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Makioka D, Inada M, Awano M, Saito E, Shinoda T, Abe S, Yoshimura T, Müller M, Sasagawa T, Ito E. Quantification of HPV16 E7 Oncoproteins in Urine Specimens from Women with Cervical Intraepithelial Neoplasia. Microorganisms 2024; 12:1205. [PMID: 38930587 PMCID: PMC11205804 DOI: 10.3390/microorganisms12061205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
We present the validity of using an ultrasensitive enzyme-linked immunosorbent assay (ELISA) for quantifying high-risk human papillomavirus (HPV) 16 E7 oncoproteins in urine specimens as a noninvasive method of analyzing the oncogenic activity of HPV. Some reports claim that the oncogenic activity of HPV is a more relevant clinical indicator than the presence of HPV DNA for estimating malignant potential. In the present study, urine containing HPV16 and related types were selected by uniplex E6/E7 polymerase chain reaction and classified according to the pathologic diagnosis of cervical intraepithelial neoplasia (CIN) in cervical biopsy specimens. Our ultrasensitive ELISA was able to detect attomole levels of HPV16 E7 oncoproteins, and it detected HPV16-positive SiHa cells at >500 cells/mL without detecting HPV18-positive cells. Our ELISA results showed E7 oncoproteins in 80% (4/5) of urine specimens from women with HPV16-positive CIN1, 71% (5/7) of urine specimens from CIN2 patients, and 38% (3/8) of urine specimens from CIN3 patients. Some urine specimens with undetectable E7 oncoproteins were thought to be negative for live HPV 16-positive cells or in an inactivated state of infection. These results provide the basis for assessing oncogenic activity by quantifying E7 oncoproteins in patient urine.
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Affiliation(s)
- Daiki Makioka
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Mikio Inada
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Masayuki Awano
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Ema Saito
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Takuya Shinoda
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Satoko Abe
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
| | - Teruki Yoshimura
- School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Tobetsu 061-0293, Hokkaido, Japan;
| | - Martin Müller
- Tumorvirus-Specific Vaccination Strategies, Deutsche Krebsforschungszentrum (DKFZ), 69120 Heidelberg, Germany;
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada 920-0293, Ishikawa, Japan
| | - Etsuro Ito
- Department of Biology, Waseda University, Shinjuku, Tokyo 162-8480, Japan; (D.M.); (M.I.); (M.A.); (E.S.); (T.S.); (S.A.)
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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2
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Girdhar N, Sharma D, Kumar R, Sahu M, Lin CC. Emerging trends in biomedical trait-based human identification: A bibliometric analysis. SLAS Technol 2024; 29:100136. [PMID: 38677477 DOI: 10.1016/j.slast.2024.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
Personal human identification is a crucial aspect of modern society with applications spanning from law enforcement to healthcare and digital security. This bibliometric paper presents a comprehensive analysis of recent advances in personal human identification methodologies focusing on biomedical traits. The paper examines a diverse range of research articles, reviews, and patents published over the last decade to provide insights into the evolving landscape of biometric identification techniques. The study categorizes the identified literature into distinct biomedical trait categories, including but not limited to, fingerprint and palmprint recognition, iris and retinal scanning, facial recognition, voice and speech analysis, gait recognition, and DNA-based identification. Through systematic analysis, the paper highlights key trends, emerging technologies, and interdisciplinary collaborations in each category, revealing the interdisciplinary nature of research in this field. Furthermore, the bibliometric analysis examines the geographical distribution of research efforts, identifying prominent countries and institutions contributing to advancements in personal human identification. Collaboration networks among researchers and institutions are visualized to depict the knowledge flow and collaborative dynamics within the field. Overall, this study serves as a valuable reference for researchers, practitioners, and policymakers, shedding light on the current status and potential future directions of personal human identification leveraging biomedical traits.
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Affiliation(s)
- Nancy Girdhar
- L3i, University of La Rochelle, La Rochelle, 17000, France.
| | - Deepak Sharma
- Department of Computer Science, Christian-Albrechts-University zu Kiel, Kiel, 24118, Germany.
| | - Rajeev Kumar
- Blockchain Technology Research Lab, Department of Computer Science and Engineering, Delhi Technological University, New Delhi, 110042, India.
| | - Monalisa Sahu
- Amrita School of Computing, Amrita Vishwa Vidyapeetham, Amaravati, Andhra Pradesh, 522503, India.
| | - Chia-Chen Lin
- Department of Computer Science and Information Engineering, National Chin-Yi University of Technology, Taichung, 411030, Taiwan.
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3
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Galati L, Chiantore MV, Marinaro M, Di Bonito P. Human Oncogenic Viruses: Characteristics and Prevention Strategies-Lessons Learned from Human Papillomaviruses. Viruses 2024; 16:416. [PMID: 38543781 PMCID: PMC10974567 DOI: 10.3390/v16030416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 05/23/2024] Open
Abstract
Approximately 12% of human cancers worldwide are associated with infectious agents, which are classified by the International Agency for Research on Cancer (IARC) as Group 1 within the agents that are carcinogenic to humans. Most of these agents are viruses. Group 1 oncogenic viruses include hepatitis C virus, hepatitis B virus (HBV), human T-cell lymphotropic virus type 1, Epstein-Barr virus, Kaposi sarcoma-associated herpesvirus, human immunodeficiency virus-1 and high-risk human papillomaviruses (HPVs). In addition, some human polyomaviruses are suspected of inducing cancer prevalently in hosts with impaired immune responses. Merkel cell polyomavirus has been associated with Merkel cell carcinoma and included by the IARC in Group 2A (i.e., probably carcinogenic to humans). Linking viruses to human cancers has allowed for the development of diagnostic, prophylactic and therapeutic measures. Vaccination significantly reduced tumours induced by two oncogenic viruses as follows: HBV and HPV. Herein, we focus on mucosal alpha HPVs, which are responsible for the highest number of cancer cases due to tumour viruses and against which effective prevention strategies have been developed to reduce the global burden of HPV-related cancers.
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Affiliation(s)
- Luisa Galati
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Maria Vincenza Chiantore
- Department of Infectious Diseases, Viral Hepatitis and Oncovirus and Retrovirus Diseases (EVOR) Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Mariarosaria Marinaro
- Department of Infectious Diseases, Microorganisms and Host Response: Research and Technological Innovation (MICROS) Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Paola Di Bonito
- Department of Infectious Diseases, Viral Hepatitis and Oncovirus and Retrovirus Diseases (EVOR) Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
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Wang X, Zhang H, Chen L, Xu J, Qu P. A novel method for colposcopic shunting in HPV-positive women: Quantitative detection of HPV E7 oncoprotein. Heliyon 2024; 10:e25238. [PMID: 38420415 PMCID: PMC10900405 DOI: 10.1016/j.heliyon.2024.e25238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
The objective of the study was to evaluate the clinical application potential of quantitatively detecting human papillomavirus (HPV) E7 oncoprotein in HPV-positive women, with the goal of detecting potential high-grade cervical squamous intraepithelial lesions (HSIL) and cervical cancer improving the accuracy of colposcopic shunting in these patients.HPV-positive women (N = 611) were selected for quantitatively detecting HPV E7 protein levels by magnetic particle-based chemiluminescence immunoassay before colposcopy. Receiver operating characteristic (ROC) curve analysis was performed (n = 400) to determine diagnostic detection thresholds for HPV E7 oncoprotein. ThinPrep cytology test (TCT) and Aptima HPV E6/E7 mRNA analysis were also performed (n = 211). The diagnostic performance of these three diagnostic methods in detecting HSIL and cervical cancer was compared with the gold standard of pathological diagnosis. The area under the ROC curve was 0.724. The diagnostic detection threshold of HPV E7 oncoprotein was ≥10.88 ng/mL. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and Youden index of HPV E7 oncoprotein for the identification of HSIL and cervical cancer were 78.7 %, 77.9 %, 72.2 %, 83.3 %, and 56.6 %, respectively, which were higher than those of TCT and HPV E6/E7 mRNA.The results indicate that quantitative detection of HPV E7 oncoprotein can effectively shunt HPV-positive women and reduce unnecessary colposcopy and biopsy. It can detect potential HSIL and cervical cancer in a timely manner and prevent high-risk patients from missing diagnosis.
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Affiliation(s)
- Xinmei Wang
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Hongyuan Zhang
- Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Leiyi Chen
- Department of Outpatient office, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Juan Xu
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300100, China
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Song Y, Zou J, Choi KS, Lei B, Qin J. Cell classification with worse-case boosting for intelligent cervical cancer screening. Med Image Anal 2024; 91:103014. [PMID: 37913578 DOI: 10.1016/j.media.2023.103014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
Cell classification underpins intelligent cervical cancer screening, a cytology examination that effectively decreases both the morbidity and mortality of cervical cancer. This task, however, is rather challenging, mainly due to the difficulty of collecting a training dataset representative sufficiently of the unseen test data, as there are wide variations of cells' appearance and shape at different cancerous statuses. This difficulty makes the classifier, though trained properly, often classify wrongly for cells that are underrepresented by the training dataset, eventually leading to a wrong screening result. To address it, we propose a new learning algorithm, called worse-case boosting, for classifiers effectively learning from under-representative datasets in cervical cell classification. The key idea is to learn more from worse-case data for which the classifier has a larger gradient norm compared to other training data, so these data are more likely to correspond to underrepresented data, by dynamically assigning them more training iterations and larger loss weights for boosting the generalizability of the classifier on underrepresented data. We achieve this idea by sampling worse-case data per the gradient norm information and then enhancing their loss values to update the classifier. We demonstrate the effectiveness of this new learning algorithm on two publicly available cervical cell classification datasets (the two largest ones to the best of our knowledge), and positive results (4% accuracy improvement) yield in the extensive experiments. The source codes are available at: https://github.com/YouyiSong/Worse-Case-Boosting.
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Affiliation(s)
- Youyi Song
- Center for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jing Zou
- Center for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kup-Sze Choi
- Center for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Baiying Lei
- Marshall Laboratory of Biomedical Engineering, School of Biomedical Engineering, Shenzhen University Medical School, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China.
| | - Jing Qin
- Center for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Jha AK, Mithun S, Sherkhane UB, Jaiswar V, Osong B, Purandare N, Kannan S, Prabhash K, Gupta S, Vanneste B, Rangarajan V, Dekker A, Wee L. Systematic review and meta-analysis of prediction models used in cervical cancer. Artif Intell Med 2023; 139:102549. [PMID: 37100501 DOI: 10.1016/j.artmed.2023.102549] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 11/18/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Cervical cancer is one of the most common cancers in women with an incidence of around 6.5 % of all the cancer in women worldwide. Early detection and adequate treatment according to staging improve the patient's life expectancy. Outcome prediction models might aid treatment decisions, but a systematic review on prediction models for cervical cancer patients is not available. DESIGN We performed a systematic review for prediction models in cervical cancer following PRISMA guidelines. Key features that were used for model training and validation, the endpoints were extracted from the article and data were analyzed. Selected articles were grouped based on prediction endpoints i.e. Group1: Overall survival, Group2: progression-free survival; Group3: recurrence or distant metastasis; Group4: treatment response; Group5: toxicity or quality of life. We developed a scoring system to evaluate the manuscript. As per our criteria, studies were divided into four groups based on scores obtained in our scoring system, the Most significant study (Score > 60 %); Significant study (60 % > Score > 50 %); Moderately Significant study (50 % > Score > 40 %); least significant study (score < 40 %). A meta-analysis was performed for all the groups separately. RESULTS The first line of search selected 1358 articles and finally 39 articles were selected as eligible for inclusion in the review. As per our assessment criteria, 16, 13 and 10 studies were found to be the most significant, significant and moderately significant respectively. The intra-group pooled correlation coefficient for Group1, Group2, Group3, Group4, and Group5 were 0.76 [0.72, 0.79], 0.80 [0.73, 0.86], 0.87 [0.83, 0.90], 0.85 [0.77, 0.90], 0.88 [0.85, 0.90] respectively. All the models were found to be good (prediction accuracy [c-index/AUC/R2] >0.7) in endpoint prediction. CONCLUSIONS Prediction models of cervical cancer toxicity, local or distant recurrence and survival prediction show promising results with reasonable prediction accuracy [c-index/AUC/R2 > 0.7]. These models should also be validated on external data and evaluated in prospective clinical studies.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Sneha Mithun
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Umeshkumar B Sherkhane
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vinay Jaiswar
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Biche Osong
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Homi Bhabha National Institute, Mumbai, Maharashtra, India; Advance Centre for Treatment, Research, Education in Cancer, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India; Advance Centre for Treatment, Research, Education in Cancer, Mumbai, Maharashtra, India
| | - Ben Vanneste
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Andre Dekker
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Leonard Wee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Singini MG, Singh E, Bradshaw D, Ramaliba T, Chen WC, Motlhale M, Kamiza AB, Babb de Villiers C, Muchengeti M, Mathew CG, Newton R, Bender N, Waterboer T, Sitas F. Usefulness of high-risk HPV early oncoprotein (E6 and E7) serological markers in the detection of cervical cancer: A systematic review and meta-analysis. J Med Virol 2023; 95:e27900. [PMID: 35641882 PMCID: PMC10952611 DOI: 10.1002/jmv.27900] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 01/11/2023]
Abstract
We reviewed the literature on the importance of selected anti-high-risk human papillomavirus (HR-HPV) antibodies (namely, 16/18 and early oncoproteins E6 and E7) as potential serological markers for early detection of individuals at high risk of cervical cancer. We searched for studies in PubMed and Embase databases published from 2010 to 2020 on antibodies against HR-HPV E6 and E7 early proteins and cervical cancer. Pooled sensitivity and specificity for HPV16 and HPV18 antibodies were calculated using a bivariate hierarchical random-effects model. A total of 69 articles were identified; we included three studies with 1550 participants. For the three HPV16/18 E6 and E7 antibody tests, enzyme-linked immunosorbent assay-based assays had a sensitivity of 18% for detecting CIN2+ (95% confidence interval [CI]: 15-21) and a specificity of 96% (95% CI: 92-98), for slot-blot, sensitivity was 28.9% (95% CI: 23.3-35.1) and specificity was 72% (95% CI: 66.6-77.0) for detecting CIN2+, and for multiplex HPV serology assay based on a glutathione S-transferase, sensitivity was 16% (95% CI: 8.45-28.6) and specificity was 98% (95% CI: 97-99) for detecting invasive cervical cancer. HR-HPV16/18 E6 and E7 serological markers showed high specificity, but sensitivity was suboptimal for the detection of cervical cancer in either population screening settings or as point-of-care screening tests.
