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Boitano TKL, Kako T, Leath CA. New Paradigms in the Treatment of Cervical Cancer. Obstet Gynecol 2023; 142:1322-1332. [PMID: 37826852 PMCID: PMC10841100 DOI: 10.1097/aog.0000000000005413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
Despite effective screening strategies and the development and implementation of prophylactic high-risk human papillomavirus vaccination, cervical cancer remains a significant public health burden. This burden is most pronounced in under-resourced countries without fully developed screening and vaccination programs, although the disease remains present worldwide, including in industrialized countries. To that end, the World Health Organization (WHO) has an active focus on the elimination of cervical cancer, with objective metrics to be achieved by countries by the year 2030. Although increased vaccination and screening will be needed to approach potential eradication of cervical cancer, as recognized by the WHO initiative, treatment will need to continue to not only be effective in the near term, but to improve outcomes as well. Accordingly, assessments to improve primary treatment options, including surgery for women with early-stage disease, modification of chemoradiation for those with locally advanced cervical cancer, and systemic therapy for those with recurrent or metastatic presentations, are ongoing. Accordingly, we highlight important areas of both recent and ongoing focus as they relate to improving cervical cancer outcomes.
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Affiliation(s)
- Teresa K. L. Boitano
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Tavonna Kako
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35294, USA
| | - Charles A. Leath
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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2
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Volesky-Avellaneda KD, Laurie C, Tsyruk-Romano O, El-Zein M, Franco EL. Human Papillomavirus Detectability and Cervical Cancer Prognosis: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:1055-1067. [PMID: 37856917 DOI: 10.1097/aog.0000000000005370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/29/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To evaluate whether testing positive for human papillomavirus (HPV) before treatment is associated with cervical cancer recurrence and disease-free, cancer-specific, and overall survival and to report the relationship of HPV to cervical cancer histology, stage, grade, tumor size, lymph node involvement, and treatment response. DATA SOURCES EMBASE and MEDLINE were searched from inception to January 27, 2022, with the use of MeSH terms and keywords relating to cervical cancer, HPV, and prognosis. ClinicalTrials.gov was not searched because of the nature of our review question. METHODS OF STUDY SELECTION Studies must have assessed HPV DNA or RNA in cervical pretreatment biopsies or cells from 20 or more patients with invasive cervical cancer followed up for any length of time and reported the effect of testing positive or negative for HPV on cervical cancer recurrence, disease-free survival, cancer-specific survival, or overall survival. We extracted data on HPV-detection methods, patient and tumor characteristics, and clinical outcomes. TABULATION, INTEGRATION, AND RESULTS Hazard ratios (HRs) and 95% CIs were pooled with a random-effects model. Meta-regression was performed to explore heterogeneity. Of 11,179 titles or abstracts and 474 full-text articles reviewed, 77 studies were included in the systematic review. Among these 77 studies, 30 reported on the relationship of HPV status to histology, 39 to cancer stage, 13 to tumor grade, 17 to tumor size, 23 to lymph node involvement, and four to treatment response. Testing positive for HPV was associated with better disease-free survival (HR 0.38, 95% CI 0.25-0.57; 15 studies with 2,564 cases), cancer-specific survival (HR 0.56, 95% CI 0.44-0.71; nine studies with 1,398 cases), and overall survival (HR 0.59, 95% CI 0.47-0.74; 36 studies with 9,169 cases), but not recurrence (HR 0.59, 95% CI 0.33-1.07; eight studies with 1,313 cases). Meta-regression revealed that the number of cases, tumor grade, specimen type, gene target, and HPV prevalence together explained 73.8% of the between-study heterogeneity. CONCLUSION This review indicates that HPV detectability in cervical cancer is associated with a better clinical prognosis. SYSTEMATIC REVIEW REGISTRATION https://osf.io/dtyeb .
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Affiliation(s)
- Karena D Volesky-Avellaneda
- Division of Cancer Epidemiology and the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
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Wang Q, He M, Guo L, Chai H. AFEI: adaptive optimized vertical federated learning for heterogeneous multi-omics data integration. Brief Bioinform 2023; 24:bbad269. [PMID: 37497720 DOI: 10.1093/bib/bbad269] [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: 05/19/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023] Open
Abstract
Vertical federated learning has gained popularity as a means of enabling collaboration and information sharing between different entities while maintaining data privacy and security. This approach has potential applications in disease healthcare, cancer prognosis prediction, and other industries where data privacy is a major concern. Although using multi-omics data for cancer prognosis prediction provides more information for treatment selection, collecting different types of omics data can be challenging due to their production in various medical institutions. Data owners must comply with strict data protection regulations such as European Union (EU) General Data Protection Regulation. To share patient data across multiple institutions, privacy and security issues must be addressed. Therefore, we propose an adaptive optimized vertical federated-learning-based framework adaptive optimized vertical federated learning for heterogeneous multi-omics data integration (AFEI) to integrate multi-omics data collected from multiple institutions for cancer prognosis prediction. AFEI enables participating parties to build an accurate joint evaluation model for learning more information related to cancer patients from different perspectives, based on the distributed and encrypted multi-omics features shared by multiple institutions. The experimental results demonstrate that AFEI achieves higher prediction accuracy (6.5% on average) than using single omics data by utilizing the encrypted multi-omics data from different institutions, and it performs almost as well as prognosis prediction by directly integrating multi-omics data. Overall, AFEI can be seen as an efficient solution for breaking down barriers to multi-institutional collaboration and promoting the development of cancer prognosis prediction.
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Affiliation(s)
- Qingyong Wang
- School of Information and Computer, Anhui Agricultural University, Hefei 230000, China
| | - Minfan He
- School of Mathematics and Big Data, Foshan University, Foshan 528000, China
| | - Longyi Guo
- Guangdong Provincial Hospital of Traditional Chinese Medical, Guangzhou 510000, China
| | - Hua Chai
- School of Mathematics and Big Data, Foshan University, Foshan 528000, China
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4
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Li Z, Winer RL, Ba S, Sy MP, Lin J, Feng Q, Gottlieb GS, Salif Sow P, Kiviat NB, Hawes SE. Effect of Human Immunodeficiency Virus Infection on Human Papillomavirus Clearance Among Women in Senegal, West Africa. J Infect Dis 2023; 227:1088-1096. [PMID: 36314598 PMCID: PMC10319963 DOI: 10.1093/infdis/jiac428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Persistent infection with high-risk human papillomavirus (HPV) is associated with development of invasive cervical cancer. METHODS Longitudinal data was collected from 174 Senegalese women. We employed marginal Cox proportional hazards models to examine the effect of human immunodeficiency virus (HIV) status (HIV positive vs HIV negative) and HIV type (HIV-1 vs HIV-2 vs dual HIV-1/HIV-2) on clearance of type-specific HPV infection. Analyses were stratified by incident versus prevalent HPV infection. RESULTS Incident HPV infections in HIV-positive women were less likely to clear than those in HIV-negative women (adjusted hazard ratio [HR] = 0.60; 95% confidence interval [CI], .38-.94). Among HIV-positive women, HIV-2-infected women and HIV-1/2 dually infected women were more likely to clear HPV incident infections than HIV-1-infected women (HR = 1.66; 95% CI, .95-2.92 and HR = 2.17; 95% CI, 1.12-4.22, respectively). Incident HPV infections in HIV-positive women with CD4 cell count ≤500 cells/μL were less likely to clear than those in HIV-positive women with CD4 cell count >500 cells/μL (HR = 0.65; 95% CI, .42-1.01). No significant associations were observed for prevalent HPV infections. CONCLUSIONS HIV infection reduced the likelihood of clearance of incident HPV infection. Furthermore, among HIV-positive women, low CD4 cell count and dual HIV infection were each associated with reduced likelihood of clearance.
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Affiliation(s)
- Zhuochen Li
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Selly Ba
- Service des Maladies Infectieuses Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Sénégal
| | - Marie Pierre Sy
- Service des Maladies Infectieuses Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Sénégal
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Pathology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Qinghua Feng
- Department of Pathology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Geoffrey S Gottlieb
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Papa Salif Sow
- Service des Maladies Infectieuses Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Sénégal
| | - Nancy B Kiviat
- Department of Pathology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
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Tong Y, Orang’o E, Nakalembe M, Tonui P, Itsura P, Muthoka K, Titus M, Kiptoo S, Mwangi A, Ong’echa J, Tonui R, Odongo B, Mpamani C, Rosen B, Moormann A, Cu-Uvin S, Bailey JA, Oduor CI, Ermel A, Yiannoutsos C, Musick B, Sang E, Ngeresa A, Banturaki G, Kiragga A, Zhang J, Song Y, Chintala S, Katzenellenbogen R, Loehrer P, Brown DR. The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS. Ann Med 2022; 54:1202-1211. [PMID: 35521812 PMCID: PMC9090376 DOI: 10.1080/07853890.2022.2067897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 12/24/2022] Open
Abstract
The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. KEY MESSAGESThe East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.Collaborations have been established between researchers in North America and East African countries for these studies.Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.
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Affiliation(s)
- Y. Tong
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - M. Nakalembe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | | | - M. Titus
- Maseno University, Kisumu, Kenya
| | | | | | - J. Ong’echa
- Kenya Medical Research Institute, Eldoret, Kenya
| | | | | | - C. Mpamani
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - B. Rosen
- Beaumont Gynecology Oncology, Royal Oak, MI, USA
| | - A. Moormann
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | | | - A. Ermel
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - C. Yiannoutsos
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - B. Musick
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - G. Banturaki
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - A. Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - J. Zhang
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Y. Song
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - S. Chintala
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - P. Loehrer
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - D. R. Brown
- Indiana University School of Medicine, Indianapolis, IN, USA
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Suresh RR, Kulandaisamy AJ, Nesakumar N, Nagarajan S, Lee JH, Rayappan JBB. Graphene Quantum Dots – Hydrothermal Green Synthesis, Material Characterization and Prospects for Cervical Cancer Diagnosis Applications: A Review. ChemistrySelect 2022. [DOI: 10.1002/slct.202200655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Raghavv Raghavender Suresh
- Department of Bioengineering School of Chemical & Biotechnology SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB) SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
| | - Arockia Jayalatha Kulandaisamy
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB) SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
- School of Electrical & Electronics Engineering SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
| | - Noel Nesakumar
- Department of Bioengineering School of Chemical & Biotechnology SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB) SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
| | - Saisubramanian Nagarajan
- Center for Research in Infectious Diseases (CRID) School of Chemical and Biotechnology SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
| | - Jung Heon Lee
- Research Center for Advanced Materials Technology School of Advanced Materials Science & Engineering Biomedical Institute for Convergence at SKKU (BICS) Sungkyunkwan University (SKKU) Suwon 16419 South Korea
| | - John Bosco Balaguru Rayappan
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB) SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
- School of Electrical & Electronics Engineering SASTRA Deemed University Thanjavur 613 401 Tamil Nadu India
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Gapare CR, El-Zein M, Patel H, Tope P, Franco EL. Ecological analysis of correlates of cervical cancer morbidity and mortality in Sub-Saharan Africa. Cancer Epidemiol Biomarkers Prev 2022; 31:1804-1811. [PMID: 35700009 DOI: 10.1158/1055-9965.epi-22-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth leading cause of death among women worldwide, with 85% of the burden falling on low- to middle- income countries. We studied the correlates of cervical cancer incidence and mortality, and case-fatality in Sub-Saharan Africa. METHODS Country-level data on 16 putative cervical cancer correlates for 37 Sub-Saharan African countries were collected from publicly available data sources. We performed univariate and multiple (stepwise) linear regression analyses to identify correlates of cervical cancer incidence and mortality, and case-fatality. RESULTS In univariate analyses, incidence and mortality rates were significantly correlated with contraceptive use, penile cancer incidence, and human immunodeficiency virus prevalence. Incidence rates were also correlated with literacy rates, whereas mortality rates were correlated with the proportion of rural population and screening coverage. Multiple regression analyses showed contraceptive use (p=0.009) and penile cancer incidence (p=0.004) as associated with cervical cancer incidence. Penile cancer incidence (p=9.77 x 10-5) and number of medical doctors (p=0.0433) were associated with mortality. The goodness of fit of the incidence and mortality models was moderate at best, explaining 49% and 37% of variability in the data, respectively. However, the case-fatality model had the best fit explaining most of the variation (adjusted R2=0.948; p=6.822 x 10-16). CONCLUSIONS To reduce the burden of cervical cancer in Sub-Saharan Africa, it would be important to design multimodal interventions that not only target screening and HPV vaccination, but also focus on cervical cancer correlates. IMPACT Identifying contextual factors associated with cervical cancer in this region could inform targeted interventions.
