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Malagón T, Franco EL, Tejada R, Vaccarella S. Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination. Nat Rev Clin Oncol 2024; 21:522-538. [PMID: 38760499 DOI: 10.1038/s41571-024-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.
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Affiliation(s)
- Talía Malagón
- Department of Oncology, McGill University, Montréal, Quebec, Canada.
- St Mary's Research Centre, Montréal West Island CIUSSS, Montréal, Quebec, Canada.
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada.
| | - Eduardo L Franco
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Romina Tejada
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
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2
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Khoja L, Wang Y, Haque SE, Ahsan H, Islam T, Munshi SU, Hasan AKMR, Islam MT, Jharna AB, Pearce CL. Understanding of cervical cancer, acceptability of HPV self-collection, and prevalence of HPV in a semi-urban setting in Bangladesh. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003157. [PMID: 38656991 PMCID: PMC11042693 DOI: 10.1371/journal.pgph.0003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
Human Papillomavirus (HPV) self-sampling has been implemented successfully as an alternative to traditional forms of cervical cancer screening in low-resource settings. Through Bangladesh's current national cervical cancer screening program, only about 10% of the at-risk population is reached. Thus, Bangladesh is an ideal setting to consider HPV self-sampling to improve cervical cancer prevention efforts. However, the feasibility and acceptability of HPV self-sampling has not been evaluated in Bangladesh. We aimed to understand levels of HPV and cervical cancer knowledge and to evaluate the feasibility and acceptability of HPV self-sampling for cervical cancer screening in a semi-urban Bangladeshi community. Participants were recruited from a local clinic; 164 women completed a cross-sectional questionnaire about attitudes towards screening, and cervical cancer and HPV risk factor knowledge, and provided self-collected cervical samples for high-risk HPV testing. Of the participants, 4.3% tested positive for high-risk HPV and were referred for appropriate follow-up care. Nearly all participants had heard of cervical cancer, though specific knowledge was quite low. Self-sampling for high-risk HPV testing had high rates of acceptability, high rates of convenience, and very little discomfort and embarrassment reported in this study population, making implementing HPV self-sampling as a form of cervical cancer screening in Bangladesh appear feasible.
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Affiliation(s)
- Lilah Khoja
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Yuting Wang
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | | | - Habibul Ahsan
- Institute for Population and Precision Health, University of Chicago, Chicago, Illinois, United States of America
| | - Tariqul Islam
- Center for Multidisciplinary Research, Gono Bishwabidyalay, Dhaka, Bangladesh
| | - Saif Ullah Munshi
- Department of Virology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | | | - Celeste Leigh Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
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3
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Castañeda KM, Sidorenkov G, Mourits MJE, van der Vegt B, Siebers AG, Vermeulen KM, Schuuring E, Wisman GBA, de Bock GH. Impact of health-related behavioral factors on participation in a cervical cancer screening program: the lifelines population-based cohort. BMC Public Health 2023; 23:2376. [PMID: 38037016 PMCID: PMC10688458 DOI: 10.1186/s12889-023-17293-0] [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: 03/04/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Regular participation in cervical cancer screening is critical to reducing mortality. Although certain sociodemographic factors are known to be associated with one-time participation in screening, little is known about other factors that could be related to regular participation. Therefore, this study evaluated the association between health-related behavioral factors and regular participation in cervical cancer screening. METHODS The Lifelines population-based cohort was linked to data for cervical cancer screening from the Dutch Nationwide Pathology Databank. We included women eligible for all four screening rounds between 2000 and 2019, classifying them as regular (4 attendances), irregular (1-3 attendances), and never participants. Multinomial logistic regression was performed to evaluate the association between behavioral factors and participation regularity, with adjustment made for sociodemographic factors. RESULTS Of the 48,325 included women, 55.9%, 35.1%, and 9% were regular, irregular, and never screening participants. After adjustment for sociodemographic factors, the likelihood of irregular or never screening participation was increased by smoking, obesity, marginal or inadequate sleep duration, alcohol consumption and low physical activity, while it was decreased by hormonal contraception use. CONCLUSION An association exists between unhealthy behavioral factors and never or irregular participation in cervical cancer screening.
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Affiliation(s)
- Kelly M Castañeda
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands.
| | - Grigory Sidorenkov
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - Albert G Siebers
- Dutch Nationwide Pathology Databank, PALGA, 3991 SZ, Houten, the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - G Bea A Wisman
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
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Feng T, Cheng B, Sun W, Yang Y. Outcome and associated factors of high-risk human papillomavirus infection without cervical lesions. BMC Womens Health 2023; 23:599. [PMID: 37957634 PMCID: PMC10644444 DOI: 10.1186/s12905-023-02764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To study the outcome of human papillomavirus (HPV) infection in women with cervical pathology results of non-cervical intraepithelial neoplasia (CIN) or cervical cancer and positive high-risk HPV test, as well as analyze the associated risk factors affecting the outcome of infection. METHODS To investigate the outcome of high-risk (HR)-HPV infection in the female genital tract and analyze the associated risk factors affecting their outcome, a total of 196 women with positive HR-HPV test results and non-CIN or cervical cancer cervical pathology results were selected for follow-up at the Cervical Disease Clinic of the Obstetrics and Gynecology Hospital, Zhejiang University School of Medicine from January 2017 to March 2020. The follow-up interval was every 6 months, and both cervical cytology (TCT) and HR-HPV testing were performed at each follow-up visit. If the cervical cytology results were normal upon recheck and the HR-HPV test was negative, the woman was considered to be cleared of the HPV infection and was entered into the routine cervical screening population. When the repeat HR-HPV test remained positive after 6 months, the woman was defined as having a persistent HR-HPV infection. If HR-HPV persisted but the TCT results were normal, follow-up was continued. If HR-HPV persisted and the TCT results were abnormal, a colposcopy-guided biopsy was performed immediately. In this situation, if the histological results were still non-CIN or cervical cancer, the follow-up was continued. If the histological results confirmed the development of CIN or invasive cancer, then enter another study follow-up to further track its development and outcome, and the woman commenced the treatment process. The HPV infection clearance time was analyzed by the Kaplan-Meier method, and the comparison of the HPV clearance rate and infection clearance time between each of the different groups was performed using aχ2 test or Fisher's exact test, as appropriate. After the univariate analysis, several significant factors were included in the Cox model and independent risk factors were analyzed. RESULTS A total of 163 women were enrolled in this study. The median age was 40.0 years (22-67 years) and the median follow-up time was 11.5 months (6-31 months). The spontaneous clearance rate of HR-HPV infection was 51.5%, and the median time to viral clearance was 14.5 months. Age and the initial viral load were high risk factors affecting the spontaneous clearance of HR-HPV infection. The factors significantly associated with HPV clearance rate and time to HPV clearance consisted of menopause and full-term delivery (P < 0.05). CONCLUSIONS In women with normal or low-grade lesions on the cell smear, the spontaneous clearance rate of HR-HPV infection was 51.5% and the time to clearance was 14.5 months. Age and the initial viral load were independent associated factors affecting the spontaneous clearance of HR-HPV infection in the female genital tract. These findings suggest that non-young women or those with high viral loads have a higher rate of persistent HR-HPV infection. Thus, intensive screening should be recommended.
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Affiliation(s)
- Ting Feng
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, No.369 Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang Province, China
| | - Bei Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310008, Zhejiang Province, China
| | - Wenchao Sun
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, No.369 Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang Province, China
| | - Yuhong Yang
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, No.369 Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang Province, China.
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Shahnaz S, Fricovsky E, Anwar R, Arain MI. Cervical Cancer Awareness and Attitude Towards Cervical Cancer Screening and Human Papillomavirus Vaccines Among Urban Women of Karachi, Pakistan. Cureus 2023; 15:e42970. [PMID: 37671214 PMCID: PMC10475580 DOI: 10.7759/cureus.42970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Cervical cancer is the second most common cancer among women under 50 years of age in Pakistan. The current study was designed to assess the level of awareness through educational outreach presentations about cervical cancer, Papanicolaou (Pap) smear test, and human papillomavirus (HPV) vaccination in Karachi, Pakistan. Women from different urban hospitals were enrolled. Participants participated in a 45-minute presentation on cervical cancer awareness led by student pharmacists from Nazeer Hussain University, Karachi. A pre-and post-test was administered to assess the impact of the intervention. Descriptive statistics were used to summarize the findings, and a t-test was used for matched comparison, and a p-value <0.05 for statistical significance. A total of 150 women participated in the study. The study found that Pakistani women living in urban settings were less knowledgeable about the causes of cervical cancer and prevention. After the presentation, we observed a 45% increase in knowledge, and 31% of participants said they would obtain a Pap smear test in the next six months. Supervised pharmacy student-led presentations on cervical cancer educational awareness that significantly impacted women participants. Pharmacists can play a key role in reducing cervical cancer deaths through increased awareness, education, prevention, and immunization.
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Affiliation(s)
| | - Eduardo Fricovsky
- Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, USA
| | | | - Mudassar Iqbal Arain
- Pharmacy, University of SIndh, Jamshoro, PAK
- Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, USA
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Voidăzan TS, Uzun CC, Kovacs Z, Rosznayai FF, Turdean SG, Budianu MA. The Hybrid Capture 2 Results in Correlation with the Pap Test, Sexual Behavior, and Characteristics of Romanian Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3839. [PMID: 36900850 PMCID: PMC10001103 DOI: 10.3390/ijerph20053839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) infection is the major cause of cervical cancer (CC); hence, it is critical to understand the processes by which HPV infection causes squamous intraepithelial lesions, as well as the proper diagnostic tools. The objective of this study was to establish the correlations between Pap test results and Hybrid Capture 2 (HC2) tests findings. MATERIALS AND METHODS This study included 169 women between the ages of 30 and 64, who presented for consultation in gynecological clinics in both the public and the private sectors. These women reported symptoms, such as abnormal vaginal discharge and genital irritation, as well as early onset of sexual activity, multiple sexual partners, history of other sexually transmitted infections or high-risk sexual partners, immunosuppression, or tobacco smoking. Pap tests and HPV testing, using the HC2 method, were performed for the women enrolled in the study, including data gathered after patients completed questionnaires concerning their sexual behavior. RESULTS The HC2 method revealed that 66 patients (39.1%) tested positive for high-risk HPV types. Of the patients with positive results, 14 (21.2%) presented Atypical Squamous Cells of Undetermined Significance (ASC-US) compared to 10 (9.7%) patients in the negative group (p = 0.042). Atypical Squamous Cells for which a high-grade lesion cannot be excluded (ASC-H) were identified primarily in women with positive HC2 (6.1%). HR-HPV positivity was substantially more associated with low-grade ASC-US or low-grade squamous intraepithelial lesion (LSIL) and high-grade ASC-H cytology (OR = 2.53; 95% CI: 1.10-5.80, respectively, OR = 14.9; 95%CI: 1.006-34.59). Unmarried women (31.8%; p = 0.004) and women with multiple partners (over four partners, 10.6%; p = 0.03) were more likely to have an HPV infection when compared to married women and those with fewer sexual partners. CONCLUSIONS Understanding the epidemiology of HPV genital infections is essential for developing preventive measures against this infection and CC. Identifying the most prevalent HPV types, and determining the incidence of HPV oncogenic infections, in conjunction with Pap test results and sexual behavior information, can constitute part of an algorithm for the efficient management of cervical intraepithelial lesions.
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Affiliation(s)
- Toader Septimiu Voidăzan
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Cosmina Cristina Uzun
- Department of Biochemistry, Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Zsolt Kovacs
- Department of Biochemistry, Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Florin Francisc Rosznayai
- Department of Obstetrics Gynecology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Sabin Gligore Turdean
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Mihaela-Alexandra Budianu
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
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7
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Yang H, Xie Y, Guan R, Zhao Y, Lv W, Liu Y, Zhu F, Liu H, Guo X, Tang Z, Li H, Zhong Y, Zhang B, Yu H. Factors affecting HPV infection in U.S. and Beijing females: A modeling study. Front Public Health 2022; 10:1052210. [PMID: 36589946 PMCID: PMC9794849 DOI: 10.3389/fpubh.2022.1052210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background Human papillomavirus (HPV) infection is an important carcinogenic infection highly prevalent among many populations. However, independent influencing factors and predictive models for HPV infection in both U.S. and Beijing females are rarely confirmed. In this study, our first objective was to explore the overlapping HPV infection-related factors in U.S. and Beijing females. Secondly, we aimed to develop an R package for identifying the top-performing prediction models and build the predictive models for HPV infection using this R package. Methods This cross-sectional study used data from the 2009-2016 NHANES (a national population-based study) and the 2019 data on Beijing female union workers from various industries. Prevalence, potential influencing factors, and predictive models for HPV infection in both cohorts were explored. Results There were 2,259 (NHANES cohort, age: 20-59 years) and 1,593 (Beijing female cohort, age: 20-70 years) participants included in analyses. The HPV infection rate of U.S. NHANES and Beijing females were, respectively 45.73 and 8.22%. The number of male sex partners, marital status, and history of HPV infection were the predominant factors that influenced HPV infection in both NHANES and Beijing female cohorts. However, condom application was not an independent influencing factor for HPV infection in both cohorts. R package Modelbest was established. The nomogram developed based on Modelbest package showed better performance than the nomogram which only included significant factors in multivariate regression analysis. Conclusion Collectively, despite the widespread availability of HPV vaccines, HPV infection is still prevalent. Compared with condom promotion, avoidance of multiple sexual partners seems to be more effective for preventing HPV infection. Nomograms developed based on Modelbest can provide improved personalized risk assessment for HPV infection. Our R package Modelbest has potential to be a powerful tool for future predictive model studies.
