV-16 AF tumors. CONCLUSIONS Our findings corroborate that serum biomarkers are highly sensitive and specific biomarkers for detection of HPV-associated OPC.
Collapse
Affiliation(s)
- Laura Sichero
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Milena Giulia Gonçalves
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Fabiana Bettoni
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Giana Mota
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Rafaella A L Nunes
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ana Maria da Cunha Mercante
- Department of Pathology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil
| | - Renato Natalino
- Department of Pathology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil
| | - Miyuki Uno
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Maria José Ferreira Alves
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Leandro Luongo Matos
- Department of Head and Neck Surgery, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | | | - Daniela Höfler
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - Luisa Lina Villa
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo FMUSP HC, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil; Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
4
|
Kusters JMA, Diergaarde B, Ness A, Schim van der Loeff MF, Heijne JCM, Schroeder L, Hueniken K, McKay JD, Macfarlane GJ, Lagiou P, Lagiou A, Polesel J, Agudo A, Alemany L, Ahrens W, Healy CM, Conway DI, Robinson M, Canova C, Holcátová I, Richiardi L, Znaor A, Pring M, Thomas S, Hayes DN, Liu G, Hung RJ, Brennan P, Olshan AF, Virani S, Waterboer T. Diagnostic accuracy of HPV16 early antigen serology for HPV-driven oropharyngeal cancer is independent of age and sex. Int J Cancer 2024; 154:389-402. [PMID: 37694289 DOI: 10.1002/ijc.34710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Abstract
A growing proportion of head and neck cancer (HNC), especially oropharyngeal cancer (OPC), is caused by human papillomavirus (HPV). There are several markers for HPV-driven HNC, one being HPV early antigen serology. We aimed to investigate the diagnostic accuracy of HPV serology and its performance across patient characteristics. Data from the VOYAGER consortium was used, which comprises five studies on HNC from North America and Europe. Diagnostic accuracy, that is, sensitivity, specificity, Cohen's kappa and correctly classified proportions of HPV16 E6 serology, was assessed for OPC and other HNC using p16INK4a immunohistochemistry (p16), HPV in situ hybridization (ISH) and HPV PCR as reference methods. Stratified analyses were performed for variables including age, sex, smoking and alcohol use, to test the robustness of diagnostic accuracy. A risk-factor analysis based on serology was conducted, comparing HPV-driven to non-HPV-driven OPC. Overall, HPV serology had a sensitivity of 86.8% (95% CI 85.1-88.3) and specificity of 91.2% (95% CI 88.6-93.4) for HPV-driven OPC using p16 as a reference method. In stratified analyses, diagnostic accuracy remained consistent across sex and different age groups. Sensitivity was lower for heavy smokers (77.7%), OPC without lymph node involvement (74.4%) and the ARCAGE study (66.7%), while specificity decreased for cases with <10 pack-years (72.1%). The risk-factor model included study, year of diagnosis, age, sex, BMI, alcohol use, pack-years, TNM-T and TNM-N stage. HPV serology is a robust biomarker for HPV-driven OPC, and its diagnostic accuracy is independent of age and sex. Future research is suggested on the influence of smoking on HPV antibody levels.
Collapse
Affiliation(s)
- Johannes M A Kusters
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Institute for Infection and Immunity (AII), Amsterdam UMC, Amsterdam, The Netherlands
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Brenda Diergaarde
- School of Public Health, University of Pittsburgh and UPMC Hillman Cancer Centre, Pittsburgh, Pennsylvania, USA
| | - Andrew Ness
- NIHR Bristol Biomedical Research Centre, Weston NHS Foundation Trust, University of Bristol, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Maarten F Schim van der Loeff
- Institute for Infection and Immunity (AII), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Janneke C M Heijne
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Lea Schroeder
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katrina Hueniken
- Princess Margaret Cancer Centre, Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James D McKay
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Pagona Lagiou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Areti Lagiou
- School of Public Health, University of West Attica, Athens, Greece
| | - Jerry Polesel
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group, Epidemiology Public Health Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Laia Alemany
- Nutrition and Cancer Group, Epidemiology Public Health Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Claire M Healy
- Trinity College School of Dental Science, Dublin, Ireland
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Dublin, UK
| | - Max Robinson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Ivana Holcátová
- First Faculty of Medicine, Institute of Hygiene and Epidemiology, Charles University, Prague, Czech Republic
| | - Lorenzo Richiardi
- Reference Center for Epidemiology and Cancer Prevention, Piemonte, Italy
| | - Ariana Znaor
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Steve Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - D Neil Hayes
- Division of Medical Oncology and Center for Cancer Research, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rayjean J Hung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Paul Brennan
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Andrew F Olshan
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Shama Virani
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
5
|
Ye X, Zhang P, Tao J, Wang JCK, Mafi A, Grob NM, Quartararo AJ, Baddock HT, Chan LJG, McAllister FE, Foe I, Loas A, Eaton DL, Hao Q, Nile AH, Pentelute BL. Discovery of reactive peptide inhibitors of human papillomavirus oncoprotein E6. Chem Sci 2023; 14:12484-12497. [PMID: 38020382 PMCID: PMC10646941 DOI: 10.1039/d3sc02782a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023] Open
Abstract
Human papillomavirus (HPV) infections account for nearly all cervical cancer cases, which is the fourth most common cancer in women worldwide. High-risk variants, including HPV16, drive tumorigenesis in part by promoting the degradation of the tumor suppressor p53. This degradation is mediated by the HPV early protein 6 (E6), which recruits the E3 ubiquitin ligase E6AP and redirects its activity towards ubiquitinating p53. Targeting the protein interaction interface between HPV E6 and E6AP is a promising modality to mitigate HPV-mediated degradation of p53. In this study, we designed a covalent peptide inhibitor, termed reactide, that mimics the E6AP LXXLL binding motif by selectively targeting cysteine 58 in HPV16 E6 with quantitative conversion. This reactide provides a starting point in the development of covalent peptidomimetic inhibitors for intervention against HPV-driven cancers.
