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Geris JM, Amirian ES, Marquez-Do DA, Guillaud M, Dillon LM, Follen M, Scheurer ME. Polymorphisms in the Nonhomologous End-joining DNA Repair Pathway are Associated with HPV Integration in Cervical Dysplasia. Cancer Prev Res (Phila) 2023; 16:461-469. [PMID: 37217238 PMCID: PMC10524768 DOI: 10.1158/1940-6207.capr-23-0051] [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: 02/09/2023] [Revised: 03/06/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023]
Abstract
Previous evidence indicates that human papillomavirus (HPV) integration status may be associated with cervical cancer development and progression. However, host genetic variation within genes that may play important roles in the viral integration process is understudied. The aim of this study was to examine the association between HPV16 and HPV18 viral integration status and SNPs in nonhomologous-end-joining (NHEJ) DNA repair pathway genes on cervical dysplasia. Women enrolled in two large trials of optical technologies for cervical cancer detection and positive for HPV16 or HPV18 were selected for HPV integration analysis and genotyping. Associations between SNPs and cytology (normal, low-grade, or high-grade lesions) were evaluated. Among women with cervical dysplasia, polytomous logistic regression models were used to evaluate the effect of each SNP on viral integration status. Of the 710 women evaluated [149 high-grade squamous intraepithelial lesion (HSIL), 251; low-grade squamous intraepithelial lesion (LSIL, 310 normal)], 395 (55.6%) were positive for HPV16 and 192 (27%) were positive for HPV18. Tag-SNPs in 13 DNA repair genes, including RAD50, WRN, and XRCC4, were significantly associated with cervical dysplasia. HPV16 integration status was differential across cervical cytology, but overall, most participants had a mix of both episomal and integrated HPV16. Four tag-SNPs in the XRCC4 gene were found to be significantly associated with HPV16 integration status. Our findings indicate that host genetic variation in NHEJ DNA repair pathway genes, specifically XRCC4, are significantly associated with HPV integration, and that these genes may play an important role in determining cervical cancer development and progression. PREVENTION RELEVANCE HPV integration in premalignant lesions and is thought to be an important driver of carcinogenesis. However, it is unclear what factors promote integration. The use of targeted genotyping among women presenting with cervical dysplasia has the potential to be an effective tool in assessing the likelihood of progression to cancer.
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Affiliation(s)
- Jennifer M Geris
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - E Susan Amirian
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Martial Guillaud
- Department of Cancer Imaging, British Columbia Cancer Research Centre, Vancouver, British Columbia
| | - Laura M Dillon
- Department of Diagnostic and Biomedical Sciences, UTHealth School of Dentistry, Houston, Texas
| | | | - Michael E Scheurer
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Racial/ethnic differences in HPV 16/18 genotypes and integration status among women with a history of cytological abnormalities. Gynecol Oncol 2017; 148:357-362. [PMID: 29276057 DOI: 10.1016/j.ygyno.2017.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE HPV genotype distribution varies by race/ethnicity, but is unclear whether there are racial/ethnic variations in HPV 16/18 integration in the host genome. We describe HPV16/18 infection and integration status in a racially/ethnically diverse sample of women with a recent abnormal Pap test. METHODS Patients (n=640) represent a subset of women participating in a clinical trial. Cervical swabs were tested for HPV16/18 DNA using type-specific polymerase chain reaction assays. Viral integration status was assessed using type-specific integration assays and categorized as fully integrated, fully non-integrated, or mixed. Unconditional logistic regression was used to generate unadjusted (OR) and adjusted odds ratios (aOR) to assess the association between self-reported race/ethnicity and risk of these outcomes. RESULTS Hispanic and non-Hispanic black women had half the odds of prevalent HPV16 compared to non-Hispanic white women (aORs: 0.43 and 0.45, respectively). The prevalence odds of HPV18 was less than half among Hispanic women (aOR: 0.48), but not significantly different between black and white women (aOR: 0.72). Among women with prevalent HPV16, the odds of fully integrated viral DNA were significantly higher among black women (aORs: 2.78) and marginally higher among Hispanic women (aOR: 1.93). No racial/ethnic differences were observed for HPV18 DNA integration. CONCLUSIONS While HPV16 and 18 infections were less prevalent among Hispanic and black women compared to whites, their HPV16 DNA was more likely to be present in a fully integrated state. This could potentially contribute to the higher rates of abnormal cytology and cervical dysplasia observed among Hispanic and black women.
