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Tokarski AO, Bernardelli RS, Bruscato JR, Lucena CR, Linhares JC, Tsunoda AT. Quality of Life Post Cervical Cancer Treatment: A Comparison Between Radical Surgery Approach and Radiotherapy and Chemotherapy. J Surg Oncol 2024. [PMID: 39318140 DOI: 10.1002/jso.27911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/26/2024] [Accepted: 08/18/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION The assessment of quality of life (QoL) in women with cervical cancer is crucial due to the profound changes they undergo during and after treatment. Often, the significance of sexual factors is underestimated, likely due to societal taboos surrounding such discussions. OBJECTIVE This study aimed to determine the long-term QoL outcomes, particularly focusing on sexuality, among three therapeutic approaches for cervical cancer: chemotherapy, radiotherapy, and brachytherapy; isolated hysterectomy; and hysterectomy combined with radiotherapy. METHODS Conducted from November 2022 to July 2023, this cross-sectional study involved 131 cervical cancer patients. Their QoL was assessed using the MDASI, FACIT-Cx, and risk factor questionnaires. Results were compared across the three treatment groups, revealing notable differences. RESULTS Patients undergoing chemo/radio/brachytherapy showed significantly lower QoL scores compared to those undergoing isolated hysterectomy. This was evident in reduced scores across FACIT-Cx subscales for physical well-being, specific concerns, and FACIT-total (p < 0.05). The MDASI results similarly indicated greater symptoms and interference in daily activities for the chemo/radio/brachytherapy group. CONCLUSION In conclusion, isolated hysterectomy, demonstrated superior QoL outcomes compared to chemo/radio/brachytherapy. Furthermore, the study underscored the importance of addressing sexual concerns in QoL assessments of cervical cancer survivors, emphasizing the need for comprehensive care to enhance overall well-being posttreatment.
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Affiliation(s)
- Alyne O Tokarski
- Medical Student in Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Rafaella S Bernardelli
- Assistant Professor at the School of Medicine at Pontifícia Universidade Católica do Paraná in the Department of Medical Scientific Initiation, Epidemiology, and Biostatistics, Curitiba, Paraná, Brazil
| | - Julia R Bruscato
- Medical Student in Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Claudio R Lucena
- Surgical Oncologist at Erasto Gaertner Hospital, Curitiba, Paraná, Brazil
| | - Jose C Linhares
- Head-Gynecologic Oncology Department at Erasto Gaertner Hospital, Curitiba, Paraná, Brazil
| | - Audrey T Tsunoda
- Surgical Oncologist at Erasto Gaertner Hospital and at HCor and Assistant Professor at the School of Medicine at Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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Cochrane AC, Bullington BW, Prokopowicz C, Rahangdale L, Knittel AK. Comparing Cervical Cancer Screening Strategies in an Incarcerated Population. J Womens Health (Larchmt) 2024; 33:1034-1041. [PMID: 38607557 DOI: 10.1089/jwh.2023.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Objective: To describe the prevalence of cervical intraepithelial neoplasia (CIN), high-risk human papillomavirus (hrHPV) infection, and cervical cancer in a high-risk, underscreened incarcerated population and to evaluate the performance of current cervical cancer screening options to detect cervical precancer (CIN 2/3) in this population. Study Design: Deidentified data were obtained from all cytological, hrHPV DNA, and histopathological testing of cervical biopsies performed on people incarcerated at the North Carolina Correctional Institute for Women between January 1, 2013, and December 31, 2020. These were linked to corresponding demographic data. The proportions of histopathological diagnoses of CIN2+ and CIN3+ immediately preceded by abnormal cytology testing or hrHPV testing were determined, and prevalence differences and 95% confidence intervals were calculated. Results: A total of 15,319 individuals incarcerated at the North Carolina Correctional Institute for Women had at least one cytology result during 2013-2020. Of these, 2,829 (18%) had abnormal cervical cytology, and 3,724 (24.3%) had positive hrHPV testing. The detection of CIN2+ was 95.9% by preceding abnormal cervical cytology, 89.9% by preceding positive hrHPV testing (p = 0.03), and 96.5% by preceding positive co-testing. The detection rate of CIN3+ was 96.6% by preceding abnormal cervical cytology, 90.8% by preceding positive hrHPV testing (p = 0.12), and 96.6% by positive co-testing. Conclusion: In our sample, primary cytology and co-testing detected CIN2+ at higher rates when compared with primary hrHPV testing. This reinforces that incarcerated populations do not fall into average-risk populations for which current cervical cancer screening options are designed, which should be considered when performing screening in this population.
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Affiliation(s)
- Anna Caroline Cochrane
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
| | - Brooke W Bullington
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caroline Prokopowicz
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Lisa Rahangdale
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- University of North Carolina at Chapel Hill Lineberger Cancer Research Center, Chapel Hill, North Carolina, USA
| | - Andrea K Knittel
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Zhou YY, Chang M, Li CP, Han XL, Fang P, Xia XP. Causal effect of age first had sexual intercourse and lifetime number of sexual partners on cervical cancer. Heliyon 2024; 10:e23758. [PMID: 38226234 PMCID: PMC10788439 DOI: 10.1016/j.heliyon.2023.e23758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
Objective In this study, we aimed to investigate whether age first had sexual intercourse (AFSI) and lifetime number of sexual partners (LNSP) have a direct causal effect on cervical cancer by Mendelian randomization (MR) analysis. Methods Four approaches were used for MR Analysis, including MR-Egger, weighted method, weighted median, and inverse variance weighted (IVW). MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) as well as MR-Egger regression analysis were conducted to detect whether there was pleiotropy between IVs and outcome, and the outlier SNPs can be detected by MR-PRESSO. The presence or absence of heterogeneity among IVs was suggested according to Cochran's Q statistic. Leave-one-out sensitivity analysis was performed to identify and remove SNPs which could independently change the results. We corrected the results using Bonferroni correction. Results From the results of IVW, AFSI had a negative effect on cervical cancer (OR = 0.996, 95 % CI: 0.995, 0.998 P = 1.70E-07), which still persisted after Bonferroni correction. However, no causal effect of LNSP on cervical cancer was found according to the IVW results (OR = 1.003, 95 % CI: 1.000, 1.007, P = 0.071). From the results of MR-PRESSO and MR-Egger, no SNP with horizontal pleiotropy between cervical cancer was detected and no SNP was identified as an outlier SNP. Cochran's Q statistic suggested that no heterogeneity existed among IVs of AFSI and LNSP. According to Leave-one-out analysis, the results of MR did not change after excluding any single IV. Conclusion This MR study reveals that early AFSI has a causal effect on cervical cancer.
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Affiliation(s)
- Yuan-yuan Zhou
- Department of Obstetrics and Gynecology, Anhui Provincial Children's Hospital, Children's Hospital of Fudan University Anhui Hospital, Children's Hospital of Anhui Medical University, Hefei, Anhui, 230051, China
| | - Man Chang
- Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui, 230051, China
| | - Chuan-ping Li
- Department of Obstetrics and Gynecology, Hefei University of Technology Hospital, Hefei, Anhui, 230051, China
| | - Xi-ling Han
- Department of Obstetrics and Gynecology, Anhui Provincial Children's Hospital, Children's Hospital of Fudan University Anhui Hospital, Children's Hospital of Anhui Medical University, Hefei, Anhui, 230051, China
| | - Ping Fang
- Department of Oncology, The 902nd Hospital of the PlA Joint Logistics Support Force, Bengbu, Anhui, 233000, China
| | - Xiao-ping Xia
- Department of Obstetrics and Gynecology, Anhui Provincial Children's Hospital, Children's Hospital of Fudan University Anhui Hospital, Children's Hospital of Anhui Medical University, Hefei, Anhui, 230051, China
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Šavrova A, Jaal J, Nõmm O, Innos K. Factors associated with advanced-stage diagnosis of cervical cancer in Estonia: a population-based study. Public Health 2023; 225:369-375. [PMID: 37989009 DOI: 10.1016/j.puhe.2023.10.025] [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: 07/05/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Cervical cancer (CC) remains a crucial public health issue in Estonia, with high incidence and late diagnosis. The aim of this study was to examine time trends of stage-specific CC incidence in Estonia and factors associated with advanced-stage diagnosis of CC. STUDY DESIGN This was a nationwide population-based retrospective study. METHODS Data on CC cases diagnosed in Estonia in 2007-2018 were obtained from the Estonian Cancer Registry, including tumour, nodes, metastases stage at diagnosis. Sociodemographic data were obtained from the Population Registry. To estimate the risk of advanced-stage diagnosis (stages II-IV vs stage I) associated with sociodemographic factors, Poisson regression with robust variance was used to calculate univariate and multivariate prevalence ratios (PR) with 95% confidence intervals (CIs). Time trends of stage-specific CC incidence for 2005-2019 were examined with joinpoint analysis. RESULTS Incidence of stage I CC showed a significant decline of 4.9% per year since 2007, whereas no change was seen for other stages. Of the 2046 women diagnosed in 2007-2018, 1137 (55.6%) were diagnosed at an advanced stage; this proportion increased from 51% in 2007-2009 to 58% in 2015-2018 (P = 0.004). Multivariate regression analysis showed that advanced-stage diagnosis was associated with age (PR 2.16, 95% CI 1.87-2.49 for women aged ≥75 years compared with those aged 30-44 years), educational level (PR 1.32, 95% CI 1.15-1.51 for women with basic/primary education compared to university education) and marital status (PR 1.14, 95% CI 1.01-1.29 for single women compared to married/cohabiting women). No associations were observed by region of residence or nationality. CONCLUSIONS To reduce CC mortality, it is crucial to improve prevention and early diagnosis of CC in Estonia through human papillomavirus vaccination and effective and quality-assured screening particularly targeting high-risk groups as well as encouraging symptom awareness and regular check-ups among older women.
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Affiliation(s)
- A Šavrova
- North Estonia Medical Centre Foundation, Womens Clinic, J. Sütiste tee 19, 13419, Tallinn, Estonia.
| | - J Jaal
- Institute of Clinical Medicine, University of Tartu, L, Puusepa 8, 50406, Tartu, Estonia
| | - O Nõmm
- National Institute for Health Development, Department of Epidemiology and Biostatistics, Hiiu 42, 11619, Tallinn, Estonia
| | - K Innos
- National Institute for Health Development, Department of Epidemiology and Biostatistics, Hiiu 42, 11619, Tallinn, Estonia
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Winters AN, Berry AK, Dewenter TA, Chowdhury NU, Wright KL, Cameron JE. MicroRNA expression associated with low-grade cervical intraepithelial neoplasia outcomes. J Cancer Res Clin Oncol 2023; 149:11969-11978. [PMID: 37421453 PMCID: PMC10465678 DOI: 10.1007/s00432-023-05023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/24/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Only a fraction of low-grade cervical intraepithelial neoplasia (CIN) progresses to high-grade CIN; however, the biological processes that differentiate progressive CIN from CIN that resolves naturally are poorly understood. MicroRNAs (miRNAs) are important epigenetic regulators of gene expression and thus, miRNA expression profiling can reveal the dysregulated biology underlying disease processes. The purpose of this case-control study was to reveal miRNA expression patterns and predict the underlying biological pathways that are associated with clinical outcomes of low-grade CIN. METHODS Women with low-grade CIN diagnosis and definitive clinical outcomes (n = 51) were identified retrospectively using electronic clinical records. Comprehensive miRNA expression profiling was performed on the low-grade CIN diagnostic cervical biopsies retrieved from pathology archives. Differential miRNA expression was analyzed by comparing women with CIN that progressed to women with CIN that resolved naturally. RESULTS Differential expression of 29 miRNAs was observed in low-grade CIN that progressed to high-grade compared to low-grade CIN that resolved. Of these, 24 were significantly downregulated in progressive CIN, including miR-638, miR-3196, miR-4488, and miR-4508, while 5 miRNAs, including miR-1206a, were significantly upregulated. Computational gene ontology analysis based on the discovered miRNAs and their putative mRNA targets revealed biological processes associated with oncogenic phenotypes. CONCLUSION Distinct miRNA expression profiles are associated with clinical outcomes of low-grade CIN. The functional effects of the differentially expressed miRNAs may be biological determinants of CIN progression or resolution.
