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Nguyen P, Calderon-Mora J, Singh V, Hernandez A, Roy S, Molokwu J. Impact of the COVID-19 pandemic on HPV vaccine uptake in a predominantly Hispanic Border Community: A retrospective cross-sectional analysis of the "Tiempo de Vacunarte Program". Arch Public Health 2024; 82:96. [PMID: 38915042 PMCID: PMC11194890 DOI: 10.1186/s13690-024-01318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/09/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) is implicated in the pathogenesis of cancer in the cervix, vagina, throat and anogenital region. Although HPV vaccination rates in the Hispanic community have increased owing to public health efforts, the COVID-19 pandemic has brought unique public health challenges and contributed to health inequity in this population. METHODS To evaluate the impact of the COVID-19 pandemic on HPV vaccine uptake in a program designed to improve HPV vaccination rate in a predominantly Hispanic community in the border region of Texas (Tiempo de Vacunarte [time to get vaccinated]), we performed a retrospective cross-sectional analysis to evaluate the uptake of the first dose of HPV vaccine series among eligible adolescents and adults before (2016-2019), during (2020-2021), and after the COVID-19 pandemic (2022-2023). RESULTS We observed a decrease in HPV vaccine uptake during the pandemic (69.59% vs. 89.92%) and post-pandemic (76% vs. 89.92%) compared to the pre-pandemic period. After adjusting for confounding factors, the reduction in the odds ratio was more pronounced in the pandemic (OR = 0.091, p < 0.001) and post-pandemic (OR = 0.109, p < 0.001) periods. CONCLUSION Our findings suggest that the COVID-19 pandemic significantly impacted the uptake of the HPV vaccine in a comprehensive intervention program to increase HPV vaccination in a border community.
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Affiliation(s)
- Phong Nguyen
- Paul L. Foster School of Medicine Texas, Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Jessica Calderon-Mora
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Vishwajeet Singh
- Office of Research, Biostatistics and Epidemiology Consulting Lab El Paso, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Amir Hernandez
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center El Paso, 9849 Kenworthy Street, El Paso, TX, 79924, USA
| | - Sonya Roy
- Paul L. Foster School of Medicine Texas, Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Jennifer Molokwu
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center El Paso, 9849 Kenworthy Street, El Paso, TX, 79924, USA.
- Paul L. Foster School of Medicine Texas, Tech University Health Sciences Center El Paso, El Paso, TX, USA.
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Kipp B, Ulrich E, van Meegen C, Schwenzer T. Risk of cervical high-grade squamous intraepithelial neoplasia in cytologic negative and persistently high-risk human papillomavirus positive patients according to genotypes: a retrospective single center analysis. BMC Infect Dis 2024; 24:558. [PMID: 38834951 DOI: 10.1186/s12879-024-09449-z] [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: 12/29/2023] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
In January 2020, a different cervical cancer screening program started in Germany. Women above the age of 35 are recommended to have a combined HPV and cytology swab every three years. Showing persistent high-risk human papillomavirus (hrHPV), cytologic negative cervical samples at baseline and after 12 months, patients are referred to colposcopy. Entailing considerable additional workload due to the required colposcopies, we analyzed the risk of high-grade cervical intraepithelial neoplasia (CIN 3) in cytologic negative and persistent hrHPV women according to their hrHPV genotypes.Methods In this single center retrospective study, patients with persistent hrHPV, cytology negative cervical samples from our certified Colposcopy Unit in 2020 and 2021 were analyzed. Patient demographics, hrHPV types, biopsy rates and histological reports were collected.Results During the study, 69 patients were enrolled. Most frequent hrHPV genotypes were: hrHPV other 72.5%; HPV 16, 20.3% and HPV 18, 7.2%. Colposcopy showed no or minor changes in 92.7% and major changes in 7.2%. CIN 3 was found in 7 patients (10.1%). Prevalence of CIN 3 by hrHPV genotypes was 27.3% for HPV16, 20.0% for HPV18 and 7.1% for HPVO. A statistically significant dependency between hrHPV and cervical intraepithelial neoplasia was demonstrated (p = 0.048).Conclusion Within this single center study of persistent hrHPV, cytologic negative samples, patients with HPV 16 were more likely to have high-grade disease compared to other hrHPV subtypes. Larger prospective randomized trials are needed to substantiate our results and obtain adjusted cervical cancer screening time intervals according to the hrHPV genotypes.
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Affiliation(s)
- Barbara Kipp
- Department of Gynecology and Obstetrics, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany.
- Department of Health, Witten/Herdecke University, Witten, Germany.
| | - Elena Ulrich
- Department of Gynecology and Obstetrics, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany
- Department of Health, Witten/Herdecke University, Witten, Germany
| | - Carmen van Meegen
- Center for Higher Education, Statistical Consulting and Analysis, TU Dortmund University, Vogelpothsweg 78, 44221, Dortmund, Germany
| | - Thomas Schwenzer
- Department of Gynecology and Obstetrics, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany
- Department of Health, Witten/Herdecke University, Witten, Germany
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3
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Wickenheisser NE, Dillon M, Broadwater G, Zacherl K, Bixel K, Levine M, Newton M, Thel H, Tucker K, Gehrig P, Khetan VU, Brunette-Masi LL, Matsuo K, Khouri OR, Duhon A, Gowthaman D, Cowan M, Mojdehbakhsh R, Rose S, Olawaiye A, Davidson BA, Moss HA, Havrilesky LJ. Radical hysterectomy case volume and cervical cancer treatment in the era of COVID-19: A multi-site analysis of National Cancer Institute-designated Comprehensive Cancer Centers. Gynecol Oncol 2023; 179:70-78. [PMID: 37944328 DOI: 10.1016/j.ygyno.2023.10.010] [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: 07/08/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To compare radical hysterectomy case volume, cancer stage, and biopsy-to-treatment time of invasive cervical cancer diagnosed before and after onset of the COVID-19 pandemic. METHODS In a multi-institution retrospective cohort study conducted at 6 large, geographically diverse National Cancer Institute-designated cancer centers, patients treated for newly diagnosed invasive cervical cancer were classified into 2 temporal cohorts based on date of first gynecologic oncology encounter: (1) Pre-Pandemic: 3/1/2018-2/28/2020; (2) Pandemic & Recovery: 4/1/2020-12/31/2021. The primary outcome was total monthly radical hysterectomy case volume. Secondary outcomes were stage at diagnosis and diagnosis-to-treatment time. Statistical analyses used chi-squared and two sample t-tests. RESULTS Between 3/1/2018-12/31/2021, 561 patients were diagnosed with cervical cancer. The Pre-Pandemic and Pandemic & Recovery cohorts had similar age, race, ethnicity, smoking status, and Body Mass Index (BMI). During Pandemic & Recovery, the mean monthly radical hysterectomy case volume decreased from 7[SD 2.8] to 5[SD 2.0] (p = 0.001), the proportion of patients diagnosed with Stage I disease dropped from 278/561 (49.5%) to 155/381 (40.7%), and diagnosis of stage II-IV disease increased from 281/561 (50.1%) to 224/381 (58.8%). Primary surgical management was less frequent (38.3% Pandemic & Recovery versus 46.7% Pre-Pandemic, p = 0.013) and fewer surgically-treated patients received surgery within 6 weeks of diagnosis (27.4% versus 38.9%; p = 0.025). CONCLUSIONS Lower radical hysterectomy case volume, a shift to higher cervical cancer stage, and delay in surgical therapy were observed across the United States following the COVID-19 outbreak. Decreased surgical volume may result from lower detection of early-stage disease or other factors.
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Affiliation(s)
- Natalie E Wickenheisser
- Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Mairead Dillon
- Biostatistics Shared Resources, Duke Cancer Institute, Durham, NC, United States of America
| | - Gloria Broadwater
- Biostatistics Shared Resources, Duke Cancer Institute, Durham, NC, United States of America
| | - Kathleen Zacherl
- Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Monica Levine
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Meredith Newton
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Hannah Thel
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Katherine Tucker
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Paola Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Varun U Khetan
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Laurie L Brunette-Masi
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Koji Matsuo
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
| | - Olivia R Khouri
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Ashley Duhon
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Divya Gowthaman
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Matthew Cowan
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, NY, United States of America
| | - Rachel Mojdehbakhsh
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Wisconsin Health, Madison, WI, United States of America
| | - Stephen Rose
- Divison of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Wisconsin Health, Madison, WI, United States of America
| | - Alexander Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Haley A Moss
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC, United States of America.