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Ouyang M, Yu C, Deng X, Zhang Y, Zhang X, Duan F. O-GlcNAcylation and Its Role in Cancer-Associated Inflammation. Front Immunol 2022; 13:861559. [PMID: 35432358 PMCID: PMC9010872 DOI: 10.3389/fimmu.2022.861559] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
Cancer cells, as well as surrounding stromal and inflammatory cells, form an inflammatory tumor microenvironment (TME) to promote all stages of carcinogenesis. As an emerging post-translational modification (PTM) of serine and threonine residues of proteins, O-linked-N-Acetylglucosaminylation (O-GlcNAcylation) regulates diverse cancer-relevant processes, such as signal transduction, transcription, cell division, metabolism and cytoskeletal regulation. Recent studies suggest that O-GlcNAcylation regulates the development, maturation and functions of immune cells. However, the role of protein O-GlcNAcylation in cancer-associated inflammation has been less explored. This review summarizes the current understanding of the influence of protein O-GlcNAcylation on cancer-associated inflammation and the mechanisms whereby O-GlcNAc-mediated inflammation regulates tumor progression. This will provide a theoretical basis for further development of anti-cancer therapies.
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Affiliation(s)
- Muzi Ouyang
- Department of Pharmacology, School of Medicine, Sun Yat-sen University, Shenzhen, China
| | - Changmeng Yu
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Xiaolian Deng
- Department of Pharmacology, School of Medicine, Sun Yat-sen University, Shenzhen, China
| | - Yingyi Zhang
- Department of Pharmacology, School of Medicine, Sun Yat-sen University, Shenzhen, China
| | - Xudong Zhang
- Department of Pharmacology, School of Medicine, Sun Yat-sen University, Shenzhen, China
| | - Fangfang Duan
- Department of Pharmacology, School of Medicine, Sun Yat-sen University, Shenzhen, China
- *Correspondence: Fangfang Duan,
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9
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Polymorphism of TP53 gene and the risk of high human papillomavirus load in cervical epithelial cells. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2021.101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Piyathilake CJ, Badiga S, Simons JL, Bell WC, Jolly PE. HPV E1 qPCR, a Low-Cost Alternative Assay to Roche Diagnostic Linear Array is Effective in Identifying Women at Risk for Developing Cervical Cancer. Int J Womens Health 2022; 14:257-266. [PMID: 35221728 PMCID: PMC8865867 DOI: 10.2147/ijwh.s347546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Since a quantitative polymerase chain reaction (qPCR) assay targeting the E1 region of HPV genome is cost-effective/simple to perform, we evaluated the agreement between the Roche Diagnostics Linear Array (RDLA) genotyping test and qPCR-based E1 assay to detect HR-HPV genotypes that are included or not included in HPV vaccines and compared their accuracy to detect CIN 2+. METHODS Study population included 257 African American (AA) and 266 Caucasian American (CA) diagnosed with intraepithelial neoplasia (CIN) grades ≤CIN 1 or ≥CIN 2 (CIN 2+) and tested for HPV by the RDLA and E1 assay. The concordance was determined using Gwet's AC1. The calculated positive predictive value (PPV) and negative predictive value (NPV) of the two assays were used to determine their suitability to detect CIN lesions. RESULTS Overall, the E1 assay showed substantial agreement with the RDLA assay to detect any HR-HPV genotype and the agreement was higher in women diagnosed with CIN 2+ than ≤CIN 1. The concordance was largely higher in Cas than in Aas. The NPV and PPV values to detect CIN lesions were similar between the two assays. CONCLUSION Utilization of the HPV E1 assay as a tool for CC screening could be a cost-effective approach that applies to both vaccinated and unvaccinated populations.
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Affiliation(s)
- Chandrika J Piyathilake
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Suguna Badiga
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Janice L Simons
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Walter C Bell
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Pauline E Jolly
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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11
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Zhong G, Wang Y, Yao S, Fang X, Lin R, Lin Z, Peng Y, Yao T. Squamous cell carcinoma antigen combined with HPV-16 infection in predicting high-grade squamous intraepithelial lesions of the cervix. J OBSTET GYNAECOL 2021; 42:696-700. [PMID: 34565271 DOI: 10.1080/01443615.2021.1948511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An early screening of HPV and the Thinprep Cytology Test (TCT) can effectively prevent cervical cancer. However, patients with high-grade cervical intraepithelial neoplasia usually escape current screening methods and commonly develop cervical cancer. Hence, to identify effective and specific screening methods for high-grade cervical intraepithelial neoplasia is of vital necessity. In this study, 541 patients collected in Sun Yat-Sen hospital from January 2007 to December 2016 were selected. HPV genotype detection and SCC-ag detection were done in these patients. It was found that when serum SCC-ag level exceeded over 0.39 ng/ml in HPV-16 positive patients, the sensitivity and specificity of this novel approach to predict high-grade cervical intraepithelial neoplasia could reach to 83.1% and 62.1%, respectively. The result suggested that the combination of serum SCC-ag level and HPV-16 infection could be used as a novel approach for high-grade cervical intraepithelial neoplasia screening.Impact statementWhat is already known on this subject? Patients with a high-grade cervical intraepithelial neoplasia usually escape current screening methods.What do the results of this study add? When serum SCC-ag level exceeded over 0.39 ng/ml in HPV-16 positive patients, the sensitivity and specificity to predict high-grade cervical intraepithelial neoplasia could reach to 83.1 and 62.1%, respectively.What are the implications of these findings for clinical practice and/or further research? Combination of serum SCC-ag level and HPV-16 infection could be used to screen high-grade cervical intraepithelial neoplasia.
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Affiliation(s)
- Guanglei Zhong
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Yuhan Wang
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Shixian Yao
- Department of Gynaecology and Obstetrics, Kiang Wu Hospital, Macau, PR China
| | - Xingyu Fang
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Rongchun Lin
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Zhongqiu Lin
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Yongpai Peng
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Tingting Yao
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-Sen University, Guangzhou, PR China
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12
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Ermel A, Tong Y, Tonui P, Orang'o O, Muthoka K, Wong N, Manai T, Kiptoo S, Loehrer PJ, Brown DR. Longer duration of anti-retroviral therapy is associated with decreased risk of human papillomaviruses detection in Kenyan women living with HIV. Int J STD AIDS 2021; 32:1212-1220. [PMID: 34233531 DOI: 10.1177/09564624211030766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE A longitudinal study was conducted among women living with HIV in Kenya to determine if duration of anti-retroviral (ART) usage altered detection and persistence of oncogenic (high-risk) human papillomaviruses (HR-HPV). METHODS Women living with HIV without cervical dysplasia were enrolled at a cervical cancer screening clinic. Three cervical swabs, HIV viral loads, and CD4 cell counts were obtained at enrollment and at two annual visits. HPV genotyping was performed on swabs (Roche Linear Array). Linear regression models assessed effects of ART duration on HR-HPV detection and persistence. RESULTS Seventy-seven women, median age 38 years, completed three study visits and were included in the analysis. The mean time from HIV diagnosis to enrollment was 9.6 years (SD 3.9 years). The mean ART duration was 6.2 years (SD 3.1 years). Most women had undetectable HIV viral loads and CD4 cell counts above 500 cells/L. Each additional year of ART use reduced the likelihood of detection of HR-HPV by 10-15% and persistent detection of A9 HR-HPV by 20%. CONCLUSION Among Kenyan women living with HIV, longer duration of ART use was associated with significantly reduced risk of all detection and persistent detection of HR-HPV.
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Affiliation(s)
- Aaron Ermel
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phillip Tonui
- College of Health Sciences, School of Medicine, Department of Reproductive Health, 107853Moi University, Eldoret, Kenya
| | - Omenge Orang'o
- College of Health Sciences, School of Medicine, Department of Reproductive Health, 107853Moi University, Eldoret, Kenya
| | - Kapten Muthoka
- College of Health Sciences, School of Medicine, Department of Reproductive Health, 107853Moi University, Eldoret, Kenya
| | - Nelson Wong
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Stephen Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH) Cervical Cancer Screening Program, 107853Moi University, Eldoret, Kenya
| | - Patrick J Loehrer
- 12250Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Darron R Brown
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
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13
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Tong Y, Tonui P, Ermel A, Orang’o O, Wong N, Titus M, Kiptoo S, Muthoka K, Loehrer PJ, Brown DR. Persistence of oncogenic and non-oncogenic human papillomavirus is associated with human immunodeficiency virus infection in Kenyan women. SAGE Open Med 2020; 8:2050312120945138. [PMID: 32782796 PMCID: PMC7388102 DOI: 10.1177/2050312120945138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Cervical cancer is caused by persistent infection with oncogenic, or "high-risk" types of human papillomaviruses, and is the most common malignancy in Kenyan women. A longitudinal study was initiated to investigate factors associated with persistent human papillomavirus detection among HIV-infected and HIV-uninfected Kenyan women without evidence of cervical dysplasia. METHODS Demographic/behavioral data and cervical swabs were collected from HIV-uninfected women (n = 82) and HIV-infected women (n = 101) at enrollment and annually for 2 years. Human papillomavirus typing was performed on swabs (Roche Linear Array). Logistic regression models of human papillomavirus persistence were adjusted for demographic and behavioral characteristics. RESULTS HIV-infected women were older and less likely to be married and to own a home and had more lifetime sexual partners than HIV-uninfected women. All HIV-infected women were receiving anti-retroviral therapy at enrollment and had satisfactory CD4 cell counts and HIV viral loads. One- and two-year persistent human papillomavirus detection was significantly associated with HIV infection for any human papillomavirus, high-risk human papillomavirus, International Agency for the Research on Cancer-classified high-risk human papillomavirus, and non-oncogenic "low-risk" human papillomavirus. CONCLUSION Persistent detection of oncogenic and non-oncogenic human papillomavirus was strongly associated with HIV infection in Kenyan women with re-constituted immune systems based on satisfactory CD4 cell counts. In addition to HIV infection, factors associated with an increased risk of human papillomavirus persistence included a higher number of lifetime sex partners. Factors associated with decreased risk of human papillomavirus persistence included older age and being married. Further studies are needed to identify the immunological defects in HIV-infected women that allow human papillomavirus persistence, even in women receiving effective anti-retroviral therapy. Further studies are also needed to determine the significance of low-risk human papillomavirus persistence in HIV-infected women.