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Affiliation(s)
- Mwiza Gideon Singini
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Elvira Singh
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Debbie Bradshaw
- Burden of Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Thendo Ramaliba
- Burden of Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Wenlong Carl Chen
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Melitah Motlhale
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Abram Bunya Kamiza
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Mazvita Muchengeti
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- South African DSI‐NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA)Stellenbosch UniversityStellenboschSouth Africa
| | - Christopher G. Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Medical and Molecular GeneticsFaculty of Life Sciences and Medicine, King's College LondonLondonUK
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research UnitEntebbeUganda
- University of YorkYorkUK
| | - Noemi Bender
- Division of Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Tim Waterboer
- Division of Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Freddy Sitas
- Burden of Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
- Centre for Primary Health Care and Equity, School of Population HealthUniversity of New South Wales SydneyNew South WalesSydneyAustralia
- Menzies Centre of Health Policy, School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
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Rosário A, Sousa A, Marinho-Dias J, Medeiros R, Lobo C, Leça L, Coimbra N, Tavares F, Baldaque I, Martins G, Monteiro P, Henrique R, Sousa H. Impact of high-risk Human Papillomavirus genotyping in cervical disease in the Northern region of Portugal: Real-world data from regional cervical cancer screening program. J Med Virol 2023; 95:e28414. [PMID: 36541747 DOI: 10.1002/jmv.28414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Cervical cancer prevention is based on primary prevention with vaccines against Human Papillomavirus (HPV) and secondary prevention by screening with High-Risk-HPV (Hr-HPV) detection. Since 2017, cervical cancer screening in women aged 25-60 years has been performed in Portugal using Hr-HPV detection, followed by cytology in Hr-HPV-positive cases. Herein we report the prevalence of Hr-HPV genotypes and cytological abnormalities among 462 401 women (mean age: 43.73 ± 10.79; median age: 45; range: 24-66 years) that participated in the Regional Cervical Cancer Screening Program of the Northern Region of Portugal, performed between August 2016 and December 2021. Overall, we describe a prevalence rate of 12.50% for Hr-HPV varying from 20.76% at age 25% to 8.32% at age 64. The five most common Hr-HPV genotypes identified were HPV-68 (16.09%), HPV-31 (15.30%), HPV-51 (12.96%), HPV-16 (11.06%), and HPV-39 (11.01%). The prevalence of Hr-HPV included in the nonavalent vaccine (HPV-9valent) was 55.00% ranging from 47.78% to 59.18% across different age groups. Considering positive Hr-HPV cases, 65.68% had a Negative for Intraepithelial Lesion or Malignancy (NILM) cytology, 20.83% atypical squamous cells of undetermined significance (ASC-US), 8.85% Low-Grade Squamous Intraepithelial Lesion (LSIL), 1.65% High-Grade Squamous Intraepithelial Lesion (HSIL), 2.85% ASC-H, 0.09% Atypical Glandular Cells, 0.02% Adenocarcinomas, and 0.02% Squamous Cell Carcinoma (SCC). Our analysis revealed that HPV-9val genotypes were responsible for 52.13% NILM, 59.21% ASC-US, 55.06% LSIL, 90.14% HSIL, 83.50% ASC-H, and 100.00% SCC. Furthermore, multiple Hr-HPV infections (risk ratio [RR] = 1.46; 95% confidence interval [CI] 1.34-1.58), HPV-16/18 (RR = 5.16; 95% CI 4.75-5.93), or HPV-9val genotypes (RR = 5.23; 95% CI 4.68-5.85) were associated with a significant risk of developing > HSIL (p < 0.001). To date, this is the largest study on Hr-HPV genotyping in cervical cancer screening that includes data from a complete cycle of the screening program. Our findings suggest a high prevalence of HPV-9valent genotypes and a significant association with an increased risk of developing > HSIL. This constitutes important data for health authorities, which may help define the future of vaccination and cervical cancer screening strategies.
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Affiliation(s)
- Andreia Rosário
- Molecular Oncology & Viral Pathology Group, Research Center (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Department of Pathology and Laboratory Medicine, Clinical Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | - Ana Sousa
- Molecular Oncology & Viral Pathology Group, Research Center (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Department of Health Sciences, Escola Superior de Saúde do Instituto Politécnico de Bragança, Bragança, Portugal
| | - Joana Marinho-Dias
- Department of Pathology and Laboratory Medicine, Clinical Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology & Viral Pathology Group, Research Center (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Department of Pathology and Laboratory Medicine, Clinical Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Research Department, Portuguese League Against Cancer (LPCC-NRNorte), Porto, Portugal
| | - Cláudia Lobo
- Department of Pathology and Laboratory Medicine, Anatomic Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | - Luís Leça
- Department of Pathology and Laboratory Medicine, Anatomic Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | - Nuno Coimbra
- Department of Pathology and Laboratory Medicine, Anatomic Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | | | - Inês Baldaque
- Department of Pathology and Laboratory Medicine, Clinical Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | - Gabriela Martins
- Department of Pathology and Laboratory Medicine, Clinical Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | - Paula Monteiro
- Department of Pathology and Laboratory Medicine, Anatomic Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Laboratory Medicine, Anatomic Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Cancer Biology and Epigenetics Group, Research Center (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Department of Pathology and Molecular Immunology, University of Porto, Porto, Portugal
| | - Hugo Sousa
- Molecular Oncology & Viral Pathology Group, Research Center (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Department of Pathology and Laboratory Medicine, Clinical Pathology Service, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Early Phase Clinical Trial Unit, Clinical Research Unit, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal.,Instituto Superior de Saúde-ISAVE, Amares, Portugal.,Department of Biological Sciences, FFUP-Faculty of Pharmacy, University of Porto, Porto, Portugal
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9
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Isaacson S, Adewumi K, Smith JS, Novak C, Oketch S, Huchko MJ. A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya. Oncologist 2022; 28:e9-e18. [PMID: 36239434 PMCID: PMC9847557 DOI: 10.1093/oncolo/oyac208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cervical cancer screening through self-collected high-risk human papillomavirus (HPV) testing has increased screening uptake, particularly in low-resource settings. Improvement ultimately depends, however, on women with positive results accessing follow-up treatment. Identifying the barriers to timely treatment is needed to tailor service delivery for maximum impact. MATERIALS AND METHODS This qualitative study was conducted within a self-collected HPV screening trial in Migori County, Kenya. HPV-positive women were referred for no-cost cryotherapy treatment at the county hospital. Women not attending within 60 days of receiving HPV-positive results were randomly selected for in-depth interviews (IDIs). IDIs were coded and analyzed to develop an analytical framework and identify treatment barriers. RESULTS Eighty-one women were interviewed. IDIs showed a poor understanding of HPV and cervical cancer, impacting comprehension of screening results and treatment instructions. All 81 had not undergone treatment but reported intending to in the future. Eight reported seeking treatment unsuccessfully or not qualifying, primarily due to pregnancy. Transportation costs and long distances to the hospital were the most reported barriers to treatment. Other obstacles included work, household obligations, and fear of treatment. Impacts of social influences were mixed; some women reported their husbands prevented seeking treatment, others reported their husbands provided financial or emotional support. Few women experienced peer support. CONCLUSIONS Women faced many barriers to treatment following HPV screening in rural Kenya. Transportation barriers highlight a need for local treatment capacity or screen-and-treat approaches. Ensuring women understand their results and how to seek treatment is essential to improving cervical cancer screening in low-resource settings.
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Affiliation(s)
- Sinéad Isaacson
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Konyin Adewumi
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jennifer S Smith
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carissa Novak
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | | | - Megan J Huchko
- Corresponding author: Megan J. Huchko, MD, MPH, Duke Global Health Institute, Duke University, Durham, NC, USA.
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10
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The Role of p16/Ki-67 Immunostaining, hTERC Amplification and Fibronectin in Predicting Cervical Cancer Progression: A Systematic Review. BIOLOGY 2022; 11:biology11070956. [PMID: 36101337 PMCID: PMC9312145 DOI: 10.3390/biology11070956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/11/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
Human papillomaviruses (HPVs) are common sexually transmitted infectious agents responsible for several anogenital and head and neck cancers. Cervical cancer (CC) is the fourth leading cause of death in women with cancer. The progression of a persistent HPV infection to cancer takes 15–20 years and can be preventable through screening. Cervical cytology (Pap smear) is the standard screening test for CC and precancerous lesions. For ASC-US and ASC-H lesions, a combination of Pap smear and HR-HPV analysis is recommended as a triage step before colposcopy. However, these tests cannot predict progression to CC. For this purpose, we summarized current scientific data on the role of p16/Ki-67 immunohistostaining, telomerase and fibronectin in predicting progression to CC. p16 and p16/Ki-67 dual staining (DS) were more specific than HR-HPV DNA testing for the detection of CIN2+/CIN3+ in women with ASC-US and LSIL. Similarly, hTERC FISH analysis significantly improved the specificity and positive predictive value of HPV DNA testing in differentiating CIN2+ from CIN2 cytological samples. In conclusion, p16 IHC, p16/Ki-67 DS and hTERC FISH amplification are all valid adjunctive biomarkers which significantly increase the sensitivity and specificity of cervical dysplasia diagnosis, especially when combined with HPV DNA testing. However, considering the global socioeconomic background, we can postulate that p16 and p16/ Ki-67 IHC can be used as a next step after positive cytology for ASC-US or LSIL specimens in low-income countries, instead of HPV DNA testing. Alternatively, if HPV DNA testing is covered by insurance, p16 or p16/Ki-67 DS and HPV DNA co-testing can be performed. In middle- and high-income countries, hTERC amplification can be performed as an adjunctive test to HPV DNA testing in women with ASC-US and LSIL.