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Corey L, Wallbillich JJ, Wu S, Farrell A, Hodges K, Xiu J, Nabhan C, Guastella A, Kheil M, Gogoi R, Winer I, Bandyopadhyay S, Huang M, Jones N, Wilhite A, Karnezis A, Thaker P, Herzog TJ, Oberley M, Korn WM, Vezina A, Morris R, Ali-Fehmi R. The Genomic Landscape of Vulvar Squamous Cell Carcinoma. Int J Gynecol Pathol 2023; 42:515-522. [PMID: 37131274 PMCID: PMC10417246 DOI: 10.1097/pgp.0000000000000950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Vulvar squamous cell cancer (VSC) accounts for 90% of vulvar cancers. Next-generation sequencing studies of VSC imply human papillomavirus (HPV) and p53 status play separate roles in carcinogenesis and prognosis. We sought to describe the genomic landscape and analyze the immunologic profiles of VSC with respect to HPV and p53 status. A total of 443 VSC tumors underwent tumor profiling. Next-generation sequencing was performed on genomic DNA isolated from formalin-fixed paraffin-embedded tumor samples. PD-L1, microsatellite instability were tested by fragment analysis, IHC, and next-generation sequencing. Tumor mutational burden-high was defined as >10 mutations per MB. HPV 16/18 positive (HPV+) status was determined using whole exome sequencing on 105 samples. Three cohorts were identified from 105 samples with known HPV: HPV+, HPV-/p53wt, and HPV-/p53mt. Where HPV and p53 status were examined, TP53 mutations were exclusive of HPV+ tumors. In all, 37% of samples were HPV+. Among the 66 HPV- tumors, 52 (78.8%) were HPV-/p53mt and 14 (21.2%) were HPV-/p53wt. The HPV-/p53wt cohort had a higher rate of mutations in the PI3KCA gene (42.9% HPV-/p53wt vs 26.3% HPV+ vs. 5.8% HPV-/p53mt, q =0.028) and alterations in the PI3K/AkT/mTOR pathway (57.1% HPV-/p53wt vs. 34.2% HPV+ vs. 7.7% HPV-/p53mt, q =0.0386) than the other 2 cohorts. Ninety-eight VSC tumors with HPV16/18 information underwent transcriptomic analysis and immune deconvolution method. No differences were observed in immune profiles. The HPV-/p53wt VSC tumors had significantly higher rates of mutations in the PI3KCA gene and alterations in the PI3K/AkT/mTOR pathway, a potential target that merits further investigation in this subgroup.
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Kwek MEJ, Ang JX, Mathur M, Kho LCL. Comparison of awareness, attitudes and knowledge on human papilloma virus vaccination in Singapore: 2019 versus 2013. Singapore Med J 2023:384042. [PMID: 37675669 DOI: 10.4103/singaporemedj.smj-2020-437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Introduction This study aimed to assess the changes in the awareness, attitudes and knowledge regarding human papillomavirus (HPV) vaccination among the local population. The secondary aims were to identify barriers and to evaluate the effectiveness of national HPV vaccination campaigns over a six-year period in Singapore. Methods We conducted and compared two cross-sectional surveys in 2013 and 2019 among female participants attending a general gynaecology clinic. Results A total of 597 participants completed the survey in 2013 and 2019. The participants were comparable in their race, marital status, educational level, occupation and monthly household income. Knowledge scores for cervical cancer and HPV infection showed significant improvement from 2013 to 2019. There was no significant difference in knowledge scores for HPV vaccination, which resulted in similar uptake of the HPV vaccine. Age, educational level and knowledge of HPV vaccine were significant predictors of acceptance of the HPV vaccine. The top two reasons for declining the HPV vaccine were the lack of knowledge and cost, as noted in the 2019 survey. Conclusion The Singapore government's efforts to improve cervical cancer awareness through national campaigns and policy changes have led to an improvement in knowledge of HPV infection. However, this has not translated into improvements in the vaccine acceptance rates. The decision for vaccine uptake is complex, and there are multiple factors to be addressed to ensure cost-effective implementation of the strategies. Our study highlights the need for effective dissemination of vaccine information, additional subsidies and consideration of a mandatory school-based vaccination programme.
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Affiliation(s)
- Michelle E-Jyn Kwek
- Department of Obstetrics and Gynaecology, KK Women and Children's Hospital, Singapore
| | - Joella Xiaohong Ang
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Manisha Mathur
- Department of Obstetrics and Gynaecology, KK Women and Children's Hospital, Singapore
| | - Lily Chye Lee Kho
- Department of Obstetrics and Gynaecology, KK Women and Children's Hospital, Singapore
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Morici LA, McLachlan JB. Non-mucosal vaccination strategies to enhance mucosal immunity. VACCINE INSIGHTS 2023; 2:229-236. [PMID: 37881504 PMCID: PMC10599649 DOI: 10.18609/vac.2023.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The SARS-CoV-2 pandemic has highlighted the need for improved vaccines that can elicit long-lasting mucosal immunity. Although mucosal delivery of vaccines represents a plausible method to enhance mucosal immunity, recent studies utilizing intradermal vaccine delivery or incorporation of unique adjuvants suggest that mucosal immunity may be achieved by vaccination via non-mucosal routes. In this expert insight, we highlight emerging evidence from pre-clinical studies that warrant further mechanistic investigation to improve next-generation vaccines against mucosal pathogens, especially those with pandemic potential.
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Affiliation(s)
- Lisa A Morici
- Tulane University School of Medicine, Department of Microbiology and Immunology, 1430 Tulane Avenue, New Orleans, LA, USA
| | - James B McLachlan
- Tulane University School of Medicine, Department of Microbiology and Immunology, 1430 Tulane Avenue, New Orleans, LA, USA
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Plotzker RE, Vaidya A, Pokharel U, Stier EA. Sexually Transmitted Human Papillomavirus: Update in Epidemiology, Prevention, and Management. Infect Dis Clin North Am 2023; 37:289-310. [PMID: 37105644 DOI: 10.1016/j.idc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This review presents the epidemiology, pathophysiology, prevention, and management of sexually transmitted human papillomavirus (HPV) and its associated diseases. HPV is the most common sexually transmitted infection worldwide. Prevalence varies regionally. Low-risk strains cause anogenital warts, which can be managed with patient- or provider-applied therapies. High-risk strains cause lower anogenital cancers. Primary and secondary prevention strategies include vaccination and screening for precancerous lesions, respectively. Management of abnormal screening results vary by test result, anatomic site, and individual cancer risk. Approaches include close rescreening, high-resolution visualization with biopsy, and-when biopsy-proven precancer is identified-removal or destruction of the lesion.
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Affiliation(s)
- Rosalyn E Plotzker
- California Prevention Training Center, University of California San Francisco, Bixby Center for Global Reproductive Health 490 Illinois Street, 10th Floor, San Francisco, CA 94143, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, Mission Hall: Global Health and Clinical Sciences, Box 0560 550 16th Street, San Francisco, CA 94143, USA.
| | - Akanksha Vaidya
- California Prevention Training Center, University of California San Francisco, Bixby Center for Global Reproductive Health 490 Illinois Street, 10th Floor, San Francisco, CA 94143, USA
| | - Utsav Pokharel
- California Emerging Infections Program, HPV Impact, 360 22nd Street #750, Oakland, CA 94612, USA
| | - Elizabeth A Stier
- Boston University School of Medicine, Boston Medical Center, 771 Albany Street, Dowling 4, Boston, MA 02118, USA
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Ashique S, Hussain A, Fatima N, Altamimi MA. HPV pathogenesis, various types of vaccines, safety concern, prophylactic and therapeutic applications to control cervical cancer, and future perspective. Virusdisease 2023:1-19. [PMID: 37363362 PMCID: PMC10208188 DOI: 10.1007/s13337-023-00824-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
Over 98% of cervical cancers (CC) are caused by regular infections with "high risk" genotype of the human papilloma virus (HPV). However, this is not always the causative factor. Therefore, production of HPV vaccinations represents a significant chance to minimize the risk of CC. Phase III studies for a number of preventative HPV vaccines based on L1-virus-like particle (VLPs) have just been completed and the preliminary results are very convincing. However, there are a lot of practical concerns that need to be resolved before the use of these vaccinations. These vaccines were challenged with obvious queries such as protection time, subject receiving vaccines, time of vaccination, and how to include them into ongoing screening programs. Although these vaccines were 90% effective at preventing HPV infection as these offered only modest advantages for the removal of pre-existing infections. New advancements in the creation of therapeutic vaccinations have been explored for further improvement and post-vaccination surveillance. Therapeutic vaccines attempted to boost cell-mediated immunities and these are detrimental to the infected cell as opposed to neutralizing antibodies (different from prophylactic vaccines).
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Affiliation(s)
- Sumel Ashique
- Department of Pharmaceutics, School of Pharmacy, Bharat Institute of Technology (BIT), Meerut, Uttar Pradesh 250103 India
| | - Afzal Hussain
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi Arabia
| | - Neda Fatima
- Department of Pharmacology, Sai College of Pharmacy, Mau, Uttar Pradesh 275102 India
| | - Mohammad A. Altamimi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi Arabia
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Saxena K, Sawhney B, Yande S, Kathe N, Chatterjee S. The Burden of Cervical Conization in Privately Insured Young and Mid-Adult Women in the United States. Vaccines (Basel) 2023; 11:vaccines11040804. [PMID: 37112716 PMCID: PMC10142968 DOI: 10.3390/vaccines11040804] [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: 02/27/2023] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
In 2019, the United States (US) Advisory Committee on Immunization Practices (ACIP) recommended that healthcare providers engage in shared clinical decision making for adults aged 27-45 who may benefit from HPV vaccination. However, it is difficult to assess these benefits as there is a lack of data on HPV burden on young and mid-adult women. This analysis estimates the incidence of conization and the burden associated with treating pre-cancerous states related to HPV with a loop electrosurgical excision procedure (LEEP) or a cold knife conization (CKC) among commercially insured women aged 18-45. This retrospective cohort study used the IBM MarketScan commercial claims encounter database for women aged 18-45 treated with conization. We assessed the annual incidence of conization (2016-2019) and adjusted the two-year health care costs post-conization using a multivariable Generalized Linear Model (GLM)-accounting for follow-up time and other characteristics-stratified by the age groups, namely 18-26 and 27-45. The inclusion criteria were met by 6735 women, with a mean age of 33.9 years (SD = 6.2). Conization incidence was lowest for women aged 18-26 (41/100,000 to 62/100,000 women-years) and highest for women aged 31-35 (243/100,000 to 269/100,000). The GLM-adjusted, all-cause healthcare costs per patient per year were USD 7279 and USD 9249 in the 18-26 and 27-45 age groups, respectively. The adjusted costs for disease-specific care were USD 3609 and USD 4557 for women ages 18-26 and 27-45, respectively. The burden of conization and the associated costs were significant, indicating a potential healthcare benefit of HPV vaccination among young and middle-aged women.