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Affiliation(s)
- Yan Tong
- Indiana University School of Medicine,
Indianapolis, IN, USA
| | | | - Aaron Ermel
- Indiana University School of Medicine,
Indianapolis, IN, USA
| | | | - Nelson Wong
- Indiana University School of Medicine,
Indianapolis, IN, USA
| | | | | | | | | | - Darron R Brown
- Indiana University School of Medicine,
Indianapolis, IN, USA
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Abstract
Curcumin is a hydrophobic compound with good anti-proliferative, anti-oxidative, and anti-cancer properties but has poor bioavailability. Liquid crystals (LC) can accommodate both hydrophilic and hydrophobic drugs. The aim of this study was to formulate and evaluate a novel vaginal drug delivery system for cervical cancer using a curcumin LC system. The curcumin LC system was formulated using surfactant, glycerol, and water together with curcumin. Three types of surfactants were used to optimize the formulation, i.e., Tween 80, Cremphor EL, and Labrasol. The optimized formulations were subjected to physicochemical analysis, and their efficacy was evaluated in HeLa cells. The pH of the formulations was in the range of 3.91–4.39. Environmental scanning electron microscopy (ESEM) observations revealed spherical as well as hexagonal micelles. In vitro release of LC curcumin from vaginal simulated fluid (VSF, pH 4.5) showed a release from 20.47% to 87.25%. The IC50 of curcumin in HeLa cells was 22.5 μg/mL, while the IC25 and IC75 were 6.5 μg/mL and 35μg/mL, respectively. The cytotoxicity of the formulations was determined in comparison with liquid crystals without curcumin and pure curcumin by performing a t-test based on a significance level of p less than or equal to 0.05 (p ≤ 0.05). The curcumin LC system was able to release the required amount of drug and was effective against the cervical cancer cell line examined.
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Tomita LY, Horta BL, da Silva LLS, Malta MB, Franco EL, Cardoso MA. Fruits and vegetables and cervical cancer: a systematic review and meta-analysis. Nutr Cancer 2020; 73:62-74. [PMID: 32156167 DOI: 10.1080/01635581.2020.1737151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We conducted a meta-analysis to examine the association of fruits and vegetables intake with the occurrence of cervical intraepithelial neoplasia (CIN) and invasive cancer. MEDLINE, LILACS, Scopus, Cochrane Library, and Web of Science databases and gray literature on Google Scholar were searched before December 17, 2018. Odds ratio (OR) or relative risk (RR) estimates for the highest vs. the lowest intake of intake and 95% confidence intervals (CI) from the included studies were pooled using fixed and random-effects models. We found 18 studies: 17 case-control studies (n = 9,014 cases, n = 29,088 controls) and one cohort study (n = 299,651). No association was observed for CIN. The pooled adjusted ORs (95% CI) for cervical cancer were 0.61 (95% CI 0.52-0.73) for vegetables and 0.80 (95% CI 0.70-0.93) for fruits. However, no association was observed when the pooled effect was estimated among studies that adjusted for human papillomavirus (HPV). Consumption of vegetables and fruits was not associated with incidence of cervical cancer among studies that controlled for HPV infection. The level of evidence is limited because only one cohort study was included in the analysis.
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Affiliation(s)
- Luciana Yuki Tomita
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Bernardo Lessa Horta
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, Pelotas, Brazil
| | | | - Maira Barreto Malta
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Luis Franco
- Division of Cancer Epidemiology, Department of Oncology and Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Marly Augusto Cardoso
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
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Malagón T, Louvanto K, Ramanakumar AV, Koushik A, Coutlée F, Franco EL. Viral load of human papillomavirus types 16/18/31/33/45 as a predictor of cervical intraepithelial neoplasia and cancer by age. Gynecol Oncol 2019; 155:245-253. [PMID: 31604665 DOI: 10.1016/j.ygyno.2019.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We assessed whether human papillomavirus (HPV) viral load is an independent predictor of underlying cervical disease and its diagnostic accuracy by age. METHODS The Biomarkers of Cervical Cancer Risk study was a case-control study from 2001 to 2010 in Montréal, Canada. Cases were histologically-confirmed cervical intraepithelial neoplasia (CIN), adenocarcinoma in situ (AIS), or cervical cancer cases. Controls were women presenting for routine screening with normal cytology results. We quantified HPV16/18/31/33/45 viral load from exfoliated cervical cells using a real-time PCR assay. Diagnostic accuracy of viral load was assessed using the area under the receiver operating characteristic curve (AUC). We restricted the analysis to the 632 cases and controls who were HPV16/18/31/33/45 positive. RESULTS Geometric mean HPV16/18/31/33/45 viral load increased with severity of lesion grade, ranging from 0.7, 3.1, 4.8, 7.2, and 12.4 copies/cell in normal, CIN1, CIN2, CIN3&AIS, and cervical cancer respectively. The adjusted odds ratio of CIN1+ and CIN2+ increased respectively by 1.3 (95%CI 1.1-1.4) and 1.2 (95%CI 1.1-1.3) per log-transformed viral copy/cell increase of HPV16/18/31/33/45. This association was mainly driven by HPV16, 18, and 31 viral loads. The AUC of HPV16/18/31/33/45 viral load for discriminating between normal and CIN1+ women was 0.70 (95%CI 0.64-0.76) in HPV-positive women, and was 0.76 (95%CI 0.66-0.86) for women ≥30 years and 0.66 (95%CI 0.58-0.74) for women under 30 years. CONCLUSIONS HPV viral load has lower diagnostic accuracy than has been reported for other HPV screening triage tests. However, it may be useful for triaging HPV tests in settings without cytology results such as HPV self-sampling.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Faculty of Medicine, McGill University, Montréal, Canada.
| | - Karolina Louvanto
- Department of Obstetrics and Gynaecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Agnihotram V Ramanakumar
- Research Institute-McGill University Health Centre, Montréal, Canada; Division of Cancer Epidemiology, Faculty of Medicine, McGill University, Montréal, Canada
| | - Anita Koushik
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - François Coutlée
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Faculty of Medicine, McGill University, Montréal, Canada
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Wagh P, Kulkarni P, Kerkar S, Tongaonkar H, Deodhar K, Rekhi B, Salvi V, Chaudhari H, Warke H, Mania-Pramanik J. Types of human papillomavirus observed in hospital-based population. Indian J Med Microbiol 2019; 37:557-562. [PMID: 32436880 DOI: 10.4103/ijmm.ijmm_19_451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Objectives Human papillomavirus (HPV) is the causative agent of cervical cancer, a major cause of cancer mortality in Indian women. The current study was undertaken to add information to the existing data on HPV type distribution in Indians, in an attempt to document HPV types for future vaccination programme, if any. Materials and Methods HPV infection was screened in 223 cervical cancer cases and 2408 healthy women without cancer and cervical intraepithelial neoplasia (control). HPV was typed using polymerase chain reaction, Southern hybridisation using specific probes and HPV GenoArray (Hybribio) test. Results HPV DNA was found in 92.8% of cases and 7.3% of controls. Of the 383 HPV-infected women, 30.0% had single infection; 50.9% had multiple infections (two or more types) and 19.1% were infected with HPV types other than HPV-16, -18, -6 and -11. Besides HPV-16, HPV-51 and HPV-33 were also seen as single infection in cases. In cases, HPV-18 or its homologous HPV-45 was always present as co-infection with HPV-16 or with other high-risk type. Binary logistic regression (backward) analysis highlighted significant association of age, parity and socioeconomic status with HPV infection. The present study highlighted the presence of multiple HPV infection (186 of 207, 89.9%) along with HPV-16 in women with cervical cancer. In control, 27.3% were co-infected with other sexually transmitted infections, while Chlamydia trachomatis infection was seen in 13% of cases. Conclusions The study highlighted the type of HPV infection seen among the hospital-based population. For better screening, HPV tests available in the market should include all the types seen in the population.
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Affiliation(s)
- Priyanka Wagh
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Priyanka Kulkarni
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Shilpa Kerkar
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Hemant Tongaonkar
- Department of Urologic and Gynecologic Oncology, Hinduja Hospital, Mahim; Department of Urology and Gynecologic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vinita Salvi
- Department of Obstetrics and Gynecology, Seth G. S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Hemangi Chaudhari
- Department of Obstetrics and Gynecology, Seth G. S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Himangi Warke
- Department of Obstetrics and Gynecology, Seth G. S. Medical College, KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
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Translatable gene therapy for lung cancer using Crispr CAS9-an exploratory review. Cancer Gene Ther 2019; 27:116-124. [PMID: 31222183 DOI: 10.1038/s41417-019-0116-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/29/2019] [Accepted: 05/19/2019] [Indexed: 12/12/2022]
Abstract
Gene therapy using CRISPR Cas9 technique is rapidly gaining popularity among the scientific community primarily because of its versatility, cost-effectiveness, and high efficacy. While the laboratory-based experiments and findings making use of CRISPR as a gene editing tool are available in ample amounts, the question arises that how much of these findings are actually translatable into measures helping in combating particular disease conditions. In this review, we highlight the important studies and findings done till now in the perspective of lung cancer with an in-depth analysis of various clinical trials associated with the use of CRISPR Cas9 technology in the field of cancer research.