Collapse
Affiliation(s)
- Xiyun Ye
- Department of Chemistry, Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Peiyuan Zhang
- Department of Chemistry, Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Jason Tao
- Department of Chemistry, Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - John C K Wang
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Amirhossein Mafi
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Nathalie M Grob
- Department of Chemistry, Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Anthony J Quartararo
- Department of Chemistry, Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Hannah T Baddock
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Leanne J G Chan
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Fiona E McAllister
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Ian Foe
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Andrei Loas
- Department of Chemistry, Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139 USA
| | - Dan L Eaton
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Qi Hao
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Aaron H Nile
- Calico Life Sciences LLC 1170 Veterans Boulevard South San Francisco CA 94080 USA
| | - Bradley L Pentelute
- Department of Chemistry, Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139 USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology 500 Main Street Cambridge MA 02142 USA
- Center for Environmental Health Sciences, Massachusetts Institute of Technology 77 Massachusetts Avenue Cambridge MA 02139 USA
- Broad Institute of MIT and Harvard 415 Main Street Cambridge MA 02142 USA
| |
Collapse
|
6
|
DSouza G, Tewari SR, Troy T, Waterboer T, Struijk L, Castillo R, Wright H, Shen M, Miles B, Johansson M, Robbins HA, Fakhry C. Prevalence of oral and blood oncogenic human papillomavirus biomarkers among an enriched screening population: Baseline results of the MOUTH study. Cancer 2023; 129:2373-2384. [PMID: 37032449 PMCID: PMC10330354 DOI: 10.1002/cncr.34783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Human papillomavirus (HPV)-related oropharyngeal cancer screening is being explored in research studies, but strategies to identify an appropriate population are not established. The authors evaluated whether a screening population could be enriched for participants with oncogenic HPV biomarkers using risk factors for oral HPV. METHODS Participants were enrolled at Johns Hopkins Hospitals and Mount Sinai Icahn School of Medicine. Eligible participants were either men aged 30 years or older who had two or more lifetime oral sex partners and a personal history of anogenital dysplasia/cancer or partners of patients who had HPV-related cancer. Oral rinse and serum samples were tested for oncogenic HPV DNA, RNA, and E6 or E7 antibodies, respectively. Participants with any biomarker were considered at-risk. RESULTS Of 1108 individuals, 7.3% had any oncogenic oral HPV DNA, and 22.9% had serum antibodies for oncogenic HPV E6 or E7. Seventeen participants (1.5%) had both oral and blood biomarkers. HPV type 16 (HPV16) biomarkers were rarer, detected in 3.7% of participants, including 20 with oral HPV16 DNA and 22 with HPV16 E6 serum antibodies (n = 1 had both). In adjusted analysis, living with HIV (adjusted odds ratio, 2.65; 95% CI, 1.60-4.40) and older age (66-86 vs. 24-45 years; adjusted odds ratio, 1.70; 95% CI, 1.07-2.70) were significant predictors of being at risk. Compared with the general population, the prevalence of oral HPV16 (1.8% vs. 0.9%), any oncogenic oral HPV DNA (7.3% vs. 3.5%), and HPV16 E6 antibodies (2.2% vs. 0.3%) was significantly elevated. CONCLUSIONS Enrichment by the eligibility criteria successfully identified a population with higher biomarker prevalence, including HPV16 biomarkers, that may be considered for screening trials. Most in this group are still expected to have a low risk of oropharyngeal cancer.
Collapse
Affiliation(s)
- Gypsyamber DSouza
- Departments of Epidemiology & Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland
| | - Sakshi R Tewari
- Departments of Epidemiology & Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland
| | - Tanya Troy
- Departments of Epidemiology & Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Struijk
- Viroclinics-DDL Diagnostic Laboratory, Rijswijk, Netherlands
| | - Rachel Castillo
- Departments of Epidemiology & Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland
| | - Hannah Wright
- Departments of Epidemiology & Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland
| | - Michael Shen
- Departments of Epidemiology & Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Northwell Health, New York, NY
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Carole Fakhry
- Departments of Epidemiology & Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland
| |
Collapse
|
7
|
Budhathoki S, Diergaarde B, Liu G, Olshan A, Ness A, Waterboer T, Virani S, Basta P, Bender N, Brenner N, Dudding T, Hayes N, Hope A, Huang SH, Hueniken K, Kanterewicz B, McKay JD, Pring M, Thomas S, Wisniewski K, Thomas S, Brhane Y, Agudo A, Alemany L, Lagiou A, Barzan L, Canova C, Conway DI, Healy CM, Holcatova I, Lagiou P, Macfarlane GJ, Macfarlane TV, Polesel J, Richiardi L, Robinson M, Znaor A, Brennan P, Hung RJ. A risk prediction model for head and neck cancers incorporating lifestyle factors, HPV serology and genetic markers. Int J Cancer 2023; 152:2069-2080. [PMID: 36694401 PMCID: PMC10006331 DOI: 10.1002/ijc.34444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
Head and neck cancer is often diagnosed late and prognosis for most head and neck cancer patients remains poor. To aid early detection, we developed a risk prediction model based on demographic and lifestyle risk factors, human papillomavirus (HPV) serological markers and genetic markers. A total of 10 126 head and neck cancer cases and 5254 controls from five North American and European studies were included. HPV serostatus was determined by antibodies for HPV16 early oncoproteins (E6, E7) and regulatory early proteins (E1, E2, E4). The data were split into a training set (70%) for model development and a hold-out testing set (30%) for model performance evaluation, including discriminative ability and calibration. The risk models including demographic, lifestyle risk factors and polygenic risk score showed a reasonable predictive accuracy for head and neck cancer overall. A risk model that also included HPV serology showed substantially improved predictive accuracy for oropharyngeal cancer (AUC = 0.94, 95% CI = 0.92-0.95 in men and AUC = 0.92, 95% CI = 0.88-0.95 in women). The 5-year absolute risk estimates showed distinct trajectories by risk factor profiles. Based on the UK Biobank cohort, the risks of developing oropharyngeal cancer among 60 years old and HPV16 seropositive in the next 5 years ranged from 5.8% to 14.9% with an average of 8.1% for men, 1.3% to 4.4% with an average of 2.2% for women. Absolute risk was generally higher among individuals with heavy smoking, heavy drinking, HPV seropositivity and those with higher polygenic risk score. These risk models may be helpful for identifying people at high risk of developing head and neck cancer.