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11
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Paboriboune P, Phongsavan K, Arounlangsy P, Flaissier B, Aphayarath O, Phimmasone P, Banchongphanith K, Xayaovong M, Jourdain G, Schott A, Saadatian‐Elahi M, Magaud L, Klich A, Ngo‐Giang‐Huong N, Heard I, Rabilloud M, Picot VS, Longuet C. Efficacy of careHPV™ human papillomavirus screening versus conventional cytology tests for the detection of precancerous and cancerous cervical lesions among women living with HIV-1 in Lao People's Democratic Republic. Cancer Med 2022; 11:1984-1994. [PMID: 35257506 PMCID: PMC9089224 DOI: 10.1002/cam4.4502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/12/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In the Lao People's Democratic Republic (Lao PDR), cervical cancer is the third leading cause of women cancer. AIMS The objective of this cross-sectional study was to compare the efficacy of careHPV™ test versus conventional Pap smear or Siriraj liquid-based cytology in the detection of cervical cancer in women living with human immunodeficiency virus type 1 (HIV-1). MATERIALS & METHODS Overall, 631 women consented to participate. Four cervical specimens were taken for the purpose of conventional Pap smear, Siriraj liquid-based cytology, careHPV™ test, and HPV-16 genotyping. The exact McNemar test was used to compare the efficacy and diagnostic performance of the tests. RESULTS Of the 631 women with follow-up, 331 were human papillomavirus (HPV) negative. High-grade squamous intraepithelial lesions were found in 37 women, biopsy-proven high-grade cervical intraepithelial neoplasia in 50 women, and invasive carcinoma in seven women. The proportion of women with high-grade cervical lesion or carcinoma detected after abnormal careHPV™ test was higher (6.02%; 95% confidence interval [CI]: 4.4-8.1) than that detected by conventional Pap smear (4.59%; 95% CI: 3.2-6.5). careHPV™ and HPV-16 genotyping had, respectively, the highest sensitivity (80.8%; 95% CI: 67.4-89.5) and specificity (92.2%; 95% CI: 89.8-94.2). HPV-16 was the most frequently detected genotype. CONCLUSIONS careHPV™ test represents a screening option in Lao PDR, particularly in women living with HIV-1 because of higher prevalence of chronic HPV in this population.
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Affiliation(s)
| | | | | | - Bruno Flaissier
- Fondation MérieuxPhu Phanang National Bio‐DiversityVientianeLao‐PDR
| | | | | | | | - Mixi Xayaovong
- Centre d'Infectiologie Christophe Mérieux (CICML)VientianeLao‐PDR
| | - Gonzague Jourdain
- French National Research Institute for Sustainable Development (IRD)MarseilleFrance
| | | | - Mitra Saadatian‐Elahi
- Service HygièneEpidémiologieInfectiovigilance et PréventionCentre Hospitalier Edouard HerriotHospices Civils de LyonLyonFrance
- Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID) – Inserm – U1111 – UCBL Lyon 1 – CNRS – UMR5308 – ENS de LyonLyonFrance
| | | | - Amna Klich
- Université de LyonLyonFrance
- Université Lyon 1VilleurbanneFrance
- Service de Biostatistique‐BioinformatiquePôle Santé PubliqueHospices Civils de LyonLyonFrance
- Équipe Biostatistique‐SantéLaboratoire de Biométrie et Biologie ÉvolutiveCNRS UMR 5558VilleurbanneFrance
| | | | - Isabelle Heard
- French National Human papillomavirus Reference LaboratoryInstitut PasteurParisFrance
| | - Muriel Rabilloud
- Université de LyonLyonFrance
- Université Lyon 1VilleurbanneFrance
- Service de Biostatistique‐BioinformatiquePôle Santé PubliqueHospices Civils de LyonLyonFrance
- Équipe Biostatistique‐SantéLaboratoire de Biométrie et Biologie ÉvolutiveCNRS UMR 5558VilleurbanneFrance
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12
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Zhang L, Tan W, Yang H, Zhang S, Dai Y. Detection of Host Cell Gene/HPV DNA Methylation Markers: A Promising Triage Approach for Cervical Cancer. Front Oncol 2022; 12:831949. [PMID: 35402283 PMCID: PMC8990922 DOI: 10.3389/fonc.2022.831949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer is the most prevalent gynecologic malignancy, especially in women of low- and middle-income countries (LMICs). With a better understanding of the etiology and pathogenesis of cervical cancer, it has been well accepted that this type of cancer can be prevented and treated via early screening. Due to its higher sensitivity than cytology to identify precursor lesions of cervical cancer, detection of high-risk human papillomavirus (HR-HPV) DNA has been implemented as the primary screening approach. However, a high referral rate for colposcopy after HR-HPV DNA detection due to its low specificity in HR-HPV screening often leads to overtreatment and thus increases the healthcare burden. Emerging evidence has demonstrated that detection of host cell gene and/or HPV DNA methylation represents a promising approach for the early triage of cervical cancer in HR-HPV-positive women owing to its convenience and comparable performance to cytology, particularly in LMICs with limited healthcare resources. While numerous potential markers involving DNA methylation of host cell genes and the HPV genome have been identified thus far, it is crucial to define which genes or panels involving host and/or HPV are feasible and appropriate for large-scale screening and triage. An ideal approach for screening and triage of CIN/ICC requires high sensitivity and adequate specificity and is suitable for self-sampling and inexpensive to allow population-based screening, particularly in LMICs. In this review, we summarize the markers of host cell gene/HR-HPV DNA methylation and discuss their triage performance and feasibility for high-grade precancerous cervical intraepithelial neoplasia or worse (CIN2+ and CIN3+) in HR-HPV-positive women.
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Affiliation(s)
- Lingyi Zhang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China.,Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Wenxi Tan
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Hongmei Yang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China.,Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Songling Zhang
- Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Changchun, China
| | - Yun Dai
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
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13
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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.
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14
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Biomarkers for detection of human papillomavirus (HPV). INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00529-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Holme F, Jeronimo J, Maldonado F, Camel C, Sandoval M, Martinez-Granera B, Montenegro M, Figueroa J, Slavkovsky R, Thomson KA, de Sanjose S. Introduction of HPV testing for cervical cancer screening in Central America: The Scale-Up project. Prev Med 2020; 135:106076. [PMID: 32247010 PMCID: PMC7218710 DOI: 10.1016/j.ypmed.2020.106076] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/30/2020] [Accepted: 03/28/2020] [Indexed: 01/02/2023]
Abstract
The Scale-Up project introduced vaginal self-sampling and low-cost human papillomavirus (HPV) testing as the primary approach for cervical cancer screening in selected public health centers in Guatemala, Honduras, and Nicaragua. We evaluate the country-specific accomplishments in screening: target-coverage, triage, and treatment. Between 2015 and 2018, cervical cancer screening was offered to women at least 30 years of age. Triage of HPV-positive women was based on visual inspection with acetic acid or Pap. Aggregated data included total women screened, use of self-sampling, age, time elapsed since last screening, HPV results, triage tests, triage results, and treatment. A total of 231,741 women were screened for HPV, representing 85.8% of the target populations within the project. HPV positivity was lower in Guatemala (12.4%) compared to Honduras and Nicaragua (14.5% and 14.2%, respectively, p < 0.05). A follow-up triage test was completed for 84.2%, 85.8%, and 50.1% of HPV-positive women in Guatemala, Nicaragua, and Honduras, respectively. Of those with a positive triage test, 84.7%, 67.1%, and 58.8% were treated in Guatemala, Nicaragua, and Honduras, respectively. First-time screening was highest in Nicaragua (55.8%) where self-sampling was also widely used (97.1%). The Scale-Up project demonstrated that large-scale cervical cancer screening and treatment intervention in a high-burden, low-resource setting can be achieved. Self-sampling and ablative treatment were key to the project's achievements. Data monitoring, loss to follow-up, and triage methods of screen- positive women remain critical to full success.
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Affiliation(s)
| | | | | | - Claudia Camel
- Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Manuel Sandoval
- Asociación Hondureña de Planificación de Familia, Tegucigalpa, Honduras.
| | | | - Mirna Montenegro
- Instancia por la Salud y el Desarrollo de las Mujeres, Guatemala City, Guatemala
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16
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Baezconde-Garbanati L, Agurto I, Gravitt PE, Luciani S, Murphy S, Ochoa C, Gallegos K, Barahona R, Rodríguez Y. Barriers and innovative interventions for early detection of cervical cancer. SALUD PUBLICA DE MEXICO 2020; 61:456-460. [PMID: 31430087 DOI: 10.21149/10425] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022] Open
Abstract
Cervical cancer has decreased significantly over the past 30 years in some countries. However, it remains among the leading causes of cancer deaths in low-income, and racial/ethnic minority women. Cervical cancer prevention technologies are not always available. Laboratories are often not well equipped to use them. HPV information has not been widely disseminated. WHO guidelines, and US and Latin American data provide context for strategies on effective interventions to reduce cervical cancer disparities. Systemic, personal and cultural barriers, combined with decision-making guidelines, and impactful messaging can accelerate reductions in cervical cancer health inequities in the Americas.
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Affiliation(s)
- Lourdes Baezconde-Garbanati
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Irene Agurto
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Chile
| | - Patti E Gravitt
- Department of Global Health, George Washington University Milken Institute School of Public Health. Washington DC, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Chile
| | - Sheila Murphy
- Annenberg School for Communication and Journalism, University of Southern California. Los Angeles, California, USA
| | - Carol Ochoa
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Katia Gallegos
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Instituto Mexicano de Seguro Social. Mexico City, Mexico
| | - Rosa Barahona
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Yaneth Rodríguez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
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17
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Na Rangsee N, Yanatatsaneejit P, Pisitkun T, Somparn P, Jintaridth P, Topanurak S. Host proteome linked to HPV E7-mediated specific gene hypermethylation in cancer pathways. Infect Agent Cancer 2020; 15:7. [PMID: 32025240 PMCID: PMC6998090 DOI: 10.1186/s13027-020-0271-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
Background Human papillomavirus (HPV) infection causes around 90% of cervical cancer cases, and cervical cancer is a leading cause of female mortality worldwide. HPV-derived oncoprotein E7 participates in cervical carcinogenesis by inducing aberrant host DNA methylation. However, the targeting specificity of E7 methylation of host genes is not fully understood but is important in the down-regulation of crucial proteins of the hallmark cancer pathways. In this study, we aim to link E7-driven aberrations in the host proteome to corresponding gene promoter hypermethylation events in the hope of providing novel therapeutic targets and biomarkers to indicate the progression of cervical cancer. Methods HEK293 cells were transfected with pcDNA3.1-E7 plasmid and empty vector and subjected to mass spectrometry-based proteomic analysis. Down-regulated proteins (where relative abundance was determined significant by paired T-test) relevant to cancer pathways were selected as gene candidates for mRNA transcript abundance measurement by qPCR and expression compared with that in SiHa cells (HPV type 16 positive). Methylation Specific PCR was used to determine promoter hypermethylation in genes downregulated in both SiHa and transfected HEK293 cell lines. The FunRich and STRING databases were used for identification of potential regulatory transcription factors and the proteins interacting with transcription factor gene candidates, respectively. Results Approximately 400 proteins totally were identified in proteomics analysis. The transcripts of six genes involved in the host immune response and cell proliferation (PTMS, C1QBP, BCAP31, CDKN2A, ZMYM6 and HIST1H1D) were down-regulated, corresponding to proteomic results. Methylation assays showed four gene promoters (PTMS, C1QBP, BCAP31 and CDKN2A) were hypermethylated with 61, 55.5, 70 and 78% increased methylation, respectively. Those four genes can be regulated by the GA-binding protein alpha chain, specificity protein 1 and ETS-like protein-1 transcription factors, as identified from FunRich database predictions. Conclusions HPV E7 altered the HEK293 proteome, particularly with respect to proteins involved in cell proliferation and host immunity. Down-regulation of these proteins appears to be partly mediated via host DNA methylation. E7 possibly complexes with the transcription factors of its targeting genes and DNMT1, allowing methylation of specific target gene promoters.