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Volesky KD, El-Zein M, Franco EL, Brenner DR, Friedenreich CM, Ruan Y. Cancers attributable to infections in Canada. Prev Med 2019; 122:109-117. [PMID: 31078164 DOI: 10.1016/j.ypmed.2019.03.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infections are estimated to cause approximately 15% of the world's cancers with large geographic variations. Yet, Canadian estimates for specific cancer-causing infections are not available. To estimate the number of infection-associated cancers diagnosed among Canadian adults in 2015, we calculated population attributable risks (PARs) and the number of attributable cases for seven carcinogenic infections and their 20 associated cancers. A systematic literature search was performed for each infection to obtain data on infection prevalence in the population and the relative risk or odds ratio associated with the cancer it causes. When mechanistic evidence suggested that detection of a given infection within cancer tissue was sufficient to attribute the cancer to the infection, prevalence among cancer cases was used to approximate the PAR. Data from 61 studies formed the basis of our analyses. The estimated number of infection-attributable cancer cases for 2015 was: 3828 for human papillomavirus (HPV), 2052 for Helicobacter pylori, 578 for Epstein-Barr virus, 509 for hepatitis B and C viruses (HBV, HCV), 100 for human herpesvirus type 8, and 30 cases for human T-cell lymphotropic virus type 1. These seven infections were responsible for 3.7% of cancers diagnosed among Canadian adults in 2015; 3.5% among men and 4.0% among women. The infections with the highest number of attributable cases are largely preventable or treatable through vaccination (HBV and HPV), antibiotic therapy (H. pylori), or a combination of interventions (HCV), thereby representing an important target for reducing the infection-caused cancer burden among Canadians.
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Affiliation(s)
- Karena D Volesky
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
| | - Mariam El-Zein
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Eduardo L Franco
- Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Darren R Brenner
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
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Human papillomavirus DNA, HPV L1 capsid protein and p16 INK4a protein as markers to predict cervical lesion progression. Arch Gynecol Obstet 2018; 299:141-149. [PMID: 30390110 DOI: 10.1007/s00404-018-4931-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Cervical cancer is the most common malignant tumors in women leading to serious morbidity and mortality worldwide, especially among developing countries. A main cause of the disease is the high-risk human papillomavirus (HR-HPV) infection. HSIL usually progress to cervical cancer, and low-grade lesions, including LSIL and ASCUS, mostly turn to normal or benign lesions, but there are still a small number of patients who will progress to HSIL. Up to now there is no efficient biomarker clinically available to predict people with high risk to progress into HSIL. This study was conducted to evaluate the value of human papillomavirus (HPV) DNA, p16INK4a protein, and HPV L1 capsid protein in predicting HSIL and minimizing unnecessary colposcopy treatments. METHODS 1222 patients with HR-HPV infection or with abnormal Thinprep cytologic test (TCT) were chosen to conduct colposcopy in the cervical out-patient clinic of Shanghai First Maternity and Infant Hospital affiliated to Shanghai Tongji University from June 2014 to January 2017. TCT, cervical biopsy, HPV DNA and HPVL1 were performed on all patients. 110 patients were selected to detect p16INK4a protein. Hybrid capture 2 (HC-2) was used to detect HPV DNA, and their subgroups using gene typing system. Immunohistochemical technology was used to detect HPV L1 and p16. RESULTS HPV DNA was positive in 1097 cases, with the positive rate of 89.7% (1097/1222). In particular, the positive expression rates of HPV DNA were 82.3, 95.7, 96.6 and 100% in Normal/CC, LSIL, HSIL and cervical cancer groups, respectively (p < 0.001). HPV L1 was negative in 781 cases with HR-HPV infection, and the overall negative rate is 71.1%. In patients with Normal/CC, LSIL and HSIL, the negative expression rates of HPV L1 were 91.3, 40 and 81.2%, respectively (p value < 0.001). In the 110 patients, HPV L1 was negative in 98.1% (53/54) of Normal/CC, 42.9% (12/28) of LSIL and 85.1% (23/27) of HSIL (p value = 0.0043). P16-positive rates in patients with Normal/CC, LSIL and HSIL were 33.3% (18/54), 75% (21/28) and 96.2% (26/27), respectively (p value < 0.001). 18 out of 28 cases express low positive (+) in LSIL, 25 out of 27 cases express strong positive (3+) in HSIL. Patients with L1(-) p16(+) including 18.5% (10/54) of normal/cervicitis, 60.7% (17/28) of LSIL and 85.1% (23/27) of HSIL (p value < 0.005). Furthermore, patients with L1(-) p16(1+) included 37% (10/27) of normal/cervicitis 59.3% (16/27) of LSIL and 3.7% (1/27) of HSIL; patients with L1(-) p16(2+) consisted of 0% of normal/cervicitis/LSIL and 100% (1/1) of HSIL; patients with L1(-) p16(3+) were composed of 0% of normal/cervicitis, 4.5% (1/22) of LSIL and 95.5% (21/22) of HSIL (p value < 0.005) (Table 6). CONCLUSION With the increase in the degree of the cervical lesions, the expression of HPV DNA and p16 is up-regulated while HPV L1 protein is down-regulated. HPV DNA, HPV L1 and p16 are useful markers for the prediction of HSIL. Combined detection of these three markers has important potential to predicting HSIL and minimizing unnecessary colposcope examination.
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Screening for cervical abnormalities associated with EBV, HPV and HSV-2 infections in South-West Nigeria: A tale between sex and non-sex workers. JOURNAL OF ONCOLOGICAL SCIENCES 2018. [DOI: 10.1016/j.jons.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Malagón T, Laurie C, Franco EL. Human papillomavirus vaccination and the role of herd effects in future cancer control planning: a review. Expert Rev Vaccines 2018; 17:395-409. [PMID: 29715059 DOI: 10.1080/14760584.2018.1471986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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Landy R, Windridge P, Gillman MS, Sasieni PD. What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study. Int J Cancer 2018; 142:709-718. [PMID: 29023748 PMCID: PMC5765470 DOI: 10.1002/ijc.31094] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 11/06/2022]
Abstract
Women vaccinated against HPV16/18 are approaching the age for cervical screening; however, an updated screening algorithm has not been agreed. We use a microsimulation model calibrated to real published data to determine the appropriate screening intensity for vaccinated women. Natural histories in the absence of vaccination were simulated for 300,000 women using 10,000 sets of transition probabilities. Vaccination with (i) 100% efficacy against HPV16/18, (ii) 15% cross-protection, (iii) 22% cross-protection, (iv) waning vaccine efficacy and (v) 100% efficacy against HPV16/18/31/33/45/52/58 was added, as were a range of screening scenarios appropriate to the UK. To benchmark cost-benefits of screening for vaccinated women, we evaluated the proportion of cancers prevented per additional screen (incremental benefit) of current cytology and likely HPV screening scenarios in unvaccinated women. Slightly more cancers are prevented through vaccination with no screening (70.3%, 95% CR: 65.1-75.5) than realistic compliance to the current UK screening programme in the absence of vaccination (64.3%, 95% CR: 61.3-66.8). In unvaccinated women, when switching to HPV primary testing, there is no loss in effectiveness when doubling the screening interval. Benchmarking supports screening scenarios with incremental benefits of ≥2.0%, and rejects scenarios with incremental benefits ≤0.9%. In HPV16/18-vaccinated women, the incremental benefit of offering a third lifetime screen was at most 3.3% (95% CR: 2.2-4.5), with an incremental benefit of 1.3% (-0.3-2.8) for a fourth screen. For HPV16/18/31/33/45/52/58-vaccinated women, two lifetime screens are supported. It is important to know women's vaccination status; in these simulations, HPV16/18-vaccinated women require three lifetime screens, HPV16/18/31/33/45/52/58-vaccinated women require two lifetime screens, yet unvaccinated women require seven lifetime screens.
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Affiliation(s)
- Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of MedicineQueen Mary University of London, Charterhouse SquareLondonEC1M 6BQUK
| | - Peter Windridge
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of MedicineQueen Mary University of London, Charterhouse SquareLondonEC1M 6BQUK
| | - Matthew S. Gillman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of MedicineQueen Mary University of London, Charterhouse SquareLondonEC1M 6BQUK
| | - Peter D. Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of MedicineQueen Mary University of London, Charterhouse SquareLondonEC1M 6BQUK
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Prinja S, Bahuguna P, Faujdar DS, Jyani G, Srinivasan R, Ghoshal S, Suri V, Singh MP, Kumar R. Cost-effectiveness of human papillomavirus vaccination for adolescent girls in Punjab state: Implications for India's universal immunization program. Cancer 2017; 123:3253-3260. [DOI: 10.1002/cncr.30734] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/09/2017] [Accepted: 03/17/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Shankar Prinja
- School of Public Health; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Pankaj Bahuguna
- School of Public Health; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Dharmjeet Singh Faujdar
- School of Public Health; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Gaurav Jyani
- School of Public Health; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Sushmita Ghoshal
- Department of Radiotherapy; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Vanita Suri
- Department of Gynaecology and Obstetrics; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Mini P. Singh
- Department of Virology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Rajesh Kumar
- School of Public Health; Post Graduate Institute of Medical Education and Research; Chandigarh India
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Piyathilake CJ, Badiga S, Chambers MM, Brill IK, Matthews R, Partridge EE. Accuracy of urinary human papillomavirus testing for the presence of cervical human papillomaviruses and higher grades of cervical intraepithelial neoplasia. Cancer 2016; 122:2836-44. [PMID: 27243771 DOI: 10.1002/cncr.30123] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although urine-based testing for human papillomavirus (HPV) is being explored as a practical approach for cervical cancer screening, whether the results differ by age, race, or indicators of excess body weight or in populations exposed to HPV vaccines has not been documented by previous studies. The purpose of this study was to determine the accuracy of urinary HPV testing for the presence of cervical HPVs and high-grade cervical intraepithelial lesions (grade 2 and 3 cervical intraepithelial neoplasia [CIN]) by the aforementioned population characteristics. METHODS The study population consisted of 502 women diagnosed with different grades of CIN. HPV testing was performed with paired urine and cervical cell DNA with the Roche Diagnostics Linear Array test. Agreement coefficient 1 and probabilities were calculated to determine the accuracy of urinary HPV testing for the presence of cervical HPVs and CIN lesions. RESULTS Substantial to almost perfect agreement (0.66-0.83) was observed in the detection of any HPV genotype in urine specimens versus cervical specimens, regardless of the population characteristics. Although the positive predictive value for the detection of CIN lesions was relatively low, the negative predictive value for CIN-3 was high (≥90%) among women positive for any of the urinary or cervical high-risk human papillomavirus (HR-HPV) genotypes or HPV genotypes not included in currently available HPV vaccines. CONCLUSIONS The results demonstrate that urinary HPV testing provides highly satisfactory results for excluding the possibility of any cervical HPV infections, including HPV types not included in vaccines and CIN lesions associated with any HR-HPV, regardless of a woman's age, race, or excess body weight. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2836-2844. © 2016 American Cancer Society.