Collapse
Affiliation(s)
- Sanjeev Budhathoki
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Brenda Diergaarde
- Graduate School of Public Health, University of Pittsburgh, and UPMC Hillman Cancer Center, Pittsburgh, USA
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Andrew Olshan
- University of North Carolina Lineberger Cancer Center, North Carolina, USA
| | - Andrew Ness
- NIHR Bristol Biomedical Research Centre, University of Bristol and Weston NHS Foundation Trust and University of Bristol, UK and Bristol Dental School, University of Bristol, Lower Maudlin St, Bristol, UK
- Bristol Dental School, University of Bristol, Lower Maudlin St, Bristol, UK
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Shama Virani
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Patricia Basta
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Noemi Bender
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicole Brenner
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tom Dudding
- Bristol Dental School, University of Bristol, Lower Maudlin St, Bristol, UK
| | - Neil Hayes
- Division of Medical Oncology and Center for Cancer Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew Hope
- Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Shao Hui Huang
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Katrina Hueniken
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | | | - James D McKay
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Lower Maudlin St, Bristol, UK
| | - Steve Thomas
- Bristol Dental School, University of Bristol, Lower Maudlin St, Bristol, UK
| | - Kathy Wisniewski
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sera Thomas
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Yonathan Brhane
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L’Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program; Bellvitge Biomedical Research Institute - IDIBELL, L’Hospitalet de Llobregat, Spain
| | | | - Areti Lagiou
- School of Public Health, University of West Attica, Greece
| | | | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - David I. Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, UK
| | | | | | - Pagona Lagiou
- School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Gary J. Macfarlane
- Epidemiology Group. School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Tatiana V. Macfarlane
- Epidemiology Group. School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Lorenzo Richiardi
- University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piemonte, Italy
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, UK
| | - Ariana Znaor
- International Agency for Research on cancer, France
| | - Paul Brennan
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Rayjean J. Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Morais S, Wissing MD, Khosrow-Khavar F, Burchell AN, Tellier PP, Coutlée F, Waterboer T, El-Zein M, Franco EL. Serologic Response to Human Papillomavirus Genotypes Among Unvaccinated Women: Findings From the HITCH Cohort Study. J Infect Dis 2023; 227:1173-1184. [PMID: 36322543 PMCID: PMC10175069 DOI: 10.1093/infdis/jiac437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Humoral immune responses may be critical for preventing, controlling, and/or eliminating human papillomavirus (HPV) infection. We analyzed humoral response to natural HPV infection considering phylogenetic relatedness among unvaccinated women. METHODS We included 399 young women attending university/college in Montreal, Canada who were participants of the HITCH cohort. Participants provided blood samples at baseline and 5 follow-up visits. Antibody response to bacterially expressed L1 and E6 glutathione S-transferase (GST) fusion proteins, and virus-like particles (VLP-L1) of Alphapapillomavirus types were measured using multiplex serology. We assessed correlations and associations between HPV types at baseline using Pearson correlation coefficients (r) and univariable linear regressions. RESULTS At baseline, > 40% were seropositive for GST-L1 antibodies of at least 1 HPV type. Strong correlations between GST-L1 were observed for α9 HPV types: 58-52 (r = 0.86), 58-33 (r = 0.75), 33-52 (r = 0.72), and between GST-E6: 52-11 (r = 0.84), 52-18 (r = 0.79), 58-33 (r = 0.78), 35-11 (r = 0.76). HPV16 VLP-L1 moderately explained variability in HPV16 GST-L1 (regression coefficient [b] = 0.38, R2 = 43.1%), and HPV45 GST-L1 in HPV18 GST-L1 (b = 0.68, R2 = 42.8%). GST-E6 antibodies accounted for a low to moderate proportion of variability in HPV16 and HPV18 GST-E6 (R2 = 6.4%-62.2%). CONCLUSIONS Associations between naturally induced HPV-specific antibodies depend on phylogenetic relatedness.
Collapse
Affiliation(s)
- Samantha Morais
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Michel D Wissing
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | | | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - François Coutlée
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
- Laboratoire de Virologie Moléculaire, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, Québec, Canada
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center, Heidelberg, Germany
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Prétet JL, Dalstein V, Touzé A, Beby-Defaux A, Soussan P, Jacquin É, Birembaut P, Clavel C, Mougin C, Rousseau A, Lacau Saint Guily J. High levels of HPV16-L1 antibody but not HPV16 DNA load or integration predict oropharyngeal patient outcome: The Papillophar study. Clin Exp Med 2023; 23:87-96. [PMID: 35199231 DOI: 10.1007/s10238-022-00796-2] [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: 09/30/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
The incidence of oropharyngeal cancers (OPC) is increasing in the world. Among OPC, those induced by human papillomaviruses have a better prognosis than non-HPV-associated OPC. The objective of this study was to highlight the relevance of HPV16 load, HPV16 DNA integration and HPV16-L1 serology on progression-free survival and overall survival of OPC patients. The PAPILLOPHAR cohort consists of 362 patients with oropharyngeal squamous cell carcinomas prospectively followed up for 5 years after treatment. Tumor biopsies and sera were collected at inclusion to investigate tumor HPV DNA/RNA characteristics and HPV16 L1 serology, respectively. Twenty-seven percent of tumor biopsies were HPV DNA- and RNA-positive and HPV16 represented 93% of HPV-positive cases. Among them, neither HPV16 viral load nor HPV16 DNA integration was associated with overall survival (OS) or progression-free survival (PFS). In contrast, high anti-HPV16 L1 antibody titers were significantly associated with a better OS and PFS. This study reveals that HPV16 load and integration are not relevant prognosis biomarkers in OPC patients.Clinical Relevance: High levels of HPV16 L1 antibodies may be useful to predict OPC patient outcome following treatment.ClinicalTrials.gov Identifier: NCT00918710, May 2017.
Collapse
Affiliation(s)
- Jean-Luc Prétet
- Laboratoire de Biologie Cellulaire Et Moléculaire, PC-Bio, EA3181, UBFC, Université de Franche-Comté, CNR Papillomavirus, Centre Hospitalier Régional Universitaire, CHRU Besancon, Boulevard A Fleming, 25030, Besançon Cedex, France.