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Affiliation(s)
| | - Baanie Sawhney
- Complete HEOR Solutions (CHEORS), North Wales, PA 19454, USA
| | - Soham Yande
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX 77204, USA
| | - Niranjan Kathe
- Complete HEOR Solutions (CHEORS), North Wales, PA 19454, USA
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Clay PA, Thompson TD, Markowitz LE, Ekwueme DU, Saraiya M, Chesson HW. Updated estimate of the annual direct medical cost of screening and treatment for human papillomavirus associated disease in the United States. Vaccine 2023; 41:2376-2381. [PMID: 36907737 PMCID: PMC10198126 DOI: 10.1016/j.vaccine.2023.02.049] [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: 10/13/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/13/2023]
Abstract
The annual direct medical cost attributable to human papillomavirus (HPV) in the United States over the period 2004-2007 was estimated at $9.36 billion in 2012 (updated to 2020 dollars). The purpose of this report was to update that estimate to account for the impact of HPV vaccination on HPV-attributable disease, reductions in the frequency of cervical cancer screening, and new data on the cost per case of treating HPV-attributable cancers. Based primarily on data from the literature, we estimated the annual direct medical cost burden as the sum of the costs of cervical cancer screening and follow-up and the cost of treating HPV-attributable cancers, anogenital warts, and recurrent respiratory papillomatosis (RRP). We estimated the total direct medical cost of HPV to be $9.01 billion annually over the period 2014-2018 (2020 U.S. dollars). Of this total cost, 55.0% was for routine cervical cancer screening and follow-up, 43.8% was for treatment of HPV-attributable cancer, and less than 2% was for treating anogenital warts and RRP. Although our updated estimate of the direct medical cost of HPV is slightly lower than the previous estimate, it would have been substantially lower had we not incorporated more recent, higher cancer treatment costs.
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Affiliation(s)
- Patrick A Clay
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
| | - Harrell W Chesson
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
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11
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Washington A, Chabaan J, Fakih A, Ford S, Rutledge L, Lilly J, Herrera MY, Kim Y, Thompson HS. "Why is it so necessary?": African American Parents' Perspectives on Delaying and Refusing HPV Vaccination. J Pediatr Health Care 2023:S0891-5245(23)00002-0. [PMID: 36764888 DOI: 10.1016/j.pedhc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION This study aimed to describe the perspectives of parents who had delayed and refused human papillomavirus (HPV) vaccination for their children, even when it was discussed or recommended by a health care provider, and to identify the factors related to vaccine hesitancy. METHOD Twenty predominantly African American parents of children aged 11-17 years were recruited from various community clinics and organizations to participate in focus groups about their decision-making regarding HPV vaccination. Using deductive content analysis and the Vaccine Hesitancy Determinants Matrix, we describe their perspectives and influences on vaccination decision-making. RESULTS Multiple reasons emerged, which included concerns about the age of children, perceived discrimination and mistrust based on race and socioeconomic status, and vaccine safety. DISCUSSION Findings support the development of targeted interventions that address vaccine safety concerns, mistrust, patient-provider communication, and parent education about the benefits of HPV vaccination.
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Affiliation(s)
- Ariel Washington
- Ariel Washington, Postdoctoral Research Fellow, School of Nursing, University of Michigan, Ann Arbor, MI.
| | - Jasmine Chabaan
- Jasmine Chabaan, Research Assistant, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
| | - Ali Fakih
- Ali Fakih, Research Assistant, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
| | - Sabrina Ford
- Sabrina Ford, Associate Professor, Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Lisa Rutledge
- Lisa Rutledge, Special Projects Manager, Western Wayne Family Health Centers, Inkster, MI
| | - Jametta Lilly
- Jametta Lilly, CEO, Detroit Parent Network, Detroit, MI
| | - Maida Y Herrera
- Maida Y. Herrera, Research Support Manager, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
| | - Yang Kim
- Yang Kim, Research Assistant, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
| | - Hayley S Thompson
- Hayley S. Thompson, Professor, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI
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12
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Tao J, Kapadia J, Fenn N, Almonte AA, Toma E, Murphy M, Nunn A, Su LJ, Chan PA. Human papillomavirus vaccination coverage among sexually active young adults aged 18 to 26 at a sexually transmitted infections clinic. Int J STD AIDS 2023; 34:315-321. [PMID: 36655673 PMCID: PMC10073331 DOI: 10.1177/09564624221146605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination is the most effective biomedical intervention for HPV infections. HPV vaccination rate among sexually active young adults is largely unknown. METHODS Patients aged 18-26 years, who attended the Rhode Island Sexually Transmitted Infections Clinic between 2013-2018, were included in the study. We extracted demographics, behavioral characteristics, and HPV vaccination status from electronic medical records. Exploratory logistic regressions were conducted to identify factors associated with vaccination status. RESULTS Among 2729 eligible individuals, the median age was 23 years (interquartile range: 22-25). Only 8.1% of males and 24.8% of females received at least one dose of HPV vaccine. Females were 144% (crude odds ratio [cOR]: 2.44, 95% confidence interval [CI]: 2.03, 2.94) more likely to receive at least one dose of HPV vaccine than males. Being Black/African American (B/AA) or Hispanic/Latino (H/L) was associated with a 21% (cOR: 0.79, 95% CI: 0.62, 1.00) and 34% (cOR: 0.66, 95% CI: 0.53, 0.81) decrease in the odds of vaccination, respectively. CONCLUSIONS HPV vaccination rate was low among sexually active young adults. Gender and racial/ethnic disparities existed in HPV vaccination. Interventions are needed to promote HPV vaccination among sexually active young adults, especially B/AA and H/L communities.
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Affiliation(s)
- Jun Tao
- Department of Medicine, 6752Brown University, Providence, RI, USA
| | - Jhanavi Kapadia
- Department of Medicine, 6752Brown University, Providence, RI, USA
| | - Natalie Fenn
- Department of Medicine, 6752Brown University, Providence, RI, USA
| | - Alexi A Almonte
- Department of Medicine, 6752Brown University, Providence, RI, USA
| | - Emily Toma
- Department of Medicine, 6752Brown University, Providence, RI, USA
| | - Matthew Murphy
- Department of Medicine, 6752Brown University, Providence, RI, USA
| | - Amy Nunn
- Department of Behavioral and Social Sciences, 12321Brown University School of Public Health, Providence, RI, USA
| | - L Joseph Su
- School of Public Health, 25989UT Southwestern Medical Center, Dallas, TX, USA
| | - Philip A Chan
- Department of Medicine, 6752Brown University, Providence, RI, USA
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13
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Mattis A, Beydoun H, Dobrydneva Y, Ganjoo R. Investigating the Efficacy of HPV Vaccines in Preventing Cervical Cancer from 2006 to 2018 in the US: A SEER Data Set Analysis. Rev Recent Clin Trials 2023; 18:214-222. [PMID: 37046192 PMCID: PMC10514505 DOI: 10.2174/1574887118666230410093715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) is the most common sexually transmitted infection in the US.The first HPV vaccine was introduced in 2006. There are three different HPV vaccines that commonly target high-risk HPV types. OBJECTIVE This study compares HPV vaccine efficacy based on alternative endpoints with the most recently available cervical cancer incidence data from the Surveillance, Epidemiology and End Results (SEER) program and SEER*Stat statistical software. METHODS The incidence of cervical cancer, mined from the most recent April 2021 SEER data set, was stratified according to age and racial groups. Trend analysis reporting cervical cancer incidence percentage change (PC) and annual percentage change (APC) was calculated by SEER*Stat statistical software. RESULTS A total of 46,583 cases of cervical cancer were reported, with an average of about 3,580 incidents of cervical cancer per year, with an overall decrement of about 60 cases over the period of 12 years. The percentage change according to age and race groups varied between -15.9 among 40- 44 years old (yo) and +13.8 among 30-34 yo, and from -12 among non-Hispanic White women to +13 among Hispanic women. Statistically significant APC was observed for five of the nine age groups and four of the five racial groups. CONCLUSION There seems to be little if any, correlation between cervical cancer incidence and the HPV vaccine program in the US. HPV vaccine efficacy based on alternative endpoints, such as nucleic acid testing and cytological, surgical, and seropositivity endpoints, is fair. Therefore, it is important to emphasize such alternative testing and surrogate endpoints.