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Affiliation(s)
| | - Suguna Badiga
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle M Chambers
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ilene K Brill
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roland Matthews
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia
| | - Edward E Partridge
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract
High-risk human papillomaviruses (HPVs) cause essentially all cervical cancers, most anal and oropharyngeal cancers, and some vaginal, vulvar, and penile cancers. Improved understanding of the pathogenesis of infection and the availability of newer tests are changing the approach to screening and diagnosis. Molecular tests to detect DNA from the most common high-risk HPVs are FDA approved for use in conjunction with cytology in cervical cancer screening programs. More-specific tests that detect RNA from high-risk HPV types are now also available. The use of molecular tests as the primary screening tests is being adopted in some areas. Genotyping to identify HPV16 and -18 has a recommended role in triaging patients for colposcopy who are high-risk HPV positive but have normal cytology. There are currently no recommended screening methods for anal, vulvar, vaginal, penile, or oropharyngeal HPV infections. HPV testing has limited utility in patients at high risk for anal cancer, but p16 immunohistochemistry is recommended to clarify lesions in tissue biopsy specimens that show moderate dysplasia or precancer mimics. HPV testing is recommended for oropharyngeal squamous cell tumors as a prognostic indicator. Ongoing research will help to improve the content of future guidelines for screening and diagnostic testing.
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Affiliation(s)
- Eileen M Burd
- Emory University School of Medicine, Department of Pathology and Laboratory Medicine, and Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA
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Naber SK, de Kok IMCM, Matthijsse SM, van Ballegooijen M. The potential harms of primary human papillomavirus screening in over-screened women: a microsimulation study. Cancer Causes Control 2016; 27:569-81. [PMID: 26970740 PMCID: PMC4796367 DOI: 10.1007/s10552-016-0732-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is well acknowledged that HPV testing should not be performed at young age and at short intervals. Cytological screening practices have shown that over-screening, i.e., from a younger age and at shorter intervals than recommended, is hard to avoid. We quantified the consequences of a switch to primary HPV screening for over-screened women, taking into account its higher sensitivity but lower specificity than cytology. METHODS The health effects of using the HPV test instead of cytology as the primary screening method were determined with the MISCAN-Cervix model. We varied the age women start screening and the interval between screens. In the sensitivity analyses, we varied the background risk of cervical cancer, the HPV prevalence, the discount rate, the triage strategy after cytology, and the test characteristics of both cytology and the HPV test. RESULTS For women screened 5 yearly from age 30, 32 extra deaths per 100,000 simulated women were prevented when switching from primary cytology to primary HPV testing. For annual screening from age 20, such a switch resulted in 6 extra deaths prevented. It was associated with 9,044 more positive primary screens in the former scenario versus 76,480 in the latter. Under all conditions, for women screened annually, switching to HPV screening resulted in a net loss of quality-adjusted life years. CONCLUSION For over-screened women, the harms associated with a lower test specificity outweigh the life years gained when switching from primary cytology to primary HPV testing. The extent of over-screening should be considered when deciding on inclusion of primary HPV screening in cervical cancer screening guidelines.
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Affiliation(s)
- Steffie K Naber
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Inge M C M de Kok
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Duff P, Ogilvie G, Shoveller J, Amram O, Chettiar J, Nguyen P, Dobrer S, Montaner J, Shannon K. Barriers to Cervical Screening Among Sex Workers in Vancouver. Am J Public Health 2016; 106:366-73. [PMID: 26562102 PMCID: PMC4724251 DOI: 10.2105/ajph.2015.302863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We longitudinally examined the social, structural, and geographic correlates of cervical screening among sex workers in Metropolitan Vancouver, British Columbia, to determine the roles that physical and social geography play in routine reproductive health care access. METHODS Analysis drew on (2010-2013) data from an open prospective cohort of sex workers (An Evaluation of Sex Workers' Health Access). We used multivariable logistic regression with generalized estimating equations (GEE) to model correlates of regular cervical screening. RESULTS At baseline, 236 (38.6%) of 611 sex workers in our sample had received cervical screening, and 63 (10.3%) were HIV-seropositive. In multivariable GEE analysis, HIV-seropositivity (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.06, 2.58) and accessing outreach services (AOR = 1.35; 95% CI = 1.09, 1.66) were correlated with regular cervical screening. Experiencing barriers to health care access (e.g., poor treatment by health care staff, limited hours of operation, and language barriers) reduced odds of regular Papanicolaou testing (AOR = 0.81; 95% CI = 0.65, 1.00). CONCLUSIONS Sex workers in Metropolitan Vancouver had suboptimal levels of cervical screening. Innovative mobile outreach service delivery models offering cervical screening as one component of sex worker-targeted comprehensive sexual and reproductive health services may hold promise.
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Affiliation(s)
- Putu Duff
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Gina Ogilvie
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Jean Shoveller
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Ofer Amram
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Jill Chettiar
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Paul Nguyen
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Sabina Dobrer
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Julio Montaner
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
| | - Kate Shannon
- Putu Duff, Ofer Amram, Jill Chettiar, Paul Nguyen, Sabina Dobrer, Julio Montaner, and Kate Shannon are with British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia. Putu Duff, Jean Shoveller, and Kate Shannon are with School of Population and Public Health, University of British Columbia, Vancouver. Gina Ogilvie is with British Columbia Centre for Disease Control, Vancouver. Julio Montaner and Kate Shannon are also with Department of Medicine, University of British Columbia, St. Paul's Hospital
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Molijn A, Jenkins D, Chen W, Zhang X, Pirog E, Enqi W, Liu B, Schmidt J, Cui J, Qiao Y, Quint W. The complex relationship between human papillomavirus and cervical adenocarcinoma. Int J Cancer 2015; 138:409-16. [PMID: 26334557 DOI: 10.1002/ijc.29722] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/17/2015] [Indexed: 02/01/2023]
Abstract
Human Papillomavirus (HPV) is reported in 60-100% of cervical adenocarcinoma (CADC) globally. We investigated this relationship in a hospital-based survey in China. 718 CADC samples from nine Chinese regions were analysed. Expert pathologists reviewed cases with p16 and progesterone receptor immunostaining. Cases were tested for HPV using whole-tissue sections (WTS) and laser-capture microdissection. All cases were HPV-tested by L1 based broad-spectrum SPF10 -DEIA-LiPA25 PCR. Negative cases were tested for DNA adequacy and with E6 oncogene, type-specific HPV PCRs. Using WTS-PCR CADC showed overall 75% HPV-positivity (33-100% for different histological types). LCM-PCR showed that none of minimal deviation or serous CADC, and <10% of all clear cell and endometrioid CADC were HPV-positive in tumour cells. Usual and adenosquamous CADC showed a single HPV genotype in 60 and 78% cases. In some cases, HPV was found in adjacent cervix but not in tumour. HPV 16, 18 and 45 accounted for 90% of HPV in tumour cells. Patients with HPV-positive tumours were on average 6 years younger and presented at a lower clinicopathological stage as compared to patients with HPV-negative cancers. CADC is diverse pathologically and in HPV status. Special histopathological tumor subtypes may develop through different cellular and molecular pathways. Between 20 and 40% usual and adenosquamous types, in particular these diagnosed in older women and at advanced FIGO stages, are not driven by oncogenic HPV. In these cases HPV may not be involved in carcinogenisis or maybe lost during tumour progression.
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Affiliation(s)
- Anco Molijn
- DDL Diagnostic Laboratory, Visseringlaan 25, 2288 ER, Rijswijk, The Netherlands
| | - David Jenkins
- DDL Diagnostic Laboratory, Visseringlaan 25, 2288 ER, Rijswijk, The Netherlands
| | - Wen Chen
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xun Zhang
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Edyta Pirog
- MINZU University of China, Haidian District, Beijing, China
| | - Wu Enqi
- Weill Medical College of Cornell University, 525 E 68th Street, New York, NY
| | - Bin Liu
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Jiangfeng Cui
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Youlin Qiao
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wim Quint
- DDL Diagnostic Laboratory, Visseringlaan 25, 2288 ER, Rijswijk, The Netherlands
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Guerrero AM, Genuino AJ, Santillan M, Praditsitthikorn N, Chantarastapornchit V, Teerawattananon Y, Alejandria M, Toral JA. A cost-utility analysis of cervical cancer screening and human papillomavirus vaccination in the Philippines. BMC Public Health 2015. [PMID: 26223975 PMCID: PMC4520072 DOI: 10.1186/s12889-015-2046-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Cervical cancer is the second leading cause of cancer cases and deaths among Filipino women because of inadequate access to screening and treatment services. This study aims to evaluate the health and economic benefits of HPV vaccination and its combination with different screening strategies to find the most optimal preventive strategy in the Philippines. Methods A cost-utility analysis was conducted using an existing semi-Markov model to evaluate different screening (i.e., Pap smear, visual inspection with acetic acid) and vaccination strategies against HPV infection implemented alone or as part of a combination strategy at different coverage scenarios. The model was run using country-specific epidemiologic, cost and clinical parameters from a health system perspective. Sensitivity analysis was performed for vaccine efficacy, duration of protection and costs of vaccination, screening and treatment. Results Across all coverage scenarios, VIA has been shown to be a dominant and cost-saving screening strategy with incremental cost-effectiveness ratio (ICER) ranging from dominant to Php 61,059 (1443 USD) per QALY gained. VIA can reduce cervical cancer cases and deaths by 25 %. Pap smear screening was found to be not cost-effective due to its high cost in the Philippines. Adding HPV vaccination at a cost of 54 USD per vaccinated girl on top of VIA screening was found to be potentially cost-effective using a threshold of 1 GDP per capita (i.e., Php 120,000 or 2835 USD/ QALY) with the most favorable assumption of providing lifelong immunity against high-risk oncogenic HPV types 16/18. The highest incremental QALY gain was achieved with 80 % coverage of the combined strategy of VIA at 35 to 45 years old done every five years following vaccination at 11 years of age with an ICER of Php 33,126 (783 USD). This strategy may result in a two-thirds reduction in cervical cancer burden. HPV vaccination is not cost-effective when vaccine protection lasts for less than 20 years. Conclusion High VIA coverage targeting women aged 35–45 years old at five-year intervals is the most efficient and cost-saving strategy in reducing cervical cancer burden in the Philippines. Adding a vaccination program at high coverage among 11-year-old girls is potentially cost-effective in the Philippines assuming a life-long duration of vaccine efficacy. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2046-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Melissa Guerrero
- Department of Health Philippines, Pharmaceutical Division, 3/F Building 15, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003, Manila, Philippines.
| | - Anne Julienne Genuino
- Department of Health Philippines, Pharmaceutical Division, 3/F Building 15, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003, Manila, Philippines.
| | - Melanie Santillan
- Product Team for Special Benefits, Philippine Health Insurance Corporation, Pasig, 1603, Philippines.
| | - Naiyana Praditsitthikorn
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, 11000, Thailand.
| | - Varit Chantarastapornchit
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, 11000, Thailand.
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, 11000, Thailand.
| | - Marissa Alejandria
- Institution of Clinical Epidemiology, University of the Philippines, Manila, 1000, Philippines.
| | - Jean Anne Toral
- Obstetrics and Gynecology, Philippine General Hospital, Manila, 1000, Philippines.