| | - Véronique Dalstein
- Inserm UMR-S 1250 P3Cell, Université de Reims Champagne-Ardenne, SFR CAP-Santé, 51092, Reims, France.,Laboratoire de Biopathologie, CHU Maison Blanche, Reims, France
| | - Antoine Touzé
- UMR INRAE ISP Équipe Biologie Des Infections À Polyomavirus, Faculté Des Sciences, Pharmaceutiques 31 avenue Monge, 37200, Tours, France
| | - Agnès Beby-Defaux
- Service de Virologie, CHU de Poitiers, Faculté de Médecine Et de Pharmacie de Poitiers, EA 4331 LITEC, Université de Poitiers, Poitiers, France
| | - Patrick Soussan
- Laboratoire de Virologie, Hôpital Tenon, CRSA Inserm U 938 Sorbonne University, Paris, France
| | - Élise Jacquin
- Laboratoire de Biologie Cellulaire Et Moléculaire, PC-Bio, EA3181, UBFC, Université de Franche-Comté, CNR Papillomavirus, Centre Hospitalier Régional Universitaire, CHRU Besancon, Boulevard A Fleming, 25030, Besançon Cedex, France.,INSERM UMR-S 1193, Faculté de Pharmacie, Châtenay-Malabry, France
| | - Philippe Birembaut
- Inserm UMR-S 1250 P3Cell, Université de Reims Champagne-Ardenne, SFR CAP-Santé, 51092, Reims, France.,Laboratoire de Biopathologie, CHU Maison Blanche, Reims, France
| | - Christine Clavel
- Inserm UMR-S 1250 P3Cell, Université de Reims Champagne-Ardenne, SFR CAP-Santé, 51092, Reims, France.,Laboratoire de Biopathologie, CHU Maison Blanche, Reims, France
| | - Christiane Mougin
- Laboratoire de Biologie Cellulaire Et Moléculaire, PC-Bio, EA3181, UBFC, Université de Franche-Comté, CNR Papillomavirus, Centre Hospitalier Régional Universitaire, CHRU Besancon, Boulevard A Fleming, 25030, Besançon Cedex, France.,INSERM UMR1098, Univ. Bourgogne Franche-Comté, 25000, Besançon Cedex, France
| | - Alexandra Rousseau
- Research Platform Paris-East (URCEST-CRC-CRB), Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jean Lacau Saint Guily
- Department of Otolaryngology, HNS, Tenon Hospital, APHP and Sorbonne University, Paris, France.,Department of OL-HNS, Rothschild Foundation Hospital and Sorbonne University, Paris, France
| | | |
Collapse
|
10
|
Galati L, Chiocca S, Duca D, Tagliabue M, Simoens C, Gheit T, Arbyn M, Tommasino M. HPV and head and neck cancers: Towards early diagnosis and prevention. Tumour Virus Res 2022; 14:200245. [PMID: 35973657 PMCID: PMC9420391 DOI: 10.1016/j.tvr.2022.200245] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide with an increasing trend of its incidence. Alcohol consumption, smoking, and viral infections, such as the mucosal high-risk (HR) human papillomaviruses (HPVs) are major risk factors for HNSCC development. In particular, HR HPVs are mainly associated with a subset of oropharyngeal squamous cell carcinoma (OPSCC), while other head and neck sites are marginally affected by HPV infection. HPV16 is the most frequently HR HPV type associated with HNSCC. In contrast to the cervix, no screening programs or identifiable pre-malignant lesions have been characterized for HPV-related HNSCC. Therefore, identification of general diagnostic algorithms and HPV biomarkers that could facilitate the early diagnosis, disease evolution and recurrence for HPV-driven HNSCCs are urgently needed. We herein review the role of HPV in HNSCC with a focus on epidemiology, biology, applied diagnostic algorithms and available biomarkers in body fluids as early diagnostic tools in HPV-driven HNSCCs.
Collapse
Affiliation(s)
- Luisa Galati
- International Agency for Research on Cancer, F-69372, Lyon, France
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139, Milan, Italy
| | - Daria Duca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139, Milan, Italy
| | - Marta Tagliabue
- Department of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Cindy Simoens
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, 1050, Brussels, Belgium
| | - Tarik Gheit
- International Agency for Research on Cancer, F-69372, Lyon, France.
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, 1050, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | | |
Collapse
|
11
|
Robbins HA, Ferreiro-Iglesias A, Waterboer T, Brenner N, Nygard M, Bender N, Schroeder L, Hildesheim A, Pawlita M, D'Souza G, Visvanathan K, Langseth H, Schlecht NF, Tinker LF, Agalliu I, Wassertheil-Smoller S, Ness-Jensen E, Hveem K, Grioni S, Kaaks R, Sánchez MJ, Weiderpass E, Giles GG, Milne RL, Cai Q, Blot WJ, Zheng W, Weinstein SJ, Albanes D, Huang WY, Freedman ND, Kreimer AR, Johansson M, Brennan P. Absolute Risk of Oropharyngeal Cancer After an HPV16-E6 Serology Test and Potential Implications for Screening: Results From the Human Papillomavirus Cancer Cohort Consortium. J Clin Oncol 2022; 40:3613-3622. [PMID: 35700419 PMCID: PMC9622695 DOI: 10.1200/jco.21.01785] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/17/2021] [Accepted: 05/05/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Seropositivity for the HPV16-E6 oncoprotein is a promising marker for early detection of oropharyngeal cancer (OPC), but the absolute risk of OPC after a positive or negative test is unknown. METHODS We constructed an OPC risk prediction model that integrates (1) relative odds of OPC for HPV16-E6 serostatus and cigarette smoking from the human papillomavirus (HPV) Cancer Cohort Consortium (HPVC3), (2) US population risk factor data from the National Health Interview Survey, and (3) US sex-specific population rates of OPC and mortality. RESULTS The nine HPVC3 cohorts included 365 participants with OPC with up to 10 years between blood draw and diagnosis and 5,794 controls. The estimated 10-year OPC risk for HPV16-E6 seropositive males at age 50 years was 17.4% (95% CI, 12.4 to 28.6) and at age 60 years was 27.1% (95% CI, 19.2 to 45.4). Corresponding 5-year risk estimates were 7.3% and 14.4%, respectively. For HPV16-E6 seropositive females, 10-year risk estimates were 3.6% (95% CI, 2.5 to 5.9) at age 50 years and 5.5% (95% CI, 3.8 to 9.2) at age 60 years and 5-year risk estimates were 1.5% and 2.7%, respectively. Over 30 years, after a seropositive result at age 50 years, an estimated 49.9% of males and 13.3% of females would develop OPC. By contrast, 10-year risks among HPV16-E6 seronegative people were very low, ranging from 0.01% to 0.25% depending on age, sex, and smoking status. CONCLUSION We estimate that a substantial proportion of HPV16-E6 seropositive individuals will develop OPC, with 10-year risks of 17%-27% for males and 4%-6% for females age 50-60 years in the United States. This high level of risk may warrant periodic, minimally invasive surveillance after a positive HPV16-E6 serology test, particularly for males in high-incidence regions. However, an appropriate clinical protocol for surveillance remains to be established.