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Affiliation(s)
- Huixia Yang
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yujin Xie
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Rui Guan
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yanlan Zhao
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Weihua Lv
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ying Liu
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Feng Zhu
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Huijuan Liu
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xinxiang Guo
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Zhen Tang
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Haijing Li
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yu Zhong
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China,Yu Zhong
| | - Bin Zhang
- Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China,Bin Zhang
| | - Hong Yu
- Labor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China,*Correspondence: Hong Yu
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Tekalegn Y, Sahiledengle B, Woldeyohannes D, Atlaw D, Degno S, Desta F, Bekele K, Aseffa T, Gezahegn H, Kene C. High parity is associated with increased risk of cervical cancer: Systematic review and meta-analysis of case-control studies. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075904. [PMID: 35114865 PMCID: PMC8819811 DOI: 10.1177/17455065221075904] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Cervical cancer is the fourth most common cancer among women. High parity has
long been suspected with an increased risk of cervical cancer. Evidence from
the existing epidemiological studies regarding the association between
parity and cervical cancer is variable and inconsistent. Therefore, the
objective of this systematic review and meta-analysis was to synthesize the
best available evidence on the epidemiological association between parity
and cervical cancer. Methods: Case–control studies reporting the association between parity and cervical
cancer were systematically searched in databases like MEDLINE/PubMed,
HINARI, Google scholar, Science direct, and Cochrane Libraries. All studies
fulfilling the inclusion criteria and published between 2000 and 7 March
2020 were included in this meta-analysis. This study reported according to
PRISMA guideline. Cochran’s Q-statistics and
I2 tests were performed to assess
heterogeneity among included studies. Egger’s regression analysis was
performed to assess publication bias. A random-effect meta-analysis model
was used to compute pooled odds ratio of the association between parity and
cervical cancer. Results: A total of 6685 participants (3227 patients and 3458 controls) were
incorporated in the 12 studies included in this meta-analysis. The
meta-analysis revealed that women with high parity had 2.65 times higher
odds of developing cervical cancer compared to their counterparts (odds
ratio = 2.65, 95% confidence interval = 2.08–3.38). Conclusion: High parity is positively associated with cervical cancer. Strong
epidemiological studies are recommended to further explore the mechanisms
and role of parity in the causation of cervical cancer.
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Affiliation(s)
- Yohannes Tekalegn
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Biniyam Sahiledengle
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, School of Medicine, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Sisay Degno
- Department of Human Anatomy, School of Medicine, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Kebebe Bekele
- Department of Surgery, School of Medicine, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Tesfaye Aseffa
- Department of Nursing, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Habtamu Gezahegn
- Department of Human Physiology, School of Medicine, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
| | - Chala Kene
- Department of Midwifery, School of Health Sciences, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
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9
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Sierra MS, Tsang SH, Hu S, Porras C, Herrero R, Kreimer AR, Schussler J, Boland J, Wagner S, Cortes B, Rodríguez AC, Quint W, van Doorn LJ, Schiffman M, Sampson JN, Hildesheim A. Risk Factors for Non-Human Papillomavirus (HPV) Type 16/18 Cervical Infections and Associated Lesions Among HPV DNA-Negative Women Vaccinated Against HPV-16/18 in the Costa Rica Vaccine Trial. J Infect Dis 2021; 224:503-516. [PMID: 33326576 PMCID: PMC8496490 DOI: 10.1093/infdis/jiaa768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Factors that lead human papillomavirus (HPV) infections to persist and progress to cancer are not fully understood. We evaluated co-factors for acquisition, persistence, and progression of non-HPV-16/18 infections among HPV-vaccinated women. METHODS We analyzed 2153 women aged 18-25 years randomized to the HPV-vaccine arm of the Costa Rica HPV Vaccine Trial. Women were HPV DNA negative for all types at baseline and followed for approximately 11 years. Generalized estimating equation methods were used to account for correlated observations. Time-dependent factors evaluated were age, sexual behavior, marital status, hormonally related factors, number of full-term pregnancies (FTPs), smoking behavior, and baseline body mass index. RESULTS A total of 1777 incident oncogenic non-HPV-16/18 infections were detected in 12 292 visits (average, 0.14 infections/visit). Age and sexual behavior-related variables were associated with oncogenic non-HPV-16/18 acquisition. Twenty-six percent of incident infections persisted for ≥1 year. None of the factors evaluated were statistically associated with persistence of oncogenic non-HPV-16/18 infections. Risk of progression to Cervical Intraepithelial Neoplasia grade 2 or worst (CIN2+) increased with increasing age (P for trend = .001), injectable contraceptive use (relative risk, 2.61 [95% confidence interval, 1.19-5.73] ever vs never), and increasing FTPs (P for trend = .034). CONCLUSIONS In a cohort of HPV-16/18-vaccinated women, age and sexual behavior variables are associated with acquisition of oncogenic non-HPV-16/18 infections; no notable factors are associated with persistence of acquired infections; and age, parity, and hormonally related exposures are associated with progression to CIN2+.
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Affiliation(s)
- Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Sabrina H Tsang
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Shangying Hu
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
- Prevention and Implementation Group, International Agency
for Research on Cancer, Lyon, France
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - John Schussler
- Information Management Services, Silver
Spring, Maryland, USA
| | - Joseph Boland
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National
Laboratory for Cancer Research, Leidos Biomedical Research Inc,
Frederick, Maryland, USA
| | - Sarah Wagner
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National
Laboratory for Cancer Research, Leidos Biomedical Research Inc,
Frederick, Maryland, USA
| | - Bernal Cortes
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
| | | | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk,
The Netherlands
| | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
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10
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Andujar M, Roura E, Torres A, Vega B, Pavcovich M, Sanchez MA, Lubrano A, Trujillo JL, Almeida L, Santana M, Hurtado R, Arencibia O, Benito V, Medina N, Carballo S, Camacho MDC, Ruiz Del Pozo A, Quesada A, Salido E, de Sanjosé S, Bruni L. Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands. BMJ Open 2020; 10:e037402. [PMID: 32973061 PMCID: PMC7517562 DOI: 10.1136/bmjopen-2020-037402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE National Spanish studies show that prevalence of cervical human papillomavirus (HPV) infection in the female population is increasingly frequent, with an overall estimate of 14% in women aged 18-65 years. The objective of this study is to know the prevalence and distribution of HPV types in the female population of the Canary Islands prior to the introduction of HPV vaccines and to investigate the associated clinical and sociodemographic factors. METHODS Based on the Primary Health Care database, a sample of adult women (aged 18-65 years) of Gran Canaria (GC) and Tenerife (TF) stratified into nine age groups was carried out between 2002 and 2007. Women were contacted by postal letter and telephone call and were visited in their primary care centre. A clinical-epidemiological survey was completed and cervical samples were taken for cytological study and HPV detection. HPV prevalence and its 95% CI were estimated, and multivariate analyses were performed using logistic regression to identify factors associated with the infection. RESULTS 6010 women participated in the study, 3847 from GC and 2163 from TF. The overall prevalence of HPV infection was 13.6% (CI 12.8%-14.5%) and 11.1% (CI 10.3%-11.9%) for high-risk types. The most frequent HPV type was 16 followed by types 51, 53, 31, 42 and 59. HPV types included in the nonavalent vaccine were detected in 54.1% of infected women. Factors associated with an increased risk of infection were: young ages (18-29 years), the number of sexual partners throughout life, not being married, being a smoker, and having had previous cervical lesions or genital warts. CONCLUSIONS It is confirmed that prevalence of HPV infection in the female population of the Canary Islands is high, but similar to that of Spain, HPV 16 being the most frequent genotype. The determinants of infection are consistent with those of other populations.
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Affiliation(s)
- Miguel Andujar
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Esther Roura
- Unit of Infections and Cancer-Information and Interventions (UNIC-I&I)-Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alejandra Torres
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Begoña Vega
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Marta Pavcovich
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Miguel Angel Sanchez
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Amina Lubrano
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Jose Luis Trujillo
- Department of Obstetrics and Gynecology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Lucia Almeida
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Milagros Santana
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Rosaura Hurtado
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Octavio Arencibia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Virginia Benito
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Norberto Medina
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Sonia Carballo
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Maria Del Carmen Camacho
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Arancha Ruiz Del Pozo
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alfoso Quesada
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Eduardo Salido
- Department of Pathology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Silvia de Sanjosé
- Reproductive Health Global Programme, PATH, Seattle, Washington, USA
- Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Laia Bruni
- Unit of Infections and Cancer-Information and Interventions (UNIC-I&I)-Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
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11
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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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12
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Risk prediction of cervical abnormalities: The value of sociodemographic and lifestyle factors in addition to HPV status. Prev Med 2020; 130:105927. [PMID: 31756350 DOI: 10.1016/j.ypmed.2019.105927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 01/07/2023]
Abstract
High-risk human papillomavirus (hrHPV) assessment as a primary screening test improves sensitivity but decreases specificity. Determining risk for cervical abnormalities and adapting policy accordingly may improve the balance between screening benefits and harms. Our aim is to assess the value of factors other than HPV in prediction of cervical abnormalities. Data from a Dutch prospective cohort were used. Women aged 18-29 years, not yet eligible for screening, were included in 2007. Data collection consisted of a questionnaire and a cervicovaginal self-sample. Linkage with PALGA (pathology database) was performed in 2017. The analyses included 1483 women. The full model, including sociodemographic and lifestyle factors, was compared to the null model, including baseline HPV only. The outcome of interest was cervical intraepithelial neoplasia 2 or worse (CIN2+). There were 86 women with CIN2+. Baseline hrHPV status was an important predictor (OR = 5.20, 95%CI = 3.27-8.27). The area under the ROC curve (AUC) of the null model was 0.67 (95%CI = 0.61-0.72). The full model had a slightly higher AUC of 0.73 (95%CI = 0.67-0.79). Bootstrap validation indicated that overfitting was present. This exploratory study has confirmed that a single hrHPV measurement is a strong predictor of cervical abnormalities, and additional risk factors in young women appeared to have limited added value. However, prediction based on hrHPV only does leave room for improvement. Future studies should therefore focus on women in the screening age range and search for other predictors to further enhance risk prediction. Adapting policy based on risk may eventually help optimise screening performance.
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Kasamatsu E, Rodríguez Riveros MI, Soilan AM, Ortega M, Mongelós P, Páez M, Castro A, Cristaldo C, Báez FR, Centurión CC, Vester J, Barrios H, Villalba G, Amarilla ML, Giménez G, Caubere E, Hernández MDLL, Baena A, Almonte M, Herrero R, Mendoza LP. Factors associated with high-risk human papillomavirus infection and high-grade cervical neoplasia: A population-based study in Paraguay. PLoS One 2019; 14:e0218016. [PMID: 31246959 PMCID: PMC6597051 DOI: 10.1371/journal.pone.0218016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/23/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer (CC) is one of the leading causes of cancer mortality among women from Paraguay, with high incidence and mortality rates (31.2 and 16 per 100 000 women, respectively). Although the risk factors associated with high-risk human papillomavirus (hrHPV) infection and preneoplastic cervical lesions are widely studied, population-based characteristics of particular settings may influence the feasibility of HPV-based CC screening implementation. This study aimed to explore factors associated with hrHPV infection and high-grade cervical neoplasia in hrHPV-positive (hrHPV+) women from Paraguay. METHODS A total of 5677 women aged 30-64 years from the Central Department of Paraguay were screened with HPV test (Hybrid Capture 2) and Pap smear. Sociodemographic and risk factor interviews were conducted. hrHPV+ women were referred to colposcopy and women with an abnormal colposcopy had a biopsy taken. The outcomes recorded were the hrHPV status and the presence of high-grade cervical intraepithelial neoplasia or worse (CIN2+) among hrHPV+ women. Associations were investigated using multivariate logistic regressions. RESULTS hrHPV prevalence was 13.8% (95%CI 13.0-14.8). This value decreased with the age of women (p-trend<0.001) and increased with the lifetime number of sexual partners (p-trend<0.001) and number of previous female partners of their current male partner if women had had one lifetime sexual partner (p-trend<0.001), increasing from 3.06 (95%CI 0.073-20.9) if partners had had one previous female partner to 9.19 (95%CI 2.36-61.1) if they had had eight or more. In hrHPV+ women, CIN2+ prevalence was 10.7% (95%CI 8.58-13.2) and increased with time since the last Pap smear (p-trend<0.001) and with the increasing number of pregnancies (p-trend = 0.05). CONCLUSION In these settings, the sexual behavior of women and their male partners is associated with hrHPV infection. In hrHPV+ women, underscreening practices and multiple pregnancies are associated with CIN2+. This knowledge can contribute to public health policies for CC prevention and control in Paraguay.