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Affiliation(s)
- Nopphamon Na Rangsee
- 1Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand
| | | | - Trairak Pisitkun
- 3Center of Excellence in Systems Biology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Poorichaya Somparn
- 3Center of Excellence in Systems Biology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand.,4Center of Excellence in Immunology and Immune-mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Pornrutsami Jintaridth
- 5Department of Tropical Nutrition and Food Science, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand
| | - Supachai Topanurak
- 1Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand
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18
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Sousa H, Tavares A, Campos C, Marinho-Dias J, Brito M, Medeiros R, Baldaque I, Lobo C, Leça L, Monteiro P, Tavares F, Henrique R. High-Risk human papillomavirus genotype distribution in the Northern region of Portugal: Data from regional cervical cancer screening program. ACTA ACUST UNITED AC 2019; 8:100179. [PMID: 31377173 PMCID: PMC6702237 DOI: 10.1016/j.pvr.2019.100179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022]
Abstract
High-Risk Human papillomavirus (HR-HPV) full genotyping methods have been described as of great potential use in epidemiology and preventive strategies, including cervical cancer screening and HPV vaccination. We characterized the prevalence and distribution of HR-HPV genotypes in cervico-vaginal samples obtained from the Regional Cervical Cancer Screening Program from the Northern Region of Portugal. HR-HPV genotyping was performed using Anyplex™ II HPV-HR Detection kit in 105,458 women enrolled between August 2016 and December 2017. HR-HPVs were detected in 10,665 women (10.2%) with a prevalence ranging from 6.2 to 17.1% depending on age, and from 8.7 to 10.7% depending on geographical location. Multiple infections with two or more HR-HPVs were detected in 2736 (25.7%) of HR-HPV women ranging from 16.5 to 31.0% depending on age. Amongst HR-HPV positive women, HPV-16 (17.5%), HPV-39 (16.7%), HPV-31 (15.0%), HPV-68 (13.2%), HPV-52 (10.7%) and HPV-51 (10.6%) were the most common genotypes in our population, being HPV-16 more frequent in women aged from 30 to 45 years and HPV-39 in 50–65 years. Results also show that HPV16/18 are present in 22.1% and HPV16/18/31/33/45/52/58 in 47.6% of HR-HPV positive women. This is the largest study on HR-HPV genotyping for Cervical Cancer Screening in European populations and provides critical data for program management and vaccine policy. HPV genotyping is important for cervical cancer screening and HPV-vaccine strategies. Largest HR-HPV genotyping Cervical Cancer Screening in European populations. 105,458 women enrolled of which 10,665 (10.2%) were HR-HPV positive. Multiple infections with two or more HR-HPVs were detected in 2736 (25.7%). HPV-16, -39, −31, −68, −52 and −51, in specific rank order, were the most common in our population.
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Affiliation(s)
- Hugo Sousa
- Virology Service, Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Ana Tavares
- Virology Service, Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Department of Pathology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Carla Campos
- Virology Service, Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Joana Marinho-Dias
- Virology Service, Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Margarida Brito
- Virology Service, Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Rui Medeiros
- Virology Service, Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Research Department, Portuguese League Against Cancer (LPCC-NRNorte), Estrada Interior da Circunvalação 6657, 4200-172, Porto, Portugal
| | - Inês Baldaque
- Virology Service, Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Cláudia Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Luís Leça
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Paula Monteiro
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Cancer Biology and Epigenetics Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Fernando Tavares
- Administração Regional de Saúde do Norte I.P., Rua de Santa Catarina 1288, 4000-477, Porto, Portugal
| | - Rui Henrique
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Cancer Biology and Epigenetics Group, IPO-Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto FG EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal; Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar - University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
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Dennison C, King AR, Rutledge H, Bednarczyk RA. HPV Vaccine-Related Research, Promotion and Coordination in the State of Georgia: A Systematic Review. J Community Health 2019; 44:313-321. [PMID: 30374822 PMCID: PMC6414259 DOI: 10.1007/s10900-018-0589-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Human papillomavirus (HPV) vaccine was first recommended for female adolescents in the United States in 2006, and for male adolescents in 2011. In 2016, national HPV vaccine coverage was 43.4%, and slightly higher in Georgia (45.6%). Little is known about sub-state-level variation in HPV vaccination or Georgia specific research conducted to improve HPV vaccine uptake. We aimed to describe current uptake of HPV vaccination and synthesize Georgia-specific research of HPV vaccine uptake. We reviewed existing published and grey literature for different development, implementation and best practices related to vaccine uptake in adolescents. Studies measuring HPV vaccine uptake in Georgia utilizing quantitative, qualitative, or mixed-methods approaches were included alongside state-level information from National Immunization Survey-Teen, Community Health Needs Assessments, Behavioral Risk Factor Surveillance and Georgia Adolescent Immunization Surveys. Key findings across these reports were summarized. Forty-two titles and abstracts were identified through electronic database search for literature published between 2006 and 2017. Of these, five were from database sources and 37 were from additional sources. The most often mentioned barriers of HPV vaccine uptake in Georgia include cultural norms, vaccination education and a misalignment of vaccine uptake goals between the state and regional hospital community needs assessments. Increasing knowledge and uptake of HPV vaccine in Georgia requires significant research and to understand the vast socioeconomic, cultural and geographic barriers preventing uptake among adolescents. Georgia-specific efforts have been limited, however ongoing collaborations spearheaded by the Georgia Cancer Control Coalition provide opportunities for state-level support of research to address these barriers.
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Affiliation(s)
- Cori Dennison
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Adrian R King
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hannah Rutledge
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
- Emory Vaccine Center, Emory University, Atlanta, GA, USA.
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, CNR 7019, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
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20
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Gong L, Lei Y, Tan X, Dong Y, Luo Z, Zhang D, Han S. Propranolol selectively inhibits cervical cancer cell growth by suppressing the cGMP/PKG pathway. Biomed Pharmacother 2019; 111:1243-1248. [PMID: 30841438 DOI: 10.1016/j.biopha.2019.01.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/29/2018] [Accepted: 01/08/2019] [Indexed: 01/27/2023] Open
Abstract
AIM To observe the effect of propranolol in cervical cancer and investigate the mechanism of the effect. METHODS AND RESULTS: We found 5 direct protein targets (DPTs) of propranolol (PRO) by DrugBank5.0 firstly. Next, we analyzed protein-protein interaction (PPI) network and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways of PRO DPTs and the result showed that PRO was linked with cGMP/PKG pathway. Then, we recognized the top 38 upexpressed genes of cervical cancer (CC) based original microarray datasets (GSE7803, GSE9750, GSE39001 and GSE63514). Further, we analyzed the biological process with the 38 overexpressed genes by STRING. We found some of overexpressed genes of CC participated in GMP biosynthetic process. Lastly, the function of PRO in CC was validated by MTT assay, Western blotting, flow cytometry and colony formation assay methods. We verified PRO can suppress cGMP/PKG pathway then inhibits CC cell growth. CONCLUSION The bioinformatical analysis combine with traditional experiment can help us understanding potential molecular mechanism about how PRO acting in CC. This method is a new paradigm which can guide future researches about mechanism in existing diseases and drugs.
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Affiliation(s)
- Liuyun Gong
- Department of Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, 710061, PR China
| | - Yutiantian Lei
- Department of Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, 710061, PR China
| | - Xinyue Tan
- Department of Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, 710061, PR China
| | - Yiping Dong
- Department of Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, 710061, PR China
| | - Zhenzhen Luo
- Department of Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, 710061, PR China
| | - Dan Zhang
- Department of Cell Biology and Genetics, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shanxi, 710061, PR China
| | - Suxia Han
- Department of Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, 710061, PR China.
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Veijalainen O, Kares S, Kujala P, Vuento R, Osuala V, Tirkkonen M, Luukkaala T, Kholová I, Mäenpää J. Implementation ofHPV‐based cervical cancer screening in an organised regional screening programme: 3 years of experience. Cytopathology 2018; 30:150-156. [DOI: 10.1111/cyt.12652] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Olga Veijalainen
- Department of Gynaecology and Obstetrics Päijät Hämeen Central Hospital Lahti Finland
| | - Saara Kares
- Department of Pathology Fimlab Laboratories Ltd Tampere Finland
| | - Paula Kujala
- Department of Pathology Fimlab Laboratories Ltd Tampere Finland
| | - Risto Vuento
- Department of Microbiology Fimlab Laboratories Ltd Tampere Finland
| | - Veronika Osuala
- Department of Gynaecology and obstetrics Municipal Hospital of Tampere Tampere Finland
| | - Mika Tirkkonen
- Department of Pathology Fimlab Laboratories Ltd Tampere Finland
| | - Tiina Luukkaala
- Science Centre Tampere University Hospital and Health Sciences Faculty of Social Sciences University of Tampere Tampere Finland
| | - Ivana Kholová
- Department of Pathology Fimlab Laboratories Ltd Tampere Finland
- Department of Pathology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Johanna Mäenpää
- Department of Gynaecology and Obstetrics Tampere University Hospital and Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
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22
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Verlaat W, Van Leeuwen RW, Novianti PW, Schuuring E, Meijer CJLM, Van Der Zee AGJ, Snijders PJF, Heideman DAM, Steenbergen RDM, Wisman GBA. Host-cell DNA methylation patterns during high-risk HPV-induced carcinogenesis reveal a heterogeneous nature of cervical pre-cancer. Epigenetics 2018; 13:769-778. [PMID: 30079796 PMCID: PMC6224221 DOI: 10.1080/15592294.2018.1507197] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cervical cancer development following a persistent infection with high-risk human papillomavirus (hrHPV) is driven by additional host-cell changes, such as altered DNA methylation. In previous studies, we have identified 12 methylated host genes associated with cervical cancer and pre-cancer (CIN2/3). This study systematically analyzed the onset and DNA methylation pattern of these genes during hrHPV-induced carcinogenesis using a longitudinal in vitro model of hrHPV-transformed cell lines (n = 14) and hrHPV-positive cervical scrapings (n = 113) covering various stages of cervical carcinogenesis. DNA methylation analysis was performed by quantitative methylation-specific PCR (qMSP) and relative qMSP values were used to analyze the data. The majority of genes displayed a comparable DNA methylation pattern in both cell lines and clinical specimens. DNA methylation onset occurred at early or late immortal passage, and DNA methylation levels gradually increased towards tumorigenic cells. Subsequently, we defined a so-called cancer-like methylation-high pattern based on the DNA methylation levels observed in cervical scrapings from women with cervical cancer. This cancer-like methylation-high pattern was observed in 72% (38/53) of CIN3 and 55% (11/20) of CIN2, whereas it was virtually absent in hrHPV-positive controls (1/26). In conclusion, hrHPV-induced carcinogenesis is characterized by early onset of DNA methylation, typically occurring at the pre-tumorigenic stage and with highest DNA methylation levels at the cancer stage. Host-cell DNA methylation patterns in cervical scrapings from women with CIN2 and CIN3 are heterogeneous, with a subset displaying a cancer-like methylation-high pattern, suggestive for a higher cancer risk.
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Affiliation(s)
- Wina Verlaat
- a Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology , Cancer Center Amsterdam , Amsterdam , The Netherlands
| | - Robert W Van Leeuwen
- b Department of Gynecologic Oncology , University of Groningen, University Medical Center Groningen, Cancer Research Center Groningen , Groningen , The Netherlands
| | - Putri W Novianti
- a Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology , Cancer Center Amsterdam , Amsterdam , The Netherlands
| | - Ed Schuuring
- c Department of Pathology , University of Groningen, University Medical Center Groningen, Cancer Research Center Groningen , Groningen , The Netherlands
| | - Chris J L M Meijer
- a Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology , Cancer Center Amsterdam , Amsterdam , The Netherlands
| | - Ate G J Van Der Zee
- b Department of Gynecologic Oncology , University of Groningen, University Medical Center Groningen, Cancer Research Center Groningen , Groningen , The Netherlands
| | - Peter J F Snijders
- a Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology , Cancer Center Amsterdam , Amsterdam , The Netherlands
| | - Daniëlle A M Heideman
- a Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology , Cancer Center Amsterdam , Amsterdam , The Netherlands
| | - Renske D M Steenbergen
- a Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology , Cancer Center Amsterdam , Amsterdam , The Netherlands
| | - G Bea A Wisman
- b Department of Gynecologic Oncology , University of Groningen, University Medical Center Groningen, Cancer Research Center Groningen , Groningen , The Netherlands
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Shen J, Olwanda E, Kahn JG, Huchko MJ. Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya. BMC Health Serv Res 2018; 18:378. [PMID: 29801496 PMCID: PMC5970469 DOI: 10.1186/s12913-018-3195-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is the most frequent neoplasm among Kenyan women, with 4800 diagnoses and 2400 deaths per year. One reason is an extremely low rate of screening through pap smears, at 13.8% in 2014. Knowing the costs of screening will help planners and policymakers design, implement, and scale programs. Methods We conducted HPV-based cervical cancer screening via self-collection in 12 communities in rural Migori County, Kenya. Six communities were randomized to community health campaigns (CHCs), and six to screening at government clinics. All HPV-positive women were referred for cryotherapy at Migori County Hospital. We prospectively estimated direct costs from the health system perspective, using micro-costing methods. Cost data were extracted from expenditure records, staff interviews, and time and motion logs. Total costs per woman screening included three activities: outreach, HPV-based screening, and notification. Types of inputs include personnel, recurrent goods, capital goods, and services. We costed potential changes to implementation for scaling. Results From January to September 2016, 2899 women were screened in CHCs and 2042 in clinics. Each CHC lasted for 30 working days, 10 days each for outreach, screening, and notification. The mean cost per woman screened was $25.00 for CHCs [median: $25.09; Range: $22.06-30.21] and $29.56 for clinics [$28.90; $25.27-37.08]. Clinics had higher costs than CHCs for personnel ($14.27 vs. $11.26) and capital ($5.55 vs. $2.80). Screening costs were higher for clinics at $21.84, compared to $17.48 for CHCs. In contrast, CHCs had higher outreach costs ($3.34 vs. $0.17). After modeling a reduction in staffing, clinic per-screening costs ($25.69) were approximately equivalent to CHCs. Conclusions HPV-based cervical cancer screening through community health campaigns achieved lower costs per woman screened, compared to screening at clinics. Periodic high-volume CHCs appear to be a viable low-cost strategy for implementing cervical cancer screening. Electronic supplementary material The online version of this article (10.1186/s12913-018-3195-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Shen
- Philip R. Lee Institute for Health Policy Studies, University of California, 3333 California Street Suite 265, Box 0936, San Francisco, CA, 94118, USA.