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Affiliation(s)
- Ashley N Winters
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA, 70112, USA
| | - Alex K Berry
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA, 70112, USA
- Department of Microbiology and Immunology, Tulane University School of Medicine, 1430 Tulane Ave. 8638, New Orleans, LA, 70112, USA
| | - Tracy A Dewenter
- Department of Pathology, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA, 70112, USA
| | - Nowrin U Chowdhury
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA, 70112, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, 1161 21St Ave S Medical Center North T-2219, Nashville, TN, 37232, USA
| | - Kelly L Wright
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA, 70112, USA
- Medical Science Liaison, Gynecologic Oncology, AstraZeneca. 1 Medimmune Way, Gaithersburg, MD, 20878, USA
| | - Jennifer E Cameron
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA, 70112, USA.
- The Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA, 70112, USA.
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Bowden SJ, Doulgeraki T, Bouras E, Markozannes G, Athanasiou A, Grout-Smith H, Kechagias KS, Ellis LB, Zuber V, Chadeau-Hyam M, Flanagan JM, Tsilidis KK, Kalliala I, Kyrgiou M. Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies. BMC Med 2023; 21:274. [PMID: 37501128 PMCID: PMC10375747 DOI: 10.1186/s12916-023-02965-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Persistent infection by oncogenic human papillomavirus (HPV) is necessary although not sufficient for development of cervical cancer. Behavioural, environmental, or comorbid exposures may promote or protect against malignant transformation. Randomised evidence is limited and the validity of observational studies describing these associations remains unclear. METHODS In this umbrella review, we searched electronic databases to identify meta-analyses of observational studies that evaluated risk or protective factors and the incidence of HPV infection, cervical intra-epithelial neoplasia (CIN), cervical cancer incidence and mortality. Following re-analysis, evidence was classified and graded based on a pre-defined set of statistical criteria. Quality was assessed with AMSTAR-2. For all associations graded as weak evidence or above, with available genetic instruments, we also performed Mendelian randomisation to examine the potential causal effect of modifiable exposures with risk of cervical cancer. The protocol for this study was registered on PROSPERO (CRD42020189995). RESULTS We included 171 meta-analyses of different exposure contrasts from 50 studies. Systemic immunosuppression including HIV infection (RR = 2.20 (95% CI = 1.89-2.54)) and immunosuppressive medications for inflammatory bowel disease (RR = 1.33 (95% CI = 1.27-1.39)), as well as an altered vaginal microbiome (RR = 1.59 (95% CI = 1.40-1.81)), were supported by strong and highly suggestive evidence for an association with HPV persistence, CIN or cervical cancer. Smoking, number of sexual partners and young age at first pregnancy were supported by highly suggestive evidence and confirmed by Mendelian randomisation. CONCLUSIONS Our main analysis supported the association of systemic (HIV infection, immunosuppressive medications) and local immunosuppression (altered vaginal microbiota) with increased risk for worse HPV and cervical disease outcomes. Mendelian randomisation confirmed the link for genetically predicted lifetime smoking index, and young age at first pregnancy with cervical cancer, highlighting also that observational evidence can hide different inherent biases. This evidence strengthens the need for more frequent HPV screening in people with immunosuppression, further investigation of the vaginal microbiome and access to sexual health services.
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Affiliation(s)
- Sarah J Bowden
- Department of Metabolism, Digestion and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, Hammersmith Hospital campus, London, W12 0HS, UK.
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Triada Doulgeraki
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emmanouil Bouras
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Antonios Athanasiou
- Department of Metabolism, Digestion and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, Hammersmith Hospital campus, London, W12 0HS, UK
| | - Harriet Grout-Smith
- Department of Metabolism, Digestion and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, Hammersmith Hospital campus, London, W12 0HS, UK
| | - Konstantinos S Kechagias
- Department of Metabolism, Digestion and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, Hammersmith Hospital campus, London, W12 0HS, UK
| | - Laura Burney Ellis
- Department of Metabolism, Digestion and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, Hammersmith Hospital campus, London, W12 0HS, UK
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verena Zuber
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - James M Flanagan
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Ilkka Kalliala
- Department of Metabolism, Digestion and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, Hammersmith Hospital campus, London, W12 0HS, UK
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maria Kyrgiou
- Department of Metabolism, Digestion and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, Hammersmith Hospital campus, London, W12 0HS, UK
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Sakakibara A, Nakayama T, Uchida H, Odagiri Y, Ito Y, Katayama T, Ueda Y, Higuchi T, Terakawa K, Matsui K, Miyazaki K, Konishi I. Trends and future projections of cervical cancer-related outcomes in Japan: What happens if the HPV vaccine program is not implemented? Int J Cancer 2023; 152:1863-1874. [PMID: 36468173 DOI: 10.1002/ijc.34391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 12/09/2022]
Abstract
Contrary to other developed countries, in Japan, recent years have seen increases in cervical cancer incidence and mortality among young people. However, the human papillomavirus (HPV) vaccine program, a key measure for avoiding cervical cancer, has been virtually suspended. Temporal changes in cervical cancer profiles in this unique situation have not been fully investigated epidemiologically. Our study aimed to determine the current status and future trends of the incidence and mortality of cervical cancer and precancerous lesions in Japan. Mortality rates of cervical cancer during 1975 to 2016 and incidence rates of cervical cancer and cervical intraepithelial neoplasia (CIN) 3 during 1975 to 2013 were examined using vital statistics and population-based cancer registry data in Japan. Bayesian age-period-cohort analyses were performed to analyze temporal changes of the three cervical cancer-related outcomes. We also calculated projections to 2028 for the three outcomes, assuming that HPV vaccination coverage and screening rates in Japan would be maintained at the current level after the resumption of the national vaccination program. The risk of occurrence of the three outcomes showed similar changes by birth cohort, peaking in the mid-1890s to 1900s birth cohorts, declining sharply in the 1940s birth cohort, and persistently increasing in the 1950s and later birth cohorts. Projections to 2028 show increases in cervical cancer incidence and mortality in the 30 to 69 age group, with a particular increase in CIN3 incidence in the 25 to 49 age group, if HPV vaccine programs and screening are not effectively implemented. These findings revealed an increasing cervical disease burden among reproductive age females in Japan.
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Affiliation(s)
- Atsuko Sakakibara
- Department of Preventive Medicine, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Hiroyuki Uchida
- Division of Clinical Dietetics and Human Nutrition Graduate School of Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Youichi Odagiri
- Graduate School of Nursing, Yamanashi Prefectural University, Yamanashi, Japan
| | - Yuri Ito
- Department of Medical Statistics Research & Development Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshiro Katayama
- Department of Medical Engineering, Morinomiya University of Medical Sciences, Osaka, Japan.,Help Center of Medical Research, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Gynecology and Obstetrics, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Koichi Terakawa
- Department of Gynecology, Kansai Electric Power Hospital, Osaka, Japan
| | - Kunihiko Matsui
- Department of Community Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Kikuko Miyazaki
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.,National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Choi S, Ismail A, Pappas-Gogos G, Boussios S. HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK. Pathogens 2023; 12:pathogens12020298. [PMID: 36839570 PMCID: PMC9960303 DOI: 10.3390/pathogens12020298] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS.
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Affiliation(s)
- Sunyoung Choi
- GKT School of Medicine, King’s College London, London SE1 9RT, UK
| | - Ayden Ismail
- GKT School of Medicine, King’s College London, London SE1 9RT, UK
| | - George Pappas-Gogos
- Department of General Surgery, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, 6th Kilometer, 68100 Alexandroupolis, Greece
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki—Thermi, 57001 Thessaloniki, Greece
- Correspondence: or or or
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Population-Based Temporal Trends and Ethnic Disparity in Cervical Cancer Mortality in South Africa (1999-2018): A Join Point and Age-Period-Cohort Regression Analyses. Cancers (Basel) 2022; 14:cancers14246256. [PMID: 36551741 PMCID: PMC9816936 DOI: 10.3390/cancers14246256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/25/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022] Open
Abstract
Cervical cancer is one of the leading causes of cancer deaths among women in low- and middle-income countries such as South Africa. The current impact of national cervical cancer control and sexual and reproductive health interventions in South Africa reduce its burden. The aim of this study was to assess the trends in cervical cancer mortality and its relation to breast and gynaecological cancers in South Africa from 1999 to 2018. We conducted joinpoint regression analyses of the trends in crude and age-standardised mortality rates (ASMR) for cervical cancer mortality in South Africa from 1999 to 2018. An age−period−cohort regression analysis was also conducted to determine the impact of age, period, and cohort on cervical cancer mortality trends. Analyses were stratified by ethnicity. Cervical cancer (n = 59,190, 43.92%, 95% CI: 43.65−44.18%) was responsible for about 43.9% of breast and gynecological cancer deaths. The mortality rate of cervical cancer (from 11.7 to 14.08 per 100,000) increased at about 0.9% per annum (Average Annual Percent Change (AAPC): 0.9% (AAPC: 0.9%, p-value < 0.001)), and young women aged 25 to 49 years (AAPC: 1.2−3.5%, p-value < 0.001) had increased rates. The risk of cervical cancer mortality increased among successive birth cohorts. In 2018, cervical cancer mortality rate among Blacks (16.74 per 100,000 women) was about twice the rates among Coloureds (8.53 deaths per 100,000 women) and approximately four-fold among Indians/Asians (4.16 deaths per 100,000 women), and Whites (3.06 deaths per 100,000 women). Cervical cancer control efforts should be enhanced in South Africa and targeted at ethnic difference, age, period, and cohort effects.
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Nothacker J, Nury E, Roebl Mathieu M, Raatz H, Meerpohl JJ, Schmucker C. Women's attitudes towards a human papillomavirus-based cervical cancer screening strategy: a systematic review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:295-306. [PMID: 36223918 PMCID: PMC9606488 DOI: 10.1136/bmjsrh-2022-201515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To provide insights into women's attitudes towards a human papillomavirus (HPV)-based cervical cancer screening strategy. DATA SOURCES Medline, Web of Science Core Collection, Cochrane Library, PsycINFO, CINAHL and ClinicalTrials.gov were systematically searched for published and ongoing studies (last search conducted in August 2021). METHODS OF STUDY SELECTION The search identified 3162 references. Qualitative and quantitative studies dealing with women's attitudes towards, and acceptance of, an HPV-based cervical cancer screening strategy in Western healthcare systems were included. For data analysis, thematic analysis was used and synthesised findings were presented descriptively. TABULATION, INTEGRATION, AND RESULTS Twelve studies (including 9928 women) from USA, Canada, UK and Australia met the inclusion criteria. Women's attitudes towards HPV-based screening strategies were mainly affected by the understanding of (i) the personal risk of an HPV infection, (ii) the implication of a positive finding and (iii) the overall screening purpose. Women who considered their personal risk of HPV to be low and women who feared negative implications of a positive finding were more likely to express negative attitudes, whereas positive attitudes were particularly expressed by women understanding the screening purpose. Overall acceptance of an HPV-based screening strategy ranged between 13% and 84%. CONCLUSION This systematic review provides insights into the attitudes towards HPV-based cervical cancer screening and its acceptability based on studies conducted with women from USA, Canada, UK and Australia. This knowledge is essential for the development of education and information strategies to support the implementation of HPV-based cervical cancer screening. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020178957).
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Affiliation(s)
- Julia Nothacker
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Edris Nury
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Heike Raatz
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Evidence Based Insurance Medicine, University Hospital Basel, Basel, Switzerland
- European Center of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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Yang D, Zhang J, Cui X, Ma J, Wang C, Piao H. Status and epidemiological characteristics of high-risk human papillomavirus infection in multiple centers in Shenyang. Front Microbiol 2022; 13:985561. [PMID: 36187989 PMCID: PMC9520659 DOI: 10.3389/fmicb.2022.985561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
The different human papillomavirus (HPV) strains cause warts in various regions of the body. However, considering that the status and genotype distribution of HPV infection in women in Shenyang remain unknown, herein, we investigated the epidemiological characteristics of high-risk HPV (HR-HPV) infection in women in Shenyang, as well as the current state of HPV infection in Shenyang, to provide a theoretical basis for the prevention and treatment of cervical cancer. From December 2018 to December 2021, 6,432 urban and rural women from the Liaoning Cancer Hospital and the Sujiatun Women and Infants’ Hospital were assessed via the Thinprep cytology test (TCT) and HR-HPV detection. Of the 5,961 women enrolled, 739 were HPV positive (12.40%) and 562 were TCT positive (9.43%). Statistical analyses identified the following HPV risk factors: high school education or lower [OR = 1.426 (1.199–1.696), p < 0.001], age at first sexual encounter ≤ 19 years [OR = 1.496 (1.008–2.220), p = 0.046], and number of sexual partners > 1 [OR = 1.382 (1.081–1.768), p = 0.010], atypical squamous cells of undetermined significance (ASCUS) and above [OR = 10.788 (8.912–13.060), p < 0.001], non-condom-based contraception [OR = 1.437 (1.103–1.871), p = 0.007], nationalities other than Han [OR = 1.690 (1.187–2.406), p = 0.004], rural residence [OR = 1.210 (1.031–1.419), p = 0.020]. Compared to the HPV infection rate of women aged 56–65, that in women aged 35–45 [OR = 0.687 (0.549–0.860), p = 0.001] and 46–55 [OR = 0.740 (0.622–0.879), p = 0.001] decreased significantly. To conclude, risk factors of HPV infection among female patients include high school age and below, initial sexual encounter at age ≤ 19 years, number of sexual partners > 1, ASCUS and above, non-condom contraception, nationalities other than Han nationality and rural population. Collectively, this study provides insights for the improved prevention and treatment of cervical cancer.