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Affiliation(s)
- Alexander Mattis
- Department of Biomedical Laboratory Science, School of Medicine and Health Sciences, The George Washington University, Ashburn VA, USA
| | - Hind Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Yuliya Dobrydneva
- School of System’s Biology, George Mason University, Fairfax, VA, USA
| | - Rohini Ganjoo
- Department of Biomedical Laboratory Science, School of Medicine and Health Sciences, The George Washington University, Ashburn VA, USA
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14
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Berenson AB, Chang M, Hawk ET, Ramondetta LM, Hoang T. Vulvar Cancer Incidence in the United States and its Relationship to Human Papillomavirus Vaccinations, 2001-2018. Cancer Prev Res (Phila) 2022; 15:777-784. [PMID: 35969832 DOI: 10.1158/1940-6207.capr-22-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/13/2022] [Accepted: 08/01/2022] [Indexed: 01/31/2023]
Abstract
The human papillomavirus (HPV) vaccine was indicated for the prevention of vulvovaginal cancers in 2008, but its impact on the incidence of vulvar cancers within the US is unknown. To determine this, we conducted a secondary analysis of 88,942 vulvar cancer cases among women 20+ years old using the US Cancer Statistics 2001-2018 databases. Data were stratified by tumor behavior (in situ or invasive), age (20-44, 45-64, 65+ years old), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), and US census region (Northeast, South, Midwest, West), and incidence rates and average annual percentage changes (AAPC) were calculated by group. Reversing previous trends, the incidence of vulvar carcinoma in situ significantly decreased between 2001 and 2018 among women from all age groups, races/ethnicities, and regions (combined AAPC, -4.3; 95% confidence interval (CI), -4.7 to -3.8). The incidence of invasive vulvar squamous cell carcinoma decreased significantly among 20- to 44-year-old women (AAPC, -0.8; 95% CI, -1.3 to -0.3), but significantly increased among those 45 to 64 (AAPC, 2.3; 95% CI, 1.8-2.8) and 65+ years old (AAPC, 1.2; 95% CI, 1.1-1.4). Regardless of tumor behavior, incidence was highest among non-Hispanic Whites and the Midwest region. Overall, the significant declines in vulvar carcinoma in situ among all ages, as well as invasive vulvar cancer among younger women, are encouraging and complement other recent data suggesting HPV vaccinations are already reducing anal and cervical cancer incidence. Over time, further declines in vulvar carcinoma incidence are likely as uptake and completion rates of the HPV vaccine increase in the US. PREVENTION RELEVANCE We found evidence that HPV vaccinations likely contributed to a decrease in the incidences of vulvar carcinoma in situ and invasive vulvar carcinoma among 20- to 44-year-old women between 2001 and 2018. Our data add to the growing evidence that HPV vaccinations are reducing the incidence of HPV-related anogenital cancers.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, Texas.,Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, Texas.,Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mihyun Chang
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, Texas
| | - Ernest T Hawk
- Department of Clinical Cancer Prevention, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lois M Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thao Hoang
- Graduate School of Biomedical Sciences, The University of Texas Medical Branch, Galveston, Texas
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15
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Brackney MM, Weinberger DM, Higgins K, Meek J, Niccolai LM. Trends in Precancerous Cervical Lesions by Area-Based Measures of Poverty, Race, and Ethnicity, Connecticut, 2008-2018. Public Health Rep 2022; 137:1146-1152. [PMID: 34727517 PMCID: PMC9574305 DOI: 10.1177/00333549211056300] [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] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Trends in the incidence of precancerous cervical lesions can be monitored to evaluate the impact of human papillomavirus (HPV) vaccination. The objective of this analysis was to determine whether declines in precancerous cervical lesions varied by area-based measures of poverty, race, and ethnicity. METHODS We analyzed 11 years of incidence data (2008-2018) from a statewide active surveillance system of precancerous cervical lesions in Connecticut. We divided area-based measures of poverty, race, and ethnicity (percentage of the population in a census tract who were living below the federal poverty level, who were Black, and who were Hispanic) at the census-tract level into 4 groups (<5.0%, 5.0%-9.9%, 10.0%-19.9%, ≥20.0%) using recommended cut points from the Public Health Disparities Geocoding Project. We estimated incidence rates and average annual percentage changes (AAPCs) stratified by age and each area-based measure using Joinpoint regression software. We used total population and estimated screened population as denominators for each age group to calculate rates and AAPCs. RESULTS During 2008-2018 in Connecticut, 18 878 women aged 21-39 were diagnosed with precancerous cervical lesions. After adjusting for screening, the largest declines occurred among women aged 21-24 (AAPC = -11.5%; 95% CI, -13.6% to -9.4%). We found significant and similar annual declines (~10%-12%) in this age group across all 4 levels of poverty, race, and ethnicity. CONCLUSIONS This analysis adds to the growing body of evidence demonstrating the positive impact of population-level HPV vaccination among young women that appears similar across area-based measures of sociodemographic characteristics. Monitoring is necessary to ensure the continuation of this progress in all communities.
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Affiliation(s)
- Monica M. Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Kyle Higgins
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Linda M. Niccolai
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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16
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Zhou WL, Yue YY. Trends in the Incidence of Vulvar and Vaginal Cancers With Different Histology by Race, Age, and Region in the United States (2001–2018). Int J Public Health 2022; 67:1605021. [PMID: 36105176 PMCID: PMC9464823 DOI: 10.3389/ijph.2022.1605021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: The race, age, and region-stratified incidence of vulvar (VUC) and vaginal (VAC) cancers with different histology were unclear. Methods: Data was retrieved from the United States Cancer Statistics database. Average annual percent change (AAPC) and incidence rate ratio (IRR) were calculated. Results: Overall, VUC incidence increased from 18.3 (per 1,000,000 woman-years) to 19.6, but VAC incidence decreased from 5.6 to 4.4. VUC squamous cell carcinoma (SCC) incidence increased (AAPC, 0.96; 95% CI, 0.66–1.25), VUC adenocarcinoma (ADE) incidence stabilized (AAPC, −0.24; 95% CI, −1.44 to 0.98), and VUC other malignancies (OM) incidence decreased (AAPC, −1.31; 95% CI, −2.58 to −0.02). While VAC incidence decreased for any histology (AAPC, -0.63; 95% CI, −1.03 to −0.22; AAPC, −1.60; 95% CI, −2.80 to −0.39; and AAPC, −1.57; 95% CI, −2.24 to −0.89 for SCC, ADE, and OM). Similar trends were observed in most of the stratifications. Conclusion: VUC and VAC incidences varied by histology overall and within stratifications by race, age, and region. The incidence decreased for VUC and VAC with all histologies, except for the increasing VUC SCC incidence.
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Affiliation(s)
- Wei-Li Zhou
- Department of General Surgery, ShengJing Hospital of China Medical University, Shenyang, China
| | - Yang-Yang Yue
- Department of Health Management, ShengJing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yang-Yang Yue,
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17
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Gargano JW, McClung N, Lewis RM, Park IU, Whitney E, Castilho JL, Pemmaraju M, Niccolai LM, Brackney M, Debess E, Ehlers S, Bennett NM, Scahill M, Cleveland AA, Querec TD, Unger ER, Markowitz LE. HPV type-specific trends in cervical precancers in the United States, 2008-2016. Int J Cancer 2022; 152:137-150. [PMID: 35904861 DOI: 10.1002/ijc.34231] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022]
Abstract
Declines in cervical intraepithelial neoplasia grades 2-3 and adenocarcinoma in situ (CIN2+) observed among young women suggest impact from human papillomavirus (HPV) vaccination. To further evaluate vaccine impact including cross-protection and type replacement, we described high-risk (HR)-HPV type-specific cervical precancer incidence rates among women aged 20-39 years, 2008-2016. We analyzed cross-sectional population-based data on 18,344 cases of CIN2+ from a 5-site surveillance system. Diagnostic specimens were tested for individual HPV types, including 14 HR-HPV types (HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68). We estimated age-specific annual HR-HPV type-specific CIN2+ incidence per 100,000 screened women for individual types, vaccine HR-HPV types (HPV16/18) and non-vaccine HR-HPV types (non-HPV16/18). We evaluated trends using average annual percent changes (AAPC) and 95% confidence intervals (CI), and estimated total declines by comparing 2015-2016 to 2008-2009 using incidence rate ratios. Among 20-24-year-olds, HPV16/18-CIN2+ declined from 2008 through 2016 (AAPC: -21.3%, 95% CI: -28.1%, -13.8%), whereas no trend was observed for non-HPV16/18-CIN2+ (AAPC: -1.8%, 95% CI: -8.1%, 4.9%). After 2010, CIN2+ among 20-24-year-olds was more often caused by non-vaccine versus vaccine HR-HPV types. No significant declining trends were observed in older age groups. In 2015-2016 compared to 2008-2009, HPV16-CIN2+ declined 78%, HPV18-CIN2+ 72%, and HPV31-CIN2+ 51% among 20-24-year-olds; no increases were observed in type-specific CIN2+ incidence. Among 25-29-year-olds, HPV16-CIN2+ declined 18%; CIN2+ attributed to seven nonvaccine types increased significantly. No significant declines were observed in older groups. Significant declines in HPV16/18-CIN2+ in 20-24-year-olds and HPV16-CIN2+ in 25-29-year-olds corroborate impact of HPV vaccination. A declining trend in HPV31-CIN2+ is consistent with cross-protection from vaccination.
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Affiliation(s)
- Julia W Gargano
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Nancy McClung
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Rayleen M Lewis
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States.,Synergy America, Inc., Duluth, Georgia, United States
| | - Ina U Park
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, United States
| | - Erin Whitney
- California Emerging Infections Program, Oakland, California
| | - Jessica L Castilho
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Linda M Niccolai
- Connecticut Emerging Infections Program at Yale, New Haven, Connecticut, United States
| | - Monica Brackney
- Connecticut Emerging Infections Program at Yale, New Haven, Connecticut, United States
| | - Emilio Debess
- Oregon Department of Human Services, Portland, Oregon, United States
| | - Sara Ehlers
- Oregon Department of Human Services, Portland, Oregon, United States
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Mary Scahill
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Angela A Cleveland
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Troy D Querec
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Elizabeth R Unger
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Lauri E Markowitz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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18
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Lewis RM, Markowitz LE. Disparities in human papillomavirus vaccination coverage in the United States, National Health and Nutrition Examination Survey, January 2017-March 2020. Vaccine 2022; 40:2828-2832. [PMID: 35393147 DOI: 10.1016/j.vaccine.2022.03.028] [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: 12/22/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND We assessed disparities in HPV vaccination coverage by sociodemographic characteristics in the United States. METHODS Using 2017-March 2020 National Health and Nutrition Examination Survey data, we estimated vaccination coverage of ≥ 1 dose of HPV vaccine by race/ethnicity and poverty, insurance, and nativity status for females and males aged 9-14, 15-19, and 20-29 years. RESULTS Among those aged 9-14 years, coverage among non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian (NHA) females (40.0%, 33.6%, 34.0%) and males (27.1%, 35.3%, 30.9%) was higher than non-Hispanic White (NHW) females (26.5%) and males (25.2%). Among those aged 15-19 and 20-29 years, coverage varied among NHB, Hispanic, and NHA compared to NHW females and was lower among NHB, Hispanic, and NHA than NHW males. Coverage was lower among uninsured than insured in most comparisons. CONCLUSIONS HPV vaccination coverage varied by race/ethnicity and other characteristics. Efforts are needed to increase HPV vaccination coverage in all populations.