| | - Easter Olwanda
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - James G Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California, 3333 California Street Suite 265, Box 0936, San Francisco, CA, 94118, USA
| | - Megan J Huchko
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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24
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Bhatia R, Kavanagh K, Stewart J, Moncur S, Serrano I, Cong D, Cubie HA, Haas JG, Busby-Earle C, Williams ARW, Howie SEM, Cuschieri K. Host chemokine signature as a biomarker for the detection of pre-cancerous cervical lesions. Oncotarget 2018; 9:18548-18558. [PMID: 29719625 PMCID: PMC5915092 DOI: 10.18632/oncotarget.24946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/12/2018] [Indexed: 01/24/2023] Open
Abstract
Background The ability to distinguish which hrHPV infections predispose to significant disease is ever more pressing as a result of the increasing move to hrHPV testing for primary cervical screening. A risk-stratifier or “triage” of infection should ideally be objective and suitable for automation given the scale of screening. Results CCL2, CCL3, CCL4, CXCL1, CXCL8 and CXCL12 emerged as the strongest, candidate biomarkers to detect underlying disease [cervical intraepithelial neoplasia grade 2 or worse (CIN2+)]. For CIN2+, CCL2 had the highest area under the curve (AUC) of 0.722 with a specificity of 82%. A combined biomarker panel of six chemokines CCL2, CCL3, CCL4, CXCL1, CXCL8, and CXCL12 provides a sensitivity of 71% and specificity of 67%. Conclusion The present work demonstrates that the levels of five chemokine-proteins are indicative of underlying disease. We demonstrate technical feasibility and promising clinical performance of a chemokine-based biomarker panel, equivalent to that of other triage options. Further assessment in longitudinal series is now warranted. Methods A panel of 31 chemokines were investigated for expression in routinely taken archived and prospective cervical liquid based cytology (LBC) samples using Human Chemokine Proteomic Array kit. Nine chemokines were further validated using Procartaplex assay on the Luminex platform.
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Affiliation(s)
- Ramya Bhatia
- Human Papillomavirus Research Group, Division of Pathology, University of Edinburgh, Edinburgh, United Kingdom
| | - Kim Kavanagh
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, United Kingdom
| | - June Stewart
- Centre for Inflammation research, University of Edinburgh, Edinburgh, United Kingdom
| | - Sharon Moncur
- Centre for Inflammation research, University of Edinburgh, Edinburgh, United Kingdom
| | - Itziar Serrano
- Division of Infection and Pathway Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Duanduan Cong
- Centre for Inflammation research, University of Edinburgh, Edinburgh, United Kingdom
| | - Heather A Cubie
- Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom
| | - Juergen G Haas
- Division of Infection and Pathway Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Camille Busby-Earle
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Alistair R W Williams
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Sarah E M Howie
- Centre for Inflammation research, University of Edinburgh, Edinburgh, United Kingdom
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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25
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Present and future of cervical cancer prevention in Spain: a cost-effectiveness analysis. Eur J Cancer Prev 2018; 25:430-9. [PMID: 26375246 DOI: 10.1097/cej.0000000000000202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Human papillomavirus (HPV) vaccination within a nonorganized setting creates a poor cost-effectiveness scenario. However, framed within an organized screening including primary HPV DNA testing with lengthening intervals may provide the best health value for invested money. To compare the effectiveness and cost-effectiveness of different cervical cancer (CC) prevention strategies, including current status and new proposed screening practices, to inform health decision-makers in Spain, a Markov model was developed to simulate the natural history of HPV and CC. Outcomes included cases averted, life expectancy, reduction in the lifetime risk of CC, life years saved, quality-adjusted life years (QALYs), net health benefits, lifetime costs, and incremental cost-effectiveness ratios. The willingness-to-pay threshold is defined at 20 000&OV0556;/QALY. Both costs and health outcomes were discounted at an annual rate of 3%. A strategy of 5-year organized HPV testing has similar effectiveness, but higher efficiency than 3-year cytology. Screening alone and vaccination combined with cytology are dominated by vaccination followed by 5-year HPV testing with cytology triage (12 214&OV0556;/QALY). The optimal age for both ending screening and switching age from cytology to HPV testing in older women is 5 years later for unvaccinated than for vaccinated women. Net health benefits decrease faster with diminishing vaccination coverage than screening coverage. Primary HPV DNA testing is more effective and cost-effective than current cytological screening. Vaccination uptake improvements and a gradual change toward an organized screening practice are critical components for achieving higher effectiveness and efficiency in the prevention of CC in Spain.
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Zhang JJ, Cao XC, Zheng XY, Wang HY, Li YW. Feasibility study of a human papillomavirus E6 and E7 oncoprotein test for the diagnosis of cervical precancer and cancer. J Int Med Res 2018; 46:1033-1042. [PMID: 29322839 PMCID: PMC5972251 DOI: 10.1177/0300060517736913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective To evaluate the clinical value of human papillomavirus (HPV) E6 and E7 oncoprotein (HPV E6/E7) detection in the early screening of cervical cancer. Methods This prospective study evaluated all patients with suspected cervical intraepithelial neoplasia (CIN) as identified by the presence of at least one positive indicator from a ThinPrep cytologic test (TCT) and/or a Hybrid Capture 2 (HC2) HPV DNA test. The levels of E6/E7 oncoproteins were determined using Western blot analysis. The diagnostic value of the HPV E6/E7 protein assay was compared with the clinical diagnosis from TCT, HC2 and the gold standard of cervical biopsy histology. Results A total of 450 patients were enrolled in the study and based on histological findings, 102 patients were diagnosed with CIN1 (22.7%), 241 with CIN2 (53.6%), 96 with CIN3 (21.3%) and 11 with squamous cell carcinoma (2.4%). For a diagnosis of CIN2+, although the sensitivity of the HPV E6/E7 assay was lower than HC2 (65.5% versus 96.6%, respectively), the specificity was higher (38.2% versus 5.9%, respectively). The sensitivity of the HPV E6/E7 assay was higher than TCT (65.5% versus 36.2%, respectively). Conclusion Measuring HPV E6/E7 oncoprotein levels is a potential new biomarker for HPV type 16.
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Affiliation(s)
- Jin-Jun Zhang
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
| | - Xin-Chun Cao
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
| | - Xiang-Yu Zheng
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
| | - Hai-Ying Wang
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
| | - Yong-Wei Li
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
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Lie AK, Tropé A, Skare GB, Bjørge T, Jonassen CM, Brusegard K, Lönnberg S. HPV genotype profile in a Norwegian cohort with ASC-US and LSIL cytology with three year cumulative risk of high grade cervical neoplasia. Gynecol Oncol 2017; 148:111-117. [PMID: 29132873 DOI: 10.1016/j.ygyno.2017.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the HPVgenotype profile in Norwegian women with ASC-US/LSIL cytology and the subsequent risk of high-grade cervical neoplasia (CIN 3+). METHODS In this observational study delayed triage of ASC-US/LSIL of 6058 women were included from 2005 to 2010. High-risk HPV detection with Hybrid Capture 2 (HC2) was used and the HC2+ cases were genotyped with in-house nmPCR. Women were followed-up for histologically confirmed CIN3+ within three years of index HPV test by linkage to the screening databases at the Cancer Registry of Norway. RESULTS HC2 was positive in 45% (2756/6058) of the women. Within 3years CIN3+ was diagnosed in 26% of women<34year and in 15%≥34year. HC2 was positive at index in 94% of CIN3+ cases and negative in 64 cases including three women with cervical carcinomas. Women<34years with single infections of HPV 16, 35, 58 or 33 or multiple infections including HPV 16, 52, 33 or 31 were associated with highest proportions of CIN 3+. Older women with single infection with HPV 16, 33, 31 or 35 or multiple infections including HPV 16, 33, 31 or 18/39 were more likely to develop CIN 3+. CONCLUSIONS HPV 16 and HPV 33 at baseline both as single or multiple infections, were associated with the highest risk for CIN3+. Among older women, all 13 high-risk genotypes as single infection were associated with >20% risk of CIN3+. Further studies are necessary to risk stratify the individual genotypes to reduce the number of colposcopies in Norway.
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Affiliation(s)
- A K Lie
- Department of Pathology, Oslo University Hospital, Norway; Center for Laboratory Medicine, Østfold Hospital Trust, Norway.
| | - A Tropé
- Norwegian Cervical Cancer Screening Programme, Cancer Registry of Norway, Oslo, Norway
| | - G B Skare
- Norwegian Cervical Cancer Screening Programme, Cancer Registry of Norway, Oslo, Norway
| | - T Bjørge
- Norwegian Cervical Cancer Screening Programme, Cancer Registry of Norway, Oslo, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - C M Jonassen
- Center for Laboratory Medicine, Østfold Hospital Trust, Norway
| | - K Brusegard
- Department of Pathology, Oslo University Hospital, Norway
| | - S Lönnberg
- Norwegian Cervical Cancer Screening Programme, Cancer Registry of Norway, Oslo, Norway
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Shi WJ, Liu H, Wu D, Tang ZH, Shen YC, Guo L. E6/E7 proteins are potential markers for the screening and diagnosis of cervical pre-cancerous lesions and cervical cancer in a Chinese population. Oncol Lett 2017; 14:6251-6258. [PMID: 29113275 DOI: 10.3892/ol.2017.6932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/14/2017] [Indexed: 12/14/2022] Open
Abstract
The present prospective study aimed to evaluate the effects of E6/E7 protein detection by western blotting on cervical cancer (CC) early screening compared with detection by Hybrid Capture 2 (HC2) test and ThinPrep cytological test (TCT) in a Chinese population. A total of 450 cases of cervical intraepithelial neoplasia (CIN) suspected samples (positive in ≥1 indicator of TCT and HC2 test) were recruited from women who were treated at the International Peace Maternity and Child Health Hospital (Shanghai, China) from March 2014 to February 2015. Each sample was analyzed by cytological test. In addition, human papillomavirus (HPV) DNA examination by Hybrid Capture Tube test and E6/E7 protein expression detection by western blotting were performed in all samples, as well as histologic diagnosis to determine the stage of CIN. The results revealed that, for the diagnosis of CIN2+, although the sensitivity of E6/E7 protein detection was lower than that of HC2 test (71.3 vs. 96.6%, respectively), the specificity was markedly improved (67.6 vs. 5.9%, respectively). Compared with that of TCT, the sensitivity of E6/E7 protein detection was much higher (36.2 vs. 71.3%, respectively), but the specificity was lower (88.2 vs. 67.6%, respectively). In the present study, HPV E6/E7 protein expression was evaluated as a potential new biomarker for CC, with satisfactory diagnostic values for HPV types 16 and 18. The relative diagnostic value may be further improved by combination of E6/E7 messenger RNA detection.