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Affiliation(s)
- Di Yang
- Department of Gynecology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Jing Zhang
- Department of Gynecology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Xiaoli Cui
- Department of Gynecology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Jian Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunyan Wang
- Department of Gynecology, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
- *Correspondence: Chunyan Wang,
| | - Haozhe Piao
- Department of Neurosurgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
- Haozhe Piao,
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12
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Delage de Luget C, Blanc J, Chantalat E, Auquier P, Carcopino X. [Database's development for prospective national collection of clinical data on cervical cancer: A Delphi survey identifying consensual variables]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:615-619. [PMID: 35667561 DOI: 10.1016/j.gofs.2022.05.004] [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: 02/23/2022] [Revised: 04/24/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Cervical cancer (CC) is associated with poor prognosis and therapeutic morbidity in young women. The impact of European recommendations for treatments and follow-up of these patients must be assessed. There is no real-time CCU tracking basis. Main objective of our study was to identify the items of the clinical and therapeutic data necessary for the constitution of a national, dynamic and prospective clinical database allowing to characterize treatments and follow-up of patients with CC in France. METHODS An exhaustive bibliographic research was lead with the help of the ESGO recommendations. A list of qualitative and quantitative variables characterizing CC was established. These variables were assessed by a panel of national experts from the Francogyn group, using the Delphi survey. The rate of agreement was calculated for each variable. RESULTS 345 variables divided into 6 sections were identified and submitted to 26 experts. 17 experts responded to the three rounds of the Delphi method. A total of 273 items were validated. The majority of experts (90 %) also gave a favorable opinion on the addition of a quality of life section in the database. CONCLUSION This is the first study identifying 273 items chosen by consensus. The items are collected in a future national gynecological database "Epigyn".
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Affiliation(s)
- Claire Delage de Luget
- Department of Obstetrics and Gynecology, Nord Hospital, APHM, chemin des Bourrely, 13015 Marseille, France.
| | - Julie Blanc
- Department of Obstetrics and Gynecology, Nord Hospital, APHM, chemin des Bourrely, 13015 Marseille, France; EA 3279, Public Health, Chronic Diseases and Quality of Life, Research Unit, Aix-Marseille University, 13284 Marseille, France.
| | - Elodie Chantalat
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France.
| | - Pascal Auquier
- Department of Public Health, CHU Timone, Aix-Marseille University, 264, rue St-Pierre, Marseille, France.
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Nord Hospital, APHM, chemin des Bourrely, 13015 Marseille, France; Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR, Marseille, France
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13
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Fugmann D, Boeker M, Holsteg S, Steiner N, Prins J, Karger A. A Systematic Review: The Effect of Cancer on the Divorce Rate. Front Psychol 2022; 13:828656. [PMID: 35356338 PMCID: PMC8959852 DOI: 10.3389/fpsyg.2022.828656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Research on the impact of cancer on close relationships brings up conflicting results. This systematic review collects empirical evidence on the research questions whether a cancer diagnosis in general or the type of cancer affects the divorce rate. Materials and Methods This systematic review was conducted according to the guidelines of the Cochrane Collaboration and the PRISMA statement. The following electronic databases were searched: Web of Science, Ovid SP MEDLINE, PsycINFO, PsyINDEX, CINAHL, ERIC. Risk of bias assessment was performed with the preliminary risk of bias for exposures tool template (ROBINS-E tool). The grading of methodological quality was assessed with the Newcastle-Ottawa Scale. Results Of 13,929 identified records, 15 were included in the qualitative synthesis. In 263,616 cancer patients and 3.4 million healthy individuals, we found that cancer is associated with a slightly decreased divorce rate, except for cervical cancer, which seems to be associated with an increased divorce rate. Discussion According to this systematic review, cancer is associated with a tendency to a slightly decreased divorce rate. However, most of the included studies have methodologic weaknesses and an increased risk of bias. Further studies are needed.
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Affiliation(s)
- Dominik Fugmann
- Medical Faculty, Clinical Institute of Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University-Düsseldorf, Düsseldorf, Germany
| | - Martin Boeker
- University Medical Center Rechts der Isar, School of Medicine, Institute of Artificial Intelligence and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Steffen Holsteg
- Medical Faculty, Clinical Institute of Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University-Düsseldorf, Düsseldorf, Germany
| | - Nancy Steiner
- Medical Faculty, Clinical Institute of Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University-Düsseldorf, Düsseldorf, Germany
| | - Judith Prins
- Department of Medical Psychology, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - André Karger
- Medical Faculty, Clinical Institute of Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University-Düsseldorf, Düsseldorf, Germany
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14
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Gebisa T, Bala ET, Deriba BS. Knowledge, Attitude, and Practice Toward Cervical Cancer Screening Among Women Attending Health Facilities in Central Ethiopia. Cancer Control 2022; 29:10732748221076680. [PMID: 35315704 PMCID: PMC8943579 DOI: 10.1177/10732748221076680] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background In Ethiopia, cervical cancer ranked as the second leading cause of female
cancer and also stands as the most common cancer among women aged from 15 to
44 years old. Hence, this study aimed to assess knowledge, attitude, and
practice toward cervical cancer screening among women attending health
facilities in central Ethiopia. Methods Institutional-based cross-sectional study was conducted among 420 study
participants. Data were collected using an interviewer-administered
questionnaire. The collected data were entered into EPI data 3.1 and
exported to SPSS version 23 for analysis. Binary and multivariate logistic
regressions were used to identify factors associated with knowledge,
attitude, and practice of cervical cancer screening. Odds ratio (OR) with
95% CI and a P-value < .05 were used to declare
statistical significance. Results Half, 50.7% of study participants had good knowledge. Less than half, 46.1%
had a positive attitude toward cervical cancer screening. Only 6.3% of women
have been screened for cervical cancer. Diploma and above education (AOR:
2.22, 95% CI: 1.32, 6.157), no idea about cervical cancer curable at an
early stage (AOR: 6.23, 95% CI: 6.23 (2.77, 15.13) were significantly
associated with knowledge of cervical cancer screening. Diploma and above
education (AOR: 0.37, 95% CI: 0.19, 0.74) and multiple sexual partners (AOR:
0.18, 95% CI: 0.05, 0.62) were factors associated with a negative attitude
toward cervical cancer screening. Positive attitude about cervical cancer
screening (AOR: 2.37, 95% CI: 1.91, 6.20) was significantly associated with
the practice of being screened. Conclusions Cervical cancer screening knowledge and attitudes were moderate, but practice
was low. Educational status, considering cervical cancer is not curable at
an early stage and not having an idea about its curability at an early
stage, was significantly associated with knowledge of cervical cancer
screening. Sexual partner status and educational status showed significant
association with an attitude toward cervical cancer screening and having a
positive attitude toward cervical cancer screening were significantly
associated with the practice of cervical cancer screening. Health
professionals need to disseminate cervical cancer screening information and
offer cervical cancer treatment during health-care appointments.
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Affiliation(s)
- Tulu Gebisa
- Department of Public Health, Oromia Regional Health Bureau West Shewa Zonal Health Office, Ambo, Ethiopia
| | - Elias Teferi Bala
- Department of Public Health, 361570Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
| | - Berhanu Senbeta Deriba
- Department of Public Health, 576981Salale University College of Health Sciences, Fitche, Ethiopia
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15
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Welby S, Rosillon D, Feng Y, Borys D. Progression from human papillomavirus (HPV) infection to cervical lesion or clearance in women (18-25 years): Natural history study in the control arm subjects of AS04-HPV-16/18 vaccine efficacy study in China between 2008 and 2016. Expert Rev Vaccines 2021; 21:407-413. [PMID: 34939897 DOI: 10.1080/14760584.2022.2021077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND : Cervical cancer is the third most frequent cancer in Chinese women aged 15-44 years old. Human papillomavirus (HPV) is recognized as the main etiologic agent of cervical carcinomas. This study aims to better understand the natural history of HPV infections in Chinese women aged 18-25 years. RESEARCH DESIGN AND METHODS Data from 3,025 control arm women (AS04-HPV-16/18 vaccine trial) were analyzed to assess the probability of progression or clearance from a 6-month persistent infection (6MPI) to a cervical intraepithelial neoplasia grade 2 or greater (CIN2+), and the association with clinical determinants. Data were analyzed using univariate and multivariable Cox models. RESULTS A total of 1,324 women with 3,814 HPV infections were included, and 65.7% of the women had at least one 6MPI. Among those 6MPI, 5.0% progressed to CIN2+, while 61.0% cleared within 6 months. The risk of progression from 6MPI to CIN2+ was substantially higher for oncogenic versus non-oncogenic HPV types. CONCLUSIONS Oncogenic HPV infections showed lower clearance and higher risk to progress to CIN2+. These findings observed in a population of Chinese women, confirmed previous findings from multinational studies. TRIAL REGISTRATION : The PATRICIA and AS04-HPV-16/18 vaccine trials are registered at ClinicalTrials.gov (NCT00779766 and NCT00122681).
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Affiliation(s)
| | | | - Yang Feng
- Ningyang Group Co. Ltd on behalf of GSK, Xiamen, China.,Xiamen Chazen Biomedical Technology Co. Ltd, Xiamen, China
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16
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Singini MG, Sitas F, Bradshaw D, Chen WC, Motlhale M, Kamiza AB, de Villiers CB, Lewis CM, Mathew CG, Waterboer T, Newton R, Muchengeti M, Singh E. Ranking lifestyle risk factors for cervical cancer among Black women: A case-control study from Johannesburg, South Africa. PLoS One 2021; 16:e0260319. [PMID: 34879064 PMCID: PMC8654217 DOI: 10.1371/journal.pone.0260319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. METHODS We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. RESULTS Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53-3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2-1 children (ORadj = 1.25, 95% CI = 1.07-1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24-1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15-1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41-1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 4.4%). CONCLUNSION This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.
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Affiliation(s)
- Mwiza Gideon Singini
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales Sydney, Australia
- Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Melitah Motlhale
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Abram Bunya Kamiza
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College, London, United Kingdom
| | - Christopher G. Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College, London, United Kingdom
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York, United Kingdom
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- * E-mail:
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17
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Hansen BT, Campbell S, Nygård M. Regional differences in cervical cancer incidence and associated risk behaviors among Norwegian women: a population-based study. BMC Cancer 2021; 21:935. [PMID: 34412617 PMCID: PMC8377942 DOI: 10.1186/s12885-021-08614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/10/2021] [Indexed: 12/09/2022] Open
Abstract
Background Cervical cancer incidence is influenced by screening and risk factors in the population. The main risk factor for cervical cancer is sexually transmitted human papillomavirus (HPV), which is sexually transmitted and thus associated with sexual behavior. Smoking, parity and hormonal contraceptive use may also be associated with cervical cancer risk. We compared incidence, screening coverage and risk behaviors for cervical cancer between health regions in Norway. Methods We obtained data on incidence of cervical cancer among Norwegian women during 1992–2016 and data on screening coverage from the Cancer Registry of Norway. We obtained data on sexual behavior and smoking from a population-based survey of 16,575 Norwegian women who were 18–45 years old in 2005. Results Cervical cancer incidence was higher in the northern and southeastern region than in the middle and western region (range in incidence per 100,000 person-years during 1992–2016; north: 10.5 to 14.6; southeast: 9.3 to 12.9; mid: 6.8 to 9.5; west: 8.4 to 10.0). The incidence decreased modestly in the north (average annual percentage change (95% confidence interval) − 1.0 (− 1.2 to − 0.7)) and southeast (− 0.7 (− 1.0 to − 0.3)), but did not change significantly in the mid (− 0.3 (− 1.0 to 0.4)) and west (− 0.3 (− 0.6 to 0.0)). Compared to the national average, women in the north had earlier sexual debut, more partners and higher prevalence of ever having had a sexually transmitted infection (STI), while the opposite was observed among women in the west. Women in the middle and southeastern regions tended to be similar to the national average for sexual behaviors. Although less pronounced, the prevalence of smoking showed regional patterns similar to that observed for sexual behaviors, while ever-use of hormonal contraceptives and cervical screening coverage was similar between regions. Conclusions There were regional differences in cervical cancer incidence during the era of nationally organized cervical screening in Norway. To some extent, these differences corresponded to regional differences in risk behavior for cervical cancer in the Norwegian female population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08614-w.