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Ersan G, Kose S, Senger SS, Gunes H, Sehirali S, Gurbuz I. The prevalence and risk factors of human papillomavirus in female sex workers. Eurasian J Med 2015; 45:16-20. [PMID: 25610243 DOI: 10.5152/eajm.2013.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 11/12/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Human papillomavirus virus (HPV) is the major causative factor for cervical cancer, and sex workers are at high risk for HPV infection. In this study, we aimed to estimate the prevalence and risk factors of HPV infection among female sex workers (FSWs). MATERIALS AND METHODS The study included 239 brothel-based FSWs who work in Izmir, Turkey. A self-administered questionnaire for risk factors was completed, and cervical brush samples were taken for HPV detection and typing. HPV detection and typing were performed by multiplex polymerase chain reaction (PCR) and reverse hybridization methods. The risk factors related to HPV infection were determined by multivariate analysis. RESULTS The prevalence of HPV among FSWs was 20.1%. HPV18 was the most common type (40%), followed by HPV16 (17%) and HPV50 (15%). Logistic regression analysis revealed that being less than 30 years of age, having a high frequency of sexual contacts, smoking, and lack of condom use were significantly associated with HPV infection. CONCLUSION FSWs have a high prevalence of HPV infection and are at increased risk for cervical cancer. As they are a priority group for active follow-up, national strategies for reducing HPV among FSWs and regular cervical cancer screening programs should be implemented for this population.
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Affiliation(s)
- Gursel Ersan
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Suheyla Serin Senger
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Research and Training Hospital, Izmir, Turkey
| | | | - Salim Sehirali
- Ege Obstetrics and Gynecology Education and Research Hospital, İzmir, Turkey
| | - Ilhan Gurbuz
- Izmir Branch of Ministry of Health, Izmir, Turkey
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Togami S, Sasajima Y, Kasamatsu T, Oda-Otomo R, Okada S, Ishikawa M, Ikeda SI, Kato T, Tsuda H. Immunophenotype and human papillomavirus status of serous adenocarcinoma of the uterine cervix. Pathol Oncol Res 2014; 21:487-94. [PMID: 25370301 DOI: 10.1007/s12253-014-9854-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 10/14/2014] [Indexed: 01/18/2023]
Abstract
Serous adenocarcinoma of the cervix (SACC) is a very rare tumor. Our study aimed to characterize the immune profile and human papillomavirus (HPV) status of SACC, in comparison with other serous adenocarcinomas arising in the female genital tract. The pathological specimens obtained from 81 patients with serous carcinoma of the uterine cervix (n = 12), 29 endometrium, 20 ovary and 20 patients with mucinous carcinoma of the uterine cervix were reviewed. We assessed the expression of WT-1, p53, p16, HER2, CEA, and CA125 by immunohistochemistry and HPV DNA by PCR in 12 SACC samples. Their immune profile was compared with that of uterine papillary serous carcinoma (UPSC), ovarian serous adenocarcinoma (OSA), and mucinous endocervical adenocarcinoma (MEA). WT-1 and HER2 were expressed in very few SACC samples (0 and 0%, respectively), but p16, CA125, CEA and p53 were present in 100, 92, 58 and 50%, respectively. The difference in WT-1 expression between SACC and UPSC, MEA is not significant, but SACC differ significantly from OSA (p < 0.01). HPV DNA (type 16 or 18) was detected in 4 of the 12 SACC. The immunophenotype of SACC was similar to UPSC, whereas the frequency of expression of WT-1 was significantly lower in SACC than OSA. It appeared that p53 expression was associated with worse clinical outcome in patients with SACC, and that HPV infection was related to its occurrence.
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Affiliation(s)
- Shinichi Togami
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan,
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MTHFR/p53 Polymorphisms as Genetic Factors for Cervical Intraepithelial Neoplasia and Cervical Cancer in HPV-infected Mexican Women. Int J Biol Markers 2014; 29:e142-9. [DOI: 10.5301/jbm.5000070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2013] [Indexed: 02/04/2023]
Abstract
We performed a case-control association study to evaluate the association between common polymorphisms in MTHFR (C677T and A1298C) and the Arg72Pro polymorphism in the p53 gene and the risk for cervical intraepithelial neoplasia (CIN) or invasive cervical cancer (ICC) in Mexican HPV-infected women. We included 131 women with diagnosis of CIN grade I-II and 78 with CIN III or ICC; as controls we also included 274 women with normal Pap smear and negative HPV test. Genotyping for MTHFR and p53 polymorphisms was performed by PCR-RFPLs. HPV was tested by Hybrid Capture II. Odds ratios and 95% confidence intervals were estimated. Genotype frequencies for the 3 studied polymorphisms were distributed according to the Hardy-Weinberg equilibrium. The A1298C-MTHFR polymorphism showed significant differences for the heterozygous AC genotype and the C allele, whereas the AA genotype and A allele resulted to be genetic risk factors for CIN or ICC (p<0.03). The Arg72Pro-p53 polymorphism showed for the genotypes Arg/Pro and Pro/Pro, and for the Pro allele, a significant association only to the risk for CIN (p<0.03). The MTHFR/p53 interaction showed that the genotype combinations AA/ArgArg and AA/ArgPro were associated, respectively, to the risk of ICC and CIN (p<0.05). This study suggests that the A1298C-MTHFR polymorphism contributes to the genetic risk for both CIN and ICC, whereas the Arg72Pro-p53 polymorphism only contributes to the risk for CIN. The MTHFR/p53 genetic combinations AA/ArgArg and AA/ArgPro are associated genetic risk factors for ICC and CIN in Mexican HPV-infected women.
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Wu Y, Antony S, Meitzler JL, Doroshow JH. Molecular mechanisms underlying chronic inflammation-associated cancers. Cancer Lett 2013; 345:164-73. [PMID: 23988267 DOI: 10.1016/j.canlet.2013.08.014] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/08/2013] [Accepted: 08/13/2013] [Indexed: 12/17/2022]
Abstract
Although it is now accepted that chronic inflammation plays an essential role in tumorigenesis, the underlying molecular mechanisms linking inflammation and cancer remain to be fully explored. Inflammatory mediators present in the tumor microenvironment, including cytokines and growth factors, as well as reactive oxygen species (ROS) and reactive nitrogen species (RNS), have been implicated in the etiology of inflammation-associated cancers. Epithelial NADPH oxidase (Nox) family proteins, which generate ROS regulated by cytokines, are upregulated during chronic inflammation and cancer. ROS serve as effector molecules participating in host defense or as chemo-attractants recruiting leukocytes to wounds, thereby influencing the inflammatory reaction in damaged tissues. ROS can alter chromosomal DNA, leading to genomic instability, and may serve as signaling molecules that affect tumor cell proliferation, survival, metabolism, angiogenesis, and metastasis. Targeting Noxs and their downstream signaling components may be a promising approach to pre-empting inflammation-related malignancies.
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Affiliation(s)
- Yongzhong Wu
- Laboratory of Molecular Pharmacology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Smitha Antony
- Laboratory of Molecular Pharmacology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jennifer L Meitzler
- Laboratory of Molecular Pharmacology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - James H Doroshow
- Laboratory of Molecular Pharmacology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Lo YL, Wang W. Formononetin potentiates epirubicin-induced apoptosis via ROS production in HeLa cells in vitro. Chem Biol Interact 2013; 205:188-97. [PMID: 23867903 DOI: 10.1016/j.cbi.2013.07.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 06/08/2013] [Accepted: 07/05/2013] [Indexed: 11/26/2022]
Abstract
The frequent development of multidrug resistance (MDR) hampers the efficacy of available anticancer drugs in treating cervical cancer. In this study, we aimed to use formononetin (7-hydroxy-4'-methoxyisoflavone), a potential herbal isoflavone, to intensify the chemosensitivity of human cervical cancer HeLa cells to epirubicin, an anticancer drug. The reactive oxygen species (ROS) levels were correlated with MDR modulation mechanisms, including the transporter inhibition and apoptosis induction. Our results revealed that formononetin significantly enhanced the cytotoxicity of epirubicin. Co-incubation of epirubicin with formononetin increased the ROS levels, including hydrogen peroxide and superoxide free radicals. Epirubicin alone markedly increased the mRNA expression of MDR1, MDR-associated protein (MRP) 1, and MRP2. In contrast, formononetin alone or combined treatment decreased the mRNA expression of MRP1 and MRP2. This result indicates that efflux transporter-mediated epirubicin resistance is inhibited at different degrees by the addition of formononetin. This isoflavone significantly intensified epirubicin uptake into HeLa cells. Apoptosis was induced by formononetin and/or epirubicin, as signified by nuclear DNA fragmentation, chromatin condensation, increased sub-G1 and G2/M phases. The cotreatment triggered the mitochondrial apoptotic pathway indicated by increased Bax-to-Bcl-2 expression ratio, loss of mitochondrial membrane potential, and significant activation of caspase-9 and -3. In addition, extrinsic/caspases-8 apoptotic pathway was also induced by the cotreatment. N-acetyl cysteine abrogated these events induced by formononetin, supporting the involvement of ROS in the MDR reversal mechanism. This study pioneered in demonstrating that formononetin may potentiate the cytotoxicity of epirubicin in HeLa cells through the ROS-mediated MRP inhibition and concurrent activation of the mitochondrial and death receptor pathways of apoptosis. Hence, the circumvention of pump and non-pump resistance using formononetin and epirubicin may pave the way for a powerful chemotherapeutic regimen for treating human cervical cancer.
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Affiliation(s)
- Yu-Li Lo
- Department of Biological Sciences and Technology, National University of Tainan, Tainan, Taiwan ROC.
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Vargens OMDC, Silva CM, Azevedo e Silva G, Girianelli VR. Diagnóstico de HPV: o processo de interação da mulher com seu parceiro. Rev Bras Enferm 2013; 66:327-32. [DOI: 10.1590/s0034-71672013000300004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 04/18/2013] [Indexed: 11/22/2022] Open
Abstract
Pesquisa descritiva, com abordagem qualitativa, que objetivou analisar o processo de interação da mulher com seu parceiro a partir do diagnóstico de infecção pelo papilomavírus humano (HPV). Foi realizada em treze comunidades dos municípios de Duque de Caxias e Nova Iguaçu, Estado do Rio de Janeiro, de outubro/2006 a setembro/2008. Foram entrevistadas 20 mulheres com diagnóstico de infecção pelo HPV de alto risco oncogênico. Os pressupostos do Interacionismo Simbólico e da Grounded Theory nortearam a coleta e análise dos dados. Os resultados revelaram que o diagnóstico do HPV significa sérios desafios no relacionamento das mulheres com seu parceiro principalmente no que se refere à adoção de medidas preventivas. Conclui-se que estas questões indicam a necessidade de um atendimento humanizado que favoreça o empoderamento das mulheres.