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Affiliation(s)
- Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - María Isabel Rodríguez Riveros
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Ana María Soilan
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Pamela Mongelós
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Malvina Páez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Amalia Castro
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Carmen Cristaldo
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Fátima Romina Báez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Claudia Carolina Centurión
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Jaime Vester
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Hernán Barrios
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Griselda Villalba
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - María Luisa Amarilla
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Graciela Giménez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Elodie Caubere
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | | | - Armando Baena
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Maribel Almonte
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Rolando Herrero
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Laura Patricia Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
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Nakalembe M, Makanga P, Mubiru F, Swanson M, Martin J, Huchko M. Prevalence, correlates, and predictive value of high-risk human papillomavirus mRNA detection in a community-based cervical cancer screening program in western Uganda. Infect Agent Cancer 2019; 14:14. [PMID: 31114629 PMCID: PMC6515623 DOI: 10.1186/s13027-019-0230-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 12/26/2022] Open
Abstract
Background New strategies are needed to combat the high incidence of cervical cancer in resource-limited settings such as sub-Saharan Africa. Screening for high-risk human papillomavirus (hrHPV) DNA is sensitive for pre-cancer, but its lack of specificity results in substantial overtreatment in low resource settings where additional testing (e.g., colposcopy) is rarely available. Testing for hrHPV E6/E7 mRNA may enhance specificity, but little is known about its performance characteristics in resource-limited settings. Methods In a series of community health fairs in rural Uganda, women aged 25 to 49 years provided self-collected vaginal samples, which were tested for hrHPV (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) E6/E7 mRNA with the Aptima® assay. Positive specimens underwent testing for HPV-16 and 18/45. After excluding pregnant women, all women testing positive for any hrHPV subsequently were offered cervical biopsy to determine pathology. Results A total of 1892 women provided a vaginal sample for hrHPV testing during 24 health fairs. The median age was 34 years, HIV prevalence was 10, and 95% had not been previously screened. Prevalence of any hrHPV E6/E7 mRNA was 21% (95% confidence interval (CI): 19 to 23%); the prevalence of HPV-16 was 2.6%, HPV-18/45 1.9%, and HPV 16 and 18/45 were jointly found in 0.1% of the study population. Younger age, pregnancy and HIV-positivity were independently associated with any hrHPV infection. Of the 255 evaluable cervical biopsies, the positive predictive value of detecting any hrHPV E6/E7 mRNA for presence of cervical intraepithelial neoplasia grade 2 or higher ("CIN 2+") was 8.2% (95% CI: 5.1 to 12%). The positive predictive value associated with detection of HPV-16 mRNA (15%) or HPV-18/45 mRNA (15%) was only slightly higher. Conclusion Among community-based women in Uganda, the prevalence of any hrHPV E6/E7 mRNA in vaginal samples was high, but the prevalence of the most oncogenic HPV types (16, 18, or 45) was substantially lower. Positive predictive value of hrHPV mRNA-positivity for CIN 2+ was also low, including when restricting to HPV 16/18/45-positivity. The findings emphasize the need to identify more specific screening approaches for cervical cancer.
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Affiliation(s)
- Miriam Nakalembe
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Philippa Makanga
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Frank Mubiru
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Megan Swanson
- Department of Obstetrics and Gynecology, University of California, San Francisco, Uganda
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, Uganda
| | - Megan Huchko
- 4Department of Obstetrics and Gynecology, Global Health Institute, Duke University, Durham, North Carolina USA
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Roik E, Sharashova E, Kharkova O, Nieboer E, Postoev V, Odland JØ. Sociodemographic characteristics, sexual behaviour and knowledge about cervical cancer prevention as risk factors for high-risk human papillomavirus infection in Arkhangelsk, North-West Russia. Int J Circumpolar Health 2019; 77:1498681. [PMID: 30039744 PMCID: PMC6060378 DOI: 10.1080/22423982.2018.1498681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
While sociodemographic predictors of cervical cancer (CC) are well understood, predictors of high-risk (HR) human papillomavirus (HPV) infection have not been fully elucidated. This study explored the HR-HPV infection positivity in relation to sociodemographic, sexual behavior characteristics and knowledge about HPV and CC prevention among women who visited the Arkhangelsk clinical maternity hospital named after Samoylova, Russia. This cross-sectional study was conducted in the city of Arkhangelsk, Northwest Russia. Women who consulted a gynecologist for any reason between 1 January 2015 and 30 April 2015 were residents of Arkhangelsk, 25-65 years of age were included. The Mann-Whitney and Pearson's χ2 tests were used. To determine the HR-HPV status, we used the Amplisens HPV-DNA test. We used a questionnaire to collect the information on sociodemographic factors. Logistic regression was applied. The prevalence of HR-HPV infection was 16.7% (n = 50). HR-HPV infection was more prevalent in younger women, cohabiting, nulliparae, smokers, having had over three sexual partners and early age of sexual debut. The odds of having a positive HR-HPV status increased by 25% with an annual decrease in the age of sexual debut. Moreover women with one child or more were less likely to have positive HR-HPV status.
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Affiliation(s)
- Elena Roik
- a Department of Community Medicine, Faculty of Health Sciences , UiT - The Arctic University of Norway , Tromsø , Norway.,b International School of Public Health , Northern State Medical University , Arkhangelsk , Russia
| | - Ekaterina Sharashova
- a Department of Community Medicine, Faculty of Health Sciences , UiT - The Arctic University of Norway , Tromsø , Norway
| | - Olga Kharkova
- a Department of Community Medicine, Faculty of Health Sciences , UiT - The Arctic University of Norway , Tromsø , Norway.,b International School of Public Health , Northern State Medical University , Arkhangelsk , Russia
| | - Evert Nieboer
- c Department of Biochemistry and Biomedical Sciences , McMaster University , Hamilton , ON , Canada
| | - Vitaly Postoev
- b International School of Public Health , Northern State Medical University , Arkhangelsk , Russia
| | - Jon Ø Odland
- a Department of Community Medicine, Faculty of Health Sciences , UiT - The Arctic University of Norway , Tromsø , Norway.,d Department of Public Health and Nursing, Faculty of Medicine and Health Sciences , The Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
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Agenjo González M, Lampaya Nasarre B, Salazar F, Varillas D, Cristobal I. Influence of intrauterine dispositive in human papillomavirus clearance. Eur J Obstet Gynecol Reprod Biol 2018; 232:65-69. [PMID: 30472624 DOI: 10.1016/j.ejogrb.2018.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION An important inverse relation between IUD use and risk of cervical cancer has been proved. Women who used IUD had half the risk of developing cervical cancer. The mechanism how IUD is a protector factor is still unknown. Could be improving the clearance of HPV infection or stopping progression to cancer from preneoplasic lesion. The aim of the study is to check if IUD increases HPV clearance, that is, checking if after 1 year HPV infection disappears in more patients using IUD than those not using it. STUDY DESIGN This is a cohort case-control prospective study, carried out in Universitary Hospital La Zarzuela in Madrid, Spain, performed between October 2015 and April 2018. No pregnant women between 25-50 years old, with HPV cervical infection were enrolled. We separated the participants into two groups: an IUD group, with women starting using IUD and non IUD group, with women using any other contraceptive method or none. HPV genotyping of cervical cytology samples were performed initially on enrolment day and one year after. RESULTS 254 participants were enrolled at the beginning of the study, 85 in the IUD group and 169 in the control group (non IUD). 179 participants completed the study, 54 (31%) in IUD group and 120 participants in non IUD group (69%). 38 women from IUD group cleared HPV infection (69.5%) and 65 women from control group cleared it (54.2%) (p = 0.044). An association in logistic regression was observed in HPV clearance with different factors. Firstly, higher percentage of patients with IUD clear the HPV infection than those in control group significantly associated (OR = 0.698, CI 95%; 0.251-0.998, p = 0.046). Clearance was higher in patients with low-risk HPV infection comparing with high risk HPV (OR = 1.078, CI 95%; 1.126-4.6.281, p = 0.026) and in patients with only one HPV type than those with more than one (OR = 0.194, CI 95%; 0.084-0.403, p < 0.001). CONCLUSIONS In Spanish women with HPV infection, the HPV clearance between IUD and non IUD groups show results with statistical significance, patients with IUD have higher clearance rates. There were differences also between suffering one HPV type or more than one, and having low-risk HPV or high-risk HPV infection.
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Affiliation(s)
- Marta Agenjo González
- Universitary Hospital La Zarzuela, Pleyades street, 25, 28023, Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
| | - Belén Lampaya Nasarre
- Universitary Hospital La Zarzuela, Pleyades street, 25, 28023, Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Fernando Salazar
- Universitary Hospital La Zarzuela, Pleyades street, 25, 28023, Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - David Varillas
- Universitary Hospital La Zarzuela, Pleyades street, 25, 28023, Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Ignacio Cristobal
- Universitary Hospital La Zarzuela, Pleyades street, 25, 28023, Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
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Sengupta D, Guha U, Mitra S, Ghosh S, Bhattacharjee S, Sengupta M. Meta-Analysis of Polymorphic Variants Conferring Genetic Risk to Cervical Cancer in Indian Women Supports CYP1A1
as an Important Associated Locus. Asian Pac J Cancer Prev 2018; 19:2071-2081. [PMID: 30139066 PMCID: PMC6171405 DOI: 10.22034/apjcp.2018.19.8.2071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: Association of multiple polymorphic variants with cervical cancer has been elucidated by several
candidate gene based as well as genome-wide association studies. However, contradictory outcomes of those studies
have failed to estimate the true effect of the polymorphic variants on cervical cancer. Methods: Literature mining of
the PubMed database was done to gather all the publications related to genetic association with cervical cancer in India.
Out of 98 PubMed hits only 29 genetic association studies were selected for meta-analysis based on specific inclusion
criteria. A fixed-effect meta-analysis was performed to evaluate the overall association of the genetic polymorphisms
with cervical cancer. Cochran’s Q test was performed to assess between study heterogeneity. Publication bias was
also estimated by funnel plots and Egger’s regression test. Further, sub-group analysis was conducted by fixed-effect
meta-regression to assess the impact of polymorphisms on cervical cancer in the presence of Human Papilloma Virus
(HPV). Result: Following a fixed-effect model, meta-analysis was conducted that revealed 2 polymorphic variants
viz. ‘deletion polymorphism (Del2) (OR=1.79, 95% CI= 1.08-2.95, P=0.023) in GSTM1’ and ‘rs1048943 (OR = 2.34,
95% CI=1.37-3.99, P=0.0018) in CYP1A1’ to be associated with cervical cancer. However, multiple testing correction
showed only rs1048943 of CYP1A1 to be significantly associated (P-value=0.029) with cervical cancer with significant
publication bias (P-value=0.0113) as estimated by Egger’s regression test. The polymorphic variants ‘rs1801131’,
‘rs1801133’, ‘rs2430561’, ‘rs1799782’, ‘rs25486’ and ‘rs25487’ showed significant (p<0.05) evidence of heterogeneity
between studies by Cochran’s Q test and also by heterogeneity index (I2) calculation. Conclusion: Therefore, our study
revealed significant association of rs1048943 in CYP1A1, but a nominal association of deletion polymorphism (Del2)
in GSTM1 with cervical cancer, which provides a comprehensive insight on the true effect of the polymorphisms,
reported in various case-control studies, on the risk of the development of cervical cancer in Indian women.
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Hsu YY, Wang WM, Fetzer SJ, Cheng YM, Hsu KF. Longitudinal psychosocial adjustment of women to human papillomavirus infection. J Adv Nurs 2018; 74:2523-2532. [PMID: 29845650 DOI: 10.1111/jan.13725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/14/2018] [Accepted: 04/10/2018] [Indexed: 12/30/2022]
Abstract
AIM The aim of this study was to examine the psychosocial adjustment trajectory, focusing on psychological distress, sexual relationships and healthcare information, and factors which have an impact on adjustment on receiving a positive diagnosis of human papillomavirus infection. BACKGROUND Human papillomavirus is a common sexually transmitted infection in females. To date, knowledge of the longitudinal psychosocial response to the diagnosis of human papillomavirus is limited. DESIGN A prospective longitudinal design was conducted with a convenience sample. METHODS Women aged 20-65 years old were followed at one, 6 and 12 months after a diagnosis of HPV. Participants completed measures of initial emotional distress and followed up psychosocial adjustment. A mixed-effects model was applied to analyse the longitudinal changes in psychosocial adjustment. RESULTS Seventy human papillomavirus positive women participated in the study with nearly 20% of the women reporting emotional distress during their first visit. Mixed-effects model analyses showed that a trajectory of psychosocial adjustment in healthcare orientation, sexual relationship and psychosocial distress occur from one to 6 months after HPV diagnosis. However, a declining trend from 6 to 12 months was significant in healthcare orientation. Initial emotional distress was associated with changes in psychological adjustment. CONCLUSIONS Psychosocial adjustment to human papillomavirus was worse at 1 month compared with 6 and 12 months after diagnosis. Healthcare providers should offer health information and psychosocial support to women according to their disease progression.