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Affiliation(s)
- Bo T Hansen
- Department of Research, Cancer Registry of Norway, Postbox 5313 Majorstuen, 0304, Oslo, Norway.
| | - Suzanne Campbell
- Department of Research, Cancer Registry of Norway, Postbox 5313 Majorstuen, 0304, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Postbox 5313 Majorstuen, 0304, Oslo, Norway
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18
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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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Tanaka LF, Schriefer D, Radde K, Schauberger G, Klug SJ. Impact of opportunistic screening on squamous cell and adenocarcinoma of the cervix in Germany: A population-based case-control study. PLoS One 2021; 16:e0253801. [PMID: 34260601 PMCID: PMC8279357 DOI: 10.1371/journal.pone.0253801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background We investigated the uptake of opportunistic cervical cancer screening (CCS) and other risk factors and their association with cervical cancer in Germany in a case-control study. Methods and findings We recruited incident cases of cervical cancer (ICD-10 C53) diagnosed between 2012 and 2016 and matched with three population-based controls, based on age and region of residence. Cases and controls reported their CCS participation during the past ten years (frequent: every three years; no or infrequent: less than every three years) and other relevant variables. We fitted conditional logistic regression models, reporting odds ratios (OR) and 95% confidence intervals (95% CI). We report overall and stratified analyses by histologic group (squamous cell–SCC, and adenocarcinoma–AC), T category (T1 and T2+), and age (<50 and ≥50 years). We analysed 217 cases and 652 matched controls. 53.0% of cases and 85.7% of controls attended CCS frequently. In the overall adjusted model, no or infrequent participation in CCS (OR 5.63; 95% CI 3.51 to 9.04), having had more than one sexual partner (OR 2.86; 95%CI 1.50 to 5.45) and obesity (OR 1.69; 95% CI 1.01 to 2.83) were associated with cervical cancer. Twelve years of schooling (OR 0.37; 95% CI 0.23 to 0.60) and a net monthly income of €3000 or more (OR 0.50; 95% CI 0.30 to 0.82) were protective factors. In the stratified analyses, no or infrequent participation was associated with T1 (OR 4.37; 95% CI 2.48 to 7.71), T2+ (OR 10.67; 95% CI 3.83 to 29.74), SCC (OR 6.88; 95% CI 4.08 to 11.59) and AC (OR 3.95; 95% CI 1.47 to 10.63). Conclusion Although women who frequently attended CCS were less likely to develop cervical cancer, especially larger tumours, the high proportion of cases who had been frequently screened prior to diagnosis underscores the need to investigate the quality of cytology and treatment of precancerous lesions in Germany.
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Affiliation(s)
- Luana F Tanaka
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Dirk Schriefer
- Center of Clinical Neuroscience, University Clinic Carl Gustav Carus Dresden, Dresden, Germany
| | - Kathrin Radde
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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20
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Distribution of HPV Genotypes Differs Depending on Behavioural Factors among Young Women. Microorganisms 2021; 9:microorganisms9040750. [PMID: 33918429 PMCID: PMC8066411 DOI: 10.3390/microorganisms9040750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Risk factors for the different human papillomavirus (HPV) genotypes are not well understood, although the risk of cancer is known to vary among them. Our aim was to evaluate the association of diverse behavioral and reproductive factors with genotype-specific HPV prevalence among 879 unvaccinated women aged 18–75 years referred to the colposcopy clinic at Helsinki University Hospital in Finland. Cervical swabs for HPV genotyping were collected in the first visit and assessed for 34 high-risk (hr) and low-risk (lr) HPV genotypes. Participants completed a questionnaire on behavioral, reproductive, and lifestyle factors. Differences in genotype-specific HPV prevalence were analyzed overall and in age groups using binary logistic regression. Smoking was associated with higher prevalence in HPV16 compared with other hrHPV genotypes together with decreasing age, being highest among younger women <30 years old, odds ratio (OR) 3.74 (95% CI 1.42–9.88). The later the sexual debut, the more it seemed to protect from HPV16 infection. The best protection was achieved when the sexual debut took place at >20 years of age, with an OR of 0.43 (95% CI 0.23–0.83). This association was not seen with other hrHPV genotypes. Methods of contraception seemed not to have an effect on hrHPV positivity, regardless of the HPV genotype. The genotype specific hrHPV prevalence differs, depending on behavioral factors, especially among younger women referred to colposcopy.
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21
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Huang Y, Wu X, Lin Y, Li W, Liu J, Song B. Multiple sexual partners and vaginal microecological disorder are associated with HPV infection and cervical carcinoma development. Oncol Lett 2020; 20:1915-1921. [PMID: 32724435 PMCID: PMC7377087 DOI: 10.3892/ol.2020.11738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
There is an indirect link between multiple sexual partners (MSP) and cervical intraepithelial neoplasia (CIN) or even cervical cancer (CC). MSP may also lead to bacterial vaginosis (BV). The relationship among MSP, BV, human papillomavirus (HPV) infection and CIN/CC development in Chinese women remains unclear. The present study was designed to clarify their association. The study retrospectively analyzed 549 female patients who had visited a physical examination center. The MSP information was acquired, and vaginal microecology, HPV and cervical conization pathology (CCP) tests were performed when necessary. MSP status was distinct among patients with different levels of BV severity. In addition, as the severity of BV progressed, the HPV-positive ratio increased. Meanwhile, MSP was significantly associated with a positive HPV outcome, including HPV 16, HPV 18 and other high-risk HPV infections. The MSP group had a significantly higher percentage of positive CCP outcomes (particularly cases with CIN-II and CIN-III). Similarly, higher BV severity meant more severe CIN/CC progression. A logistic regression model based on age, MSP status and the Nugent score level was used in order to predict the CCP outcome. Furthermore, a receiver operating characteristic curve analysis resulted in an area under the curve of 0.834. In conclusion, the combination of MSP information and BV examination may provide a rapid, economic and accurate prediction of CIN/CC. Health education on sexual behavior and timely detection/treatment of BV should be conducted to reduce the risk of CC.
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Affiliation(s)
- Yu Huang
- Department of Obstetrics and Gynecology, Shengli Clinical Medical College of Fujian Medical University and Fujian Provincial Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Xinzhi Wu
- Department of Obstetrics and Gynecology, Shengli Clinical Medical College of Fujian Medical University and Fujian Provincial Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Ying Lin
- Department of Pathology, Shengli Clinical Medical College of Fujian Medical University and Fujian Provincial Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Wenzhou Li
- Department of Obstetrics and Gynecology, Shengli Clinical Medical College of Fujian Medical University and Fujian Provincial Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Jiahua Liu
- Department of Obstetrics and Gynecology, Shengli Clinical Medical College of Fujian Medical University and Fujian Provincial Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Baozhi Song
- Department of Obstetrics and Gynecology, Shengli Clinical Medical College of Fujian Medical University and Fujian Provincial Hospital, Fuzhou, Fujian 350001, P.R. China
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22
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Hansen BT, Kjaer SK, Arnheim-Dahlström L, Liaw KL, Juul KE, Thomsen LT, Frederiksen K, Elfström KM, Munk C, Nygård M. Age at first intercourse, number of partners and sexually transmitted infection prevalence among Danish, Norwegian and Swedish women: estimates and trends from nationally representative cross-sectional surveys of more than 100 000 women. Acta Obstet Gynecol Scand 2019; 99:175-185. [PMID: 31529491 DOI: 10.1111/aogs.13732] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/23/2019] [Accepted: 09/07/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sexual behavior at the population level impacts on public health. Recent representative sexual behavior data are lacking. MATERIAL AND METHODS Cross-sectional surveys in 2005 and 2012 on women age 18-45 years randomly selected from the general population in Denmark (n = 40 804), Norway (n = 30 331) and Sweden (n = 32 114). RESULTS Median (interquartile range) age at first intercourse was 16 (15-18) years in Denmark, 17 (16-18) years in Norway, and 17 (15-18) years in Sweden. Women in the most recent birth cohort had sexual debut at the lowest age, and were most likely to have sexual debut before the legal age of consent. Proportions with debut age ≤14 years among women born 1989-1994 vs 1971-1976, odds ratio (95% confidence interval) were: 18.4% vs 10.9%, 1.95 (1.74-2.18) in Denmark, 12.9% vs 6.3%, 2.38 (2.01-2.82) in Norway, 17.8% vs 11.4%, 1.75 (1.55-1.98) in Sweden. Median (interquartile range) number of lifetime sexual partners was 6 (3-10) in Denmark, 5 (2-10) in Norway, and 6 (3-11) in Sweden. The proportion of women reporting >10 sexual partners was also highest in the most recent survey. The percentage with odds ratio (95% confidence interval) in 2012 vs 2005 surveys were: 24.9% vs 22.8%, 1.13 (1.07-1.18) for Denmark; 23.8% vs 19.8%, 1.27 (1.19-1.34) for Norway; and 28.3% vs 23.8%, 1.31 (1.24-1.38) for Sweden. Similarly, the proportion of women reporting ever having had a sexually transmitted infection among women age <30 years were: 29.4% vs 26.4%, 1.21 (1.13-1.31) in Denmark, 28.9% vs 25.0%, 1.20 (1.10-1.31) in Norway, and 29.4% vs 22.2%, 1.45 (1.33-1.58) in Sweden. CONCLUSIONS Scandinavian women reported lower age at first intercourse in younger birth cohorts. Moreover, they reported more lifetime sexual partners and a higher prevalence of ever having a sexually transmitted infection in 2012 than in 2005. Our findings may inform the interpretation of trends in outcomes associated with sexual health, and public health policies.
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Affiliation(s)
- Bo T Hansen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisen Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kai-Li Liaw
- Epidemiology, Merck Sharp & Dome Corporation, Whitehouse Station, NJ, USA
| | - Kirsten E Juul
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Adhikari I, Eriksson T, Luostarinen T, Apter D, Lehtinen M. Is the risk of cervical atypia associated with the interval between menarche and the start of sexual activity? A population-based cohort study. BMJ Open 2019; 9:e030091. [PMID: 31511286 PMCID: PMC6738745 DOI: 10.1136/bmjopen-2019-030091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We investigated whether the risk of cervical atypia is associated with a short interval between the age at first sexual intercourse (FSI) or age at the start of oral contraceptive (OC) use and menarche. DESIGN A population-based cohort study. SETTING Finnish women in the age range of 16-17 years old were enrolled in the PATRICIA trial of human papillomavirus (HPV) 16/18 vaccine efficacy. PARTICIPANTS The association of cervical atypia with the interval between FSI or start of OC use and menarche was assessed in the control arm (hepatitis A vaccinated) who had participated in biannual clinical follow-up visits for 4 years. Altogether, 913 women had normal baseline cervical cytology and answered behavioural questionnaires at enrolment and end of the follow-up. MAIN OUTCOME MEASURE ORs with 95% CIs using univariate and multivariable logistic regression were used to assess the association between cervical atypia and the interval between FSI or the start of OC use and menarche. RESULTS The mean ages at menarche, FSI and the start of OC use were 12.4, 16.0 and 16.4. Chlamydiatrachomatis infection was associated with an increased risk of cervical atypia in women with a short (<3 years) interval between menarche and FSI/start of OC use (OR 1.8, 95% CI 1.0 to 3.6 and OR 2.2, 95% CI 1.0 to 5.1). Whereas HPV 16/18 infection was associated with increased atypia risk estimates in women with a longer (≥3 years) interval (OR 1.8, 95% CI 1.1 to 2.7 and OR 1.4, 95% CI 1.0 to 2.1). In women with a short interval between menarche and FSI, early age at the start of OC use was not associated with an increased risk of cervical atypia in the univariate (OR 0.7) nor multivariable analyses. CONCLUSION Short interval between menarche and the age at start of sexual activity does not increase the risk of HPV-associated cervical atypia. TRIAL REGISTRATION NUMBER NCT00122681.