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Affiliation(s)
- Wen-Jing Shi
- Department of Clinical Laboratory, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, P.R. China
| | - Hao Liu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, SAR 999077, P.R. China
| | - Dan Wu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, P.R. China
| | - Zhen-Hua Tang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, P.R. China
| | - Yu-Chen Shen
- Department of Clinical Laboratory, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, P.R. China
| | - Lin Guo
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China
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Rosales C, Rosales R. Prophylactic and Therapeutic Vaccines against Human Papillomavirus Infections. Vaccines (Basel) 2017. [DOI: 10.5772/intechopen.69548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Awua AK, Wiredu EK, Afari EA, Tijani AS, Djanmah G, Adanu RMK. A tailored within-community specimen collection strategy increased uptake of cervical cancer screening in a cross-sectional study in Ghana. BMC Public Health 2017; 18:80. [PMID: 28764756 PMCID: PMC5540566 DOI: 10.1186/s12889-017-4631-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background The implementation of cervical cancer screening strategies has reported different rates of success in different countries due to population specific factors that limit women’s participation. We report observations and the development of a community-based specimen collection strategy which resulted from interactions with women in the study communities, following an initial low response to a hospital based cervical cancer screening strategy. Method Women were recruited by a house survey and invited to report at a hospital either within a week or after a week for self and health-personnel specimen collections. However, due to the very low response and subsequent interactions with the women of the communities, another strategy was developed that required recruited women report at a central location within their respective communities for specimen collections at times that did not interfere with their daily routines. Results For specimen collection, of the 156 participants who opted to report after a week at the hospital, 60 (38.5%) reported. Of the 118 participants who opted to report within 1 week at the hospital, 55 (46.6%) reported. Of the 103 participants were invited to report at a specified location within the community, 98 (95.1%) reported. An overall response rate of 60.4% was attained. Almost 89.7% (226 of 253) of the women performed both self and health personnel sample collection. Conclusion The community-based strategy with self-specimen collection and HPV testing holds great potential for increasing women’s participation in cervical cancer screening in Ghana as compared to the hospital based strategy. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4631-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adolf K Awua
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana. .,Cellular and Clinical Research Centre, Radiological and Medical Sciences Research Institute, GAEC, Accra, Ghana.
| | - Edwin K Wiredu
- University of Health and Allied Sciences, Ho, Ghana.,Department of Pathology, School of Biomedical and Allied Health Science, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - Edwin A Afari
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Ahmad S Tijani
- Akuse Government Hospital, Ghana Health Service, Akuse, Ghana
| | - Gabriel Djanmah
- Akuse Government Hospital, Ghana Health Service, Akuse, Ghana
| | - Richard M K Adanu
- Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Lorincz AT, Nathan M, Reuter C, Warman R, Thaha MA, Sheaff M, Vasiljevic N, Ahmad A, Cuzick J, Sasieni P. Methylation of HPV and a tumor suppressor gene reveals anal cancer and precursor lesions. Oncotarget 2017; 8:50510-50520. [PMID: 28881579 PMCID: PMC5584159 DOI: 10.18632/oncotarget.17984] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/06/2017] [Indexed: 12/24/2022] Open
Abstract
We studied DNA methylation patterns of human papillomavirus (HPV) and tumor suppressor gene EPB41L3 in 148 anal and perianal biopsies to determine whether high levels of methylation would be associated with anal intraepithelial neoplasia (AIN). The most prevalent HPV type was HPV16, detected in 54% of the 30 benign biopsies, 33% of the 43 low-grade AIN (lgAIN), 82% of the 59 high grade AIN (hgAIN) and 4 of the 5 anal cancers. A methylation score was developed (0.561*HPV16me+0.439*EPB41L3) which had increasing values with severity of disease: the mean was 8.1% in benign, 13.2% in lgAIN, 22.3% in hgAIN and 49.3% in cancers (p < 0.0001). The methylation score as a triage classifier at a cut-off of 8.8 gave a sensitivity of 90.6% (95% CI: 82.8, 96.9), specificity of 50.7% (95% CI: 39.7, 61.6) and area under the curve of 0.82 (95% CI: 0.75-0.89) for separating hgAIN and cancer from benign and lgAIN biopsies. We conclude that methylation of HPV16 and EPB41L3 show highly significant association with increasing severity of AIN and cancer and may be useful as biomarkers in anal disease.
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Affiliation(s)
- Attila T. Lorincz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Mayura Nathan
- Homerton Anal Neoplasia Service, Homerton University Hospital NHS Foundation Trust, London E9 6SR, UK
| | - Caroline Reuter
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Rhian Warman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Mohamed A. Thaha
- National Bowel Research Centre, Blizard Institute, Queen Mary University of London, London E1 2AT, UK
- Barts Anal Neoplasia Centre, Department of Colorectal Surgery, Surgery and Cancer CAG, The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London E1 1BB, UK
| | - Michael Sheaff
- Cellular Pathology, Barts Health NHS Trust, London E1 2ES, UK
| | - Natasa Vasiljevic
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Amar Ahmad
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, UK
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Schiffman M. In response to: Human papillomavirus screening for low and middle-income countries. Prev Med 2017; 100:297-298. [PMID: 28583663 DOI: 10.1016/j.ypmed.2017.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/23/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
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Optomagnetic Imaging Spectroscopy Application in Cervical Dysplasia and Cancer Detection: Comparation of Stained and Unstained Papanicolaou Smears. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0255-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Clarke MA, Luhn P, Gage JC, Bodelon C, Dunn ST, Walker J, Zuna R, Hewitt S, Killian JK, Yan L, Miller A, Schiffman M, Wentzensen N. Discovery and validation of candidate host DNA methylation markers for detection of cervical precancer and cancer. Int J Cancer 2017; 141:701-710. [PMID: 28500655 DOI: 10.1002/ijc.30781] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/13/2017] [Indexed: 01/03/2023]
Abstract
Human papillomavirus (HPV) testing has been recently introduced as an alternative to cytology for cervical cancer screening. However, since most HPV infections clear without causing clinically relevant lesions, additional triage tests are required to identify women who are at high risk of developing cancer. We performed DNA methylation profiling on formalin-fixed, paraffin-embedded tissue specimens from women with benign HPV16 infection and histologically confirmed cervical intraepithelial neoplasia grade 3, and cancer using a bead-based microarray covering 1,500 CpG sites in over 800 genes. Methylation levels in individual CpG sites were compared using a t-test, and results were summarized by computing p-values. A total of 12 candidate genes (ADCYAP1, ASCL1, ATP10, CADM1, DCC, DBC1, HS3ST2, MOS, MYOD1, SOX1, SOX17 and TMEFF2) identified by DNA methylation profiling, plus an additional three genes identified from the literature (EPB41L3, MAL and miR-124) were chosen for validation in an independent set of 167 liquid-based cytology specimens using pyrosequencing and targeted, next-generation bisulfite sequencing. Of the 15 candidate gene markers, 10 had an area under the curve (AUC) of ≥ 0.75 for discrimination of high grade squamous intraepithelial lesions or worse (HSIL+) from <HSIL cytology using at least one assay. Overall, SOX1, DCC, and EPB41L3 showed the best discrimination with AUC values of ≥0.80, irrespective of methylation detection assay. In addition to verifying candidate markers from the literature (e.g., SOX1 and EPB41L3), we identified novel markers that may be considered for detection of cervical precancer and cancer and warrant further validation in prospective studies.
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Affiliation(s)
- Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - S Terence Dunn
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Joan Walker
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rosemary Zuna
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephen Hewitt
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - J Keith Killian
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Mboumba Bouassa RS, Prazuck T, Lethu T, Jenabian MA, Meye JF, Bélec L. Cervical cancer in sub-Saharan Africa: a preventable noncommunicable disease. Expert Rev Anti Infect Ther 2017; 15:613-627. [PMID: 28440679 DOI: 10.1080/14787210.2017.1322902] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Infections caused by high-risk human papillomavirus (HPV) are responsible for 7.7% of cancers in developing countries, mainly cervical cancer. This disease is steadily increasing in sub-Saharan Africa, with more than 75,000 new cases and 50,000 deaths yearly, further increased by HIV infection. Areas covered: The current status of cervical cancer associated with HPV in sub-Saharan Africa has been systematically revised. The main issues discussed here are related to the public health burden of cervical cancer in sub-Saharan Africa and predictions for the coming decades, including molecular epidemiology and determinants of HPV infection in Africa, and promising prevention measures currently being evaluated in Africa. Expert commentary: By the year 2030, cervical cancer will kill more than 443,000 women yearly worldwide, most of them in sub-Saharan Africa. The increase in the incidence of cervical cancer in Africa could counteract the progress made by African women in reducing maternal mortality and longevity. Nevertheless, cervical cancer is a potentially preventable noncommunicable disease, and intervention strategies to eliminate cervical cancer as a public health concern should be urgently implemented.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- a Laboratoire de virologie, hôpital Européen Georges Pompidou , Assistance Publique-Hôpitaux de Paris , France.,b Department of Immunology, INSERM U970 , Université Paris Descartes, Sorbonne Paris-Cité , Paris , France
| | - Thierry Prazuck
- c Service des Maladies Infectieuses et Tropicales , Centre Hospitalier Régional Orléans La Source , Orléans , France
| | - Thérèse Lethu
- d Department of health and well-being , Global Health Objectives , Geneva , Switzerland
| | - Mohammad-Ali Jenabian
- e Departement des Sciences Biologiques et Centre de recherche BioMed , Universite du Quebec a Montreal (UQAM) , Montreal , QC , Canada
| | - Jean-François Meye
- f Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire d'Angondjé, Libreville et Faculté de Médecine de Libreville , Université des Sciences de la Santé , Libreville , Gabon
| | - Laurent Bélec
- a Laboratoire de virologie, hôpital Européen Georges Pompidou , Assistance Publique-Hôpitaux de Paris , France.,b Department of Immunology, INSERM U970 , Université Paris Descartes, Sorbonne Paris-Cité , Paris , France
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Options in human papillomavirus (HPV) detection for cervical cancer screening: comparison between full genotyping and a rapid qualitative HPV-DNA assay in Ghana. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2017; 4:5. [PMID: 28270915 PMCID: PMC5335847 DOI: 10.1186/s40661-017-0041-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/18/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Modern cervical cancer screening increasingly relies on the use of molecular techniques detecting high-risk oncogenic human papillomavirus (hr-HPV). A major challenge for developing countries like Ghana has been the unavailability and costs of HPV DNA-based testing. This study compares the performance of careHPV, a semi-rapid and affordable qualitative detection assay for 14 hr-HPV genotypes, with HPV genotyping, for the detection of cytological cervical squamous intraepithelial lesions (SIL). METHODS A study comparing between frequency matched HIV-1 seropositive and HIV-seronegative women was conducted in the Cape Coast Teaching Hospital, Ghana. A systematic sampling method was used to select women attending clinics in the hospital. Cervical samples were tested for HPV by careHPV and Anyplex-II HPV28 genotyping assay, and by conventional cytology. RESULTS A total of 175 paired results (94 from HIV-1 seropositive and 81 from HIV-seronegative women) were analyzed based on the ability of both tests to detect the 14 hr-HPV types included in the careHPV assay. The inter-assay concordance was 94.3% (95%CI: 89.7-97.2%, kappa = 0.88), similar by HIV serostatus. The careHPV assay was equally sensitive among HIV-1 seropositive and seronegative women (97.3% vs. 95.7%, p = 0.50) and slightly more specific among HIV-seronegative women (85.0% vs. 93.1%, p = 0.10). careHPV had good sensitivity (87.5%) but low specificity (52.1%) for the detection of low SIL or greater lesions, but its performance was superior to genotyping (87.5 and 38.8%, respectively). Reproducibility of careHPV, tested on 97 samples by the same individual was 82.5% (95%CI: 73.4-89.4%). CONCLUSIONS The performance characteristics of careHPV compared to genotyping suggest that this simpler and cheaper HPV detection assay could offer a suitable alternative for HPV screening in Ghana.