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Affiliation(s)
- Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ming Wang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Susan Jane Fetzer
- College of Health and Human Services, University of New Hampshire, Durham, NH
| | - Ya-Min Cheng
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Fu Hsu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chandler E, Ding L, Gorbach P, Franco EL, Brown DA, Widdice LE, Bernstein DI, Kahn JA. Epidemiology of Any and Vaccine-Type Anogenital Human Papillomavirus Among 13-26-Year-Old Young Men After HPV Vaccine Introduction. J Adolesc Health 2018; 63:43-49. [PMID: 30060856 PMCID: PMC6086131 DOI: 10.1016/j.jadohealth.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE The aims of this study were to determine prevalence of and factors associated with any human papillomavirus (HPV) and vaccine-type HPV among young men after vaccine introduction, stratified by vaccination status. METHODS Young men were recruited from clinical sites from 2013 to 2015, completed a survey, and were tested for 36 anogenital HPV types. We determined factors associated with ≥1 HPV type among all participants, and vaccine-type HPV (HPV6, 11, 16, and/or 18) among all, vaccinated and unvaccinated participants, using multivariable regression. RESULTS Mean age was 21.5 years and 26% had received at least one HPV vaccine dose. HPV prevalence was lower in vaccinated versus unvaccinated young men (50.5% vs. 62.6%, p = .03). HPV positivity was discordant by anogenital site. At both sites, 59.4% were positive for ≥1 HPV type and 26.0% for ≥1 4-valent vaccine type. In multivariable logistic regression, factors associated with ≥1 HPV type among all participants were frequency of oral sex (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.00-3.24), recent smoking (OR = 1.84, CI = 1.17-2.90), and sexually transmitted infection history (OR = 1.56, CI = 1.02-2.38). Factors associated with vaccine-type HPV among all participants were white versus black race (OR = 1.91, CI = 1.10-3.34) and gonorrhea history (OR = 2.52, CI = 1.45-4.38); among vaccinated participants were private versus Medicaid insurance (OR = 5.6, CI = 1.46-20.4) and private versus no insurance (OR = 15.9, CI = 3.06-83.3); and among unvaccinated participants was gonorrhea history (OR = 1.83, CI = 1.03-3.24). CONCLUSIONS Anogenital HPV prevalence was high and vaccination rates low among young men 2-4 years after vaccine introduction, underscoring the urgency of increasing vaccination rates and vaccinating according to national guidelines.
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Affiliation(s)
- Emmanuel Chandler
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Ave Cincinnati, OH 45229
| | - Lili Ding
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Ave Cincinnati, OH 45229
| | - Pamina Gorbach
- Department of Epidemiology, University of California, Los Angeles, CA, CHS 41–295, Conference Room: 46-070A, Box 951772, Los Angeles, CA 90095-1772
| | - Eduardo L. Franco
- Departments of Oncology and Epidemiology & Biostatistics, McGill University, 5100 Maisonneuve Blvd West, Suite 720; Montreal, QC, Canada H4A3T2
| | - Darron A. Brown
- Department of Medicine, Indiana University, 545 Barnhill Dr. Emerson Hall, Suite 305 Indianapolis, IN 46202
| | - Lea E. Widdice
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Ave Cincinnati, OH 45229
| | - David I. Bernstein
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Ave Cincinnati, OH 45229
| | - Jessica A. Kahn
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Ave Cincinnati, OH 45229
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Prevalence of human papillomavirus types associated with cervical lesions in Sergipe state, Northeastern Brazil: high frequency of a possibly carcinogenic type. Epidemiol Infect 2018; 146:1184-1193. [DOI: 10.1017/s095026881800105x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractPersistent infection with high-risk human papillomavirus (HPV) is the main cause of cervical cancer and the prevalence of HPV types varies depending on the geographic region. Therefore, this study assessed the prevalence of HPV types in women with cervical lesions from Sergipe state, Northeastern Brazil. A cross-sectional study was conducted in women with cervical lesions from March to December 2014. These lesions were investigated by PCR and HPV types were identified by DNA sequencing. 432 patients were included, of which 337 patients tested positive for HPV. Eighteen different HPV types were detected, and high-risk HPV types were detected in 69.2%. HPV 16 (63.4%) was the most prevalent HPV type found, followed by HPV 66 (4.6%), HPV 18 (1.6%) and HPV 45 (1.4%). These results highlight the importance of the high prevalence of HPV 66, which is a possibly carcinogenic virus type not covered by the available vaccines. The prevalence of HPV 16 was high in the studied population, reaffirming the importance of young vaccination. However, the high prevalence of HPV 66 found in this study shows the importance of monitoring the diversity of HPV types in different populations and geographic regions to better understand the impacts of current HPV vaccines.
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21
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Sequera VG, Mena M, Hollmann M, Mani E, Ramas V, Bonilla S, Guerra A, Borgia F. Identifying populations most susceptible to get benefit from broadening the scope for prevention of cervical cancer: Example from Uruguay. PAPILLOMAVIRUS RESEARCH 2018; 5:122-127. [PMID: 29555600 PMCID: PMC5886960 DOI: 10.1016/j.pvr.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/29/2017] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
Objectives To identify factors associated with high-risk human papillomavirus (HPV) infection and high grade squamous intraepithelial lesion (HSIL) among a high-risk group of HPV-unvaccinated women in Montevideo. Methods Participants completed a questionnaire on socio-demographics, sexual behavior and gynecological history and received a gynecological examination. HPV DNA was detected by PCR using MY09/11 primers. Logistic regression analyses were performed to identify factors associated with high-risk HPV infection and HSIL. Results A total of 469 women with HPV DNA and cytological results completed the questionnaire. Among women older than 30 years, those with high number of sexual partners and regular housing conditions were more likely to be positive for high-risk HPV infection (adjusted OR: 2.94, 95%CI: 1.01–8.51 and 2.68, 95%CI: 1.01–7.21, respectively). A marginally non-statistically significant association between getting a HSIL and having a high number of sexual partners was also observed (adjusted OR: 3.22, 95%CI: 0.97–10.75). Conclusions In an era of development of new strategies for accelerating the reduction of cervical cancer incidence and mortality, our results may contribute to identify populations most susceptible to get benefit from broadening the scope for prevention of cervical cancer and could be used with other triage strategies.
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Affiliation(s)
- Víctor-Guillermo Sequera
- Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology (ICO), Av. Gran Via de l'Hospitalet 199-203 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marisa Mena
- Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology (ICO), Av. Gran Via de l'Hospitalet 199-203 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Malen Hollmann
- Programa Sumar, Ministerio de Salud de la Nación, Argentina
| | - Estefani Mani
- Asociación Latinoamericana de Medicina Social, ALAMES, Uruguay
| | - Viviana Ramas
- Virology Department, Faculty of Science. University of the Republic. Montevideo, Uruguay
| | - Sylvia Bonilla
- Cytology Laboratory, Health Care Service, Municipality of Montevideo, Uruguay
| | - Alicia Guerra
- Asociación Latinoamericana de Medicina Social, ALAMES, Uruguay; Health Care Service, Municipality of Montevideo, Uruguay
| | - Fernando Borgia
- Asociación Latinoamericana de Medicina Social, ALAMES, Uruguay; Dirección de la Unidad de Capacitación Ciudadana, del Centro de Formación y Estudios, de la Intendencia de Montevideo, Uruguay
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Ayres ARG, Silva GAE, Teixeira MTB, Duque KDCD, Machado MLSM, Gamarra CJ, Levi JE. HPV in women assisted by the Family Health Strategy. Rev Saude Publica 2017; 51:92. [PMID: 29020120 PMCID: PMC5676731 DOI: 10.11606/s1518-8787.2017051000065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/05/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Estimate the prevalence of cervical HPV infection among women assisted by the Family Health Strategy and identify the factors related to the infection. METHODS A cross-sectional study involving 2,076 women aged 20–59 years old residing in Juiz de Fora, State of Minas Gerais, who were asked to participate in an organized screening carried out in units were the Family Health Strategy had been implemented. Participants answered the standardized questionnaire and underwent a conventional cervical cytology test and HPV test for high oncogenic risk. Estimates of HPV infection prevalence were calculated according to selected characteristics referenced in the literature and related to socioeconomic status, reproductive health and lifestyle. RESULTS The overall prevalence of HPV infection was 12.6% (95%CI 11.16–14.05). The prevalence for the pooled primer contained 12 oncogenic HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) was 8.6% (95%CI 7.3–9.77). In the multivariate analysis, it was observed that the following variables were significantly associated with a higher prevalence of HPV infection: marital status (single: adjusted PR = 1.40, 95%CI 1.07–1.8), alcohol consumption (any lifetime frequency: adjusted PR = 1.44, 95%CI 1.11–1.86) and number of lifetime sexual partners (≥ 3: adjusted PR = 1.35, 95%CI 1.04–1.74). CONCLUSIONS The prevalence of HPV infection in the study population ranges from average to particularly high among young women. The prevalence of HPV16 and HPV18 infection is similar to the worldwide prevalence. Homogeneous distribution among the pooled primer types would precede the isolated infection by HPV18 in magnitude, which may be a difference greater than the one observed. The identification of high-risk oncogenic HPV prevalence may help identify women at higher risk of developing preneoplastic lesions.
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Affiliation(s)
| | - Gulnar Azevedo E Silva
- Departamento de Epidemiologia. Instituto de Medicina Social. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | | | | | | | - Carmen Justina Gamarra
- Faculdade de Saúde Coletiva. Universidade Federal da Integração Latino-Americana. Foz do Iguaçu, PR, Brasil
| | - José Eduardo Levi
- Laboratório de Virologia. Instituto de Medicina Tropical. Universidade de São Paulo. São Paulo, SP, Brasil
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Wang H, Zhao Y, Chen M, Cui J. Identification of Novel Long Non-coding and Circular RNAs in Human Papillomavirus-Mediated Cervical Cancer. Front Microbiol 2017; 8:1720. [PMID: 28970820 PMCID: PMC5609541 DOI: 10.3389/fmicb.2017.01720] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/24/2017] [Indexed: 01/04/2023] Open
Abstract
Cervical cancer is the third most common cancer worldwide and the fourth leading cause of cancer-associated mortality in women. Accumulating evidence indicates that long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs) may play key roles in the carcinogenesis of different cancers; however, little is known about the mechanisms of lncRNAs and circRNAs in the progression and metastasis of cervical cancer. In this study, we explored the expression profiles of lncRNAs, circRNAs, miRNAs, and mRNAs in HPV16 (human papillomavirus genotype 16) mediated cervical squamous cell carcinoma and matched adjacent non-tumor (ATN) tissues from three patients with high-throughput RNA sequencing (RNA-seq). In total, we identified 19 lncRNAs, 99 circRNAs, 28 miRNAs, and 304 mRNAs that were commonly differentially expressed (DE) in different patients. Among the non-coding RNAs, 3 lncRNAs and 44 circRNAs are novel to our knowledge. Functional enrichment analysis showed that DE lncRNAs, miRNAs, and mRNAs were enriched in pathways crucial to cancer as well as other gene ontology (GO) terms. Furthermore, the co-expression network and function prediction suggested that all 19 DE lncRNAs could play different roles in the carcinogenesis and development of cervical cancer. The competing endogenous RNA (ceRNA) network based on DE coding and non-coding RNAs showed that each miRNA targeted a number of lncRNAs and circRNAs. The link between part of the miRNAs in the network and cervical cancer has been validated in previous studies, and these miRNAs targeted the majority of the novel non-coding RNAs, thus suggesting that these novel non-coding RNAs may be involved in cervical cancer. Taken together, our study shows that DE non-coding RNAs could be further developed as diagnostic and therapeutic biomarkers of cervical cancer. The complex ceRNA network also lays the foundation for future research of the roles of coding and non-coding RNAs in cervical cancer.
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Affiliation(s)
- Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Yingchao Zhao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Mingyue Chen
- CAS Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of SciencesWuhan, China
| | - Jie Cui
- CAS Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of SciencesWuhan, China
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Baussano I, Tshering S, Choden T, Lazzarato F, Tenet V, Plummer M, Franceschi S, Clifford GM, Tshomo U. Cervical cancer screening in rural Bhutan with the careHPV test on self-collected samples: an ongoing cross-sectional, population-based study (REACH-Bhutan). BMJ Open 2017; 7:e016309. [PMID: 28724543 PMCID: PMC5734451 DOI: 10.1136/bmjopen-2017-016309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/31/2017] [Accepted: 04/06/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The Bhutanese Screening Programme recommends a Pap smear every 3 years for women aged 25-65 years, and coverage ranges from 20% to 60%, being especially challenging in rural settings. The 'REACH-Bhutan' study was conducted to assess the feasibility and outcomes of a novel approach to cervical cancer screening in rural Bhutan. DESIGN Cross-sectional, population-based study of cervical cancer screening based on the careHPV test on self-collected samples. SETTING Women were recruited in rural primary healthcare centres, that is, Basic Health Units (BHU), across Bhutan. PARTICIPANTS Overall, 3648 women aged 30-60 were invited from 15 BHUs differing in accessibility, size and ethnic composition of the population. INTERVENTIONS Participants provided a self-collected cervicovaginal sample and were interviewed. Samples were tested using careHPV in Thimphu (the Bhutanese capital) referral laboratory. MAIN OUTCOME MEASURES Screening participation by geographic area, centre, age and travelling time. Previous screening history and careHPV positivity by selected characteristics of the participants. RESULTS In April/May 2016, 2590 women (median age: 41) were enrolled. Study participation was 71% and significantly heterogeneous by BHU (range: 31%-96%). Participation decreased with increase in age (81% in women aged 30-39 years; 59% in ≥50 years) and travelling time (90% in women living <30 min from the BHU vs 62% among those >6 hours away). 50% of participants reported no previous screening, with the proportion of never-screened women varying significantly by BHU (range: 2%-72%). 265 women (10%; 95% CI 9% to 11%) were careHPV positive, with a significant variation by BHU (range: 5%-19%) and number of sexual partners (prevalence ratio for ≥3 vs 0-1, 1.55; 95% CI 1.05 to 2.27). CONCLUSIONS Community-based cervical cancer screening by testing self-collected samples for human papillomavirus (HPV) can achieve high coverage in rural Bhutan. However, solutions to bring self-collection, HPV testing and precancer treatment closer to the remotest villages are needed.