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Affiliation(s)
- Indira Adhikari
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Tiina Eriksson
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Tapio Luostarinen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | | | - Matti Lehtinen
- Department of Health Sciences, Tampere University, Tampere, Finland
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24
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Lu D, Andrae B, Valdimarsdóttir U, Sundström K, Fall K, Sparén P, Fang F. Psychological distress is associated with cancer-specific mortality among patients with cervical cancer. Cancer Res 2019; 79:3965-3972. [PMID: 31253667 DOI: 10.1158/0008-5472.can-19-0116] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/08/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022]
Abstract
Emerging evidence suggests a role of psychological factors in the progression of different cancer types. However, it is unclear whether psychological distress around the time of diagnosis of invasive cervical cancer places patients at a higher risk of cancer-specific mortality, independently of tumor characteristics and treatment modalities. We conducted a nationwide cohort study, including 4,245 patients with newly diagnosed cervical cancer during 2002-2011 in Sweden. Psychological distress was indicated by a clinical diagnosis of depression, anxiety, or stress reaction and adjustment disorders, or the experience of a stressful life event, including death or severe illness of a family member, divorce, or between jobs, from one year before cancer diagnosis and onwards. We calculated the hazard ratios (HRs) of cancer-specific mortality among the patients exposed to psychological distress, compared to unexposed patients, controlling for socioeconomic characteristics and other known prognostic indicators such as tumor and treatment characteristics. We found that patients exposed to psychological distress had an increased risk of cancer-specific mortality (HR 1.33, 95% CI 1.14 to 1.54). The association was primarily driven by distress experienced within one year before or after diagnosis (HR 1.30, 95% CI 1.11 to 1.52), but not thereafter (HR 1.12, 95% CI 0.84 to 1.49). In summary, our study shows that psychiatric disorders and stressful life events around cancer diagnosis are associated with increased cancer-specific mortality among patients with cervical cancer, independent of tumor characteristics and treatment modality.
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Affiliation(s)
- Donghao Lu
- Department of Medical Epidemiology & Biostatistics, Karolinska Institute
| | - Bengt Andrae
- Dept of Medical Epidemiology and Biostatistics, Karolinska Institute
| | - Unnur Valdimarsdóttir
- Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland
| | | | | | - Pär Sparén
- Department of Medical Epidemiology & Biostatistics, Karolinska Institute
| | - Fang Fang
- Department of Medical Epidemiology & Biostatistics, Karolinska Institute
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25
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Blomberg M, Dehlendorff C, Kjaer SK. Risk of CIN2+ following a diagnosis of genital warts: a nationwide cohort study. Sex Transm Infect 2019; 95:614-618. [PMID: 31092605 DOI: 10.1136/sextrans-2019-054008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Individuals with genital warts may be particularly susceptible to human papillomavirus since they have failed to clear the virus. Consequently, women with genital warts could be at increased risk of cervical dysplasia. In this cohort study we aimed to compare the incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women with a diagnosis of genital warts with that of the general female population without genital warts. METHODS Using the Danish nationwide population-based health data registers, we identified women between 15 and 45 years and followed them for diagnoses of CIN2+ from 1995 to 2006. Genital wart diagnoses were recorded from birth, and Cox regression with attained age as underlying scale was used to estimate age-dependent HRs for the risk of CIN2+ with genital warts as a time-varying exposure. RESULTS Among 918 609 women without genital warts and 32 218 women with genital warts, 30 209 and 1533 women, respectively, had a subsequent diagnosis of CIN2+. A significantly higher risk of CIN2+ was found among women with genital warts relative to those without (HR, 2.43; 95% CI 2.30 to 2.56). Treatment-resistant genital warts posed a significantly higher risk of CIN2+ than did transient genital warts (HR, 1.20; 95% CI 1.01 to 1.43). The risks remained elevated more than 4 years after the genital wart diagnosis. CONCLUSION Clinicians should ensure that women with genital warts are screened for cervical cancer after the genital wart diagnosis and that they continue to be screened on time.
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Affiliation(s)
- Maria Blomberg
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark .,Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Juliane Marie Centre, Gynecologic Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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26
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The burden of cervical cancer in Vietnam: Synthesis of the evidence. Cancer Epidemiol 2019; 59:83-103. [DOI: 10.1016/j.canep.2018.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/19/2018] [Accepted: 11/27/2018] [Indexed: 11/17/2022]
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27
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Schilling MPR, Silva IFD, Opitz SP, Borges MFDSO, Koifman RJ, Koifman S. Beliefs about Breast Cancer among Women in the Western Amazon: A Population-Based Study. Asian Pac J Cancer Prev 2019; 20:469-478. [PMID: 30803209 PMCID: PMC6897015 DOI: 10.31557/apjcp.2019.20.2.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: Evaluate the beliefs about the risk factors for breast cancer in a population of women from the western Amazon and determine the factors associated with the higher belief scores presented by this population. Methods: A population-based cross-sectional study included 478 women aged >40 years residing in Rio Branco, Acre, Brazil. An American Cancer Society questionnaire was applied to assess the knowledge, attitudes, and beliefs about breast cancer. Results: The main beliefs about the risk factors for breast cancer were breast trauma (95%), use of underwire bra (58.5%), and a high number of sexual partners (55.5%). Women from younger age groups presented higher belief scores (Bcoefficient: –0.04, 95% CI: –0.07; –0.01) than those of women from older age groups. A strong association was noted between high knowledge scores of risk factors and signs/symptoms of the disease and high belief scores in the study group (Bcoefficient:0.33;95%CI:0.28;0.38). Conclusion: The results indicate the existence of important beliefs related to the risk factors for breast cancer. Women from younger age groups, women who have seen a gynecologist in the past 2 years, and women who had more knowledge about the risk factors and signs and symptoms of breast cancer had higher belief scores.
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Affiliation(s)
- Marla Presa Raulino Schilling
- National School of Public Health, Oswaldo Cruz Foundation, Postgraduate Program in Public Health and Environment, Brazil.
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28
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Metastatic gynecologic malignancies: advances in treatment and management. Clin Exp Metastasis 2018; 35:521-533. [PMID: 29931499 DOI: 10.1007/s10585-018-9889-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/02/2018] [Indexed: 12/27/2022]
Abstract
Gynecologic cancers comprise of mostly uterine, ovarian, and cervical malignancies and are responsible for 95,000 new cases annually in the United States. Uterine cancer is the most common and the number of new cases and mortality has been increasing. Cervical cancer has decreased due to screening, early detection, and treatment of pre-invasive cancers. However, ovarian cancer remains the most lethal because of advanced stage at diagnosis and drug resistance. The metastatic spread pattern differs amongst these cancers, with uterine and cervical cancer found mostly in the primary organ and ovarian cancer disseminating throughout the peritoneum and upper abdomen at presentation. The primary treatment of ovarian cancer typically involves surgery followed by systemic therapy for more advanced disease. Previously, systemic chemotherapy with platinums, taxanes, doxorubicin, topotecan, and gemcitabine has been the standard in either upfront or recurrent setting. With molecular and genetic breakthroughs, we now have over eight new indications and five novel biologic therapies including antiangiogenics, poly ADP ribose polymerase inhibitors, and immunotherapies approved over the last 3 years. In this review, we will examine the biology of gynecologic cancer metastasis and focus on new treatment options for these cancers with a focus on ovarian cancer.
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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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30
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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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31
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Hansen BT, Campbell S, Nygård M. Long-term incidence trends of HPV-related cancers, and cases preventable by HPV vaccination: a registry-based study in Norway. BMJ Open 2018; 8:e019005. [PMID: 29476028 PMCID: PMC5855252 DOI: 10.1136/bmjopen-2017-019005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Examine long-term incidence trends of human papillomavirus (HPV)-related cancer in Norway, and estimate the number of cancer cases preventable by vaccines against HPV 16/18 or HPV 16/18/31/33/45/52/58. DESIGN Observational registry-based study. We extracted incident cases of HPV-related cancer during 1953-2015 from the Cancer Registry of Norway. Tumour HPV prevalence estimates from large international meta-analyses or from Norway were used to estimate the protective potential of HPV vaccines. PARTICIPANTS AND SETTING The Norwegian population. PRIMARY OUTCOME MEASURES Incidence trend analyses during 1953-2015 for squamous cell carcinoma (SCC) of the cervix, vulva, vagina, oropharynx, anus and penis, and adenocarcinoma of the cervix. Additionally, the number of cancer cases preventable by HPV vaccination. RESULTS Among women, incidences of SCC of the anus, oropharynx, vulva and cervical adenocarcinoma increased, while vaginal SCC showed no trend. For these cancers combined, the average annual percentage change (AAPC) during 1953-2015 was 1.2 (95% CI 0.7 to 1.6). The incidence of cervical SCC generally decreased during 1976-2004 and remained stable thereafter. Among men, incidences of SCC of the anus, oropharynx and penis increased. The AAPC during 1953-2015 combined for all male HPV-related cancer was 1.9 (95% CI 1.3 to 2.5). A vaccine against HPV 16/18 might yearly prevent 402 (95% CI 382 to 420) cancers. A vaccine against HPV 16/18/31/33/45/52/58 might yearly prevent 478 (95% CI 464 to 490) cancers, of which 206 (95% CI 202 to 209) occur in non-cervical organs, and 113 (95% CI 110 to 115) occur among men. CONCLUSIONS The incidences of HPV-related cancers that are not effectively prevented by screening have generally increased during 1953-2015. HPV vaccination can prevent a substantial number of cancers in Norway, in cervical and non-cervical organs, among women and men.
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Affiliation(s)
- Bo T Hansen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | | | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Rothberg MB, Hu B, Lipold L, Schramm S, Jin XW, Sikon A, Taksler GB. A risk prediction model to allow personalized screening for cervical cancer. Cancer Causes Control 2018; 29:297-304. [PMID: 29450667 DOI: 10.1007/s10552-018-1013-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/09/2018] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Cervical cancer screening guidelines are in evolution. Current guidelines do not differentiate recommendations based on individual patient risk. OBJECTIVE To derive and validate a tool for predicting individualized probability of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) at a single time point, based on demographic factors and medical history. DESIGN The study design consisted of an observational cohort with hierarchical generalized linear regression modeling. SETTING The study was conducted in a setting of 33 primary care practices from 2004 to 2010. PARTICIPANTS The participants of the study were women aged ≥ 30 years. MAIN OUTCOME AND MEASURES CIN2+ was the main outcome on biopsy, and the following predictors were included: age, race, marital status, insurance type, smoking history, median income based on zip code, prior human papilloma virus (HPV) results. RESULTS The final dataset included 99,319 women. Of these, 745 (0.75%) had CIN2+. The multivariable model had a C-statistic of 0.81. All factors but race were independently associated with CIN2+. The model categorized women as having below-average CIN2+ risk (0.15% predicted vs. 0.12% observed risk), average CIN2+ risk (0.42% predicted vs. 0.36% observed), and above-average CIN2+ risk (1.76% predicted vs. 1.85% observed). Before screening, women at below-average risk had a risk of CIN2+ well below that of women with ASCUS and HPV negative (0.12 vs. 0.20%). CONCLUSIONS AND RELEVANCE A multivariable model using data from the electronic health record was able to stratify women across a 50-fold gradient of risk for CIN2+. After further validation, use of a similar model could enable more targeted cervical cancer screening.