Collapse
Affiliation(s)
- Hilary A. Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicole Brenner
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mari Nygard
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Noemi Bender
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Michael Pawlita
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hilde Langseth
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Nicolas F. Schlecht
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Lesley F. Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ilir Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Eivind Ness-Jensen
- HUNT Research Center and K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger/Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kristian Hveem
- HUNT Research Center and K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | | | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Aimée R. Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
12
|
Busch CJ, Hoffmann AS, Viarisio D, Becker BT, Rieckmann T, Betz C, Bender N, Schroeder L, Hussein Y, Petersen E, Jagodzinski A, Schäfer I, Burandt E, Lang Kuhs K, Pawlita M, Waterboer T, Brenner N. Detection of stage I HPV-driven oropharyngeal cancer in asymptomatic individuals in the Hamburg City Health Study using HPV16 E6 serology - A proof-of-concept study. EClinicalMedicine 2022; 53:101659. [PMID: 36147627 PMCID: PMC9486032 DOI: 10.1016/j.eclinm.2022.101659] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The lack of detectable precancerous lesions poses challenges to the early detection of human papillomavirus-driven oropharyngeal cancer (HPV-OPC). Antibodies against HPV16 early proteins, especially E6, are uniquely sensitive and specific biomarkers detectable years prior to HPV-OPC diagnosis. Thus, HPV16 early protein serology warrants clinical investigation for HPV-OPC screening. METHODS Using multiplex serology, we analyzed HPV16 serum antibodies of the first 5000 participants (n=4,424 sera, recruited 2016-2017) of the Hamburg City Health Study, a population-based prospective cohort (45-74 years). Participants seropositive for HPV16 E6 and at least one additional early protein (E1, E2, E7) were considered at high risk for HPV-OPC development and invited to six-monthly non-invasive head and neck follow-up (FU) examinations (visual inspection, endoscopy, ultrasonography, performed 2019-2020). Participants with suspicious lesions were examined by magnetic resonance imaging and panendoscopy with biopsy. Histologically confirmed OPC cases were treated according to standard of care. FINDINGS In total, 35 out of 4,424 study participants (0·8%, 95% confidence interval (CI) 0·6-1·1%) were HPV16 E6 seropositive. Among these, eleven (0·3%, 95%CI 0·1-0·5%) were considered at high risk for HPV-OPC of which nine were successfully re-contacted and invited to regular clinical FU examinations. Two males and one female were diagnosed with stage I HPV-OPC within 1·3 years of clinical FU (3-4 years after initial blood draw), representing one diagnosis of prevalent advanced disease, one incident diagnosis of advanced disease, and one incident diagnosis of early disease. The remaining participants showed no detectable signs of cancer, and undergo regular examinations (median clinical FU: 1·0 years, median total FU from blood draw to last clinical FU visit: 4·7 years). INTERPRETATION HPV16 early antibodies allowed identifying three asymptomatic stage I HPV-OPC patients, out of eleven participants considered at high risk. However, two of the three cases already showed signs of advanced disease at diagnosis. Targeting multiple early proteins may considerably improve the positive predictive value of HPV16 serology and may have clinical utility for HPV-OPC screening. FUNDING This work was funded by DKFZ and UKE intramural funding.
Collapse
Affiliation(s)
- Chia-Jung Busch
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medicine Greifswald, Greifswald, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Anna Sophie Hoffmann
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Daniele Viarisio
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benjamin T. Becker
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Thorsten Rieckmann
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Laboratory of Radiobiology & Experimental Radiooncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christian Betz
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Noemi Bender
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yassin Hussein
- Hamburg City Health Study, Epidemiologic Study Center, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Elina Petersen
- Hamburg City Health Study, Epidemiologic Study Center, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Annika Jagodzinski
- Hamburg City Health Study, Epidemiologic Study Center, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Ines Schäfer
- Hamburg City Health Study, Epidemiologic Study Center, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Eike Burandt
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Krystle Lang Kuhs
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Pawlita
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Corresponding author.
| | - Nicole Brenner
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
13
|
Galati L, Combes JD, Le Calvez-Kelm F, McKay-Chopin S, Forey N, Ratel M, McKay J, Waterboer T, Schroeder L, Clifford G, Tommasino M, Gheit T. Detection of Circulating HPV16 DNA as a Biomarker for Cervical Cancer by a Bead-Based HPV Genotyping Assay. Microbiol Spectr 2022; 10:e0148021. [PMID: 35225653 PMCID: PMC9045285 DOI: 10.1128/spectrum.01480-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) circulating tumor DNA (HPV ctDNA) was proposed as a biomarker for the detection and disease monitoring of HPV-related cancers. One hundred eighty plasma samples obtained from women diagnosed with HPV16-positive cervical cancer (CC) (n = 100), HPV16-positive premalignant lesions (cervical intraepithelial neoplasia grade 3 [CIN3]) (n = 20), and HPV DNA-negative controls (n = 60) were randomly selected from the archives for evaluating the performance of a bead-based HPV genotyping assay (E7 type-specific multiplex genotyping assay [E7-MPG]) in detecting HPV16 ctDNA. The performance of the E7-MPG was compared with those of DNA detection by droplet digital PCR (ddPCR) and detection of HPV16 E6 antibodies evaluated in an independent study. Internal controls to assess DNA quality were included in the molecular assays, i.e., beta-globin and ESR1, respectively. The sensitivity and specificity of E7-MPG and/or E6 antibodies to detect HPV16-positive CCs were evaluated. HPV16 ctDNA was detected using the E7-MPG in 42.3% of all plasma samples and in 74.7% of plasma samples from HPV16-positive CC cases. The validation of E7-MPG data by ddPCR showed that the sensitivity of the E7-MPG test for HPV16-positive CC detection was higher than that of ddPCR (74.7% versus 63.1%; P < 0.001). When both HPV16 ctDNA and E6 antibodies were considered, the sensitivity for HPV16-positive CC detection increased from 74.7% to 86.1%, while the specificity was unchanged at 97.8%. The performance of E7-MPG for the detection of HPV16 ctDNA appears to be at least as sensitive as that of ddPCR, offering an additional tool for ctDNA detection of HPV16-positive CC. The use of an additional blood marker of HPV infection, such as E6 antibodies, further improved the detection of CC. IMPORTANCE The validity of HPV ctDNA as a marker of HPV-driven cancers has been previously reported. Herein we validated an alternative to ddPCR for HPV16 ctDNA detection, using a bead-based HPV genotyping assay that offers the potential advantage of reducing the cost of clinical management due to the multiplex capability of the test, thus facilitating its use in clinical settings. In addition, we analyzed HPV ctDNA in the context of E6 antibodies as an additional HPV marker. The HPV16 ctDNA biomarker appeared to be highly specific and, to a lesser extent, sensitive for the detection of CC, mainly indicated for those at an advanced tumor stage. In this proof-of-principle study, E6 antibodies were mainly detected in early tumor stages of CC, while HPV ctDNA was mainly positive at advanced tumor stages.