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Affiliation(s)
- Iacopo Baussano
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Sangay Tshering
- Department of Obstetrics & Gynaecology, Dewanthang Hospital, Samdrup Jongkhar, Bhutan
| | - Tashi Choden
- Department of Pathology & Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Fulvio Lazzarato
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
- Unit of Cancer Epidemiology, AOU Città della Salute e della Scienza, Hospital of Turin, Turin, Italy
- Department of Translational Medicine, University of Piemonte Orientale Avogadro, Novara, Italy
| | - Vanessa Tenet
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Martyn Plummer
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Silvia Franceschi
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Gary M Clifford
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Ugyen Tshomo
- Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Baussano I, Diaz M, Tully S, Muñoz N, de Sanjosé S, Bosch FX, Franceschi S. Effect of age-difference between heterosexual partners on risk of cervical cancer and human papillomavirus infection. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:98-104. [PMID: 28720465 PMCID: PMC5883224 DOI: 10.1016/j.pvr.2017.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 12/03/2022]
Abstract
BACKGROUND Age difference (Adiff) within a heterosexual couple may influence a woman's risk of being HPV-positive and developing cervical cancer (CC). METHODS We assessed the relationship between Adiff within the first and current sexual partnership and risk of CC and HPV infection in 1495 cases and 1358 control women from 6 countries included in IARC's multicentric case-control study (median age: 48 years). RESULTS Large Adiff within the first partnerships was associated with increased CC risk (OR≥3 vs. ≤2 years=1.49, CI: 1.26-1.75); this association disappeared after correction for age at first sexual intercourse (OR=1.03, 0.86-1.24). The relationship between Adiff within the current partnership and HPV-positivity was opposite (OR≥3 vs. ≤2 years=0.59, 0.41-0.86) and not affected by adjustment for sexual confounding. The influences of Adiff on CC risk and HPV-positivity were consistent across age groups and countries. CONCLUSION The association between CC risk and large Adiff in the first sexual partnership is mostly explained by young age at first intercourse. Conversely, the negative association between Adiff in current partnership and HPV-positivity is probably related to decreased infectiousness of the male partner with age. The study of Adiff in sexual partnerships helps elucidate HPV circulation in different populations.
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Affiliation(s)
- Iacopo Baussano
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
| | - Mireia Diaz
- Institut Català d'Oncologia, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
| | - Stephen Tully
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
| | - Nubia Muñoz
- Colombian National Institute of Cancer, Bogota, Colombia.
| | - Silvia de Sanjosé
- Institut Català d'Oncologia, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, Barcelona 08907, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona 08036, Spain.
| | - F Xavier Bosch
- Institut Català d'Oncologia, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
| | - Silvia Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
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26
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Zhang D, Li T, Chen L, Zhang X, Zhao G, Liu Z. Epidemiological investigation of the relationship between common lower genital tract infections and high-risk human papillomavirus infections among women in Beijing, China. PLoS One 2017; 12:e0178033. [PMID: 28531212 PMCID: PMC5439700 DOI: 10.1371/journal.pone.0178033] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/08/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The incidence of lower genital tract infections in China has been increasing in recent years. The link between high-risk human papillomavirus (HR-HPV) and other sexually transmitted diseases (STDs) remains unclear. METHODS From March to October 2014, gynecological examinations and questionnaires were conducted on 1218 married women. Cervical secretions and vaginal swab specimens were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Ureaplasma urealyticum (UU), yeast, clue cells and HR-HPV. RESULTS Laboratory results were available for 1195 of 1218 married women. HR-HPV was detected in 7.0% of participants. Forty-seven percent of women had lower genital tract infections (LGTIs). UU was the most common infection (35.5%), followed by bacterial vaginosis (BV) (10.5%), yeast infection (3.7%), CT (2.2%), and Trichomonas vaginalis (1.7%). BV was associated with an increased risk of HR- HPV (P < 0.0001; odds ratio, 3.0 [95% CI, 1.7-5.4]). There was a strong correlation between abnormal cervical cytology and HR-HPV infection (P < 0.0001). CONCLUSIONS The prevalence of LGTIs in Beijing is at a high level. It is clinically important to screen for the simultaneous presence of pathogens that cause co-infections with HR-HPV.
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Affiliation(s)
- Dai Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing China
| | - Ting Li
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing China
| | - Lei Chen
- Department of Obstetrics and Gynecology, Haidian Maternal & Child Health Hospital, Beijing, China
| | - Xiaosong Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing China
| | - Gengli Zhao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing China
| | - Zhaohui Liu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing China
- * E-mail:
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Winer RL, Hughes JP, Feng Q, Stern JE, Xi LF, Koutsky LA. Incident Detection of High-Risk Human Papillomavirus Infections in a Cohort of High-Risk Women Aged 25-65 Years. J Infect Dis 2016; 214:665-75. [PMID: 27009602 PMCID: PMC4978366 DOI: 10.1093/infdis/jiw074] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The risk of incident high-risk human papillomavirus (HR-HPV) infection associated with recent sexual behaviors is undefined in mid-adult women (defined as women aged 25-65 years). METHODS Triannually, 420 female online daters aged 25-65 years submitted vaginal specimens for HPV testing and completed health and sexual behavior questionnaires. The cumulative incidence of and risk factors for incident HR-HPV detection were estimated by Kaplan-Meier and Cox proportional hazards methods. RESULTS The 12-month cumulative incidence of HR-HPV detection was 25.4% (95% confidence interval [CI], 21.3%-30.1%). Current hormonal contraceptive use was positively associated with incident HR-HPV detection. Lifetime number of male sex partners was also positively associated but only among women not recently sexually active with male partners. In analysis that adjusted for hormonal contraceptive use and marital status, women reporting multiple male partners or male partners who were new, casual, or had ≥1 concurrent partnership had a hazard of incident HR-HPV detection that was 2.81 times (95% CI, 1.38-5.69 times) that for women who reported no male sex partners in the past 6 months. Thus, among women with multiple male partners or male partners who were new, casual, or had ≥1 concurrent partnership, approximately 64% of incident HR-HPV infections were attributable to one of those partners. CONCLUSIONS Among high-risk mid-adult women with recent new male partners, multiple male partners, or male partners who were casual or had ≥1 concurrent partnership, about two thirds of incident HR-HPV detections are likely new acquisitions, whereas about one third of cases are likely redetections of prior infections.
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Affiliation(s)
| | | | | | | | - Long Fu Xi
- Department of Epidemiology Department of Pathology, University of Washington
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Ngabo F, Franceschi S, Baussano I, Umulisa MC, Snijders PJF, Uyterlinde AM, Lazzarato F, Tenet V, Gatera M, Binagwaho A, Clifford GM. Human papillomavirus infection in Rwanda at the moment of implementation of a national HPV vaccination programme. BMC Infect Dis 2016; 16:225. [PMID: 27221238 PMCID: PMC4877733 DOI: 10.1186/s12879-016-1539-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 05/05/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Cervical cancer is the most common female cancer in Rwanda that, in 2011, became the first African country to implement a national vaccination programme against human papillomavirus (HPV). METHODS To provide a robust baseline for future evaluations of vaccine effectiveness, cervical cell specimens were obtained from 2508 women aged 18-69 years from the general population in Kigali, Rwanda, during 2013/14. 20 % of women were HIV-positive. Samples were used for liquid-based cytology and HPV testing (44 types) with GP5+/6+ PCR. RESULTS HPV prevalence was 34 %, being highest (54 %) in women ≤19 years and decreasing to 20 % at age ≥50. Prevalence of high risk (HR) HPV and cytological abnormalities was 22 and 11 % respectively (including 2 % with high-grade squamous intraepithelial lesions, HSIL) decreasing with age. Age-standardised prevalence of HR HPV was 22 % (or 19 % among HIV-negative women), and HPV16 was the most common type. Prevalence of HPV and cytological abnormalities were significantly higher in HIV-positive than HIV-negative women, and the difference increased with age. Other significant risk factors for HPV positivity in multivariate analyses were high lifetime number of sexual partners, receiving cash for sex, and being a farmer. 40 % of women with HSIL were infected with HPV16/18 and there was no significant difference between HIV-positive and HIV-negative women. CONCLUSIONS This study confirms Rwanda to be a setting of high prevalence of HPV and cervical disease that is worsened by HIV. These data will serve as a robust baseline for future evaluations of HPV vaccine programme effectiveness.
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Affiliation(s)
- Fidele Ngabo
- Ministry of Health of Rwanda, Kigali, Rwanda
- Université Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium
| | - Silvia Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Iacopo Baussano
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | | | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Anne M Uyterlinde
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Fulvio Lazzarato
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Vanessa Tenet
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France
| | | | - Agnes Binagwaho
- Ministry of Health of Rwanda, Kigali, Rwanda
- Harvard Medical School, Boston, MA, USA
- Geisel School of Medicine, Dartmouth, Hanover, USA
| | - Gary M Clifford
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France.
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Audirac-Chalifour A, Torres-Poveda K, Bahena-Román M, Téllez-Sosa J, Martínez-Barnetche J, Cortina-Ceballos B, López-Estrada G, Delgado-Romero K, Burguete-García AI, Cantú D, García-Carrancá A, Madrid-Marina V. Cervical Microbiome and Cytokine Profile at Various Stages of Cervical Cancer: A Pilot Study. PLoS One 2016; 11:e0153274. [PMID: 27115350 PMCID: PMC4846060 DOI: 10.1371/journal.pone.0153274] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/25/2016] [Indexed: 12/27/2022] Open
Abstract
Cervical cancer (CC) is caused by high-risk human papillomavirus persistence due to the immunosuppressive tumor microenvironment mediated by cytokines. Vaginal microbiota determines the presence of certain cytokines locally. We assessed the association between cervical microbiota diversity and the histopathological diagnosis of each stage of CC, and we evaluated mRNA cervical expression levels of IL-4, IL-6, IL-10, TGF-β1, TNF-α and IFN-γ across the histopathological diagnosis and specific bacterial clusters. We determined the cervical microbiota by high throughput sequencing of 16S rDNA amplicons and classified it in community state types (CST). Mean difference analyses between alpha-diversity and histopathological diagnosis were carried out, as well as a β-diversity analysis within the histological diagnosis. Cervical cytokine mRNA expression was analyzed across the CSTs and the histopathological diagnoses. We found a significant difference in microbiota's diversity in NCL-HPV negative women vs those with squamous intraepithelial lesions (SIL) and CC(p = 0.006, p = 0.036).When β-diversity was evaluated, the CC samples showed the highest variation within groups (p<0.0006) and the largest distance compared to NCL-HPV negative ones (p<0.00001). The predominant bacteria in women with normal cytology were L. crispatus and L. iners, whereas for SIL, it was Sneathia spp. and for CC, Fusobacterium spp. We found higher median cervical levels of IL-4 and TGF-β1 mRNA in the CST dominated by Fusobacterium spp. These results suggest that the cervical microbiota may be implicated in cervical cancer pathology. Further cohort studies are needed to validate these findings.