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Prevalence and determinants of high-risk human papillomavirus infection in women from a sub-Saharan African community. Sex Transm Dis 2013; 38:308-15. [PMID: 21150817 DOI: 10.1097/olq.0b013e3181fc6ec0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Human papillomavirus infection with high-risk types (HR-HPV) is a necessary cause of cervical cancer, the most common malignancy among sub-Saharan African women. Little is known about prevalence of cervical HR-HPV infection in this region. METHODS A cross-sectional study of 1528 women examined the determinants of HR-HPV infection among women in Kinshasa, Democratic Republic of Congo. Information was collected on sociodemographic, reproductive, lifestyle characteristics, and health-seeking behaviors. Cervical samples were tested for HPV-DNA by Hybrid Capture 2. Unconditional logistic regression identified predictors of HPV positivity. RESULTS HR-HPV prevalence was 12.5% in all women and 8.7% in women with normal cytology. Prevalence was highest (18.3%) in individuals <35 years of age and gradually decreased with age. Excess HR-HPV infection risk was observed in women who were smokers (odds ratio [OR] = 1.60; 95% confidence interval [CI]: 1.11-2.31), divorced/separated (OR = 1.60; 95% CI: 1.11-2.32), in polygamous marriages (OR = 1.28; 95% CI: 0.90-1.82), using medical contraceptives (OR = 2.40; 95% CI: 1.20-4.80), and who preferred male physicians (OR = 1.90; 95% CI: 1.20-3.05). A statistically marginal increase was found in women whose partners had sex with prostitutes (OR = 2.40; 95% CI: 0.72-8.01). A higher standard of living was associated with reduced risk. CONCLUSION HR-HPV positivity was associated with behavioral and sexual characteristics thought to affect risk of new infections and immune function. However, HPV prevalence did not correlate with numbers of sex partners, possibly because of a high HPV infection rate per sexual contact or because subjects were older than 30 years. Our study should assist in designing strategies for control of cervical cancer in this low-resource, high cervical cancer risk setting in sub-Saharan Africa.
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Musa J, Taiwo B, Achenbach C, Olugbenga S, Berzins B, Sagay AS, Idoko JA, Kanki PJ, Murphy RL. High-risk human papillomavirus among HIV-infected women with normal cervical cytology: a pilot study in Jos, Nigeria. Arch Gynecol Obstet 2013; 288:1365-70. [PMID: 23700253 DOI: 10.1007/s00404-013-2885-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cervical cancer is strongly linked to high-risk human papillomavirus (HR-HPV) and is typically preceded by cytological abnormalities. Less is known in patients with normal cervical cytology (NCC). We investigated the epidemiology of HR-HPV among HIV-infected women with NCC. METHODOLOGY We conducted a cross-sectional study between January and June 2011 among HIV-infected women with NCC at an adult HIV clinic in Jos, Nigeria. Cervical sampling and analysis for HR-HPV by hybrid capture (HC2) with signal amplification was done to determine presence of one or more of the following HR-HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 or 68. Epidemiologic factors associated with HR-HPV were determined using bivariate statistics and multivariate logistic regression. RESULTS We evaluated 103 HIV-infected women with Pap cytology. The median age of the women was 32 years (range 21-49). Ninety-seven (94.2%) had NCC. Cervical samples for HR-HPV DNA testing were available from 89/97 (91.8%) of the HIV-infected women with NCC. Of the 89 women with cervical samples for HR-HPV DNA testing, 40 (44.9%) had detectable HR-HPV by HC2 giving a HR-HPV prevalence of 44.9% (95% CI 33.9-55.5%). Age < 30 years was associated with HR-HPV (OR 2.69 [95% CI 1.05-6.91, p = 0.039]) while history of previous abortion showed an inverse association with HR-HPV (OR 0.33[95% CI 0.15-0.94, p = 0.039]). CONCLUSION The prevalence of HR-HPV is seemingly high among HIV-infected women with NCC in our clinical setting. These data provide support for further investigation of the clinical implications of positive HR-HPV among HIV-infected women with NCC report in cervical cancer prevention programs in Nigeria.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria,
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Charbotel B, Massardier-Pilonchery A, Fort E, Dananché B, Févotte J, Confavreux-Romestaing C, Bergeret A. Occupational trichloroethylene exposure and cervical pathology: a case-control study. ACTA ACUST UNITED AC 2012; 57:407-16. [PMID: 23091111 DOI: 10.1093/annhyg/mes075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Trichloroethylene (TCE) is suspected of association with elevated risk of cervical cancer. A case-control study was performed in a geographical area in which occupational TCE exposure is high. The study objective was to analyze the correlation between occupational TCE exposure and cervical cancer (including precancerous conditions). METHODS Case and control subjects were recruited by gynecologists. General and occupational data were collected by telephonic interviews. An industrial hygienist assessed occupational TCE exposure on a task-exposure matrix. Analysis focused on occupational TCE exposure at various levels and on cumulative dose. Multivariate analysis was performed to take account of the various risk factors. RESULTS In total, 67 case and 67 age-matched control subjects were included. Mean age was 36 years in both groups. Five of the possible general risk factors correlated significantly with cervical dysplasia or cancer: number of partners, history of genital or anal wart, interval between first period and first sexual relation, parity, and body mass index, the last three showing inverse correlation. Elevated risk was found in women who had had jobs as manual workers according to the PCS French classification (professions and socioprofessional categories), and production and related workers according to ISCO classification (International Standard Classification of Occupations), with odds ratios (ORs), adjusted on general and medical risk factors, of 7.68 [95% confidence interval (CI): 1.39-42.54] and 7.48 (1.30-43.24), respectively, among skilled service sector workers; the adjusted OR was close to significance, at 4.67 (95% CI: 0.92-23.67). No occupational sectors were significantly associated with elevated risk. In all, 17 (25.4%) case and 15 (22.4%) control subjects were exposed to TCE: raw OR = 1.17 (95% CI: 0.54-2.52), adjusted OR = 1.51 (95% CI: 0.42-5.41). There was no significant correlation between cumulative dose and exposure time. CONCLUSIONS The study found no significantly increased risk of cervical dysplasia or cancer associated with occupational TCE exposure.
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IL-1RN VNTR polymorphism and genetic susceptibility to cervical cancer in Portugal. Mol Biol Rep 2012; 39:10837-42. [PMID: 23053980 DOI: 10.1007/s11033-012-1979-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 10/01/2012] [Indexed: 12/21/2022]
Abstract
Human Papillomavirus infection is considered as the main etiological factor of cervical cancer (ICC), although, the role of host genetic factors in ICC susceptibility has been increasing. Immunological response is crucial for the prevention of viral associated diseases. Interleukin 1 receptor antagonist (IL-1RN) is considered to be an important regulator of host immunity and several studies have shown a potential role of a 86 bp VNTR polymorphism within intron 2 of the IL-1RN gene in host immune response variability. We investigated the role of this polymorphism in cervical cancer development in Portugal with a case-control study developed with peripheral blood samples from 196 healthy women and 340 women with cervical lesions from the Northern Region of Portugal. We observed that IL-1RN Allele 2 homozygosis was significantly higher in cases than in controls. In fact, IL-1RN A2*A2 homozygous revealed to be associated with an increased risk of HSIL + ICC (OR = 1.90; 95 % IC 1.13-3.21; p = 0.015). Furthermore, we also observed that median age of onset of HSIL + ICC was significantly different (46.0 vs 52.0) in IL-1RN A2*A2 homozygous comparing to non-A2*A2 (p = 0.028). Our results indicated that IL-1RN A2 allele is associated with an increased susceptibility to cervical cancer development, probably by increasing predisposition to shorter immune responses.
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Boone JD, Erickson BK, Huh WK. New insights into cervical cancer screening. J Gynecol Oncol 2012; 23:282-7. [PMID: 23094132 PMCID: PMC3469864 DOI: 10.3802/jgo.2012.23.4.282] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 08/04/2012] [Indexed: 01/04/2023] Open
Abstract
Worldwide, cervical cancer is a leading cause of cancer related morbidity and mortality. For over 50 years, cervical cytology has been the gold standard for cervical cancer screening. Because of its profound effect on cervical cancer mortality in nations that have adopted screening programs, the Pap smear is widely accepted as the model screening test. Since its introduction, many studies have analyzed the Pap smear and found that it is not without its shortcomings including low sensitivity for detection of cervical intraepithelial neoplasia 2/3. Additionally, the discovery of infection with the human papillomavirus (HPV) as a necessary step in the development of cervical cancer has led to the development of HPV testing as an adjunct to cytology screening. More recently, researchers have compared HPV testing and cytology in the primary screening of cervical cancer. In this review, we will discuss cytologic testing limitations, the role of HPV DNA testing as an alternative screening tool, the impact of the HPV vaccine on screening, and future directions in cervical cancer screening.
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Affiliation(s)
- Jonathan D Boone
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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Chan PKS, Liu SJ, Cheung JLK, Cheung TH, Yeo W, Chong P, Man S. T-cell response to human papillomavirus type 52 L1, E6, and E7 peptides in women with transient infection, cervical intraepithelial neoplasia, and invasive cancer. J Med Virol 2012; 83:1023-30. [PMID: 21503915 DOI: 10.1002/jmv.21889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The E6 and E7 proteins encoded by human papillomaviruses (HPV) are prime targets for therapeutic vaccine development. Ninety-five women with HPV 52 infection (33 transient infections, 17 cervical intraepithelial neoplasia grade II, 15 cervical intraepithelial neoplasia grade III, and 30 invasive cervical cancers) were examined for T-cell responses using interferon-γ enzyme-linked immunospot (IFN-γ ELISPOT) assay. Of the 29 peptides (13 L1, 10 E6, and 6 E7) screened positive by an in vitro peptide-binding assay, 14 were positive by the IFN-γ ELISPOT assay. Positive epitopes for HLA A11 were located at amino acid positions 103-111, 332-340, 342-350, and 373-381 of the L1 protein; and at 27-35 and 86-94 of the E6 protein; and at 1-9 and 27-35 of the E7 protein. A24-specific epitopes included 60-68 and 98-106 of the L1 protein, 42-50 and 59-67 of the E6 protein, and 24-32 of the E7 protein. Only one epitope (99-107) of the E6 protein showed positive responses for HLA A2 subjects. Overall, T-cell responses against L1 were observed mainly in subjects who had cleared infection; whereas responses against E6 and E7 were confined mainly to subjects who had developed cervical neoplasia. The proportion of subjects showing detectable T-cell responses was low across all grades of cervical neoplasia suggesting that immune evasion mechanisms had set on early in the course of disease progression. This study provides the first set of T-cell epitopes mapped for HPV 52, which can be considered for further evaluation as targets for immunotherapy.
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Affiliation(s)
- Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region, China.