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Knowlton S, Yenilmez B, Anand S, Tasoglu S. Photocrosslinking-based bioprinting: Examining crosslinking schemes. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.bprint.2017.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Iftner T, Wang L, Iftner A, Holz B, Haedicke-Jarboui J, Iftner N, von Wasielewski R, Martus P, Boehmer G. Study-based evaluation of the Abbott RealTime High Risk HPV test in comparison to the HC2 HR HPV test in women aged ≥30 years using residual LBC ThinPrep specimens. BMC Infect Dis 2016; 16:672. [PMID: 27835974 PMCID: PMC5106810 DOI: 10.1186/s12879-016-1994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/29/2016] [Indexed: 12/19/2022] Open
Abstract
Background High-risk human papillomavirus (HR HPV) testing is already part of cervical cancer screening programs in a number of countries. New tests need to be validated not only in clinical studies but also in routine screening settings with regard to their clinical performance. Methods The Abbott RealTime High Risk HPV Test (RT hrHPV test) was evaluated in a random sample of 1,456 patients from a German routine screening population of 13,372 women ≥30 years of age screened primarily by liquid-based cytology (LBC) that was complemented by 48 CIN3+ cases. Clinical sensitivities, relative specificities and positive predictive values (PPV) for both HPV tests were determined based on histologically confirmed high-grade cervical disease (CIN3+) as clinical outcome. Results HR HPV prevalence in residual LBC samples was found to be 5.4 % by the RT hrHPV test and 5.6 % by the HR HC2 test, respectively. The Kappa-value for overall agreement between the RT hrHPV test and the HC2 assay for detection of HR HPV was 0.87. Relative sensitivities for detection of CIN3+ in patients with abnormal cytology was 93.8 % for the RT hrHPV assay and 97.9 % for HC2 (p-value = 0.5). Relative specificities and PPVs were comparable for both tests. The highest PPV was calculated for the specific detection of HPV16 by the RT hrHPV test (84.2 %). The RT hrHPV test showed a reduced sensitivity for detection of HVP31-positive CIN3 + . Conclusion The RT hrHPV assay is as sensitive and specific in detecting severe cervical lesions in women with abnormal cytology as the HC2 HR HPV test.
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Affiliation(s)
- Thomas Iftner
- Division of Experimental Virology, Institute of Medical Virology, University Hospital Tübingen, Elfriede-Aulhorn-Str. 6, Tübingen, 72076, Germany.
| | - Lisa Wang
- Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Tübingen, Germany
| | - Angelika Iftner
- Division of Experimental Virology, Institute of Medical Virology, University Hospital Tübingen, Elfriede-Aulhorn-Str. 6, Tübingen, 72076, Germany
| | - Barbara Holz
- Division of Experimental Virology, Institute of Medical Virology, University Hospital Tübingen, Elfriede-Aulhorn-Str. 6, Tübingen, 72076, Germany
| | - Juliane Haedicke-Jarboui
- Division of Experimental Virology, Institute of Medical Virology, University Hospital Tübingen, Elfriede-Aulhorn-Str. 6, Tübingen, 72076, Germany
| | - Nathalie Iftner
- Division of Experimental Virology, Institute of Medical Virology, University Hospital Tübingen, Elfriede-Aulhorn-Str. 6, Tübingen, 72076, Germany
| | | | - Peter Martus
- Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Tübingen, Germany
| | - Gerd Boehmer
- Amedes Laboratory Bad Münder, Bad Münder, Germany
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Lorincz AT. Virtues and Weaknesses of DNA Methylation as a Test for Cervical Cancer Prevention. Acta Cytol 2016; 60:501-512. [PMID: 27806357 DOI: 10.1159/000450595] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 12/21/2022]
Abstract
Epigenetics is the study of heritable and non-heritable genetic coding that is additive to information contained within classical DNA base pair sequences. Differential methylation has a fundamental role in the development and outcome of malignancies, chronic and degenerative diseases and aging. DNA methylation can be measured accurately and easily via various molecular methods and has become a key technology for research and healthcare delivery, with immediate roles in the elucidation of disease natural history, diagnostics and drug discovery. This review focuses on cancers of the lower genital tract, for which the most epigenetic information exists. DNA methylation has been proposed as a triage for women infected with human papillomavirus (HPV) and may eventually directly complement or replace HPV screening as a one-step molecular diagnostic and prognostic test. Methylation of human genes is strongly associated with cervical intraepithelial neoplasia (CIN) and cancer. Of the more than 100 human methylation biomarker genes tested so far in cervical tissue, close to 20 have been reported in different studies, and approximately 10 have been repeatedly shown to have elevated methylation in cervical cancers and high-grade CIN (CIN2 and CIN3), most prominently CADM1, EPB41L3, FAM19A4, MAL, miR-124, PAX1 and SOX1. Obtaining consistent performance data from the literature is quite difficult because most methylation studies used a variety of different assay methodologies and had incomplete and/or biased clinical specimen sets, varying assay thresholds and disparate target gene regions. There have been relatively few validation studies of DNA methylation biomarkers in large population-based screening studies, but an encouraging development more recently is the execution of well-designed studies to test the true performance of the markers in real-world settings. Methylation of HPV genes, especially HPV16, HPV18, HPV31, HPV33 and HPV45, in disease progression has been a major focus of research. Elevated methylation of the HPV16 L1 and L2 open reading frames, in particular, is associated with CIN2, CIN3 and invasive cancer. Essentially all cancers have high levels of methylation for human genes and for driver HPV types, which suggests that quantitative methylation tests may have utility in predicting CIN2 and CIN3 that are likely to progress. It is still early in the process of development of methylation biomarkers, but already they are showing strong promise as a universal and systematic approach to molecular triage, applicable to all cancers, not just cancer of the cervix. DNA methylation testing is better than HPV genotyping triage and is competitive with or complementary to other approaches such as cytology and p16 staining. Genome-wide studies are underway to systematically expand methylation classifier panels and find the best combinations of biomarkers. Methylation testing is likely to show big improvements in performance in the next 5 years.
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Affiliation(s)
- Attila T Lorincz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Rahmatulina MR, Nechaeva IA, Shalva M. Experience destructive therapy anogenital warts. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-5-96-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective. To assess the efficiency and tolerability of the Mardil Zinc Max, solution for external application, in topical therapy of patients with anogenital warts. Materials and methods. The study involved 58 women and 12 men at the age of 18 to 57 years old, suffering from anogenital warts. the diagnosis was confirmed by identification of human papillomavirus by the polymerase chain reaction in real time. All the patients were treated by the chemical destruction of anogenital warts with the 1.5% solution of zinc chloropropionate in 50% 2-chloropropionic acid (Mardil Zinc Max) by a single application of the solution on the pathological eruptions. The results of treatment were assessed in 2 weeks, in 1, 3, 6 and 9 months after the destructive therapy. Results. In 2 weeks 62 (88.6%) patients showed a clinical cure with complete tissue regeneration in the lesions, in 8 (11,4%) cases in areas of the preparation erosions were visualized in the epithelialization phase, and they completely resolved within 1 week. recurrences of anogenital warts were detected in 1 (1,4%) patient in the observation period up to 3 months and in 2 (2,8%) patients during 9 months after carrying out the destruction. Adverse drug events have not been identified in the course of therapy and follow-up. Conclusions. As a result of the treatment of anogenital warts with the Mardil Zinc Max high rate of performance and security was set (100%), as well as the low percentage (4,2%) of development of relapses.
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Mariano VS, Lorenzi AT, Scapulatempo-Neto C, Stein MD, Resende JCP, Antoniazzi M, Villa LL, Levi JE, Longatto-Filho A, Fregnani JHTG. A Low-Cost HPV Immunochromatographic Assay to Detect High-Grade Cervical Intraepithelial Neoplasia. PLoS One 2016; 11:e0164892. [PMID: 27764154 PMCID: PMC5072685 DOI: 10.1371/journal.pone.0164892] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022] Open
Abstract
Objective To evaluate the reproducibility and accuracy of the HPV16/18-E6 test. Methods The study population was comprised of 448 women with a previously abnormal Pap who were referred to the Barretos Cancer Hospital (Brazil) for diagnosis and treatment. Two cervical samples were collected immediately before colposcopy, one for the hr-HPV-DNA test and cytology and the other for the HPV16/18-E6 test using high-affinity monoclonal antibodies (mAb). Women with a histologic diagnosis of cervical intraepithelial neoplasia grade 2 or 3 were considered to be positive cases. Different strategies using a combination of screening methods (HPV-DNA) and triage tests (cytology and HPV16/18-E6) were also examined and compared. Results The HPV16/18-E6 test exhibited a lower positivity rate compared with the HPV-DNA test (19.0% vs. 29.3%, p<0.001) and a moderate/high agreement (kappa = 0.68, 95%CI: 0.60–0.75). It also exhibited a significantly lower sensitivity for CIN2+ and CIN3+ detection compared to the HPV-DNA test and a significantly higher specificity. The HPV16/18-E6 test was no different from cytology in terms of sensitivity, but it exhibited a significantly higher specificity in comparison to ASCH+. A triage test after HPV-DNA detection using the HPV16/18-E6 test exhibited a significantly higher specificity compared with a triage test of ASCH+ to CIN2+ (91.8% vs. 87.4%, p = 0.04) and CIN3+ (88.6% vs. 84.0%, p = 0.05). Conclusion The HPV16/18-E6 test exhibited moderate/high agreement with the HPV-DNA test but lower sensitivity and higher specificity for the detection of CIN2+ and CIN3+. In addition, its performance was quite similar to cytology, but because of the structural design addressed for the detection of HPV16/18-E6 protein, the test can miss some CIN2/3+ lesions caused by other high-risk HPV types.
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Affiliation(s)
- Vânia Sammartino Mariano
- Molecular Oncology Research Center, Barretos Cancer Hospital/Pio XII Foundation, Barretos, Sao Paulo, Brazil
| | - Adriana Tarlá Lorenzi
- Molecular Oncology Research Center, Barretos Cancer Hospital/Pio XII Foundation, Barretos, Sao Paulo, Brazil
| | | | - Maíra Degiovani Stein
- Pathology Department, Barretos Cancer Hospital/Pio XII Foundation, Barretos, Sao Paulo, Brazil
| | | | - Márcio Antoniazzi
- Cancer Prevention Department, Barretos Cancer Hospital/Pio XII Foundation, Barretos, Sao Paulo, Brazil
| | - Luisa Lina Villa
- Department of Radiology and Oncology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - José Eduardo Levi
- Virology Laboratory, LIM 52.The Institute of Tropical Medicine of the University of Sao Paulo, Sao Paulo, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital/Pio XII Foundation, Barretos, Sao Paulo, Brazil
- Laboratory of Medical Research Laboratory, LIM 14.Department of Pathology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B’s–PT Government Associate Laboratory, Braga/Guimaraes, Portugal
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Fang H, Shuang D, Yi Z, Sheng H, Liu Y. Up-regulated microRNA-155 expression is associated with poor prognosis in cervical cancer patients. Biomed Pharmacother 2016; 83:64-69. [DOI: 10.1016/j.biopha.2016.06.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 01/08/2023] Open
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Passamonti B, Gustinucci D, Giorgi Rossi P, Cesarini E, Bulletti S, Carlani A, Martinelli N, Broccolini M, D'Angelo V, D'Amico MR, Di Dato E, Galeazzi P, Malaspina M, Spita N, Tintori B, Giaimo MD. Cervical human papilloma virus (HPV) DNA primary screening test: Results of a population-based screening programme in central Italy. J Med Screen 2016; 24:153-162. [PMID: 27614992 DOI: 10.1177/0969141316663580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To present the results of the first and second round human papilloma virus (HPV)-based screening programme in the Umbria region after three years. Methods From August 2010 to November 2011, the entire female population aged 35-64 in a local health district was invited for HPV testing (HPV-DNA cobas4800 on a liquid-based cytology sample). HPV-negative women were re-invited after three years. For HPV-positive women, a slide was prepared and interpreted. Positive cytologies were referred to colposcopy; negatives were referred to repeat HPV after one year. If HPV was persistently positive, women were referred to colposcopy; if negative, to normal screening. Indicators of the first and second round are compared with those of cytology screening in the same area in the preceding three years. Results Participation was 56.5%, the same as cytology (56.6%). HPV-positivity was 6.4% (396/6272), cytology triage positivity was 35.6%; 251 cytology negative women were referred to one-year HPV retesting, 84.1% complied, and 55.5% were positive. Total colposcopy referral was 4.1%, and for cytology 1%. The detection rate for cervical intraepithelial neoplasia grade 2 or more severe was 10‰, compared with 3.7‰ using cytology. After three years, HPV-positivity was 3.4% (129/3831), overall colposcopy referral was 2.3% (most at one-year follow-up), and detection rate was 0.5/1000. Conclusions The first round detection rate was more than twice that of cytology screening, while colposcopy referral increased fourfold. At the second round, the detection rate decreased dramatically, showing that longer interval and more conservative protocols are needed.