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Affiliation(s)
- Rayleen M Lewis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA; Synergy America, Inc., 6340 Sugarloaf Parkway, Suite 200, Duluth, GA 30097, USA.
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA
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19
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Catalfamo CJ, Brown HE, Dennis LK. Evaluating the Strength of Association of Human Papillomavirus Infection With Penile Carcinoma: A Meta-Analysis. Sex Transm Dis 2022; 49:368-376. [PMID: 35082241 DOI: 10.1097/olq.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is a common sexually transmitted infection that is strongly associated with cervical cancer. A link to penile cancers has been suggested by case series. We sought to assess the strength of the association between HPV infection and penile cancer by meta-analysis. METHODS A literature search to identify population-based studies evaluating the risk of HPV infection with penile cancer was conducted via PubMed and Google Scholar databases through December 2020. Studies were included in the pooled analyses if they presented relative risk (RR) estimates comparing penile cancer cases with noncases by HPV exposure status. They were stratified by (1) type of HPV, (2) test used to determine past HPV infection, and (3) the penile cancer type. Pooled analyses were conducted for stratum with at least 2 independent studies using fixed-effects and random-effects models. RESULTS Fourteen articles representing 9 study populations fit the inclusion criteria and were included in the pooled analysis. Based on these studies, the pooled RRs are 2.9 (95% confidence interval [CI], 1.7-5.0; n = 4 studies) for invasive penile cancer and seropositivity to HPV16 L1, 4.5 (95% CI, 1.3-15.5; n = 2) for seropositivity to HPV18, and 8.7 for anogenital warts (95% CI, 5.1-14.8; n = 5). For the 3 studies reporting invasive and in situ penile cancer, the risk was 7.6 for anogenital warts. CONCLUSIONS The pooled RRs indicate up to a 4.5-fold increased risk between seropositivity for HPV infection and invasive penile cancer. This is much lower than associations seen between HPV and cervical cancer.
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Affiliation(s)
- Collin J Catalfamo
- From the Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
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20
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Bernstein TA, Broome M, Millman J, Epstein J, Derouin A. Promoting Strategies to Increase HPV Vaccination in the Pediatric Primary Care Setting. J Pediatr Health Care 2022; 36:e36-e41. [PMID: 35120779 DOI: 10.1016/j.pedhc.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/07/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Evaluation of a quality improvement project designed to improve HPV vaccine uptake in a pediatric primary care setting for young adolescents. METHOD Three strategies were implemented in one private pediatric practice to promote HPV vaccine uptake for 11- and 12-year-old adolescents. 1) a standardized vaccine policy change was made to include HPV vaccine with other adolescent vaccines, 2) a pre-visit email was sent to parents of teens to provide factual vaccine information in preparation for the visit, and 3) a provider communication initiative was implemented to ensure all providers communicated consistent messages and delivered an effective cancer prevention recommendation for HPV vaccination. A pre/post design was used to compare vaccine rates. Data was obtained via the electronic health records. RESULTS The post-intervention group demonstrated HPV vaccine rates increased substantially from 17.8% to 63.6%. DISCUSSION Strategically implementing standardized clinical vaccine policies and presumprive provider communication practices has implications for significantly increasing HPV vaccine uptake among teens and may be key to preventing cancer among future generations.
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Affiliation(s)
| | - Marion Broome
- Dean and Vice-Chancellor for Nursing Affairs, School of Nursing, Duke University, Associate Vice-President for Academic Nursing, Duke University School of Nursing, Durham, NC
| | | | - Jessica Epstein
- Pediatrician, Greenwich Pediatric Associates, Old Greenwich, CT
| | - Anne Derouin
- Professor and Assistant Dean, MSN program at Duke University School of Nursing, Durham, NC
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21
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Kaniuka AR, Job SA, Brooks BD, Guo Y, Bowling J. Human Papillomavirus Vaccination Initiation and Completion Among Heterosexual and Sexual Minority U.S. Adults. LGBT Health 2022; 9:177-185. [PMID: 35180364 DOI: 10.1089/lgbt.2021.0369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The current study examined the relationship between sexual orientation and human papillomavirus (HPV) vaccination status (no vaccination vs. vaccination initiation [one to two doses] or completion [three or more doses]) among a nationally representative sample of U.S. adults. Methods: Pooled Integrated Public Use Microdata Series-National Health Interview Survey data from 2013 to 2017 were used. The analysis sample (N = 35,266) reported on HPV vaccination status, sexual orientation, and demographic covariates. Multinomial logistic regression, stratified by sex, was conducted to assess the relationship between sexual orientation and HPV vaccination status. Results: Most of the sample (80.37%) had not received any HPV vaccination dose, and only ∼10% reported vaccine completion (three or more doses). After adjusting for demographic covariates, gay and bisexual males were more likely than heterosexual males to initiate (gay: adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 1.67-3.62; bisexual: AOR = 2.30, 95% CI = 1.28-4.12) and complete (gay: AOR = 2.59, 95% CI = 1.45-4.65; bisexual: AOR = 3.20, 95% CI = 1.56-6.55) HPV vaccination. Bisexual females were more likely than heterosexual females to initiate (AOR = 1.99, 95% CI = 1.55-2.54) and complete (AOR = 1.45, 95% CI = 1.23-1.86) HPV vaccination. Females of another sexual orientation were less likely than heterosexual females to complete HPV vaccination (AOR = 0.49, 95% CI = 0.26-0.92). Conclusions: HPV vaccination remains low across sexual orientation groups. Sexual minority status may be a promotive factor in HPV vaccination for specific subgroups.
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Affiliation(s)
- Andrea R Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Sarah A Job
- Department of Population Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Byron D Brooks
- Department of Psychology, Loyola University Chicago, Chicago, Illinois, USA
| | - Yuqi Guo
- School of Social Work, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, USA.,School of Data Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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22
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Combita AL, Reyes V, Puerto D, Murillo R, Sánchez R, Nuñez M, Hernandez-Suarez GA, Wiesner C. Reduction in Vaccine HPV Type Infections in a Young Women Group (18-25 Years) Five Years after HPV Vaccine Introduction in Colombia. Cancer Prev Res (Phila) 2022; 15:55-66. [PMID: 34610993 PMCID: PMC9662904 DOI: 10.1158/1940-6207.capr-21-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/29/2021] [Accepted: 09/21/2021] [Indexed: 01/07/2023]
Abstract
In Colombia, the human papillomavirus (HPV) vaccine was launched in 2012 in the context of a school-based national vaccination program targeting girls ages 9 to 14 and offering catch-up vaccination for girls ages 14 to 17. In this study, we evaluated the program's impact on type-specific HPV infection by comparing HPV cervical prevalence among vaccinated and nonvaccinated women. This is a comparative cross-sectional study conducted 5 years after the quadrivalent HPV vaccination implementation in a sentinel Colombian City. This study included young women (18-25 years old) who had been vaccinated in the catch-up group and were attending universities and technical institutions, and women who attended primary health care facilities for Pap smear screening. The HPV prevalence of 1,287 unvaccinated women was compared with the prevalence of 1,986 vaccinated women. The prevalence of HPV16/18 infections was significantly lower in vaccinated compared with unvaccinated women (6.5% vs. 15.4%; P < 0.001), whereas for HPV6/11 infections, a decrease of 63.7% in vaccinated women (1.02% vs. 2.81%) was observed. The adjusted effectiveness to HPV16/18 was 61.4%; 95% CI, 54.3%-67.6%. However, the effectiveness against HPV16/18 was significantly higher among women vaccinated before their sexual debut 91.5%; 95% CI, 86.8-94.5, compared with effectiveness for vaccination after their sexual debut, 36.2%; 95% CI, 23.6-46.7. Five years after the introduction of HPV vaccines in Colombia, high effectiveness of HPV to prevent HPV16/18 infections is observed in the catch-up cohorts including virgin and sexually active women. PREVENTION RELEVANCE: Monitoring HPV vaccines post-licensure plays an important role in assessing the progress of immunization programs, demonstrating the impact of vaccines on the population, and providing data for policy needs. In Colombia, HPV vaccines showed effectiveness when administered before start of sexual activity, and two doses are sufficient to achieve good protection.