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Lo YL, Wang W, Ho CT. 7,3',4'-Trihydroxyisoflavone modulates multidrug resistance transporters and induces apoptosis via production of reactive oxygen species. Toxicology 2012; 302:221-32. [PMID: 22914566 DOI: 10.1016/j.tox.2012.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/31/2012] [Accepted: 08/02/2012] [Indexed: 11/16/2022]
Abstract
The development of multidrug resistance (MDR) to conventional chemoradiation therapy usually leads to failure in treating cervical cancer. This study aims to explore the effects and mechanisms of 7,3',4'-trihydroxyisoflavone (7,3',4'-THIF), one of the major metabolites of daidzein, on potentiating cytotoxicity of epirubicin (Epi), an anticancer drug in human cervical cancer HeLa cells. The cytotoxicity of Epi remarkably increased when it was combined with 7,3',4'-THIF. The cotreatment increased the reactive oxygen species (ROS) levels, including hydrogen peroxide and superoxide free radicals. 7,3',4'-THIF was shown to down-regulate the MDR1 promoter region composed of the elements of AP1, GC-box, and Y-box, as demonstrated by a luciferase assay. A negative regulation of hMDR1 gene with multiple transcription factors by this isoflavone may provide a novel molecular mechanism for MDR modulation. The mRNA expressions of MDR1, MDR-associated protein (MRP) 1, and MRP2 for the combined treatment were significantly lower than those of the Epi treatment. This result implies that MDR transporter-mediated Epi resistance is inhibited at various degrees by the addition of 7,3',4'-THIF. This isoflavone significantly enhanced intracellular Epi accumulation in HeLa cells. 7,3',4'-THIF and/or Epi triggered apoptosis through the upregulation of p53, Bax, and caspase-9. Apoptosis induction was also confirmed by the reduced mitochondrial membrane potential, increased sub-G1 and G2/M phases, nuclear DNA fragmentation, and chromatin condensation. Our findings demonstrate for the first time that 7,3',4'-THIF causes cell death in human cervical cancer cells through the ROS-dependent suppression of MDR transporters and p53-mediated activation of the intrinsic mitochondrial pathway of apoptosis. Thus, 7,3',4'-THIF has the potential to enhance the activity of a broad range of cancer chemotherapeutics in the MDR spectrum with the advantage of reducing adverse effects.
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Affiliation(s)
- Yu-Li Lo
- Department of Biological Sciences and Technology, National University of Tainan, Tainan, Taiwan.
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Couture MC, Page K, Stein ES, Sansothy N, Sichan K, Kaldor J, Evans JL, Maher L, Palefsky J. Cervical human papillomavirus infection among young women engaged in sex work in Phnom Penh, Cambodia: prevalence, genotypes, risk factors and association with HIV infection. BMC Infect Dis 2012; 12:166. [PMID: 22839728 PMCID: PMC3436768 DOI: 10.1186/1471-2334-12-166] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 06/29/2012] [Indexed: 01/09/2023] Open
Abstract
Background Although cervical cancer is the leading cancer in Cambodia, most women receive no routine screening for cervical cancer and few treatment options exist. Moreover, nothing is known regarding the prevalence of cervical HPV or the genotypes present among women in the country. Young sexually active women, especially those with multiple sex partners are at highest risk of HPV infection. We examine the prevalence and genotypes of cervical HPV, as well as the associated risk factors among young women engaged in sex work in Phnom Penh, Cambodia. Methods We conducted a cross-sectional study among 220 young women (15–29 years) engaged in sex work in different venues including brothels or entertainment establishments, and on a freelance basis in streets, parks and private apartments. Cervical specimens were collected using standard cytobrush technique. HPV DNA was tested for by polymerase chain reaction (PCR) and genotyping using type-specific probes for 29 individual HPV types, as well as for a mixture of 10 less common HPV types. All participants were also screened for HIV status using blood samples. Multivariate logistic regression analyses were conducted to assess risk factors for any or multiple HPV infection. Results The prevalence of cervical HPV 41.1%. HPV 51 and 70 were the most common (5.0%), followed by 16 (4.6%), 71 (4.1%) and 81 (3.7%). Thirty-six women (16.4%) were infected with multiple genotypes and 23.3% were infected with at least one oncogenic HPV type. In multivariate analyses, having HIV infection and a higher number of sexual partners were associated with cervical HPV infection. Risk factors for infection with multiple genotypes included working as freelance female sex workers (FSW) or in brothels, recent binge use of drugs, high number of sexual partners, and HIV infection. Conclusions This is the first Cambodian study on cervical HPV prevalence and genotypes. We found that HPV infection was common among young FSW, especially among women infected with HIV. These results underscore the urgent need for accessible cervical cancer screening and treatment, as well as for a prophylactic vaccine that covers the HPV subtypes present in Cambodia.
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Affiliation(s)
- Marie-Claude Couture
- University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco, CA 94105, USA.
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Jamshidi M, Shekari M, Nejatizadeh AA, Malekzadeh K, Baghershiroodi M, Davudian P, Dehghan F, Jamshidi F. The impact of human papillomavirus (HPV) types 6, 11 in women with genital warts. Arch Gynecol Obstet 2012; 286:1261-7. [PMID: 22718097 DOI: 10.1007/s00404-012-2416-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 06/04/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Human papillomaviruses (HPV) are etiologically associated with the development of virtually all genital warts. HPV-6 and HPV-11 are the most commonly detected HPV genotypes, but at least 20 other HPV genotypes have occasionally been found in genital wart tissue specimens. STUDY DESIGN The aim of this study was to determine from 100 genital wart tissue specimens collected from female patients using multiplex gap-PCR technique the prevalence of various genital HPV among women with HPV genital warts in south of Iran. 100 genital wart tissue specimens were tested for the presence of HPV PG5/PG6 and also for HPV type using polymerase chain reaction (PCR). RESULTS Based on the collected data, 73 (73 %) samples were detected positive for HPV DNA and 23 (23 %) samples out of 100 samples were detected negative for HPV DNA. 49 (49 %) and 67 (67 %) of patients were detected positive for HPV type 6 and 11, respectively. There was a significant association between marital status and HPV genotype 6 (OR = 0.51, 95 % CI = 0.37-0.70, P = 0.01). Nevertheless, no significant association was found between marriage and HPV genotype 11 (OR = 0.85, 95 % CI = 0.58-1, 24, P = 0.7). Similarly, this result was demonstrated, in combined marriage and HPV-general (OR = 0.80, 95 % CI = 0.62-0.05, P = 0.4). CONCLUSION Concerning the prevalence of HPV in our study, determination of genital HPV prevalence and multiple infections among the normal population of women of Hormozgan Province is recommended.
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Affiliation(s)
- Mahin Jamshidi
- Infections Research Center, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran
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Oliveira S, Ribeiro J, Sousa H, Pinto D, Baldaque I, Medeiros R. Genetic polymorphisms and cervical cancer development: ATM G5557A and p53bp1 C1236G. Oncol Rep 2011; 27:1188-92. [PMID: 22200742 PMCID: PMC3583604 DOI: 10.3892/or.2011.1609] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 08/29/2011] [Indexed: 12/19/2022] Open
Abstract
Persistent infections by high-risk types of human papillomavirus (HPV) have been established as the etiological agent of cervical cancer. The integration of the HPV genome into the host genome is a crucial step in cervical carcinogenesis, although, correct activation of DNA damage repair pathways will avoid the development of cancer. Recent data indicate that several polymorphisms of key regulators from the DNA damage repair pathway (i.e. 53BP1 and ATM) are associated with cancer development susceptibility. We have developed a hospital-based retrospective study considering 429 cervical specimens from women with different cervical lesions including invasive carcinoma. This study aimed to evaluate the role of the ATM D1853N (5557G>A) and 53bp1 D353E (1236C>G) polymorphisms in the development of cervical cancer, using TaqMan SNP Genotyping Assays. Statistical analysis revealed that ATM 5557GG homozygous individuals (OR=1.94; p=0.044) are at increased risk of developing LSIL, while for the 53BP1 1236C>G polymorphism no association was found. Nevertheless, we observed a tendency for an increased risk of LSIL in 53BP1 1236C allele carriers (OR=1.63; p=0.069). Logistic regression adjusted for age revealed no significant differences from the non-adjusted analysis. This is the first study to evaluate the role of ATM G5557A and P53BP1 C1236G polymorphisms in cervical cancer susceptibility. This study reveals a possible trend of both polymorphisms for a genetic susceptibility pattern of cervical cancer development. Hence, our results may be of interest for future understanding of the progression of cervical cancer.
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Affiliation(s)
- S Oliveira
- Molecular Oncology Group, Portuguese Institute of Oncology of Porto, Rua Dr António Bernardino Almeida, 4200-072 Porto, Portugal
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Song SH, Hong JH, Kwak SH, Lee JK, Kim MK. Clinical performance assessment of five human papillomavirus DNA tests using liquid-based cytology samples. J Obstet Gynaecol Res 2011; 38:408-14. [DOI: 10.1111/j.1447-0756.2011.01709.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chan PK, Cheung TH, Li WH, Yu MY, Chan MY, Yim SF, Ho WC, Yeung AC, Ho KM, Ng H. Attribution of human papillomavirus types to cervical intraepithelial neoplasia and invasive cancers in Southern China. Int J Cancer 2011; 131:692-705. [DOI: 10.1002/ijc.26404] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 08/17/2011] [Indexed: 01/27/2023]
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Higher incidence and persistence of high-risk human papillomavirus infection in female sex workers compared with women attending family planning. Int J Infect Dis 2011; 15:e688-94. [DOI: 10.1016/j.ijid.2011.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/12/2011] [Accepted: 05/16/2011] [Indexed: 11/24/2022] Open
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HPV typing and its relation with apoptosis in cervical carcinoma from Indian population. Tumour Biol 2011; 33:17-22. [PMID: 21931994 DOI: 10.1007/s13277-011-0233-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 08/26/2011] [Indexed: 01/20/2023] Open
Abstract
Definite progress in understanding the etiology of cervical cancer has been achieved, and some types of human papillomavirus have been established as the central cause of cervical cancer worldwide. This study investigates the human papillomavirus infection and its correlation with apoptosis and clinicopathologic characteristics in squamous cell carcinoma of uterine cervix. Human papillomavirus typing was done by type-specific primers for high-risk human papillomavirus using standard polymerase chain reaction method. Programmed cell death (apoptosis) was determined by terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling assay. Human papillomavirus infection in tissue biopsy of cervical carcinoma was detected in 131 of 135 (97%) cases. Among the positive cases of human papillomavirus, 123 (94%) cases were human papillomavirus type 16, and five (4%) cases were human papillomavirus type 18. Out of 135 cervical carcinoma cases, 81 (60%) cases showed presence of apoptosis. The phenomenon of apoptosis was seen slightly higher in squamous cell carcinoma than in adenocarcinoma (40% in squamous cell carcinoma and 33% in adenocarcinoma). The human papillomavirus infection in cervical cancer might not play any role in the occurrence of apoptosis.
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