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Affiliation(s)
- Astride Audirac-Chalifour
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP) (Chronic Infectious Diseases and Cancer Division, Center for Research on Infectious Diseases, National Institute of Public Health), Cuernavaca, Morelos, Mexico
| | - Kirvis Torres-Poveda
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP) (Chronic Infectious Diseases and Cancer Division, Center for Research on Infectious Diseases, National Institute of Public Health), Cuernavaca, Morelos, Mexico
| | - Margarita Bahena-Román
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP) (Chronic Infectious Diseases and Cancer Division, Center for Research on Infectious Diseases, National Institute of Public Health), Cuernavaca, Morelos, Mexico
| | - Juan Téllez-Sosa
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP) (Chronic Infectious Diseases and Cancer Division, Center for Research on Infectious Diseases, National Institute of Public Health), Cuernavaca, Morelos, Mexico
| | - Jesús Martínez-Barnetche
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP) (Chronic Infectious Diseases and Cancer Division, Center for Research on Infectious Diseases, National Institute of Public Health), Cuernavaca, Morelos, Mexico
| | - Bernardo Cortina-Ceballos
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP) (Chronic Infectious Diseases and Cancer Division, Center for Research on Infectious Diseases, National Institute of Public Health), Cuernavaca, Morelos, Mexico
| | | | - Karina Delgado-Romero
- Centro de Atención para la Salud de la Mujer (CAPASAM) (Center for Women’s Health), Health Services of the State of Morelos, Cuernavaca, Mexico
| | - Ana I. Burguete-García
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP) (Chronic Infectious Diseases and Cancer Division, Center for Research on Infectious Diseases, National Institute of Public Health), Cuernavaca, Morelos, Mexico
| | - David Cantú
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), SS, Mexico City, Mexico
| | | | - Vicente Madrid-Marina
- Dirección de Infecciones Crónicas y Cáncer, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP) (Chronic Infectious Diseases and Cancer Division, Center for Research on Infectious Diseases, National Institute of Public Health), Cuernavaca, Morelos, Mexico
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30
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Gupta MK, Singh R, Banerjee M. Cytokine gene polymorphisms and their association with cervical cancer: A North Indian study. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2016. [DOI: 10.1016/j.ejmhg.2015.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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31
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Shaw E, Ramanakumar AV, El-Zein M, Silva FR, Galan L, Baggio ML, Villa LL, Franco EL. Reproductive and genital health and risk of cervical human papillomavirus infection: results from the Ludwig-McGill cohort study. BMC Infect Dis 2016; 16:116. [PMID: 26956880 PMCID: PMC4782350 DOI: 10.1186/s12879-016-1446-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background There are inconsistencies in the literature on reproductive and genital health determinants of human papillomavirus (HPV) infection, the primary cause of cervical cancer. We examined these factors in the Ludwig-McGill Cohort Study, a longitudinal, repeated-measurements investigation on the natural history of HPV infection. Methods We analyzed a cohort subset of 1867 women with one complete year of follow-up. We calculated odds ratios (OR) and 95 % confidence intervals (CI) for reproductive and genital health characteristics from questionnaire and laboratory data in relation to 1-year period prevalence of HPV infection. Two outcomes were measured; the first based on phylogenetic grouping of HPV types based on tissue tropism and oncogenicity (Alphapapillomavirus Subgenus 1: species 1, 8, 10 and 13; Subgenus 2: species 5, 6, 7, 9, 11; Subgenus 3: species 3, 4 and 14) and the second based on transient or persistent HPV infections. Results Lifetime (Subgenus 3 OR = 2.00, CI: 1.23–3.24) and current (Subgenus 3 OR = 2.00, CI: 1.15–3.47) condom use and use of contraceptive injections (Subgenus 1 OR = 1.96, CI: 1.22–3.16, Subgenus 2 OR = 1.34, CI: 1.00–1.79) were associated with increased risk of HPV infection. Intrauterine device use was protective (Subgenus 1 OR = 0.48, CI: 0.30–0.75, Subgenus 2 OR = 0.78, CI: 0.62–0.98). These factors were not associated with persistence of HPV infection. Tampon use, previous gynecologic infections and cervical inflammation were associated with an overall increased risk of HPV infection. Conclusions Cervical HPV infection was associated with reproductive and genital health factors. Further studies are necessary to confirm the low to moderate associations observed. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1446-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eileen Shaw
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada.
| | | | - Mariam El-Zein
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada.
| | - Flavia R Silva
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada.
| | - Lenice Galan
- Ludwig Institute for Cancer Research, São Paulo, Brazil. .,Molecular Biology Laboratory, Centre of Translational Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
| | - Maria L Baggio
- Ludwig Institute for Cancer Research, São Paulo, Brazil. .,Molecular Biology Laboratory, Centre of Translational Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
| | - Luisa L Villa
- Ludwig Institute for Cancer Research, São Paulo, Brazil. .,Molecular Biology Laboratory, Centre of Translational Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada.
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Téllez L, Michelli E, Mendoza JA, Vielma S, Noguera ME, Callejas D, Cavazza M, Correnti M. Persistent infection with high-risk human papilloma viruses: cohort study, Mérida, Venezuela. Ecancermedicalscience 2015; 9:579. [PMID: 26557877 PMCID: PMC4631573 DOI: 10.3332/ecancer.2015.579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Indexed: 11/25/2022] Open
Abstract
Cervical lesions have been associated with infection by high-risk human papilloma virus (high-risk HPV). In 409 women aged >15 years high-risk HPV lesions were identified. In a cohort of this population persistent infection was compared with cytological, colposcopic, and histological lesions. Cervical scrapes were taken and DNA was isolated. HPV was detected by PCR in the E6/E7 region. Genotyping was performed by PCR nested multiple E6/E7. HPV was detected in a 37.40% (153/409), high-risk HPV in 86% (153/178), HPV18 46.64% (83/178), HPV16 34.28% (61/178). Among these 53.93% (96/178) were multiple infections, and HPV18/16 (30/96) was the most frequent 31.25%. The cytology showed changes in 15% of positive patients. A 49.67% in women positive for HPV infection showed abnormalities in the colposcopic study, a relationship that turned out to be statistically significant ( p < 0.0019 test χ2). Among all 85% of the women were younger than 45 years of age. Fifty-seven patients were evaluated 15 months after the base study, with initial prevalence of morbidity 49.12% (28/57) and at the end 10.53% (6/57), showing in 89.29% (25/28) negative for HR-HPV infection, 10.34% (3/28) showed persistence of infection, 17.54% (10/57) presented cytological alterations, with 80% of positivity for HPV, and a regression of 100% (10/10) of the previously identified lesions. With colposcopy, 50% (14/28) presented alterations related to HPV, of these 85.71% (12/14) showed regression of such an alteration. The cumulative incidence for HPV was 10.34% (3/29). The incidence rate was 4.23% (3/71), which is equal to 4.23 new cases of HPV infection per 100 people, per year of follow-up. In conclusion, the present work shows a high frequency of infection by high-risk HPV, with predominance of HPV18 and 16 and in general for multiple infections. Colposcopy was better predictor than the Pap smear for infection. The follow-up study revealed a low percentage of persistent infection, and a high frequency of negativity for viral infection, high regression of cytological and colposcopic lesions, a low cumulative and incidence rate similar to that reported by other Latin American countries and higher than the European countries.
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Affiliation(s)
- Luis Téllez
- Los Andes University, Department of Microbiology, Mérida CP 5101, Venezuela
| | - Elvia Michelli
- Los Andes University, Department of Microbiology, Mérida CP 5101, Venezuela ; University of Orient, Department of Bioanalysis, Sucre CP 6101, Venezuela
| | | | - Silvana Vielma
- Los Andes University, Department of Microbiology, Mérida CP 5101, Venezuela
| | - María-Eugenia Noguera
- Los Andes University, Department of Gynecology and Obstetrics, Mérida CP 5101, Venezuela
| | - Diana Callejas
- University of Zulia (LUZ), Regional Reference Virology Laboratory, Maracaibo CP 4011, Zulia
| | - María Cavazza
- Institute of Biomedicine, MPPS, Caracas CP 10104, Venezuela
| | - María Correnti
- Institute of Oncology and Haematology, MPPS, Caracas CP 1050, Venezuela
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Human Papillomavirus Infection, Infertility, and Assisted Reproductive Outcomes. J Pathog 2015; 2015:578423. [PMID: 26609434 PMCID: PMC4644557 DOI: 10.1155/2015/578423] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/30/2015] [Indexed: 01/10/2023] Open
Abstract
The human papillomavirus (HPV) is a sexually transmitted infection common among men and women across all geographic and socioeconomic subgroups worldwide. Recent evidence suggests that HPV infection may affect fertility and alter the efficacy of assisted reproductive technologies. In men, HPV infection can affect sperm parameters, specifically motility. HPV-infected sperm can transmit viral DNA to oocytes, which may be expressed in the developing blastocyst. HPV can increase trophoblastic apoptosis and reduce the endometrial implantation of trophoblastic cells, thus increasing the theoretical risk of miscarriage. Vertical transmission of HPV during pregnancy may be involved in the pathophysiology of preterm rupture of membranes and spontaneous preterm birth. In patients undergoing intrauterine insemination for idiopathic infertility, HPV infection confers a lower pregnancy rate. In contrast, the evidence regarding any detrimental impact of HPV infection on IVF outcomes is inconclusive. It has been suggested that vaccination could potentially counter HPV-related sperm impairment, trophoblastic apoptosis, and spontaneous miscarriages; however, these conclusions are based on in vitro studies rather than large-scale epidemiological studies. Improvement in the understanding of HPV sperm infection mechanisms and HPV transmission into the oocyte and developing blastocyst may help explain idiopathic causes of infertility and miscarriage.
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34
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Kingnate C, Supoken A, Kleebkaow P, Chumworathayi B, Luanratanakorn S, Kietpeerakool C. Is Age an Independent Predictor of High-Grade Histopathology in Women Referred for Colposcopy after Abnormal Cervical Cytology? Asian Pac J Cancer Prev 2015; 16:7231-5. [PMID: 26514516 DOI: 10.7314/apjcp.2015.16.16.7231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study was conducted to determine whether advancing age is an independent predictor of increased risk of high-grade pathologies among women referred for colposcopy after abnormal cervical cytology. Medical records were reviewed for women with abnormal cervical cytology who underwent colposcopy at Khon Kaen University Hospital. Logistic regression was used to determine the independent impact of age on the risk of high-grade pathologies. Mean age of the women was 42.8 years. Of 482 women, 97 (20.1%) were postmenopausal, and 92 (19.1%) were nulliparous. The rate of high-grade pathologies included cervical intraepithelial neoplasia 2-3, 99 (20.5%), adenocarcinoma in situ, 4 (0.8%), cervical cancer, 30 (6.2%), and endometrial cancer, 1 (0.2%). The prevalence of significant lesions was 26.9% (95% CI, 23.1%-31.2%). In total, 31 women had cancers (6.4%; 95% CI, 4.4%-9.0%). When controlling for smear types and parity, age was noted to be a significant independent predictor of high-grade histopathology. Women older than 35-40 years were approximately 2 times as likely to have severe histopathology as the younger women. This study illustrates the substantial risk of underlying significant lesions especially invasive cancer in Thai women with abnormal cervical cytology. Age was a significant independent factor predicting the risk of high-grade pathologies.
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Affiliation(s)
- Chalita Kingnate
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand E-mail :
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Marek E, Berenyi K, Dergez T, Kiss I, D'Cruz G. Influence of risk-taking health behaviours of adolescents on cervical cancer prevention: a Hungarian survey. Eur J Cancer Care (Engl) 2015; 25:57-68. [PMID: 26059166 DOI: 10.1111/ecc.12332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
An anonymous questionnaire survey was conducted among the Hungarian adolescents to establish their use of tobacco, alcohol and drugs in relation to sexual behaviours, knowledge of human papillomavirus (HPV) and cervical cancer, and beliefs and attitudes towards screening and vaccination. Results indicated that adolescent risk-taking health behaviours correlate with risky sexual behaviours. As risk-taking behaviours do not correlate with a better awareness of the risk associated with HPV infection, it is of crucial importance that HPV/cervical cancer preventing educational programmes shall be sensitive to this 'vulnerable' population and draw the attention of these adolescents to their increased risk of sexually transmitted diseases and undesired pregnancies. Well-designed behavioural change interventions may be effective when in addition to providing adolescents (both men and women) with clear information about the implications of an HPV infection, they also aim to improve safer sex behaviours: consistent condom usage, limiting the number of sex partners, as well as encouraging regular participation in gynaecological screenings and uptake of the HPV vaccine. As this study population demonstrated positive attitudes towards the primary and secondary prevention of cervical cancer, the free HPV vaccination for the 12-13-year-old girls in Autumn 2014 will hopefully increase the currently low uptake of the vaccine in Hungary.
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Affiliation(s)
- E Marek
- Department of Public Health Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - K Berenyi
- Department of Public Health Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - T Dergez
- Institute of Bioanalysis, Medical School, University of Pecs, Pecs, Hungary
| | - I Kiss
- Department of Public Health Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - G D'Cruz
- School of Nursing Sciences, University of East Anglia, Norwich, UK
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Fu TCJ, Fu Xi L, Hulbert A, Hughes JP, Feng Q, Schwartz SM, Hawes SE, Koutsky LA, Winer RL. Short-term natural history of high-risk human papillomavirus infection in mid-adult women sampled monthly. Int J Cancer 2015; 137:2432-42. [PMID: 25976733 DOI: 10.1002/ijc.29602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/15/2015] [Accepted: 05/05/2015] [Indexed: 11/11/2022]
Abstract
Characterizing short-term HPV detection patterns and viral load may inform HPV natural history in mid-adult women. From 2011-2012, we recruited women aged 30-50 years. Women submitted monthly self-collected vaginal samples for high-risk HPV DNA testing for 6 months. Positive samples were tested for type-specific HPV DNA load by real-time PCR. HPV type-adjusted linear and Poisson regression assessed factors associated with (i) viral load at initial HPV detection and (ii) repeat type-specific HPV detection. One-hundred thirty-nine women (36% of 387 women with ≥4 samples) contributed 243 type-specific HR HPV infections during the study; 54% of infections were prevalent and 46% were incident. Incident (vs. prevalent) detection and past pregnancy were associated with lower viral load, whereas current smoking was associated with higher viral load. In multivariate analysis, current smoking was associated with a 40% (95% CI: 5-87%) increase in the proportion of samples that were repeatedly positive for the same HPV type, whereas incident (vs. prevalent) detection status and past pregnancy were each associated with a reduction in the proportion of samples repeatedly positive (55%, 95% CI: 38-67% and 26%, 95% CI: 10-39%, respectively). In a separate multivariate model, each log10 increase in viral load was associated with a 10% (95% CI: 4-16%) increase in the proportion of samples repeatedly positive. Factors associated with repeat HPV detection were similar to those observed in longer-term studies, suggesting that short-term repeat detection may relate to long-term persistence. The negative associations between incident HPV detection and both viral load and repeat detection suggest that reactivation or intermittent persistence was more common than new acquisition.