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Scheurer ME, Danysh HE, Follen M, Lupo PJ. Association of traffic-related hazardous air pollutants and cervical dysplasia in an urban multiethnic population: a cross-sectional study. Environ Health 2014; 13:52. [PMID: 24924773 PMCID: PMC4063240 DOI: 10.1186/1476-069x-13-52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/10/2014] [Indexed: 05/21/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) infection is a necessary cause in the development of cervical cancer; however, not all women infected with HPV develop cervical cancer indicating that other risk factors are involved. Our objective was to determine the association between exposure to ambient levels of common traffic-related air toxics and cervical dysplasia, a precursor lesion for cervical cancer. METHODS The study sample consisted of women enrolled in a Phase II clinical trial to evaluate diagnostic techniques for cervical disease in Houston, Texas. The current assessment is a secondary data analysis in which cases were defined as women diagnosed with cervical dysplasia, while those without cervical dysplasia served as controls. Residential census tract-level estimates of ambient benzene, diesel particulate matter (DPM), and polycyclic aromatic hydrocarbons (PAHs) were used to assess exposure. Census tract-level pollutant estimates were obtained from the United States Environmental Protection Agency. Multivariable logistic regression was used to estimate prevalence odds ratios (aOR) and 95% confidence intervals (CI) adjusted for age, race/ethnicity, education, smoking status, and HPV status. RESULTS Women in the highest residential exposure categories for benzene and DPM had an increased prevalence of cervical dysplasia compared to the lowest exposure category (Benzene: aOR [95% CI] for high exposure = 1.97[1.07-3.62], very high exposure = 2.30[1.19-4.46]. DPM: aOR [95% CI] for high exposure = 2.83[1.55-5.16], very high exposure = 2.10[1.07-4.11]). Similarly, women with high residential exposure to PAHs had an increased prevalence of cervical dysplasia (aOR [95% CI] = 2.46[1.35-4.48]). The highest PAH exposure category was also positively associated with cervical dysplasia prevalence but was not statistically significant. Assessment of the combined effect of HAP exposure indicates that exposure to high levels of more than one HAP is positively associated with cervical dysplasia prevalence (p for trend = 0.004). CONCLUSIONS Traffic-related HAPs, such as benzene, DPM, and PAHs, are not as well-regulated and monitored as criteria air pollutants (e.g., ozone), underscoring the need for studies evaluating the role of these toxicants on disease risk. Our results suggest that exposure to traffic-related air toxics may increase cervical dysplasia prevalence.
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Affiliation(s)
- Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Heather E Danysh
- Department of Pediatrics, Section of Hematology-Oncology and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Michele Follen
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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Whitehouse KC, Montealegre JR, Follen M, Scheurer ME, Aagaard K. Sociodemographic factors associated with pap test adherence and cervical dysplasia in surgically sterilized women. J Reprod Infertil 2014; 15:94-104. [PMID: 24918082 PMCID: PMC4032975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/11/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Routine dysplasia screening decreases the rates of cervical cancer. Since many women seek gynecological care to secure contraception, it was hypothesized that sterilized women will be less likely to undergo routine cervical cancer screening. Prior studies tried to evaluate this relationship, but results were conflicting. The study sought to further explore the sociodemographic and behavioral risk factors that might predispose sterilized women to be screening non-adherent and more likely to have cervical dysplasia. METHODS Secondary analysis of women (n=1688) enrolled in a cross-sectional study in North America and divided into screening (n=925) and diagnostic (n=763) groups was performed. Information about sociodemographic and behavioral risk factors, surgical sterilization and date of last Pap test were obtained from questionnaires. Cervical histology was obtained from pathology records. Univariable analyses identified differences in risk factors between groups. Multivariable logistic regression models were constructed to evaluate Pap adherence and cervical dysplasia. RESULTS Sterilized women were 39% more likely to be screening non-adherent (p≤0.05) especially if divorced, separated or widowed (OR=1.62), Hispanic (OR=1.57) and with a higher number of vaginal births (OR=2.00). Education was an effect measure modifier, significantly associated with non-adherence (OR=1.60). The association between sterilization and non-adherence remained significant when adjusted for confounders (AOR=1.47). Sterilization was associated with an 80% increased odds of cervical dysplasia in women over 40. CONCLUSION Sterilized women with certain sociodemographic factors are more likely to be non-adherent with Pap screening and more prone to dysplasia. These findings may assist practitioners in counseling at-risk patients.