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Affiliation(s)
- Michael B Rothberg
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. .,Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Bo Hu
- Quantitative Health Sciences Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Laura Lipold
- Department of Family Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Schramm
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Xian Wen Jin
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Andrea Sikon
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Glen B Taksler
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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High proportion of abnormal pap smear tests and cervical dysplasia in women with cystic fibrosis. Eur J Obstet Gynecol Reprod Biol 2018; 221:40-45. [DOI: 10.1016/j.ejogrb.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
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HPV Unvaccinated Status and HPV Sexual Risk Behaviour are Common among Canadian Young Adult Women and Men. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:410-417. [PMID: 29276162 DOI: 10.1016/j.jogc.2017.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The current research focuses on sexual risk behaviour among young adult Canadians who have not been vaccinated against HPV. METHODS Six hundred and forty-six Canadian university undergraduates completed a self-administered survey assessing HPV vaccination status and sexual risk behaviour. RESULTS Five hundred and thirty-seven participants (154 men and 383 women aged 17-23) who met eligibility criteria were analyzed. 48.5% (n = 185) of female and 89.6% (n = 138) of male participants had not been vaccinated against HPV. In the unvaccinated cohort, 51.4% (n = 95) of women were coitally experienced, 49.2% (n = 91) reported experience with oral sex, and 6.5% (n = 12) reported experience with receptive anal intercourse. 55.1% (n = 76) of men were coitally experienced, 22.5% (n = 31) of men reported receptive oral sex, and 2.9% (n = 4) of men reported receptive anal intercourse. Using validated sexual risk behaviour cut-offs, we determined that in the female unvaccinated population, the proportion at significantly increased risk for genital warts, cervical, anal, and oropharyngeal cancer was 11.0%, 30.0%, 6.5%, and 49.2% respectively. In the male unvaccinated population, the proportion at significantly elevated risk for genital warts and anal cancer was 27.2% and 2.9% respectively. CONCLUSION Unvaccinated young Canadian women and men commonly engaged in sexual risk behaviours for HPV infection, engaged in sexual risk behaviours at a similar level as their vaccinated counterparts, and a substantial number were at elevated risk of HPV related morbidities at a young age. Findings contribute to an evidence-based case for redoubling efforts to encourage HPV vaccination among unvaccinated young Canadians who are at risk of HPV infection.
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Ingabire C, Lim MK, Won YJ, Oh JK. Human Papillomavirus Genotype-Specific Persistence and Potential Risk Factors among Korean Women: Results from a 2-Year Follow-up Study. Cancer Res Treat 2017; 50:813-822. [PMID: 28814070 PMCID: PMC6056951 DOI: 10.4143/crt.2017.340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/08/2017] [Indexed: 01/17/2023] Open
Abstract
Purpose High-risk human papillomavirus (HPV) infection progression should be considered a critical factor for preventing cervical cancer, although most infections are transient and rarely persist. This study aimed to examine the specific types of HPV infections, their change patterns, and the potential risk factors among Korean women. Materials and Methods We included 4,588 women who visited hospitals in Busan and Suwon for cervical cancer screening, and 1,224 of thesewomen attended a 2-yearfollow-up. Infection statuswas evaluated using HPV DNA testing (Hybrid Capture 2) and genotyping testing (Linear Array). Data regarding the potential risk factors for HPV infection were collected by trained nurses using structured questionnaires. Results Among the 1,224 women (mean age, 47 years), 105 women (8.6%) were HPV-positive at baseline. HPV infections had been cleared among 92 women (87.6%) within 2 years. Only 13 infections (12.4%) were remained, and the 10 cases of them are high-risk HPV types including genotype 33, 45, 16, 35, and 52. Among women who were negative at baseline, the HPV incidence was 4.8%. The HPV incidence was marginally associated with having multiple sexual partners (odds ratio, 2.0; 95% confidence interval, 1.0 to 3.9), although it was not significantly associated with HPV persistence. Conclusion Most HPV infections (88%) among Korean women were cleared within 2 years, with only a small number of persistent infections. The persistent HPV genotypes were different in our study, compared to those from previous studies. Having multiple sexual partners was associated with acquiring a HPV infection, but not with persistence.
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Affiliation(s)
- Cecile Ingabire
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Min Kyung Lim
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,Cancer Risk Appraisal and Prevention Branch, Division of Cancer Prevention, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,Cancer Registration and Statistics Branch, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,Cancer Risk Appraisal and Prevention Branch, Division of Cancer Prevention, National Cancer Center, Goyang, Korea
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Rousselin A, Dion L, Racin A, Lavoué V, Levêque J, Nyangoh Timoh K. [Pap smear before 25 years old]. ACTA ACUST UNITED AC 2017; 45:309-315. [PMID: 28479075 DOI: 10.1016/j.gofs.2017.03.003] [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: 12/28/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Current French recommendations advocate cervical-vaginal screening for cervical cancer from age 25 whereas earlier screening is mostly found in current clinical practice although its consequences are not well understood. METHODS A literature review using the MedLine database on the natural history of HPV infections, cytological screening, management of cytological and histological anomalies in adolescents and young women. RESULTS The adolescent and young woman have some characteristics that distinguish them from adult women: a high prevalence of HPV infections (making the use of the HPV test unprofitable), accompanied by a higher clearance; frequency of minor cytological abnormalities (for which a cytological surveillance without colposcopy is sufficient) and low-grade histological lesions of low grade the usual prognosis of which is complete recovery; and rarity of CIN3 lesions and absence of invasive lesions, allowing no treatment in patients with CIN2 lesions and compliant to cytological and colposcopic surveillance. CONCLUSION Cervical screening in the adolescent and young woman is not a logical attitude and the discovery of cytological or histological lesions requires specific behavior in this particular population.
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Affiliation(s)
- A Rousselin
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
| | - L Dion
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
| | - A Racin
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
| | - V Lavoué
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
| | - J Levêque
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France.
| | - K Nyangoh Timoh
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
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Dickinson JA, Ogilvie G, Van Niekerk D, Popadiuk C. Evidence that supports policies to delay cervical screening until after age 25 years. CMAJ 2017; 189:E380-E381. [PMID: 28385818 DOI: 10.1503/cmaj.160636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- James A Dickinson
- Family Medicine and Community Health Sciences (Dickinson), University of Calgary, Calgary, Alta; Faculty of Medicine, The University of British Columbia, and Women's Health Research Institute, BC Centre for Disease Control (Ogilvie); Department of Pathology, The University of British Columbia, and Cervical Screening Program of the British Columbia Cancer Agency (Van Niekerk), Vancouver, BC; Department of Obstetrics and Gynecology, Faculty of Medicine, Memorial University, and Provincial Cervical Screening Initiative Program (Popadiuk), St. John's, NL
| | - Gina Ogilvie
- Family Medicine and Community Health Sciences (Dickinson), University of Calgary, Calgary, Alta; Faculty of Medicine, The University of British Columbia, and Women's Health Research Institute, BC Centre for Disease Control (Ogilvie); Department of Pathology, The University of British Columbia, and Cervical Screening Program of the British Columbia Cancer Agency (Van Niekerk), Vancouver, BC; Department of Obstetrics and Gynecology, Faculty of Medicine, Memorial University, and Provincial Cervical Screening Initiative Program (Popadiuk), St. John's, NL
| | - Dirk Van Niekerk
- Family Medicine and Community Health Sciences (Dickinson), University of Calgary, Calgary, Alta; Faculty of Medicine, The University of British Columbia, and Women's Health Research Institute, BC Centre for Disease Control (Ogilvie); Department of Pathology, The University of British Columbia, and Cervical Screening Program of the British Columbia Cancer Agency (Van Niekerk), Vancouver, BC; Department of Obstetrics and Gynecology, Faculty of Medicine, Memorial University, and Provincial Cervical Screening Initiative Program (Popadiuk), St. John's, NL
| | - Cathy Popadiuk
- Family Medicine and Community Health Sciences (Dickinson), University of Calgary, Calgary, Alta; Faculty of Medicine, The University of British Columbia, and Women's Health Research Institute, BC Centre for Disease Control (Ogilvie); Department of Pathology, The University of British Columbia, and Cervical Screening Program of the British Columbia Cancer Agency (Van Niekerk), Vancouver, BC; Department of Obstetrics and Gynecology, Faculty of Medicine, Memorial University, and Provincial Cervical Screening Initiative Program (Popadiuk), St. John's, NL
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Muwonge R, Ngo Mbus L, Ngoma T, Gombe Mbalawa C, Dolo A, da Ganda Manuel M, Nouhou H, Nacoulma M, Mwaiselage J, Koulibaly M, Bayo S, Nsonde Malanda J, De Vuyst H, Herrero R, Sankaranarayanan R, Keita N. Socio-demographic and reproductive determinants of cervical neoplasia in seven sub-Sahara African countries. Cancer Causes Control 2016; 27:1437-1446. [PMID: 27822586 DOI: 10.1007/s10552-016-0823-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since most human papilloma virus (HPV) infections regress without any intervention, HPV is a necessary but may not be a solely sufficient cause of cervical intraepithelial neoplasia (CIN) and cervical cancer. Hence, the influence of cofactors on progression from cervical HPV infection to high-grade CIN and invasive cervical cancer has been a subject of intensive research. OBJECTIVE We assessed the effect of socio-demographic and sexual reproductive factors on the prevalence of invasive cervical cancer and CIN diagnosed in cross-sectional cervical cancer screening projects carried out in seven sites of different sub-Saharan countries. METHODS Between January 2000 and August 2007, healthy women aged 25-59 who participated in the screening projects were interviewed for socio-demographic, reproductive, and behavioral characteristics, investigated for disease confirmation with colposcopy, and had biopsies directed from colposcopically abnormal areas by trained local physicians. Odds ratios (ORs) and their 95% confidence intervals (CIs) from logistic regression analyses were used to assess the effect of women characteristics on CIN 1, CIN 2-3, CIN 3, and invasive cancer outcome measures. RESULTS Among 47,361 women screened and investigated for disease confirmation, CIN 1 was diagnosed in 1,069 (2.3%), CIN 2 in 517 (1.1%), CIN 3 in 175 (0.5%), and invasive cancer in 485 (1.0%). The site-specific prevalence of CIN 2-3 lesions ranged from 0.3 to 5.1% and from 0.2 to 1.9% for invasive cancers. Risk factors for CIN 2-3 were being widowed or separated versus currently married (OR 1.3, 95% CI 1.0-1.7 a); and having had at least four pregnancies versus zero or one pregnancy (OR at least 1.4-fold, 95% CI 1.1-1.8). Risk factors for invasive cancer were being widowed or separated versus currently married (OR 2.0, 95% CI 1.3-3.1); and having had at least three pregnancies versus zero or one pregnancy (OR at least 3.0-fold, 95% CI 2.1-4.2). Additionally, cervical cancer risk increased with increasing age, age at menarche, and age at marriage, while the risk decreased with increasing level of education and in those with some form of employment compared to housewives. CONCLUSION The exposure of the exocervix and/or the increased levels of estrogen and progesterone for more prolonged periods during pregnancy in multiparous women and the vulnerability of widowed/separated women in society might result in increased risk of cervical neoplasia more so among women exposed to HPV infection. High parity probably explains the persistently high rates of cervical cancer in sub-Saharan Africa.
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Affiliation(s)
- Richard Muwonge
- Screening Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
| | - Louise Ngo Mbus
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Twalib Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Amadou Dolo
- Département de Gynécologie-Obstétrique, Hôpital Gabriel Touré, Bamako, Mali
| | | | - Hassan Nouhou
- Faculté des Sciences de la Santé, Université de Niamey, Niamey, Niger
| | - Marius Nacoulma
- Département de Gynécologie-Obstétrique, Centre Hospitalier National Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Julius Mwaiselage
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | - Moussa Koulibaly
- Centre National d'Anatomie Pathologique, CHU Donka, Conakry, Guinea
| | | | | | - Hugo De Vuyst
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Namory Keita
- Service de Gynécologie/Obstétrique, CHU Donka, Conakry, Guinea
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Audi CAF, Santiago SM, Andrade MDGG, Francisco PMSB. Pap smear in incarcerated women. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 19:675-678. [PMID: 27849280 DOI: 10.1590/1980-5497201600030017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/16/2015] [Indexed: 11/21/2022] Open
Abstract
In Brazil, in 2012, 6.4% of the prison population was made up of women. The aim of the study was to verify the coverage of the Pap smear according to sociodemographic characteristics and health problems reported among incarcerated women. Cross-sectional study conducted from August 2012 to July 2013, considering the records of 702 inmates aged between 25 and 64 years and the duration of imprisonment (not less than 12 months). The average age of the women surveyed was 34.7 years. The performance of cervical cytology was reported by 26.3% of inmates. There were no difference in prevalence according to selected variables. The containment condition enables the implementation of preventive measures such as offering and realization of Pap smear for most inmates. The observed results are worrying and differ significantly from those presented in the national diagnosis on the health of incarcerated women.