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Affiliation(s)
- Basilio Passamonti
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Daniela Gustinucci
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Paolo Giorgi Rossi
- 2 Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Italy
- 3 Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Elena Cesarini
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Simonetta Bulletti
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Angela Carlani
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Nadia Martinelli
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Massimo Broccolini
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Valentina D'Angelo
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | | | - Eugenio Di Dato
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Paola Galeazzi
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Morena Malaspina
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Nicoletta Spita
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Beatrice Tintori
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Maria Donata Giaimo
- 4 Regione Umbria, Responsabile Servizio Prevenzione, Sanità Veterinaria e Sicurezza Alimentare
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Schiffman M, Hyun N, Raine-Bennett TR, Katki H, Fetterman B, Gage JC, Cheung LC, Befano B, Poitras N, Lorey T, Castle PE, Wentzensen N. A cohort study of cervical screening using partial HPV typing and cytology triage. Int J Cancer 2016; 139:2606-15. [DOI: 10.1002/ijc.30375] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/01/2016] [Accepted: 07/15/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Mark Schiffman
- National Cancer Institute Division of Cancer Epidemiology and Genetics; Rockville MD
| | - Noorie Hyun
- National Cancer Institute Division of Cancer Epidemiology and Genetics; Rockville MD
| | | | - Hormuzd Katki
- National Cancer Institute Division of Cancer Epidemiology and Genetics; Rockville MD
| | - Barbara Fetterman
- Kaiser Permanente Northern California Regional Laboratory; Berkeley CA
| | - Julia C. Gage
- National Cancer Institute Division of Cancer Epidemiology and Genetics; Rockville MD
| | | | | | - Nancy Poitras
- Kaiser Permanente Northern California Regional Laboratory; Berkeley CA
| | - Thomas Lorey
- Kaiser Permanente Northern California Regional Laboratory; Berkeley CA
| | - Philip E. Castle
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx NY
| | - Nicolas Wentzensen
- National Cancer Institute Division of Cancer Epidemiology and Genetics; Rockville MD
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Brotherton JML, Jit M, Gravitt PE, Brisson M, Kreimer AR, Pai SI, Fakhry C, Monsonego J, Franceschi S. Eurogin Roadmap 2015: How has HPV knowledge changed our practice: Vaccines. Int J Cancer 2016; 139:510-7. [PMID: 26916230 PMCID: PMC7388730 DOI: 10.1002/ijc.30063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 12/18/2022]
Abstract
This review is one of two complementary reviews that have been prepared in the framework of the Eurogin Roadmap 2015 to evaluate how knowledge about HPV is changing practices in HPV infection and disease control through vaccination and screening. In this review of HPV vaccine knowledge, we present the most significant findings of the past year which have contributed to our knowledge of the two HPV prophylactic vaccines currently in widespread use and about the recently licensed nonavalent HPV vaccine. Whereas anal cancer is dealt with in the companion mini-review on screening, we also review here the rapidly evolving evidence regarding HPV-associated head and neck cancer and priority research areas.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, VCS Registries, East Melbourne, Vic, Australia
- School of Population and Global Health, University of Melbourne, Vic, Australia
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patti E Gravitt
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Marc Brisson
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | - Aimée R Kreimer
- Infections & Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
| | - Sara I Pai
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Carole Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, Baltimore, MD
| | | | - Silvia Franceschi
- International Agency for Research on Cancer, 69372 Lyon cedex 08, France
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Negulescu RA, Catarino R, De Vuyst H, Undurraga-Malinverno M, Meyer-Hamme U, Alec M, Campana A, Vassilakos P, Petignat P. Web-based instrument to assess skills in visual inspection of the cervix among healthcare providers. Int J Gynaecol Obstet 2016; 134:107-13. [PMID: 27126908 DOI: 10.1016/j.ijgo.2015.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/15/2015] [Accepted: 03/23/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To validate a web-based instrument for assessing healthcare providers' skills in visual inspection with acetic acid or Lugol iodine (VIA/VILI) for the diagnosis and management of cervical intraepithelial neoplasia. METHODS An observational cross-sectional study enrolled healthcare providers in a web-based assessment of VIA/VILI skills between August and November 2014. Participants participated in a four-module training course, followed by a multiple-choice test with 70 questions based on cervical photographs of HPV-positive women participating in cervical screening. Logistic regression was used to identify relationships between independent variables and success on the test. RESULTS Overall, 255 participants completed the test and 99 (38.8%) passed. No correlation was found between age or sex and test performance. Compared with other healthcare workers, physicians (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.01-3.63; P=0.048), and participants with more colposcopy experience (OR 3.62, 95% CI 1.91-6.85; P<0.001) and postgraduate VIA/VILI training (OR 1.95, 95% CI 1.16-3.29; P=0.012) were more likely to pass the test. Participants who repeated the test (31/255 [12.2%]) were five times more likely to succeed on their second repeat (OR 5.89, 95% CI 1.46-23.73; P=0.013). CONCLUSION Web-based training for VIA/VILI is feasible and can identify healthcare workers who are proficient in this technique.
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Affiliation(s)
- Raluca-Anca Negulescu
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
| | - Rosa Catarino
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Hugo De Vuyst
- International Agency for Research on Cancer, Lyon, France
| | - Manuela Undurraga-Malinverno
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Ulrike Meyer-Hamme
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Milena Alec
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Aldo Campana
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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Lorincz AT, Brentnall AR, Scibior‐Bentkowska D, Reuter C, Banwait R, Cadman L, Austin J, Cuzick J, Vasiljević N. Validation of a DNA methylation HPV triage classifier in a screening sample. Int J Cancer 2016; 138:2745-51. [PMID: 26790008 PMCID: PMC4832297 DOI: 10.1002/ijc.30008] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/08/2015] [Accepted: 01/11/2016] [Indexed: 01/08/2023]
Abstract
High-risk human papillomavirus (hrHPV) DNA tests have excellent sensitivity for detection of cervical intraepithelial neoplasia 2 or higher (CIN2+). A drawback of hrHPV screening, however, is modest specificity. Therefore, hrHPV-positive women might need triage to reduce adverse events and costs associated with unnecessary colposcopy. We compared the performance of HPV16/18 genotyping with a predefined DNA methylation triage test (S5) based on target regions of the human gene EPB41L3, and viral late gene regions of HPV16, HPV18, HPV31 and HPV33. Assays were run using exfoliated cervical specimens from 710 women attending routine screening, of whom 38 were diagnosed with CIN2+ within a year after triage to colposcopy based on cytology and 341 were hrHPV positive. Sensitivity and specificity of the investigated triage methods were compared by McNemar's test. At the predefined cutoff, S5 showed better sensitivity than HPV16/18 genotyping (74% vs 54%, P = 0.04) in identifying CIN2+ in hrHPV-positive women, and similar specificity (65% vs 71%, P = 0.07). When the S5 cutoff was altered to allow equal sensitivity to that of genotyping, a significantly higher specificity of 91% was reached (P < 0.0001). Thus, a DNA methylation test for the triage of hrHPV-positive women on original screening specimens might be a valid approach with better performance than genotyping.
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Affiliation(s)
- Attila T. Lorincz
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
| | - Adam R. Brentnall
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
| | - Dorota Scibior‐Bentkowska
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
| | - Caroline Reuter
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
| | - Rawinder Banwait
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
| | - Louise Cadman
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
| | - Janet Austin
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
| | - Jack Cuzick
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
| | - Natasa Vasiljević
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of MedicineCharterhouse SquareLondonEC1M 6BQUnited Kingdom
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Yu LL, Kang LN, Zhao FH, Lei XQ, Qin Y, Wu ZN, Wang H, Chen W, Qiao YL. Elevated Expression of Human Papillomavirus-16/18 E6 Oncoprotein Associates with Persistence of Viral Infection: A 3-Year Prospective Study in China. Cancer Epidemiol Biomarkers Prev 2016; 25:1167-74. [PMID: 27197295 DOI: 10.1158/1055-9965.epi-15-1057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/26/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND An association between high-risk human papillomavirus (HR-HPV) oncoprotein expression and viral persistence has been suggested by the outcome of etiology studies, but there are no epidemiologic studies evaluating that link. METHODS We performed a 3-year prospective study in which 2,498 Chinese women ages 25 to 65 years were screened by six screening tests, including the Onco E6: Cervical Test (Arbor Vita Corporation) in 2011 (baseline). Six-hundred and ninety women who were positive for any of the tests and a random sample of 164 women with all negative results received colposcopy, and cervical specimens for the cobas 4800 HPV test ("cobas," Roche Molecular Systems) were collected before colposcopy; of this group, 737 cervical specimens were collected to perform cobas and Onco E6: Cervical Test in 2014 (follow-up). Twenty-four cases of HPV16/18 E6 positives and 204 selected controls at baseline, 13 cases of HPV16/18 E6 positive and another 204 selected controls at follow-up were analyzed separately using unconditional logistical regression models to estimate ORs and 95% confidence intervals (CI). RESULTS Compared with women who were HPV16 E6 oncoprotein negative at baseline, women in the E6-positive group had a much higher risk of HPV persistence (adjusted OR, 54.64; 95% CI, 7.19-415.09) at 3-year follow-up; a statistically strong association was also found between HPV16/18 HPV persistence and E6 oncoprotein expression detected at follow-up (adjusted OR, 360.57; 95% CI, 28.30-4,593.55). CONCLUSIONS A single detection of HPV16/18 E6 oncoprotein expression was strongly associated with viral persistence. IMPACT HPV16/18 E6 oncoprotein constitutes a marker for risk of HPV persistence. Cancer Epidemiol Biomarkers Prev; 25(7); 1167-74. ©2016 AACR.
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Affiliation(s)
- Lu-Lu Yu
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Le-Ni Kang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Fang-Hui Zhao
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Xiao-Qin Lei
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Yu Qin
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Ze-Ni Wu
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Hong Wang
- The First Hospital of Fangshan District, Beijing, PR China
| | - Wen Chen
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
| | - You-Lin Qiao
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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Poljak M, Oštrbenk A, Seme K, Šterbenc A, Jančar N, Vrtačnik Bokal E. Three-year longitudinal data on the clinical performance of the Abbott RealTime High Risk HPV test in a cervical cancer screening setting. J Clin Virol 2016; 76 Suppl 1:S29-S39. [DOI: 10.1016/j.jcv.2015.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 01/29/2023]
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Bosch FX, Robles C, Díaz M, Arbyn M, Baussano I, Clavel C, Ronco G, Dillner J, Lehtinen M, Petry KU, Poljak M, Kjaer SK, Meijer CJLM, Garland SM, Salmerón J, Castellsagué X, Bruni L, de Sanjosé S, Cuzick J. HPV-FASTER: broadening the scope for prevention of HPV-related cancer. Nat Rev Clin Oncol 2016; 13:119-32. [PMID: 26323382 DOI: 10.1038/nrclinonc.2015.146] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human papillomavirus (HPV)-related screening technologies and HPV vaccination offer enormous potential for cancer prevention, notably prevention of cervical cancer. The effectiveness of these approaches is, however, suboptimal owing to limited implementation of screening programmes and restricted indications for HPV vaccination. Trials of HPV vaccination in women aged up to 55 years have shown almost 90% protection from cervical precancer caused by HPV16/18 among HPV16/18-DNA-negative women. We propose extending routine vaccination programmes to women of up to 30 years of age (and to the 45-50-year age groups in some settings), paired with at least one HPV-screening test at age 30 years or older. Expanding the indications for HPV vaccination and much greater use of HPV testing in screening programmes has the potential to accelerate the decline in cervical cancer incidence. Such a combined protocol would represent an attractive approach for many health-care systems, in particular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged >30 years and the optimal number of HPV-screening tests required in vaccinated women remain important research issues. Cost-effectiveness models will help determine the optimal combination of HPV vaccination and screening in public health programmes, and to estimate the effects of such approaches in different populations.
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Affiliation(s)
- F Xavier Bosch
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Claudia Robles
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Mireia Díaz
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | | | - Christine Clavel
- Centre Hospitalier Universitaire (CHU) Reims, Université de Reims Champagne-Ardenne and Institut National de la Santé et de la Recherche Médicale UMR-S 903, Reims, France
| | - Guglielmo Ronco
- Unit of Cancer Epidemiology, Centre for Cancer Prevention (CPO), Torino, Italy
| | - Joakim Dillner
- Departments of Laboratory Medicine, Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matti Lehtinen
- University of Tampere, School of Health Sciences, Tampere, Finland
| | - Karl-Ulrich Petry
- Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Susanne K Kjaer
- Virus, Lifestyle &Genes, Danish Cancer Society Research Centre; and Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Centre (VUmc), Amsterdam, Netherlands
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital; Murdoch Childrens Research Institute; and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Xavier Castellsagué
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Silvia de Sanjosé
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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