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Affiliation(s)
| | - Long Fu Xi
- Department of Pathology, University of Washington, Seattle, WA
| | | | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Qinghua Feng
- FIDALAB, Seattle, WA.,Universidad Estatal De Milagro, Milagro, Ecuador
| | - Stephen M Schwartz
- Department of Epidemiology, University of Washington, Seattle, WA.,Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Laura A Koutsky
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA
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Ribeiro AA, Costa MC, Alves RRF, Villa LL, Saddi VA, Carneiro MADS, Zeferino LC, Rabelo-Santos SH. HPV infection and cervical neoplasia: associated risk factors. Infect Agent Cancer 2015; 10:16. [PMID: 26244052 PMCID: PMC4524198 DOI: 10.1186/s13027-015-0011-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavioral risks such as age at first sexual intercourse, number of sexual partners and partner's sexual behavior are associated with an increased risk of HPV infection, persistence of the infection and the development of neoplastic precursor lesions. The objective of this study was to evaluate the risk factors associated with HPV positivity and with a diagnosis of cervical neoplasia in women referred with an abnormal cervical smear. METHODS This study evaluated a series of 198 women referred with an abnormal cervical smear. Risk factors for HPV infection were investigated using a questionnaire. All cervical specimens were tested for 27 HPV genotypes using the Roche polymerase chain reaction reverse line blot assay. RESULTS The overall prevalence of HPV was 87 %. First sexual intercourse before 16 years of age was significantly associated with a positive HPV test (OR 4.41; 95 %CI: 1.20 - 19.33; p = 0.01). A significant association was also found between this risk factor and CIN 1 lesions or worse (OR 2.2; 95 %CI 0.94 - 5.08; p = 0.03). CONCLUSIONS The age at which a woman begins to be sexually active is associated with HPV infection and with a diagnosis of cervical neoplasia.
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Affiliation(s)
- Andrea Alves Ribeiro
- />Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO Brazil
- />Pontifical Catholic University of Goiás, Goiânia, GO Brazil
| | - Maria Cecília Costa
- />Santa Casa de São Paulo, INCT-HPV at Santa Casa Research Institute, School of Medicine, São Paulo, Brazil
| | - Rosane Ribeiro Figueiredo Alves
- />Santa Casa de Misericórdia de Goiânia, Goiânia, GO Brazil
- />Pontifical Catholic University of Goiás, Goiânia, GO Brazil
- />School of Medicine, Federal University of Goiás, Goiânia, GO Brazil
| | - Luísa Lina Villa
- />Santa Casa de São Paulo, INCT-HPV at Santa Casa Research Institute, School of Medicine, São Paulo, Brazil
- />Department of Radiology and Oncology, School of Medicine, University of São Paulo and Cancer Institute of the State of São Paulo, ICESP, São Paulo, Brazil
| | - Vera Aparecida Saddi
- />Pontifical Catholic University of Goiás, Goiânia, GO Brazil
- />Program in Environmental Sciences and Health, Pontifical Catholic University of Goiás, Goiânia, GO Brazil
- />Laboratory of Oncogenetics and Radiology, Associação de Combate ao Câncer, Goiás, Goiânia, GO Brazil
| | | | | | - Sílvia Helena Rabelo-Santos
- />Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO Brazil
- />School of Pharmacy, Federal University of Goiás, Goiânia, GO Brazil
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Zhu C, Bassig BA, Zhang Y, Shi K, Boyle P, Li N, Zheng T. A birth cohort analysis of the incidence of adenocarcinoma of the uterine cervix in the USA. Eur J Cancer Prev 2015; 24:240-4. [PMID: 25025585 PMCID: PMC4295009 DOI: 10.1097/cej.0000000000000062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We investigated the incidence trends for adenocarcinoma (AC) of the cervix among individuals belonging to the 20-44-year age group in the USA and compared the observed birth cohort incidence patterns with the changing patterns of exposure to potential risk factors associated with AC of the cervix, such as infection with human papillomavirus, use of diethylstilbestrol (DES), obesity, and use of oral contraceptives. Using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program for 1973-2010, we conducted age-period-cohort modeling to evaluate birth cohort patterns on incidence trends of AC of the cervix over time. The increase in the incidence of AC of the cervix started among those born around the mid 1940s and accelerated up until around the mid 1960s birth cohort in both whites and all races combined, regardless of the assumed period slope. There was a suggestion that the incidence rates of AC of the cervix slowed down after the 1975 birth cohort in both whites and all races combined. DES was used by millions of women in the USA as a synthetic estrogen between the years 1940 and 1971. This time period of DES use among pregnant women parallels the observed birth cohort trends in our study, whereby a notable acceleration in the incidence rates of AC of the cervix was observed among those born in the mid 1940s through the mid 1975s. Thus, our results appear to suggest that in-utero exposure to DES might be at least partly responsible for the observed incidence pattern of AC of the cervix as observed in this study.
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Affiliation(s)
- Cairong Zhu
- West China School of Public Health, Sichuan University, Chengdu, 610041, China
- Yale School of Public Health, New Haven, CT 06510, USA
| | | | - Yawei Zhang
- Yale School of Public Health, New Haven, CT 06510, USA
| | - Kunchong Shi
- Yale School of Public Health, New Haven, CT 06510, USA
| | - Peter Boyle
- International Prevention Research Institute, Lyon, France
| | - Ni Li
- Yale School of Public Health, New Haven, CT 06510, USA
- National office for cancer prevention and control, China Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China
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Xavier-Júnior JC, Vale DB, Vieira LF, Lima MT, Zeferino LC, Dufloth RM. Results of screening for cervical cancer among pregnant and non-pregnant women in Brazil. Int J Gynaecol Obstet 2015; 130:36-9. [DOI: 10.1016/j.ijgo.2015.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/27/2014] [Accepted: 03/23/2015] [Indexed: 01/12/2023]
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Leyh-Bannurah SR, Prugger C, de Koning MN, Goette H, Lellé RJ. Cervical human papillomavirus prevalence and genotype distribution among hybrid capture 2 positive women 15 to 64 years of age in the Gurage zone, rural Ethiopia. Infect Agent Cancer 2014; 9:33. [PMID: 25320636 PMCID: PMC4197284 DOI: 10.1186/1750-9378-9-33] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/16/2014] [Indexed: 11/23/2022] Open
Abstract
Background Human papillomavirus (HPV) infection is a prerequisite of cervical cancer, the leading cause of cancer mortality in Ethiopian women today. Data on Ethiopian cervical HPV prevalence and genotype distribution are rare, but essential as pre-vaccine baseline data to monitor changes after initiating HPV vaccination. The objectives of this study were to assess the cervical HPV prevalence, genotype distribution and associated correlates among female hospital outpatients in rural Ethiopia. Methods We examined a consecutive sample of 537 women 15–64 years of age in rural Ethiopia between November and December 2006. Screening for low risk (LR) and high-risk (HR) cervical HPV infection was performed and HR positive samples were genotyped with a GP5+/6 + − and SPF10-primer based system. Results The age-standardized prevalence of HPV, HPV HR and HPV LR infection was 17.3% (95% CI 14.1-20.5), 15.8% (95% CI 12.7-18.9) and 3.9% (95% CI 2.3-5.6), respectively. Among HC2 HPV HR positive infections (n = 86), the most common genotype was HPV 16 (24.4%), followed by 52 (11.6%), 56 (10.5%) and 31 (10.5%). Non-married relationship and widowhood, increasing number of lifetime sexual partners, human immunodeficiency virus infection and non-traditional housing type, but not age, were significantly associated with HR HPV infection. Conclusions These results on cervical HPV prevalence and genotype distribution may serve as baseline data in evaluating the impact of future HPV vaccination programmes in rural Ethiopia. Electronic supplementary material The online version of this article (doi:10.1186/1750-9378-9-33) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Christof Prugger
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany ; INSERM, U970, Paris Cardiovascular Research Centre, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Hartmut Goette
- Department of Molecular Diagnostics Europe, QIAGEN GmbH, Hilden, Germany
| | - Ralph J Lellé
- Department of Gynecology and Obstetrics, University Hospital of Muenster, Muenster, Germany
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Risk factors for high-risk human papillomavirus detection among HIV-negative and HIV-positive women from Tanzania. Sex Transm Dis 2014; 40:737-43. [PMID: 23949589 DOI: 10.1097/olq.0000000000000005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. The prevalence is dependent on several known factors notably sexual behavior and age, and factors still under scrutiny. OBJECTIVE This study aimed to examine risk factors for high-risk (HR) HPV infection among HIV-positive and HIV-negative women from the general population of Tanzania and to assess whether specific risk factors could contribute to the high prevalence of HR HPV infection in older age found in some populations including Tanzanian women. METHODS A cross-sectional study of 3699 women from Tanzania was conducted. We obtained information on sociodemographic and lifestyle factors through personal interview. Cervical swabs were collected for detection of HR HPV (Hybrid Capture 2; Qiagen, Hildesheim, Germany) and genotyping (LiPaExtra; Innogenetics, Gent, Belgium). Finally, we obtained a blood sample for HIV testing. RESULTS HIV positivity was the strongest risk factor for HR HPV (odds ratio, 4.1; 95% confidence interval, 3.3-5.3). Young age, shorter duration of present relationship, and increasing number of sex partners were also associated with higher risk for HR HPV. Among women 20 to 29 years old, especially number of partners (P = 0.005) and HIV positivity (P < 0.0001) determined the risk. In underweight women 50 years or older (P = 0.004) and HIV positivity (P = 0.0009) increased the risk, whereas increasing number of partners was not related to the risk of HR HPV (P = 0.46). CONCLUSIONS Human papillomavirus risk factors among HIV-positive and HIV-negative women were similar, but the strength of association was greater among HIV-positive women, notably for lifetime number of sex partners, time in present relationship, genital warts, and body mass index. We were not able to identify a clear explanation for the high HPV prevalence among older women. However, in the age-stratified analysis, potential indicators of decreased immunity increased the risk for HPV infection among older women, whereas in younger women, risk was particularly associated with sexual activity.
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Tobing MDL, Sahiratmadja E, Dinda M, Hernowo BS, Susanto H. Human Papillomavirus Genotypes Profile in Cervical Cancer Patients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Asian Pac J Cancer Prev 2014; 15:5781-5. [PMID: 25081701 DOI: 10.7314/apjcp.2014.15.14.5781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Maringan Diapari Lumban Tobing
- Department of Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. E-mail :
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Tshomo U, Franceschi S, Dorji D, Baussano I, Tenet V, Snijders PJF, Meijer CJLM, Bleeker MCG, Gheit T, Tommasino M, Clifford GM. Human papillomavirus infection in Bhutan at the moment of implementation of a national HPV vaccination programme. BMC Infect Dis 2014; 14:408. [PMID: 25047665 PMCID: PMC4223630 DOI: 10.1186/1471-2334-14-408] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/12/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cancer is the most common female cancer in Bhutan, the first low/middle-income country to implement a national human papillomavirus (HPV) vaccination programme. METHODS To provide a robust baseline for future evaluations of vaccine effectiveness, cervical cell specimens were obtained from 2,505 women aged 18-69 years from the general population, and biopsies from 211 cervical intraepithelial neoplasia grade 3 (CIN3) and 112 invasive cervical cancer (ICC) cases. Samples were tested for HPV using GP5+/6+ PCR. RESULTS Among the general population, HPV prevalence was 26%, being highest (33%) in women ≤24 years, but remaining above 15% in all age-groups. Determinants of HPV included age, marital status, and number of sexual partners. Among the eight percent with cytological abnormalities, 24 CIN3 and 4 ICC were histologically confirmed. Even after additional testing with a sensitive E7 PCR, no infections with vaccine-targeted HPV types were detected in the few vaccinated women (n = 34) compared to 6% prevalence in unvaccinated women of similar age (p = 0 · 215). CONCLUSION Based upon type-specific prevalence among biopsies, at least 70% of ICC in Bhutan are theoretically preventable by HPV16/18 vaccination, but screening programmes should be expanded among older women, who have an important underlying burden of CIN3 and ICC.