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Affiliation(s)
- Katherine C. Whitehouse
- Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, Texas, USA
| | - Jane R. Montealegre
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA,Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA
| | - Michele Follen
- Department of Obstetrics and Gynecology School of Medicine, Philadelphia, Pennsylvania,Center for Women's Health Research Drexel University, School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael E. Scheurer
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA,Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Kjersti Aagaard
- Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, Texas, USA,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA,Corresponding Author: Kjersti M. Aagaard, Baylor College of Medicine 1 Baylor Plaza, Jones 314 Houston, TX, 77030. E-mail:
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Cantor SB, Yamal JM, Guillaud M, Cox DD, Atkinson EN, Benedet JL, Miller D, Ehlen T, Matisic J, van Niekerk D, Bertrand M, Milbourne A, Rhodes H, Malpica A, Staerkel G, Nader-Eftekhari S, Adler-Storthz K, Scheurer ME, Basen-Engquist K, Shinn E, West LA, Vlastos AT, Tao X, Beck JR, MacAulay C, Follen M. Accuracy of optical spectroscopy for the detection of cervical intraepithelial neoplasia: Testing a device as an adjunct to colposcopy. Int J Cancer 2011; 128:1151-68. [PMID: 20830707 PMCID: PMC3015005 DOI: 10.1002/ijc.25667] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 07/12/2010] [Indexed: 12/11/2022]
Abstract
Testing emerging technologies involves the evaluation of biologic plausibility, technical efficacy, clinical effectiveness, patient satisfaction, and cost-effectiveness. The objective of this study was to select an effective classification algorithm for optical spectroscopy as an adjunct to colposcopy and obtain preliminary estimates of its accuracy for the detection of CIN 2 or worse. We recruited 1,000 patients from screening and prevention clinics and 850 patients from colposcopy clinics at two comprehensive cancer centers and a community hospital. Optical spectroscopy was performed, and 4,864 biopsies were obtained from the sites measured, including abnormal and normal colposcopic areas. The gold standard was the histologic report of biopsies, read 2 to 3 times by histopathologists blinded to the cytologic, histopathologic, and spectroscopic results. We calculated sensitivities, specificities, receiver operating characteristic (ROC) curves, and areas under the ROC curves. We identified a cutpoint for an algorithm based on optical spectroscopy that yielded an estimated sensitivity of 1.00 [95% confidence interval (CI) = 0.92-1.00] and an estimated specificity of 0.71 [95% CI = 0.62-0.79] in a combined screening and diagnostic population. The positive and negative predictive values were 0.58 and 1.00, respectively. The area under the ROC curve was 0.85 (95% CI = 0.81-0.89). The per-patient and per-site performance were similar in the diagnostic and poorer in the screening settings. Like colposcopy, the device performs best in a diagnostic population. Alternative statistical approaches demonstrate that the analysis is robust and that spectroscopy works as well as or slightly better than colposcopy for the detection of CIN 2 to cancer.
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Affiliation(s)
- Scott B. Cantor
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose-Miguel Yamal
- Division of Biostatistics, The University of Texas School of Public Health, Houston, Texas
| | - Martial Guillaud
- Department of Cancer Imaging, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Dennis D. Cox
- Department of Statistics, Rice University, Houston, Texas
| | - E. Neely Atkinson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J. L. Benedet
- Department of Cancer Imaging, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Dianne Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Ehlen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasenka Matisic
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monique Bertrand
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Milbourne
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Helen Rhodes
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anais Malpica
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregg Staerkel
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shahla Nader-Eftekhari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Karen Adler-Storthz
- The University of Texas Health Science Center at Houston Dental Branch, Houston, Texas
| | - Michael E. Scheurer
- Department of Pediatrics and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eileen Shinn
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loyd A. West
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anne-Therese Vlastos
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xia Tao
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Calum MacAulay
- Department of Cancer Imaging, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Michele Follen
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, the Lyndon Baines Johnson Hospital, Houston, Texas
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