Collapse
Affiliation(s)
- Luisa Galati
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Nathalie Forey
- International Agency for Research on Cancer, Lyon, France
| | - Mathis Ratel
- International Agency for Research on Cancer, Lyon, France
| | - James McKay
- International Agency for Research on Cancer, Lyon, France
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gary Clifford
- International Agency for Research on Cancer, Lyon, France
| | | | - Tarik Gheit
- International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
14
|
Louredo BVR, Prado-Ribeiro AC, Brandão TB, Epstein JB, Migliorati CA, Piña AR, Kowalski LP, Vargas PA, Lopes MA, Santos-Silva AR. State-of-the-science concepts of HPV-related oropharyngeal squamous cell carcinoma: a comprehensive review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:190-205. [PMID: 35725962 DOI: 10.1016/j.oooo.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
High-risk (HR) human papillomavirus (HPV) infection is recognized as a primary etiologic factor of anogenital cancers and more recently of a subgroup of oropharyngeal squamous cell carcinomas (OPSCC). The incidence of HPV-related OPSCC has increased dramatically in several developed countries in the past 3 decades and is currently the most common cancer caused by HR-HPV in the United States and Germany, surpassing cervical cancer. Consequently, the patient's demographic and clinicopathologic profile has shifted to nonsmoking and nondrinking younger men with higher schooling level and with a history of multiple oral sex partners. Patients with HPV-related OPSCC often show better treatment outcomes and higher survival rates than their HPV-unrelated counterparts, which has led to a change in tumor staging for HPV-related cases. HPV vaccination is emerging as an effective primary prevention strategy, and systematic screening of HPV DNA in blood and salivary oral rinse samples of HR patients is being examined to determine if it may provide a surveillance method and support early diagnosis of HPV-related OPSCC. In this context, a narrative review was conducted to provide an overview of the state-of-the-art of HPV-related OPSCC, including epidemiology, risk factors, clinicopathologic and molecular features, screening, prevention, management, and prognosis.
Collapse
Affiliation(s)
| | - Ana Carolina Prado-Ribeiro
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil; Oral Medicine Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Joel B Epstein
- Department of Dentistry, Cedars-Sinai Health System, Los Angeles, California, USA; Department of Dentistry, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | | | | | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center (ACCCC), Sao Paulo, Brazil; Department of Head and Neck Surgery, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
| |
Collapse
|
15
|
Mentzer AJ, Brenner N, Allen N, Littlejohns TJ, Chong AY, Cortes A, Almond R, Hill M, Sheard S, McVean G, Collins R, Hill AVS, Waterboer T. Identification of host-pathogen-disease relationships using a scalable multiplex serology platform in UK Biobank. Nat Commun 2022; 13:1818. [PMID: 35383168 PMCID: PMC8983701 DOI: 10.1038/s41467-022-29307-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/04/2022] [Indexed: 12/12/2022] Open
Abstract
Certain infectious agents are recognised causes of cancer and other chronic diseases. To understand the pathological mechanisms underlying such relationships, here we design a Multiplex Serology platform to measure quantitative antibody responses against 45 antigens from 20 infectious agents including human herpes, hepatitis, polyoma, papilloma, and retroviruses, as well as Chlamydia trachomatis, Helicobacter pylori and Toxoplasma gondii, then assayed a random subset of 9695 UK Biobank participants. We find seroprevalence estimates consistent with those expected from prior literature and confirm multiple associations of antibody responses with sociodemographic characteristics (e.g., lifetime sexual partners with C. trachomatis), HLA genetic variants (rs6927022 with Epstein-Barr virus (EBV) EBNA1 antibodies) and disease outcomes (human papillomavirus-16 seropositivity with cervical intraepithelial neoplasia, and EBV responses with multiple sclerosis). Our accessible dataset is one of the largest incorporating diverse infectious agents in a prospective UK cohort offering opportunities to improve our understanding of host-pathogen-disease relationships with significant clinical and public health implications.
Collapse
Affiliation(s)
- Alexander J. Mentzer
- grid.4991.50000 0004 1936 8948The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Nicole Brenner
- grid.7497.d0000 0004 0492 0584Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Naomi Allen
- grid.4991.50000 0004 1936 8948Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK ,grid.421945.f0000 0004 0396 0496UK Biobank, Stockport, UK ,grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Thomas J. Littlejohns
- grid.4991.50000 0004 1936 8948Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amanda Y. Chong
- grid.4991.50000 0004 1936 8948The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Adrian Cortes
- grid.4991.50000 0004 1936 8948Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Rachael Almond
- grid.421945.f0000 0004 0396 0496UK Biobank, Stockport, UK
| | - Michael Hill
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948MRC-Population Health Research Unit, University of Oxford, Oxford, UK
| | - Simon Sheard
- grid.421945.f0000 0004 0396 0496UK Biobank, Stockport, UK
| | - Gil McVean
- grid.4991.50000 0004 1936 8948Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | - Rory Collins
- grid.421945.f0000 0004 0396 0496UK Biobank, Stockport, UK ,grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Adrian V. S. Hill
- grid.4991.50000 0004 1936 8948The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948The Jenner Institute, University of Oxford, Oxford, UK
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|
16
|
Singini MG, Singh E, Bradshaw D, Chen WC, Motlhale M, Kamiza AB, de Villiers CB, Muchengeti M, Mathew CG, Newton R, Bender N, Waterboer T, Sitas F. HPV types 16/18 L1 E6 and E7 proteins seropositivity and cervical cancer risk in HIV-positive and HIV-negative black South African women. Infect Agent Cancer 2022; 17:14. [PMID: 35351184 PMCID: PMC8966297 DOI: 10.1186/s13027-022-00418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background In populations with high rates of human immunodeficiency virus (HIV)-coinfection, the nature of the relationship between human papillomavirus (HPV)-16 and -18 (L1, E6 and E7) antibodies and cervical cancer is still uncertain. We measured the association between seropositivity to HPV (L1, E6 and E7) proteins and cervical cancer among black South African women with and without HIV co-infection. Methods We used questionnaire data and serum collected from consecutively recruited patients with a newly diagnosed cancer from the Johannesburg Cancer Study from 1346 cervical cancer cases and 2532 controls (diagnosed with other non-infection related cancers). Seropositivity to HPV proteins was measured using a multiplex serological assay based on recombinant glutathione S-transferase (GST) fusion proteins. We measured associations between their presence and cervical cancer using unconditional logistic regression models and evaluated the sensitivity and specificity of these HPV biomarkers. Results Among controls, HIV-negative women from rural areas compared to urban had significantly higher HPV seroprevalence, HPV16 E7 (8.6% vs 3.7%) and HPV18 E7 (7.9% vs 2.0%). HPV16 E6 and E7 antibodies were positively associated with cervical cancer in HIV-positive (Adjusted Odds Ratio (AOR) = 33; 95% CI 10–107) and HIV-negative women (AOR = 97; 95% CI 46–203). In HIV-positive women, HPV E6/E7 antibodies had low sensitivity (43.0%) and high specificity (90.6%) for cervical cancer detection. In HIV-negative women, HPV E6/E7 antibodies sensitivity was 70.6% and specificity was 89.7%. Conclusions Our data show that HPV (L1, especially E6 and E7) antibody positivity is associated with cervical cancer in both HIV-positive and HIV-negative women. Nonetheless, being HIV-positive plays an important role in the development of cervical cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-022-00418-2.