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Affiliation(s)
- Celene Aparecida Ferrari Audi
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Campinas (SP), Brasil
| | - Silvia Maria Santiago
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Campinas (SP), Brasil
| | - Maria da Graça Garcia Andrade
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Campinas (SP), Brasil
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Bezabih M, Tessema F, Sengi H, Deribew A. Risk Factors Associated with Invasive Cervical Carcinoma among Women Attending Jimma University Specialized Hospital, Southwest Ethiopia: A Case Control Study. Ethiop J Health Sci 2016; 25:345-52. [PMID: 26949299 PMCID: PMC4762973 DOI: 10.4314/ejhs.v25i4.8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Cervical cancer is a more serious public health problem than other cancers in women in Sub-Saharan Africa in general and in Ethiopia in particular. Thus, this study assessed risk factors related to invasive cervical carcinomas in southwestern Ethiopia. Methods Unmatched case control study was conducted in Jimma University Specialized Hospital from April 1 to September 30, 2010. The study consisted of 60 cases (women who had cervical cancers based on histopathologic examination) and 120 controls (women with no cervical cancers). Semi-structured questionnaire was utilized for data collection. Vaginal examinations often visualized with speculum insertions were done for both cases and controls. Punch cervical biopsies were then performed for the suspected cases at Jimma University Hospital that serves about 15 million people in a catchment radius of 250 kms. Data were analyzed using SPSS version 13.0 software. Univariate and multivariate analyes were done to describe and identify independent predictors of cervical cancer. Results The mean ages of cases and controls were 47.7 (SD=10.8) and 35.5 (SD =10.5) years respectively. Older women (40–59 years), (OR= 4.7; 95%CI= 2.3–9.6), more than one husband (OR= 2.0; 95%CI=1.0–3.9), as well as more than one wife in lifetime, (OR= 3.0; 95% CI= 1.5–5.9), women who had more than 4 children, (OR =10.3, 95% CI= 3.6–29.0), and age greater than 25 years at first full term delivery, (OR= 8.8; 95% CI= 3.5–22.0) were statistically significant and the latter two were independently associated with invasive cervical cancer. Only 7(11.7 %) of cases and 58(48.3%) of controls ever heard of cervical cancers; however, 2(3.3%) of cases and 7(5.8%) of controls had ever had history of papaneocolous (pap) smear tests done. Conclusion Poor knowledge on cervical cancer was observed that required more work to be done to increase knowledge of mothers on cervical cancer and on associated risk factors. Behavioral communication activities and establishment of cervical cancer screening programs for the young could help reduce the advancement of cervical cancer particularly among the less knowledgeable, older and grand multiparous women in our parts of the world.
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Affiliation(s)
- Mesele Bezabih
- Department of Medical laboratory Sciences and Pathology, Jimma University, Ethiopia
| | - Fasil Tessema
- Department of Epidemiology and Biostatistics, Jimma University, Ethiopia
| | | | - Amare Deribew
- Department of Epidemiology and Biostatistics, Jimma University, Ethiopia
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Skinner SR, Wheeler CM, Romanowski B, Castellsagué X, Lazcano-Ponce E, Del Rosario-Raymundo MR, Vallejos C, Minkina G, Pereira Da Silva D, McNeil S, Prilepskaya V, Gogotadze I, Money D, Garland SM, Romanenko V, Harper DM, Levin MJ, Chatterjee A, Geeraerts B, Struyf F, Dubin G, Bozonnat MC, Rosillon D, Baril L. Progression of HPV infection to detectable cervical lesions or clearance in adult women: Analysis of the control arm of the VIVIANE study. Int J Cancer 2016; 138:2428-38. [PMID: 26685704 PMCID: PMC4787275 DOI: 10.1002/ijc.29971] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 11/03/2015] [Accepted: 11/13/2015] [Indexed: 11/23/2022]
Abstract
The control arm of the phase III VIVIANE (Human PapillomaVIrus: Vaccine Immunogenicity ANd Efficacy; NCT00294047) study in women >25 years was studied to assess risk of progression from cervical HPV infection to detectable cervical intraepithelial neoplasia (CIN). The risk of detecting CIN associated with the same HPV type as the reference infection was analysed using Kaplan–Meier and multivariable Cox models. Infections were categorised depending upon persistence as 6‐month persistent infection (6MPI) or infection of any duration. The 4‐year interim analysis included 2,838 women, of whom 1,073 (37.8%) experienced 2,615 infections of any duration and 708 (24.9%) experienced 1,130 6MPIs. Infection with oncogenic HPV types significantly increased the risk of detecting CIN grade 2 or greater (CIN2+) versus non‐oncogenic types. For 6MPI, the highest risk was associated with HPV‐33 (hazard ratio [HR]: 31.9 [8.3–122.2, p < 0.0001]). The next highest risk was with HPV‐16 (21.1 [6.3–70.0], p < 0.0001). Similar findings were seen for infections of any duration. Significant risk was also observed for HPV‐18, HPV‐31, and HPV‐45. Concomitant HPV infection or CIN grade 1 or greater associated with a different oncogenic HPV type increased risk. Most women (79.3%) with an HPV infection at baseline cleared detectable infections of any duration, and 69.9% cleared a 6MPI. The risk of progression of HPV infection to CIN2+ in women >25 years in this study was similar to that in women 15–25 years in PATRICIA. What's New? Which HPV infections lead to cancer in women over 25 years? Most cervical cancer follows persistent oncogenic HPV infection, but most HPV infections clear naturally. Thus, to best predict patient outcomes, it's imperative to understand how HPV infections progress to CINs. This study confirmed that in women over 25 years, persistent infection with HPV‐33 or HPV‐16 meant the greatest chance of developing a CIN—the same as was found in women 15–25 years, in an earlier analysis.
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Affiliation(s)
- S Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, WA and Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain
| | | | | | | | | | | | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Center and Capital Health, Dalhousie University, Halifax, NS, Canada
| | - Vera Prilepskaya
- Scientific Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | | | - Deborah Money
- University of British Columbia, The Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville/Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Children's Research Institute, Parkville/Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | | | - Diane M Harper
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA and University of Louisville School of Medicine, Louisville, KT, USA
| | - Myron J Levin
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Archana Chatterjee
- Department of Pediatrics, University of South Dakota Sanford School of Medicine/Sanford Children's Specialty Clinic, Sioux Falls, SD, USA
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Liu ZC, Liu WD, Liu YH, Ye XH, Chen SD. Multiple Sexual Partners as a Potential Independent Risk Factor for Cervical Cancer: a Meta-analysis of Epidemiological Studies. Asian Pac J Cancer Prev 2016; 16:3893-900. [PMID: 25987056 DOI: 10.7314/apjcp.2015.16.9.3893] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
It's known that having multiple sexual partners is one of the risk factors of human papillomavirus (HPV) infection which is a major cause of cervical cancer. However, it is not clear whether the number of sexual partners is an independent risk factor for cervical cancer. We identified relevant studies by searching the databases of MEDLINE, PubMed and ScienceDirect published in English from January 1980 to January 2014. We analyzed those studies by combining the study-specific odds ratios (ORs) using random-effects models. Forty-one studies were included in this meta-analysis. We observed that the number of sexual partners was associated with the occurrence of non-malignant cervical disease (OR=1.82, 95%CI 1.63-2.00) and invasive cervical carcinoma (OR=1.77, 95%CI 1.50-2.05). Subgroup analyses revealed that the association remained significant after controlling for HPV infection (OR=1.52, 95%CI 1.21-1.83 for non-malignant disease; OR=1.53, 95%CI 1.30- 1.76 for invasive cervical carcinoma). We found that there was a non-linear relation of the number of sexual partners with both non-malignant cervical disease and invasive cervical carcinoma. The risk of both malignant and non-malignant disease is relatively stable in women with more than 4-7 sexual partners. Furthermore, the frequency-risk of disease remained significant after controlling for HPV infection.The study suggested that having multiple sexual partners, with or without HPV infection, is a potential risk factor of cervical cancer.
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Affiliation(s)
- Zhi-Chang Liu
- School of Public Health, Guangdong Key Laboratory of Molecular Epidemiology, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China E-mail : ,
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Franceschi S, Vaccarella S. Beral's 1974 paper: A step towards universal prevention of cervical cancer. Cancer Epidemiol 2015; 39:1152-6. [PMID: 26514971 DOI: 10.1016/j.canep.2015.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022]
Abstract
In 1974, Valerie Beral published a landmark paper on the sexually transmitted origin of cervical cancer (CC) using statistics routinely available in the United Kingdom (UK). Among women born between 1902 and 1947, CC mortality rates correlated remarkably well with the incidence rates of gonorrhoea when they were 20 years old and both were highest among women born after 1940. Hence, if CC prevention and treatment had remained unchanged, the youngest generations of women would have experienced a high risk of CC death as they grew older. Fortunately, progress in CC prevention has helped avoid this scenario. The adverse consequences of the "sexual revolution" were greatly mitigated in the UK and other high-resource countries by the implementation of high quality cytology-based CC screening. An age-period-cohort analysis suggests that >30,000 cases or approximately 35% of expected CC cases may have been prevented by screening programmes in the UK between 1983 and 2007 and this percentage has been steadily increasing. In addition, the discovery of the causal role of HPV is reshaping primary and secondary prevention of CC. Cheaper HPV tests are becoming available and HPV-based primary screening may at last facilitate CC screening in low-resource countries. In the long-term, however, HPV vaccination, which has already been adopted by many countries, represents the best hope for preventing CC and overcoming socio-economic differences in CC risk within and across countries. The additional elucidation of HPV cofactors to which Beral has greatly contributed may also help control HPV infection in unvaccinated women.
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Affiliation(s)
- Silvia Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
| | - Salvatore Vaccarella
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
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Papoutsis D, Underwood M, Parry-Smith W, Panikkar J. Risk factors for treatment failure following cold coagulation cervical treatment for CIN pathology: a cohort-based study. Arch Gynecol Obstet 2015; 292:1329-37. [DOI: 10.1007/s00404-015-3761-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/13/2015] [Indexed: 01/08/2023]
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Vukovic D, Antic L, Vasiljevic M, Antic D, Matejic B. Development of a risk index for prediction of abnormal pap test results in Serbia. Asian Pac J Cancer Prev 2015; 16:3527-31. [PMID: 25921173 DOI: 10.7314/apjcp.2015.16.8.3527] [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
BACKGROUND Serbia is one of the countries with highest incidence and mortality rates for cervical cancer in Central and South Eastern Europe. Introducing a risk index could provide a powerful means for targeting groups at high likelihood of having an abnormal cervical smear and increase efficiency of screening. The aim of the present study was to create and assess validity ofa index for prediction of an abnormal Pap test result. MATERIALS AND METHODS The study population was drawn from patients attending Departments for Women's Health in two primary health care centers in Serbia. Out of 525 respondents 350 were randomly selected and data obtained from them were used as the index creation dataset. Data obtained from the remaining 175 were used as an index validation data set. RESULTS Age at first intercourse under 18, more than 4 sexual partners, history of STD and multiparity were attributed statistical weights 16, 15, 14 and 13, respectively. The distribution of index scores in index-creation data set showed that most respondents had a score 0 (54.9%). In the index-creation dataset mean index score was 10.3 (SD-13.8), and in the validation dataset the mean was 9.1 (SD=13.2). CONCLUSIONS The advantage of such scoring system is that it is simple, consisting of only four elements, so it could be applied to identify women with high risk for cervical cancer that would be referred for further examination.
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Affiliation(s)
- Dejana Vukovic
- University of Belgrade, Faculty of Medicine, Institute for Social Medicine, Serbia E-mail :
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South African National Cancer Registry: Effect of withheld data from private health systems on cancer incidence estimates. S Afr Med J 2015; 105:107-9. [PMID: 26242527 DOI: 10.7196/samj.8858] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The National Cancer Registry (NCR) was established as a pathology-based cancer reporting system. From 2005 to 2007, private health laboratories withheld cancer reports owing to concerns regarding voluntary sharing of patient data. OBJECTIVES To estimate the impact of under-reported cancer data from private health laboratories. METHODS A linear regression analysis was conducted to project expected cancer cases for 2005-2007. Differences between actual and projected figures were calculated to estimate percentage under-reporting. RESULTS The projected NCR case total varied from 53,407 (3.8% net increase from actual cases reported) in 2005 to 54,823 (3.7% net increase) in 2007. The projected number of reported cases from private laboratories in 2005 was 26,359 (19.7% net increase from actual cases reported), 27,012 (18.8% net increase) in 2006 and 27,666 (28.4% net increase) in 2007. CONCLUSION While private healthcare reporting decreased by 28% from 2005 to 2007, this represented a minimal impact on overall cancer reporting (net decrease of <4%).