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Affiliation(s)
- Ugyen Tshomo
- Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Silvia Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, cedex 08, France
| | - Dorji Dorji
- Department of Laboratory Services, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Iacopo Baussano
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, cedex 08, France
| | - Vanessa Tenet
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, cedex 08, France
| | - Peter JF Snijders
- VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Chris JLM Meijer
- VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Maaike CG Bleeker
- VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Tarik Gheit
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, cedex 08, France
| | - Massimo Tommasino
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, cedex 08, France
| | - Gary M Clifford
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, cedex 08, France
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Leslie HH, Karasek DA, Harris LF, Chang E, Abdulrahim N, Maloba M, Huchko MJ. Cervical cancer precursors and hormonal contraceptive use in HIV-positive women: application of a causal model and semi-parametric estimation methods. PLoS One 2014; 9:e101090. [PMID: 24979709 PMCID: PMC4076246 DOI: 10.1371/journal.pone.0101090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/03/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To demonstrate the application of causal inference methods to observational data in the obstetrics and gynecology field, particularly causal modeling and semi-parametric estimation. BACKGROUND Human immunodeficiency virus (HIV)-positive women are at increased risk for cervical cancer and its treatable precursors. Determining whether potential risk factors such as hormonal contraception are true causes is critical for informing public health strategies as longevity increases among HIV-positive women in developing countries. METHODS We developed a causal model of the factors related to combined oral contraceptive (COC) use and cervical intraepithelial neoplasia 2 or greater (CIN2+) and modified the model to fit the observed data, drawn from women in a cervical cancer screening program at HIV clinics in Kenya. Assumptions required for substantiation of a causal relationship were assessed. We estimated the population-level association using semi-parametric methods: g-computation, inverse probability of treatment weighting, and targeted maximum likelihood estimation. RESULTS We identified 2 plausible causal paths from COC use to CIN2+: via HPV infection and via increased disease progression. Study data enabled estimation of the latter only with strong assumptions of no unmeasured confounding. Of 2,519 women under 50 screened per protocol, 219 (8.7%) were diagnosed with CIN2+. Marginal modeling suggested a 2.9% (95% confidence interval 0.1%, 6.9%) increase in prevalence of CIN2+ if all women under 50 were exposed to COC; the significance of this association was sensitive to method of estimation and exposure misclassification. CONCLUSION Use of causal modeling enabled clear representation of the causal relationship of interest and the assumptions required to estimate that relationship from the observed data. Semi-parametric estimation methods provided flexibility and reduced reliance on correct model form. Although selected results suggest an increased prevalence of CIN2+ associated with COC, evidence is insufficient to conclude causality. Priority areas for future studies to better satisfy causal criteria are identified.
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Affiliation(s)
- Hannah H. Leslie
- Division of Epidemiology, University of California, Berkeley, California, United States of America
| | - Deborah A. Karasek
- Division of Epidemiology, University of California, Berkeley, California, United States of America
| | - Laura F. Harris
- Joint Medical Program, University of California, Berkeley, and University of California San Francisco, San Francisco, California, United States of America
| | - Emily Chang
- Pulmonary Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Naila Abdulrahim
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - May Maloba
- FACES, Family AIDS Care and Education Services, Kisumu, Kenya
| | - Megan J. Huchko
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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Brotman RM, Shardell MD, Gajer P, Tracy JK, Zenilman JM, Ravel J, Gravitt PE. Interplay between the temporal dynamics of the vaginal microbiota and human papillomavirus detection. J Infect Dis 2014; 210:1723-33. [PMID: 24943724 DOI: 10.1093/infdis/jiu330] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We sought to describe the temporal relationship between vaginal microbiota and human papillomavirus (HPV) detection. METHODS Thirty-two reproductive-age women self-collected midvaginal swabs twice weekly for 16 weeks (937 samples). Vaginal bacterial communities were characterized by pyrosequencing of barcoded 16S rRNA genes and clustered into 6 community state types (CSTs). Each swab was tested for 37 HPV types. The effects of CSTs on the rate of transition between HPV-negative and HPV-positive states were assessed using continuous-time Markov models. RESULTS Participants had an average of 29 samples, with HPV point prevalence between 58%-77%. CST was associated with changes in HPV status (P<.001). Lactobacillus gasseri-dominated CSTs had the fastest HPV remission rate, and a low Lactobacillus community with high proportions of the genera Atopobium (CST IV-B) had the slowest rate compared to L. crispatus-dominated CSTs (adjusted transition rate ratio [aTRR], 4.43, 95% confidence interval [CI], 1.11-17.7; aTRR, 0.33, 95% CI, .12-1.19, respectively). The rate ratio of incident HPV for low Lactobacillus CST IV-A was 1.86 (95% CI, .52-6.74). CONCLUSIONS Vaginal microbiota dominated by L. gasseri was associated with increased clearance of detectable HPV. Frequent longitudinal sampling is necessary for evaluation of the association between HPV detection and dynamic microbiota.
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Affiliation(s)
- Rebecca M Brotman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine Institute for Genome Sciences, University of Maryland School of Medicine
| | - Michelle D Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - Pawel Gajer
- Institute for Genome Sciences, University of Maryland School of Medicine
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - Jonathan M Zenilman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine Department of Microbiology and Immunology, University of Maryland School of Medicine
| | - Patti E Gravitt
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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Foliaki S, Brewer N, Pearce N, Snijders PJF, Meijer CJLM, Waqatakirewa L, Clifford GM, Franceschi S. Prevalence of HPV infection and other risk factors in a Fijian population. Infect Agent Cancer 2014; 9:14. [PMID: 24891876 PMCID: PMC4040509 DOI: 10.1186/1750-9378-9-14] [Citation(s) in RCA: 10] [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: 01/16/2014] [Accepted: 03/20/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer is among the leading contributors to morbidity and mortality in the Pacific, but the magnitude of the problem and the potential for prevention have not been comprehensively studied. Over the past decade, cervical cancer has been the most common cancer among women in Fiji with an age standardised cervical cancer incidence rate of 51 per 100,000. This rate is among the highest in the South Pacific region and in the world. This high cervical cancer incidence rate is likely linked to the low cervical screening rate, but it points also to the possibility of a high burden of human papillomavirus (HPV) infection. METHODS We conducted a population-based survey in Fiji to provide information on human papillomavirus (HPV) prevalence, and the distribution of individual HPV types in a Fijian health-sub-district. We included 1,261 women aged between 16 and 64 years. A general primer GP5+/6+ mediatedpolymerase chain reaction (PCR) assay was used for HPV testing of 44 HPV types. RESULTS The crude HPV prevalence in 1,244 women with an adequate HPV sample was 24.0% (95% confidence interval (CI), 21.7-26.4%) and the corresponding age standardised prevalence was 25.5% (95% CI, 23.1-28.1%). The prevalence of high-risk HPV types was 13.6% (95% CI, 11.8-15.6%). Among 1,192 women with adequate cytological results, 13 (1.1%) showed cervical abnormalities, the majority of which were high-grade intraepithelial lesions or worse. HPV prevalence declined from 35.8% in women aged <25 years to 18.6% in those aged 55-64 years of age. After adjustment, the only variables significantly associated with HPV-positivity were age (ranging from odds ratio (OR) 0.57 (95% CI, 0.36-0.89) for 25-34 year-old-women to OR 0.43 (95% CI, 0.20-0.89) for 55-64 year-old-women) and 'husband's extramarital sexual relationships' (OR 1.69; 95% CI, 1.17-2.34). CONCLUSION These findings on HPV provide key information for future policy decisions on the most appropriate methods of cervical cancer prevention in Fiji and in the Pacific region.
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Affiliation(s)
- Sunia Foliaki
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Naomi Brewer
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Neil Pearce
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
- London School of Hygiene & Tropical Medicine, London, UK
| | - Peter JF Snijders
- Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Chris JLM Meijer
- Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Smith MA, Tellier PP, Roger M, Coutlée F, Franco EL, Richardson H. Determinants of Human Papillomavirus Coinfections among Montreal University Students: The Influence of Behavioral and Biologic Factors. Cancer Epidemiol Biomarkers Prev 2014; 23:812-22. [DOI: 10.1158/1055-9965.epi-13-1255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Human papillomavirus community in healthy persons, defined by metagenomics analysis of human microbiome project shotgun sequencing data sets. J Virol 2014; 88:4786-97. [PMID: 24522917 DOI: 10.1128/jvi.00093-14] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED Human papillomavirus (HPV) causes a number of neoplastic diseases in humans. Here, we show a complex normal HPV community in a cohort of 103 healthy human subjects, by metagenomics analysis of the shotgun sequencing data generated from the NIH Human Microbiome Project. The overall HPV prevalence was 68.9% and was highest in the skin (61.3%), followed by the vagina (41.5%), mouth (30%), and gut (17.3%). Of the 109 HPV types as well as additional unclassified types detected, most were undetectable by the widely used commercial kits targeting the vaginal/cervical HPV types. These HPVs likely represent true HPV infections rather than transitory exposure because of strong organ tropism and persistence of the same HPV types in repeat samples. Coexistence of multiple HPV types was found in 48.1% of the HPV-positive samples. Networking between HPV types, cooccurrence or exclusion, was detected in vaginal and skin samples. Large contigs assembled from short HPV reads were obtained from several samples, confirming their genuine HPV origin. This first large-scale survey of HPV using a shotgun sequencing approach yielded a comprehensive map of HPV infections among different body sites of healthy human subjects. IMPORTANCE This nonbiased survey indicates that the HPV community in healthy humans is much more complex than previously defined by widely used kits that are target selective for only a few high- and low-risk HPV types for cervical cancer. The importance of nononcogenic viruses in a mixed HPV infection could be for stimulating or inhibiting a coexisting oncogenic virus via viral interference or immune cross-reaction. Knowledge gained from this study will be helpful to guide the designing of epidemiological and clinical studies in the future to determine the impact of nononcogenic HPV types on the outcome of HPV infections.
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Xavier-Júnior JCC, Dufloth RM, do Vale DB, Tavares TA, Zeferino LC. High-grade squamous intraepithelial lesions in pregnant and non-pregnant women. Eur J Obstet Gynecol Reprod Biol 2014; 175:103-6. [PMID: 24522115 DOI: 10.1016/j.ejogrb.2014.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 12/06/2013] [Accepted: 01/12/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate if the prevalence of cervical smear results varies between pregnant and non-pregnant women stratified by age group. STUDY DESIGN Observational analytical study with a total sample of 1,336,180 pregnant and non-pregnant women, aged between 20 and 34 years, who underwent cervical cancer screening in the Primary Health Care of the national health system in the area of Campinas in Brazil during the period of 2005-2009. The source is the information system for cervical cancer screening. Data collected on abnormal cervical smears were analyzed using the Chi-square test and Fisher's exact test and the magnitude of the association between pregnancy and high-grade squamous epithelial lesions was analyzed by odds ratio (OR) and estimated values with confidence intervals (CI) of 95%. RESULTS 15,190 pregnant women and 395,961 non-pregnant women were analyzed and fulfilled the inclusion criteria. Regardless of age, no statistical differences were observed for high-grade squamous intraepithelial lesion prevalence (OR 0.90; CI 0.66-1.23). Taking into account the five-year age groups, however, low-grade squamous intraepithelial lesion was less prevalent in pregnant women aged 20-24 (OR 0.71; 0.54-0.95) and 25-29 years (OR 0.56; 0.35-0.89); also, atypical squamous cells of undetermined significance was more prevalent in non-pregnant women aged 25-29 years (OR 0.72; 0.54-0.97). CONCLUSION The study showed that the cytological prevalence of high-grade squamous intraepithelial lesion was similar in pregnant and non-pregnant women, regardless of age. The results indicate that there are no reasons for specific approaches to cervical cancer screening for pregnant women. The examination should be carried out only on pregnant women who have not been tested according to current recommendations.
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Affiliation(s)
| | - Rozany M Dufloth
- UNESP - Universidade Estadual Paulista, Pathology Department, Botucatu, SP, Brazil.
| | - Diama B do Vale
- UNICAMP - Universidade Estadual de Campinas, Department of Obstetrics and Gynecology, Oncology Division, Campinas, SP, Brazil
| | - Thalita A Tavares
- UNESP - Universidade Estadual Paulista, Pathology Department, Botucatu, SP, Brazil
| | - Luiz C Zeferino
- UNICAMP - Universidade Estadual de Campinas, Department of Obstetrics and Gynecology, Oncology Division, Campinas, SP, Brazil
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A study of cervical intraepithelial neoplasia in pregnancy. J Obstet Gynaecol India 2014; 64:193-6. [PMID: 24966504 DOI: 10.1007/s13224-013-0499-7] [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: 04/11/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To find the incidence of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in pregnant women and compare Pap smear with the HPV DNA test in detecting HPV infection. MATERIALS AND METHODS Hundred antenatal women, irrespective of gestational age, were enrolled as subjects in this prospective pilot study for blood investigations, wet mount examination of cervical discharge, Pap smear, and high-risk HPV DNA detection of cervical scrape by PCR. Women showing abnormality in Pap smear and/or those who were high-risk HPV DNA positive were subjected to colposcopy. RESULTS The incidence of HPV-positive pregnant women was 18 %. Koilocytosis on Pap smear was observed in six women. Three high-risk HPV DNA-positive women showed changes consistent with CIN 1 on colposcopy. CONCLUSIONS The HPV DNA test is the most sensitive and reliable in detecting HPV infection as compared to Pap smear, but considering the cost of PCR, Pap smear screening of all antenatal women was recommended.
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