Collapse
|
17
|
Gormley M, Dudding T, Kachuri L, Burrows K, Chong AHW, Martin RM, Thomas SJ, Tyrrell J, Ness AR, Brennan P, Munafò MR, Pring M, Boccia S, Olshan AF, Diergaarde B, Hung RJ, Liu G, Tajara EH, Severino P, Toporcov TN, Lacko M, Waterboer T, Brenner N, Smith GD, Vincent EE, Richmond RC. Investigating the effect of sexual behaviour on oropharyngeal cancer risk: a methodological assessment of Mendelian randomization. BMC Med 2022; 20:40. [PMID: 35094705 PMCID: PMC8802428 DOI: 10.1186/s12916-022-02233-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papilloma virus infection is known to influence oropharyngeal cancer (OPC) risk, likely via sexual transmission. However, sexual behaviour has been correlated with other risk factors including smoking and alcohol, meaning independent effects are difficult to establish. We aimed to evaluate the causal effect of sexual behaviour on the risk of OPC using Mendelian randomization (MR). METHODS Genetic variants robustly associated with age at first sex (AFS) and the number of sexual partners (NSP) were used to perform both univariable and multivariable MR analyses with summary data on 2641 OPC cases and 6585 controls, obtained from the largest available genome-wide association studies (GWAS). Given the potential for genetic pleiotropy, we performed a number of sensitivity analyses: (i) MR methods to account for horizontal pleiotropy, (ii) MR of sexual behaviours on positive (cervical cancer and seropositivity for Chlamydia trachomatis) and negative control outcomes (lung and oral cancer), (iii) Causal Analysis Using Summary Effect estimates (CAUSE), to account for correlated and uncorrelated horizontal pleiotropic effects, (iv) multivariable MR analysis to account for the effects of smoking, alcohol, risk tolerance and educational attainment. RESULTS In univariable MR, we found evidence supportive of an effect of both later AFS (IVW OR = 0.4, 95%CI (0.3, 0.7), per standard deviation (SD), p = < 0.001) and increasing NSP (IVW OR = 2.2, 95%CI (1.3, 3.8) per SD, p = < 0.001) on OPC risk. These effects were largely robust to sensitivity analyses accounting for horizontal pleiotropy. However, negative control analysis suggested potential violation of the core MR assumptions and subsequent CAUSE analysis implicated pleiotropy of the genetic instruments used to proxy sexual behaviours. Finally, there was some attenuation of the univariable MR results in the multivariable models (AFS IVW OR = 0.7, 95%CI (0.4, 1.2), p = 0.21; NSP IVW OR = 0.9, 95%CI (0.5 1.7), p = 0.76). CONCLUSIONS Despite using genetic variants strongly related sexual behaviour traits in large-scale GWAS, we found evidence for correlated pleiotropy. This emphasizes a need for multivariable approaches and the triangulation of evidence when performing MR of complex behavioural traits.
Collapse
Affiliation(s)
- Mark Gormley
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- Bristol Dental Hospital and School, University of Bristol, Bristol, UK.
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Tom Dudding
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Dental Hospital and School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Linda Kachuri
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, USA
| | - Kimberley Burrows
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda H W Chong
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard M Martin
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Steven J Thomas
- Bristol Dental Hospital and School, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Jessica Tyrrell
- University of Exeter Medical School, RILD Building, RD&E Hospital, Exeter, UK
| | - Andrew R Ness
- University Hospitals Bristol and Weston NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Paul Brennan
- Genetic Epidemiology Group, World Health Organization, International Agency for Research on Cancer, Lyon, France
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Miranda Pring
- Bristol Dental Hospital and School, University of Bristol, Bristol, UK
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Brenda Diergaarde
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, and UPMC Hillman Cancer Center, Pittsburgh, USA
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Princess Margaret Cancer Centre, Toronto, Canada
| | - Eloiza H Tajara
- Department of Molecular Biology, School of Medicine of São José do Rio Preto, São Paulo, Brazil
| | - Patricia Severino
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Tatiana N Toporcov
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Martin Lacko
- Department of Otorhinolaryngology and Head and Neck Surgery, Research Institute GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Nicole Brenner
- Infections and Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma E Vincent
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
18
|
Ferreiro-Iglesias A, McKay JD, Brenner N, Virani S, Lesseur C, Gaborieau V, Ness AR, Hung RJ, Liu G, Diergaarde B, Olshan AF, Hayes N, Weissler MC, Schroeder L, Bender N, Pawlita M, Thomas S, Pring M, Dudding T, Kanterewicz B, Ferris R, Thomas S, Brhane Y, Díez-Obrero V, Milojevic M, Smith-Byrne K, Mariosa D, Johansson MJ, Herrero R, Boccia S, Cadoni G, Lacko M, Holcátová I, Ahrens W, Lagiou P, Lagiou A, Polesel J, Simonato L, Merletti F, Healy CM, Hansen BT, Nygård M, Conway DI, Wright S, Macfarlane TV, Robinson M, Alemany L, Agudo A, Znaor A, Amos CI, Waterboer T, Brennan P. Germline determinants of humoral immune response to HPV-16 protect against oropharyngeal cancer. Nat Commun 2021; 12:5945. [PMID: 34642315 PMCID: PMC8511029 DOI: 10.1038/s41467-021-26151-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/13/2021] [Indexed: 12/03/2022] Open
Abstract
Although several oropharyngeal cancer (OPC) susceptibility loci have been identified, most previous studies lacked detailed information on human papillomavirus (HPV) status. We conduct a genome-wide analysis by HPV16 serology status in 4,002 oral cancer cases (OPC and oral cavity cancer (OCC)) and 5,256 controls. We detect four susceptibility loci pointing to a distinct genetic predisposition by HPV status. Our most notable finding in the HLA region, that is now confirmed to be specific of HPV(+)OPC risk, reveal two independent loci with strong protective effects, one refining the previously reported HLA class II haplotype association. Antibody levels against HPV16 viral proteins strongly implicate the protective HLA variants as major determinants of humoral response against L1 capsid protein or E6 oncoprotein suggesting a natural immune response against HPV(+)OPC promoted by HLA variants. This indicates that therapeutic vaccines that target E6 and attenuate viral response after established HPV infections might protect against HPV(+)OPC.