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Affiliation(s)
- Alba L. Combita
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia.,Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,Corresponding Author: Alba L. Combita, Cancer Biology Research Group, National Cancer Institute of Colombia (INC), Calle 1 #9-85, Bogotá 111511, Colombia. Phone: 571-4320160, ext. 4212; Fax: 571-3341360; E-mail:
| | - Viviana Reyes
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Devi Puerto
- Grupo de Investigación en Salud Pública y Epidemiología, INC, Bogotá, Colombia
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Marcela Nuñez
- GASPI. Grupo Apoyo y Seguimiento para la Investigación, INC, Bogotá, Colombia
| | | | - Carolina Wiesner
- Grupo de Investigación en Salud Pública y Epidemiología, INC, Bogotá, Colombia
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Wang W, Kothari S, Baay M, Garland SM, Giuliano AR, Nygård M, Velicer C, Tota J, Sinha A, Skufca J, Verstraeten T, Sundström K. Real-world impact and effectiveness assessment of the quadrivalent HPV vaccine: a systematic review of study designs and data sources. Expert Rev Vaccines 2021; 21:227-240. [PMID: 34845951 DOI: 10.1080/14760584.2022.2008243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vaccine effectiveness and impact studies are typically observational, generating evidence after vaccine launch in a real-world setting. For human papillomavirus (HPV) vaccination studies, the variety of data sources and methods used is pronounced. Careful selection of study design, data capture and analytical methods can mitigate potential bias in such studies. AREAS COVERED We systematically reviewed the different study designs, methods, and data sources in published evidence (1/2007-3/2020), which assessed the quadrivalent HPV vaccine effectiveness and impact on cervical/cervicovaginal, anal, and oral HPV infections, anogenital warts, lesions in anus, cervix, oropharynx, penis, vagina or vulva, and recurrent respiratory papillomatosis. EXPERT OPINION The rapid growth in access to real-world data allows global monitoring of effects of different public health interventions, including HPV vaccination programs. But the use of data which are not collected or organized to support research also underscore a need to develop robust methodology that provides insight of vaccine effects and consequences of different health policy decisions. To achieve the WHO elimination goal, we foresee a growing need to evaluate HPV vaccination programs globally. A critical appraisal summary of methodology used will provide timely guidance to researchers who want to initiate research activities in various settings.
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Affiliation(s)
- Wei Wang
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Smita Kothari
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | - Suzanne M Garland
- Department Obstetrics and Gynaecology, University of Melbourne, Centre Women's Infectious Diseases Research, Royal Women's Hospital, and Infection & Immunity Murdoch Children's Research Institute, Parkville, Australia
| | - Anna R Giuliano
- Center for Immunizaton and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Christine Velicer
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Joseph Tota
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Anushua Sinha
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Jozica Skufca
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | | | - Karin Sundström
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
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24
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Wang Q, Cai Y, Fu X, Chen L. High RPS27A Expression Predicts Poor Prognosis in Patients With HPV Type 16 Cervical Cancer. Front Oncol 2021; 11:752974. [PMID: 34796111 PMCID: PMC8593198 DOI: 10.3389/fonc.2021.752974] [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: 08/04/2021] [Accepted: 09/29/2021] [Indexed: 12/24/2022] Open
Abstract
In recent years, the incidence and the mortality rate of cervical cancer have been gradually increasing, becoming one of the major causes of cancer-related death in women. In particular, patients with advanced and recurrent cervical cancers present a very poor prognosis. In addition, the vast majority of cervical cancer cases are caused by human papillomavirus (HPV) infection, of which HPV16 infection is the main cause and squamous cell carcinoma is the main presenting type. In this study, we performed screening of differentially expressed genes (DEGs) based on The Cancer Genome Atlas (TCGA) database and GSE6791, constructed a protein–protein interaction (PPI) network to screen 34 hub genes, filtered to the remaining 10 genes using the CytoHubba plug-in, and used survival analysis to determine that RPS27A was most associated with the prognosis of cervical cancer patients and has prognostic and predictive value for cervical cancer. The most significant biological functions and pathways of RPS27A enrichment were subsequently investigated with gene set enrichment analysis (GSEA), and integration of TCGA and GTEx database analyses revealed that RPS27A was significantly expressed in most cancer types. In this study, our analysis revealed that RPS27A can be used as a prognostic biomarker for HPV16 cervical cancer and has biological significance for the growth of cervical cancer cells.
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Affiliation(s)
- Qiming Wang
- Department of Gynecology, Ningbo Women & Children's Hospital, Ningbo, China
| | - Yan Cai
- Department of Gynecology, Ningbo Women & Children's Hospital, Ningbo, China
| | - Xuewen Fu
- School of Medicine, Ningbo University, Ningbo, China
| | - Liang Chen
- Department of Gynecology, Ningbo Women & Children's Hospital, Ningbo, China
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25
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Kitsou K, Iliopoulou M, Spoulou V, Lagiou P, Magiorkinis G. Viral Causality of Human Cancer and Potential Roles of Human Endogenous Retroviruses in the Multi-Omics Era: An Evolutionary Epidemiology Review. Front Oncol 2021; 11:687631. [PMID: 34778024 PMCID: PMC8586426 DOI: 10.3389/fonc.2021.687631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
Being responsible for almost 12% of cancers worldwide, viruses are among the oldest known and most prevalent oncogenic agents. The quality of the evidence for the in vivo tumorigenic potential of microorganisms varies, thus accordingly, viruses were classified in 4 evidence-based categories by the International Agency for Research on Cancer in 2009. Since then, our understanding of the role of viruses in cancer has significantly improved, firstly due to the emergence of high throughput sequencing technologies that allowed the “brute-force” recovery of unknown viral genomes. At the same time, multi-omics approaches unravelled novel virus-host interactions in stem-cell biology. We now know that viral elements, either exogenous or endogenous, have multiple sometimes conflicting roles in human pathophysiology and the development of cancer. Here we integrate emerging evidence on viral causality in human cancer from basic mechanisms to clinical studies. We analyze viral tumorigenesis under the scope of deep-in-time human-virus evolutionary relationships and critically comment on the evidence through the eyes of clinical epidemiology, firstly by reviewing recognized oncoviruses and their mechanisms of inducing tumorigenesis, and then by examining the potential role of integrated viruses in our genome in the process of carcinogenesis.
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Affiliation(s)
- Konstantina Kitsou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Immunobiology and Vaccinology Research Laboratory, First Department of Peadiatrics, "Aghia Sophia" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Iliopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Spoulou
- Immunobiology and Vaccinology Research Laboratory, First Department of Peadiatrics, "Aghia Sophia" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Giannella L, Delli Carpini G, Di Giuseppe J, Bogani G, Gardella B, Monti E, Liverani CA, Ghelardi A, Insinga S, Montanari M, Raspagliesi F, Spinillo A, Vercellini P, Roncella E, Ciavattini A. Trend of HPV 16/18 Genotypes in Cervical Intraepithelial Neoplasia Grade 3: Data for 2007-2018. Infect Drug Resist 2021; 14:3763-3771. [PMID: 34557001 PMCID: PMC8453441 DOI: 10.2147/idr.s326851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Aim In the post-vaccination era, the starting age and time intervals of cervical screening could change (older age and longer screening intervals). This scenario may be achieved by significantly reducing human papillomavirus (HPV) 16/18 prevalence (genotypes included in the current vaccines). In this regard, assessing the trend over time of these HPV infections in high-grade cervical lesions can provide information on the objective. The present study aimed to evaluate the trend of HPV 16/18 over the years 2007–2018 in women with cervical intraepithelial neoplasia (CIN) grade 3. Methods This is a retrospective multi-institutional study including HPV genotyped and unvaccinated women under 30 with CIN3. The sample was divided into the following periods: 2007–2010, 2011–2014, 2015–2018. HPV genotypes were grouped in genotypes 16/18, genotypes 31/33/35/52/58/67 (genetically related to HPV16), genotypes 39/45/59/68/70 (genetically related to HPV18), genotypes 31/33/45/52/58 (high-risk types included in the nonavalent vaccine), possibly carcinogenic HPV (genotypes 26/30/53/67/70/73/82/85), low-risk HPV (genotypes 6/11/40/42/43/44/54/55/61). The trend between periods and HPV genotypes was measured using the Cochran–Armitage test for trend. Results The final analysis included 474 participants. HPV 16/18 prevalence decreased significantly over the years (77.8% vs 68.9% vs 66.0%, respectively, Ptrend=0.027). Possibly carcinogenic HPV (genotypes 26/30/53/67/70/73/82/85) showed a significant negative prevalence trend over time (4.9% vs 1.1% vs 1.3%, respectively, Ptrend=0.046). Finally, there was a significant positive trend over the years for high-risk HPV genotypes 31/33/45/52/58 in women under 25 (9.9% vs 17.0% vs 24.0%, respectively, Ptrend=0.048). Conclusion The prevalence of CIN3 lesions related to HPV 16/18 genotypes decreased over time from 2007 to 2018. These data highlight a herd effect of the HPV vaccine. However, fifteen years after HPV vaccine introduction, we are still a long way from herd immunity. The increase in high-risk types 31/33/45/52/58 will need to be reassessed when the nonavalent vaccine impact will be more reliable.
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Affiliation(s)
- Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Ermelinda Monti
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Carlo Antonio Liverani
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy
| | - Salvatore Insinga
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Michele Montanari
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elena Roncella
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
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27
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Zhang X, Zhang Y, Dou L. miR-552 promotes the proliferation and metastasis of cervical cancer cells through targeting MUC15 pathway. J Cancer 2021; 12:6094-6104. [PMID: 34539882 PMCID: PMC8425207 DOI: 10.7150/jca.56098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
Accumulating evidence shows that microRNAs (miRNAs) play key roles in tumorigenesis, progression, recurrence and drug resistance of malignant tumors. The tumor-promoting role of miR-552 has been evidenced in multiple tumors. Yet, the relevance of miR-552 in cervical cancer remains undetermined. This study aimed to investigate the role of miR-552 in cervical cancer proliferation and metastasis. Herein, we for first found that miR-552 expression was upregulated in cervical cancer tissues compared with their normal controls. Functional assays revealed that miR-552 promoted the proliferation and metastasis of cervical cancer cells. Mechanically, bioinformatics and luciferase reporter analysis identified MUC15 as a direct target of miR-552. Reduced MUC15 expression was detected in cervical cancer, and MUC15 overexpression exhibited a tumor-suppressive effect. MUC15 restoration partially abolished the discrepancy of growth and metastasis capacity between miR-552 overexpression cervical cancer cells and control cells. Taken together, these data demonstrate that miR-552 acts as a potential oncogene miRNA in cervical cancer, which exerts its function through targeting MUC15.