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Castellsagué X, Paavonen J, Jaisamrarn U, Wheeler CM, Skinner SR, Lehtinen M, Naud P, Chow SN, Del Rosario-Raymundo MR, Teixeira JC, Palmroth J, de Carvalho NS, Germar MJV, Peters K, Garland SM, Szarewski A, Poppe WAJ, Romanowski B, Schwarz TF, Tjalma WAA, Bosch FX, Bozonnat MC, Struyf F, Dubin G, Rosillon D, Baril L. Risk of first cervical HPV infection and pre-cancerous lesions after onset of sexual activity: analysis of women in the control arm of the randomized, controlled PATRICIA trial. BMC Infect Dis 2014; 14:551. [PMID: 25927224 PMCID: PMC4251672 DOI: 10.1186/s12879-014-0551-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More information is needed about time between sexual initiation and human papillomavirus (HPV) infection and development of cervical precancer. METHODS The objectives were to investigate the time between first sexual activity and detection of first cervical HPV infection or development of first cervical intraepithelial neoplasia (CIN), and associated factors in women from the double-blind, multinational, 4-year PATRICIA trial. PATRICIA enroled women aged 15-25 years with no more than 6 lifetime sexual partners. Women were randomized 1:1 to the HPV-16/18 AS04-adjuvanted vaccine or to control, but only women from the control arm who began sexual intercourse during the study or within 6 months before enrolment, and had no HPV infection detected before the recorded date of their first sexual intercourse, were included in the present analysis. The time between onset of sexual activity and detection of the first cervical HPV infection or development of the first CIN lesion was analyzed using Kaplan-Meier and univariate and multivariable Cox proportional-hazards models. RESULTS A total of 9337 women were enroled in the control arm of PATRICIA of whom 982 fulfilled the required inclusion criteria for analysis. A cumulative total of 28%, 44%, and 62% of the subjects had HPV infection within 12, 24, and 48 months, respectively. The overall incidence rate was 27.08 per 100 person-years. The most common oncogenic types associated with 6-month persistent infection were HPV-16 (incidence rate: 2.74 per 100 person-years), HPV-51 (2.70), HPV-52 (1.66), HPV-66 (1.14), and HPV-18 (1.09). Increased infection risk was associated with more lifetime sexual partners, being single, Chlamydia trachomatis history, and duration of hormone use. CIN1+ and CIN2+ lesions were most commonly associated with HPV-16, with an overall incidence rate of 1.87 and 1.07 per 100 person-years, respectively. Previous cervical HPV infection was most strongly associated with CIN development. CONCLUSIONS More than 25% of women were infected with HPV within 1 year of beginning sexual activity. Without underestimating the value of vaccination at older ages, our findings emphasize its importance before sexual initiation. TRIAL REGISTRATION clinicaltrials.gov: NCT00122681 .
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Affiliation(s)
- Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Avda. Gran via 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland.
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - S Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, WA and Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, NSW, Australia.
| | - Matti Lehtinen
- University of Tampere, School of Public Health, Tampere, Finland.
| | - Paulo Naud
- Hospital de Clínicas de Porto Alegre, Department of Gynecology & Obstetrics Federal University of Rio Grande do Sul - UFRGS/HCPA, Porto Alegre, Brazil.
| | - Song-Nan Chow
- Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
| | | | - Julio C Teixeira
- Departamento de Tocoginecologia da Unicamp, University of Campinas, Campinas, Sao Paulo, Brazil.
| | - Johanna Palmroth
- Central Hospital of North Carelian, Department of Obstetrics and Gynecology, Joensuu, Finland.
| | - Newton S de Carvalho
- Department of Gynecology and Obstetrics, Federal University of Paraná, Infectious Diseases in Gynecology and Obstetrics Sector, Curitiba, Parana, Brazil.
| | - Maria Julieta V Germar
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippines General Hospital, Manila, Philippines.
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg, Germany.
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville/Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Children's Research Institute, Parkville/Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Willy A J Poppe
- Department of Gynaecology, University Hospital KU Leuven Gasthuisberg, Leuven, Belgium.
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Tino F Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany.
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic and Gynaecological Oncology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium.
| | - F Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Avda. Gran via 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. .,Network on Cooperative Cancer Research, RTICC, Catalonia, Spain.
| | | | | | - Gary Dubin
- GlaxoSmithKline Vaccines, King of Prussia, PA, USA.
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Antic LG, Vukovic DS, Vasiljevic MD, Antic DZ, Aleksopulos HG. Differences in risk factors for cervical dysplasia with the applied diagnostic method in Serbia. Asian Pac J Cancer Prev 2014; 15:6697-701. [PMID: 25169511 DOI: 10.7314/apjcp.2014.15.16.6697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the etiology of cervical cancer not only HPV infection is important, but also other factors such as demographic influences and sexual and reproductive health attitudes, as well as others related to preventive measure usage (or non usage). The aim of this study was to examine factors associated with cervical dysplasia in asymptomatic women who were examined by routine cytology and cervical biopsy for early detection of cervical cancer. MATERIALS AND METHODS Socio-demographic and other characteristics were obtained from medical files of 85 examinees with pathologic cytologic findings (Pap test) and histopathologic (HP) findings after biopsy. RESULTS According to the Pap test result, a greater probability for development of cervical dysplasia was noted with examinees having a larger number of sexual partners (OR= 5.01, 95% CI 1.04-24.10), and those who are afraid of the Pap finding. Risk factors for development of cervical dysplasia according to the bioptic finding were early beginning with sexual activities, presence of any STD in personal medical history and fear of the Pap test finding. CONCLUSIONS The only risk factor found to be important for both methods was fear of the Pap testing finding.
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Affiliation(s)
- Ljiljana Gojko Antic
- Department for Medical Nurses-Midwives, College of Health Studies in Cuprija, Cuprija, Serbia E-mail :
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Silva DSMD, Silva AMN, Brito LMO, Gomes SRL, Nascimento MDDSB, Chein MBDC. Rastreamento do câncer do colo do útero no Estado do Maranhão, Brasil. CIENCIA & SAUDE COLETIVA 2014; 19:1163-70. [DOI: 10.1590/1413-81232014194.00372013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/27/2013] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi analisar o rastreamento do câncer do colo do útero no Maranhão, através dos dados do Sistema de Informação do Câncer do Colo do Útero (Siscolo). Foi realizado um estudo descritivo retrospectivo, com dados secundários dos 139.505 exames citopatológicos registrados no Siscolo do Maranhão, no ano de 2011. As variáveis: idade, escolaridade, adequabilidade do material, epitélios representados, microbiologia e alterações celulares detectadas ao exame citopatológico foram selecionadas. A faixa etária entre 25 a 29 anos e o ensino fundamental incompleto foram os mais frequentes. Os agentes microbiológicos mais comuns foram os bacilos (52,8%), cocos (45,5%) e Lactobacillus sp (32,6%). A inflamação foi a alteração celular benigna mais frequente (86,3%). As lesões intraepiteliais de baixo grau foram as atipias em células escamosas mais prevalentes (0,6%), seguidas pela lesão intraepitelial de alto grau (0,2%). O carcinoma epidermoide foi observado em 0,003% e o adenocarcinoma em 0,006%. O Siscolo revelou-se uma ferramenta útil para conhecer aspectos relacionados ao rastreamento do câncer do colo uterino, o que poderá guiar ações para reduzir a incidência e mortalidade por este câncer.
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Jaisamrarn U, Castellsagué X, Garland SM, Naud P, Palmroth J, Del Rosario-Raymundo MR, Wheeler CM, Salmerón J, Chow SN, Apter D, Teixeira JC, Skinner SR, Hedrick J, Szarewski A, Romanowski B, Aoki FY, Schwarz TF, Poppe WAJ, Bosch FX, de Carvalho NS, Germar MJ, Peters K, Paavonen J, Bozonnat MC, Descamps D, Struyf F, Dubin GO, Rosillon D, Baril L. Natural history of progression of HPV infection to cervical lesion or clearance: analysis of the control arm of the large, randomised PATRICIA study. PLoS One 2013; 8:e79260. [PMID: 24260180 PMCID: PMC3834039 DOI: 10.1371/journal.pone.0079260] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/25/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The control arm of PATRICIA (PApilloma TRIal against Cancer In young Adults, NCT00122681) was used to investigate the risk of progression from cervical HPV infection to cervical intraepithelial neoplasia (CIN) or clearance of infection, and associated determinants. METHODS AND FINDINGS Women aged 15-25 years were enrolled. A 6-month persistent HPV infection (6MPI) was defined as detection of the same HPV type at two consecutive evaluations over 6 months and clearance as ≥2 type-specific HPV negative samples taken at two consecutive intervals of approximately 6 months following a positive sample. The primary endpoint was CIN grade 2 or greater (CIN2+) associated with the same HPV type as a 6MPI. Secondary endpoints were CIN1+/CIN3+ associated with the same HPV type as a 6MPI; CIN1+/CIN2+/CIN3+ associated with an infection of any duration; and clearance of infection. The analyses included 4825 women with 16,785 infections (3363 women with 6902 6MPIs). Risk of developing a CIN1+/CIN2+/CIN3+ associated with same HPV type as a 6MPI varied with HPV type and was significantly higher for oncogenic versus non-oncogenic types. Hazard ratios for development of CIN2+ were 10.44 (95% CI: 6.96-15.65), 9.65 (5.97-15.60), 5.68 (3.50-9.21), 5.38 (2.87-10.06) and 3.87 (2.38-6.30) for HPV-16, HPV-33, HPV-31, HPV-45 and HPV-18, respectively. HPV-16 or HPV-33 6MPIs had ~25-fold higher risk for progression to CIN3+. Previous or concomitant HPV infection or CIN1+ associated with a different HPV type increased risk. Of the different oncogenic HPV types, HPV-16 and HPV-31 infections were least likely to clear. CONCLUSIONS Cervical infections with oncogenic HPV types increased the risk of CIN2+ and CIN3+. Previous or concomitant infection or CIN1+ also increased the risk. HPV-16 and HPV-33 have by far the highest risk of progression to CIN3+, and HPV-16 and HPV-31 have the lowest chance of clearance.
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Affiliation(s)
- Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO), IDIBELL, CIBER-ESP, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Suzanne M. Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville/Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Childrens Research Institute, Parkville/Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Paulo Naud
- Department of Gynecology & Obstetrics, Federal University of Rio Grande do Sul, UFRGS/HCPA - Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Johanna Palmroth
- Central Hospital of North Carelian, Department of Obstetrics and Gynecology, Joensuu, Finland
| | | | - Cosette M. Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Morelos, Mexico
| | - Song-Nan Chow
- Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan
| | - Dan Apter
- Family Federation of Finland, Sexual Health Clinic, Helsinki, Finland
| | - Julio C. Teixeira
- Departamento de Tocoginecologia da Unicamp, University of Campinas, Campinas, Sao Paulo, Brazil
| | - S. Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, Western Australia
- Sydney University Discipline of Paediatrics and Child Health, Children’s Hospital, Westmead, Sydney, New South Wales, Australia
| | - James Hedrick
- Kentucky Pediatric and Adult Research, Bardstown, Kentucky, United States of America
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fred Y. Aoki
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tino F. Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany
| | - Willy A. J. Poppe
- Department of Gynaecology, University Hospital KU Leuven Gasthuisberg, Leuven, Belgium
| | - F. Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO), IDIBELL, CIBER-ESP, L’Hospitalet de Llobregat, Catalonia, Spain
- Network on Cooperative Cancer Research, RTICC, Catalonia, Spain
| | - Newton S. de Carvalho
- Department of Gynecology and Obstetrics, Federal University of Paraná, Infectious Diseases in Gynecology and Obstetrics Sector, Curitiba, Parana, Brazil
| | - Maria Julieta Germar
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg, Germany
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland
| | | | | | | | - Gary O. Dubin
- GlaxoSmithKline Vaccines, King of Prussia, Pennsylvania, United States of America
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