Collapse
Affiliation(s)
- Aida Ferreiro-Iglesias
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - James D McKay
- Section of Genetics, Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Nicole Brenner
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Shama Virani
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Corina Lesseur
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valerie Gaborieau
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Andy R Ness
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Geoffrey Liu
- Lunenfeld-Tanenbaum Research Institute of Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Brenda Diergaarde
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neil Hayes
- Division of Medical Oncology and Center for Cancer Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA
| | - Lea Schroeder
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Noemi Bender
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Pawlita
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steve Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Tom Dudding
- Bristol Dental School, University of Bristol, Bristol, UK
| | | | | | - Sera Thomas
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Yonathan Brhane
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Virginia Díez-Obrero
- Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - Maja Milojevic
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Karl Smith-Byrne
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Daniela Mariosa
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mattias J Johansson
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Rolando Herrero
- Section of Early Detection and Prevention, Prevention and Implementation Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - Gabriella Cadoni
- Department of Head and Neck Surgery, Institute of Clinical Otorhinolaryngology, Università Cattolica del Sacro Cuore, Roma, Italy
- Istituto di Clinica Otorinolaringoiatrica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - Martin Lacko
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ivana Holcátová
- Institute of Hygiene and Epidemiology, Prague, Czech Republic
| | | | - Pagona Lagiou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Areti Lagiou
- School of Public Health, University of West Attica, Athens, Greece
| | | | | | | | - Claire M Healy
- Trinity College School of Dental Science, Dublin, Ireland
| | | | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Sylvia Wright
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle, UK
| | - Laia Alemany
- Catalan Institute of Oncology/IDIBELL, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública-CIBERESP, Madrid, Spain
| | - Antonio Agudo
- Catalan Institute of Oncology/IDIBELL, Barcelona, Spain
| | - Ariana Znaor
- Cancer Surveillance Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paul Brennan
- Section of Genetics, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France.
| |
Collapse
|
19
|
Sensitivity and Specificity of Human Papillomavirus (HPV) 16 Early Antigen Serology for HPV-Driven Oropharyngeal Cancer: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13123010. [PMID: 34208476 PMCID: PMC8234521 DOI: 10.3390/cancers13123010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Serum antibodies against human papillomavirus 16 (HPV16) proteins are associated with HPV-driven oropharyngeal cancer (HPV-OPC). The HPV status of OPC cases is clinically relevant because patients with HPV-OPC show improved survival and treatment response compared to tobacco- or alcohol-induced OPC. In clinical settings, molecular HPV tumor status is usually determined by tissue-based methods detecting molecular markers, such as viral nucleic acids or p16 overexpression. Antibodies against HPV16 in peripheral blood were shown to be very accurate in determining the molecular HPV tumor status in multiple studies. In this work, we reviewed and summarized the available literature on the performance of HPV16 serology for E2, E6 and E7 antibodies to determine molecular HPV tumor status in OPC cases in comparison with tissue-based reference methods. We calculated summary estimates across different studies for sensitivity and specificity, and we investigated factors influencing test performance. Abstract Antibodies against HPV16 early proteins have been shown to be promising biomarkers for the identification of HPV-driven oropharyngeal cancer (HPV-OPC) among OPC cases in multiple studies. A systematic literature search was performed to identify original research articles comparing HPV early antigen serology with established reference methods to determine molecular HPV tumor status. Random-effects models were used to calculate summary estimates for sensitivity and specificity of HPV16 E2, E6 and E7 serology for HPV-OPC. Subgroup analyses were performed to explore heterogeneity across studies and describe variables associated with test performance. We identified n = 23 studies meeting all eligibility criteria and included these in the meta-analysis. E6 serology showed the best performance with pooled sensitivity and specificity estimates of 83.1% (95% confidence interval (CI) 72.5–90.2%) and 94.6% (95% CI 89.0–97.4%), respectively, while E2 and E7 serological assays were highly specific (E2: 92.5% (95% CI 79.1–97.6%); E7: 88.5% (95% CI 77.9–94.4%)) but moderately sensitive (E2: 67.8% (95% CI 58.9–75.6%); E7: 67.0% (95% CI 63.2–70.6%)). Subgroup analyses revealed increased pooled sensitivity for bacterially (89.9% (95% CI 84.5–93.6%)) vs. in vitro expressed E6 antigen (55.3% (95% CI 41.0–68.7%)), while both showed high specificity (95.2% (95% CI 93.0–96.7%) and 91.1% (95% CI 46.6–99.2%), respectively). Pooled specificity estimates for HPV16 E2, E6 and E7 serology were significantly lower in studies utilizing HPV DNA PCR as the only molecular reference method compared to those using a combination of any two reference methods (HPV DNA, RNA, in situ hybridization (ISH), p16 immunohistochemistry (IHC)), or histopathological reference methods (ISH or p16 IHC) as stand-alone marker. In conclusion, HPV16 E6 seropositivity is a highly sensitive and specific biomarker for HPV-OPC. However, its performance differs between serological assays and depends on molecular reference methods.
Collapse
|
20
|
Landy R, Chaturvedi AK. HPV16 E6 seropositivity and oropharyngeal cancer: Marker of exposure, risk, or disease? EBioMedicine 2021; 63:103190. [PMID: 33418506 PMCID: PMC7804595 DOI: 10.1016/j.ebiom.2020.103190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rebecca Landy
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 6-E238, Rockville, MD 20850, United States
| | - Anil K Chaturvedi
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm. 6-E238, Rockville, MD 20850, United States.
| |
Collapse
|