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Affiliation(s)
- Xinxin Zhang
- Department of Discipline Inspection Commission, China Medical University, Shenyang 110001, Liaoning, China
| | - Yi Zhang
- Department of Discipline Inspection Commission, China Medical University, Shenyang 110001, Liaoning, China
| | - Lei Dou
- Department of Discipline Inspection Commission, China Medical University, Shenyang 110001, Liaoning, China
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28
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Shieh KR, Huang A, Xu Y. Response to Immune Checkpoint Inhibitor Treatment in Advanced Cervical Cancer and Biomarker Study. Front Med (Lausanne) 2021; 8:669587. [PMID: 34458284 PMCID: PMC8387671 DOI: 10.3389/fmed.2021.669587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/29/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Checkpoint inhibitor immunotherapy or immuno-oncology (IO) treatment in refractory cervical cancer yielded an objective response rate (ORR) of 12% in tumors expressing the programmed cell death ligand-1 (PD-L1) in the KEYNOTE-158 phase II study. We hypothesized that the positive response might be associated with the level of PD-L1 expression and/or the tumor mutation burden (TMB). We also aimed to analyze if responses could be associated with platinum sensitivity. Methods: This is a retrospective study of all consecutive patients with cervical cancer who received pembrolizumab or nivolumab. Results: Ten patients were identified. Median age was 64.5 years old (range 48-80). The response rate was 70% and the median duration of response was 21.0 months (range 1.8-26.7) after 20.7 months of follow-up (range 2.0-31.0). The response rate was 80% in patients with PD-L1 combined positive score (CPS) ≥ 10, and 75% in patients with tumor mutation burden (TMB) ≥ 10 mut/Mb. The mean progression-free survival (PFS) for the entire cohort was 20.2 months (95% CI 12.0-28.5). Seven patients had treatment for >12 months (range 14.6-31.0). Five patients were platinum-sensitive and 5 patients were platinum-resistant at the time of immunotherapy, and the response rate was similar regardless of platinum sensitivity. Conclusions: The positive response to IO treatment in advanced cervical cancer in this study was higher than published, and a possible association with the level of PD-L1 expression and the TMB level was suggested. A PD-L1 CPS score ≥ 10 or TMB ≥ 10 may be biomarkers to correlate with response, which should be explored in large studies.
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Affiliation(s)
- Kevin R. Shieh
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Anna Huang
- Comparative Effectiveness Outcomes Research, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Yiqing Xu
- Division of Hematology and Oncology, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, United States
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29
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Mix JM, Saraiya M, Thompson TD, Querec TD, Greek A, Tucker TC, Peters ES, Lynch CF, Hernandez BY, Copeland G, Goodman MT, Unger ER. Prevalence of human papillomavirus genotypes in high-grade cervical precancer and invasive cervical cancer from cancer registries before and after vaccine introduction in the United States. Cancer 2021; 127:3614-3621. [PMID: 34289090 PMCID: PMC10084843 DOI: 10.1002/cncr.33582] [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: 01/12/2021] [Revised: 03/04/2021] [Accepted: 03/22/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND US population-based cancer registries can be used for surveillance of human papillomavirus (HPV) types found in HPV-associated cancers. Using this framework, HPV prevalence among high-grade cervical precancers and invasive cervical cancers were compared before and after HPV vaccine availability. METHODS Archived tissue from 2 studies of cervical precancers and invasive cervical cancers diagnosed from 1993-2005 (prevaccine) were identified from 7 central cancer registries in Florida; Hawaii; Iowa; Kentucky; Louisiana; Los Angeles County, California; and Michigan; from 2014 through 2015 (postvaccine) cases were identified from 3 registries in Iowa, Kentucky, and Louisiana. HPV testing was performed using L1 consensus polymerase chain reaction analysis. HPV-type-specific prevalence was examined grouped by hierarchical attribution to vaccine types: HPV 16, 18, HPV 31, 33, 45, 52, 58, other oncogenic HPV types, and other types/HPV negative. Generalized logit models were used to compare HPV prevalence in the prevaccine study to the postvaccine study by patient age, adjusting for sampling factors. RESULTS A total of 676 precancers (328 prevaccine and 348 postvaccine) and 1140 invasive cervical cancers (777 prevaccine and 363 postvaccine) were typed. No differences were observed in HPV-type prevalence by patient age between the 2 studies among precancers or invasive cancers. CONCLUSIONS The lack of reduction in vaccine-type prevalence between the 2 studies is likely explained by the low number of cases and low HPV vaccination coverage among women in the postvaccine study. Monitoring HPV-type prevalence through population-based strategies will continue to be important in evaluating the impact of the HPV vaccine.
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Affiliation(s)
- Jacqueline M Mix
- Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Troy D Querec
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - April Greek
- Department of Health Research, Battelle, Seattle, Washington
| | - Thomas C Tucker
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Edward S Peters
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Charles F Lynch
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Brenda Y Hernandez
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, Hawaii
| | - Glenn Copeland
- Division for Vital Records and Health Statistics, Michigan Department of Health and Human Services, Lansing, Michigan
| | - Marc T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
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30
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Sitler CA, Weir LF, Keyser EA, Casablanca Y, Hope E. Mandatory HPV Vaccination; Opportunity to Save Lives, Improve Readiness and Cut Costs. Mil Med 2021; 186:305-308. [PMID: 34117500 DOI: 10.1093/milmed/usab232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the U.S. military and accounts for more healthcare visits than the next two most common STIs combined. Human papillomavirus is preventable with a safe, effective, prophylactic vaccine that has been available since 2006, yet vaccination rates remain low. The vaccine is approved for females and males aged 9-45 years for prevention of HPV-related dysplasia and cancers. Although it is recommended by the Centers for Disease Control and Prevention (CDC)'s Advisory Committee on Immunization Practices (ACIP), it is not part of the U.S. military's mandatory vaccine list. Human papillomavirus does not just affect female service members-male service members have a higher reported seropositive rate than their civilian counterparts and can develop oropharyngeal, anal, or penile cancers as sequelae of HPV. Oropharyngeal cancer, more common in males, is the fastest growing and most prevalent HPV-related cancer in the USA. Several countries, such as Australia and Sweden, have successfully implemented mandatory vaccine programs and have seen rates of HPV-related diseases, including cancer, decline significantly. Some models project that cervical cancer, which is the fifth-most common cancer in active duty women, will be eliminated in the next 20 years as a result of mandatory vaccination programs. Between higher seropositive rates and lack of widespread vaccination, HPV dysplasia and cancer result in lost work time, decreased force readiness, negative monetary implications, and even separation from service. With more than half of the 1.3 million service members in the catch-up vaccination age range of less than 26 years of age, we are poised to have a profound impact through mandatory active duty service member vaccination. Although multiple strategies for improving vaccination rates have been proposed, mandatory vaccination would be in line with current joint service policy that requires all ACIP-recommended vaccines. It is time to update the joint service guidelines and add HPV vaccine to the list of mandatory vaccines.
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Affiliation(s)
- Collin A Sitler
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Larissa F Weir
- Air Force Medical Readiness Agency, Falls Church, VA 22042, USA
| | - Erin A Keyser
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, Joint Base San Antonio, TX 78234, USA
| | - Yovanni Casablanca
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Erica Hope
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, Joint Base San Antonio, TX 78234, USA
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31
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Sundstrom B, Cartmell KB, White AA, Well H, Pierce JY, Brandt HM. Correcting HPV Vaccination Misinformation Online: Evaluating the HPV Vaccination NOW Social Media Campaign. Vaccines (Basel) 2021; 9:352. [PMID: 33917512 PMCID: PMC8067464 DOI: 10.3390/vaccines9040352] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
The human papillomavirus (HPV) vaccine provides protection from six HPV-related cancers. Approximately half of South Carolina adolescents have not completed the vaccination series, representing a missed opportunity to prevent cancer. The HPV Vaccination NOW: This is Our Moment social media campaign is an initiative of the South Carolina Cancer Alliance (SCCA) and Hollings Cancer Center at the Medical University of South Carolina (MUSC). This statewide social media campaign aimed to increase parental awareness of and build vaccine confidence around HPV vaccination in S.C. The ten-week campaign was strategically implemented between June and August 2019 to encourage HPV vaccination at back-to-school medical appointments. A process evaluation showed that the campaign resulted in over 370,000 total impressions, reached over 33,000 individuals, and culminated with over 1122 followers. There were over 2700 engagements on Facebook and Twitter. A qualitative content analysis indicated that pro-vaccine and anti-vaccine comments were dominated by personal stories. Comments promoting misinformation about the HPV vaccine were often countered through peer-to-peer dialogue. Findings suggest that creating opportunities for the target audience to engage with campaign messages effectively corrected misinformation.
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Affiliation(s)
- Beth Sundstrom
- Department of Communication, College of Charleston, Charleston, SC 29424, USA
| | - Kathleen B. Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA;
| | - Ashley A. White
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Henry Well
- South Carolina Cancer Alliance, Columbia, SC 29204, USA;
| | | | - Heather M. Brandt
- St. Jude Children’s Research Hospital and Comprehensive Cancer Center, Memphis, TN 38105, USA;
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Chesson HW, Laprise JF, Brisson M, Martin D, Ekwueme DU, Markowitz LE. The Estimated Lifetime Medical Cost of Diseases Attributable to Human Papillomavirus Infections Acquired in 2018. Sex Transm Dis 2021; 48:278-284. [PMID: 33492104 PMCID: PMC9969310 DOI: 10.1097/olq.0000000000001379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We estimated the lifetime medical costs of diagnosed cases of diseases attributable to human papillomavirus (HPV) infections acquired in 2018. METHODS We adapted an existing mathematical model of HPV transmission and associated diseases to estimate the lifetime number of diagnosed cases of disease (genital warts; cervical intraepithelial neoplasia; and cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers) attributable to HPV infections that were acquired in 2018. For each of these outcomes, we multiplied the estimated number of cases by the estimated lifetime medical cost per case obtained from previous studies. We estimated the costs of recurrent respiratory papillomatosis in a separate calculation. Future costs were discounted at 3% annually. RESULTS The estimated discounted lifetime medical cost of diseases attributable to HPV infections acquired in 2018 among people aged 15 to 59 years was $774 million (in 2019 US dollars), of which approximately half was accounted for by infections in those aged 15 to 24 years. Human papillomavirus infections in women accounted for approximately 90% of the lifetime number of diagnosed cases of disease and 70% of the lifetime cost attributable to HPV infections acquired in 2018 among those aged 15 to 59 years. CONCLUSIONS We estimated the lifetime medical costs of diseases attributable to HPV infections acquired in 2018 to be $774 million. This estimate is lower than previous estimates, likely due to the impact of HPV vaccination. The lifetime cost of disease attributable to incident HPV infections is expected to decrease further over time as HPV vaccination coverage increases.
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Affiliation(s)
- Harrell W. Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Dave Martin
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Donatus U. Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauri E. Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Age-related distribution of uncommon HPV genotypes in cervical intraepithelial neoplasia grade 3. Gynecol Oncol 2021; 161:741-747. [PMID: 33795132 DOI: 10.1016/j.ygyno.2021.03.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 11/21/2022]
Abstract
AIM Cervical cancer prevention guidelines include Human Papillomavirus (HPV) test, cytology, and HPV-16/18 typing for triage to determine the risk of cervical intraepithelial neoplasia (CIN) grade 3 as the best proxy of cervical cancer risk. In doing that, they do not consider how age can modify the type-specific risk of CIN3. The present study aimed to evaluate the age-related distribution of HPV genotypes affecting the risk-assessment in cervical cancer screening programs: non-screening-type-HPV and non-HPV-16/18 in unvaccinated women with CIN3. METHODS Retrospective multi-institutional study, including HPV genotyped women with CIN3 on cone histology treated between 2014 and 2019. The sample was divided into three categories of age: <30, 30-44, ≥45. HPV genotypes were grouped in non-screening-type-HPV (not-including genotypes 16/18/31/33/35/39/45/51/52/56/58/59/66/68) and non-HPV-16/18. Associations and trends between different age-groups and HPV genotypes were measured. RESULTS 1332 women were analyzed. Non-screening-type-HPV CIN3 were 73 (5.5%). Non-HPV-16/18 were found in 417 participants (31.3%). Women over 45 associated with non-screening-type HPV [odds ratio (OR) = 1.87, 95% confidence interval (CI) 1.07-3.25; p = 0.027]. Non-screening-type-HPV prevalence increased significantly with age (3.9% vs 5.1% vs 9.0%, p = 0.016). Women under 30 showed a lower rate of non-HPV-16/18 (OR = 0.65, 95% CI 0.47-0.89; p = 0.007). There was a positive trend with age of non-HPV-16/18 CIN3 (23.6% vs 32.1% vs 38.0%, p = 0.0004). CONCLUSION The proportion of CIN3 lesions unrelated to genotypes detected by primary screening tests increased with age. This implies that age probably modifies the risk of CIN3 and possibly of cancer associated with HPV types. The risk-based recommendation should take into consideration age to define the management of HPV positive women.
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Wendland EM, Kops NL, Bessel M, Comerlato J, Maranhão AGK, Souza FMA, Villa LL, Pereira GFM. Effectiveness of a universal vaccination program with an HPV quadrivalent vaccine in young Brazilian women. Vaccine 2021; 39:1840-1845. [PMID: 33674171 DOI: 10.1016/j.vaccine.2021.02.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/20/2021] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
We examined human papillomavirus (HPV) vaccine effectiveness in a nationwide sample of women aged 16 to 25 years who utilized the public health system in Brazil. This was a cross-sectional, multicentric survey conducted between September 2016 and November 2017 (POP-Brazil Study). A total of 5,945 young adult women were recruited from 119 public primary care units from all 27 federative units of Brazil by trained health professionals. The participants participated in a face-to-face interview and provided biological samples for genital HPV analysis. HPV genotyping was performed using a Linear Array HPV genotyping test in a central laboratory. Sampling weights were applied to the data. Overall, 11.92% (95% CI 10.65, 13.20) of the participants reported having been vaccinated. The frequency of vaccination was highest in 16- to 17-year-old women, with a decreasing vaccination rate with increasing age, and vaccinated women were more likely to belong to the high socioeconomic status group. The use of a quadrivalent vaccine decreased the HPV types 6, 11, 16, and 18 by 56.78%, from 15.64% in unvaccinated women to 6.76% in vaccinated women (P < 0.01), even after adjustment for age. Those who received the vaccine had lower HPV 16 (2.34% in vaccinated vs 8.91% in unvaccinated, P < 0.01) and 6 rates (2.06% vs 5.77%, P < 0.01). Additionally, a higher rate of high-risk HPV types other than HPV 16 and 18 (40.47% in vaccinated vs 32.63% in unvaccinated, P < 0.01) was observed. In conclusion, the results of this study support the effectiveness of HPV vaccination in Brazil. Continuous surveillance must be assured to monitor the HPV infection rate in the vaccination era.
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Affiliation(s)
- Eliana M Wendland
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Department of Public Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
| | | | | | - Juliana Comerlato
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Department of Public Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Flávia Moreno Alves Souza
- Department of Chronic Conditions and Sexually Transmitted Infections, Brasília, Distrito Federal, Brazil
| | - Luisa Lina Villa
- Departament of Radiology and Oncology, Faculdade de Medicina. Universidade de São Paulo and Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
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Ortiz AP, Soto-Salgado M, Calo WA, Hull P, Fernández ME, Colon-López V, Tortolero-Luna G. Elimination of cervical cancer in U.S. Hispanic populations: Puerto Rico as a case study. Prev Med 2021; 144:106336. [PMID: 33678233 DOI: 10.1016/j.ypmed.2020.106336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer remains a major burden for women around the world. In 2018, the World Health Organization called for the elimination of cervical cancer worldwide (<4 cases per 100,000 women-years), within the 21st century. In the U.S., despite great progress toward this goal, existing disparities among racial/ethnic groups in cervical cancer raise concerns about whether elimination can be achieved for all women. We describe: 1) disparities in cervical cancer among Hispanics in the U.S. and factors that contribute to their increased risk, 2) prevention and control efforts to increase equity in the elimination of cervical cancer in this population, and 3) cervical cancer control efforts in Puerto Rico (PR), a U.S. territory, as a case study for cervical cancer elimination among a minority and underserved Hispanic population. Hispanics have the highest incidence rates of cervical cancer among all racial/ethnic groups in the U.S. Despite being more likely to complete HPV vaccination series, lower cervical cancer screening and access to treatment may lead to a higher cervical cancer mortality in Hispanics compared to non-Hispanic White women. These disparities are influenced by multiple individual-, sociocultural-, and system-level factors. To achieve the goal of cervical cancer elimination in the U.S., systematic elimination plans that consider the needs of Hispanic populations should be included within the Comprehensive Cancer Control Plans of each state. Because PR has implemented coordinated efforts for the prevention and control of cervical cancer, it represents a notable case study for examining strategies that can lead to cervical cancer elimination among Hispanics.
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Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America.
| | - Marievelisse Soto-Salgado
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America; Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Pamela Hull
- University of Kentucky Markey Cancer Center, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
| | - María E Fernández
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, TX, United States of America
| | - Vivian Colon-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Guillermo Tortolero-Luna
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America
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Malagón T, Volesky KD, Franco EL. Reply to: Comments on cumulative risk of cervical intraepithelial neoplasia for women with normal cytology but positive for human papillomavirus: Systematic review and meta-analysis. Int J Cancer 2021; 148:2859-2860. [PMID: 33567100 DOI: 10.1002/ijc.33510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Karena D Volesky
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
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Priyadarshini M, Prabhu VS, Snedecor SJ, Corman S, Kuter BJ, Nwankwo C, Chirovsky D, Myers E. Economic Value of Lost Productivity Attributable to Human Papillomavirus Cancer Mortality in the United States. Front Public Health 2021; 8:624092. [PMID: 33665180 PMCID: PMC7921151 DOI: 10.3389/fpubh.2020.624092] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/23/2020] [Indexed: 01/05/2023] Open
Abstract
Objectives: To estimate years of potential life lost (YPLL) and present value of future lost productivity (PVFLP) associated with premature mortality due to HPV-attributable cancers, specifically those targeted by nonavalent HPV (9vHPV) vaccination, in the United States (US) before vaccine use. Methods: YPLL was estimated from the reported number of deaths in 2017 due to HPV-related cancers, the proportion attributable to 9vHPV-targeted types, and age- and sex-specific US life expectancy. PVFLP was estimated as the product of YPLL by age- and sex-specific probability of labor force participation, annual wage, value of non-market labor, and fringe benefits markup factor. Results: An estimated 7,085 HPV-attributable cancer deaths occurred in 2017 accounting for 154,954 YPLL, with 5,450 deaths (77%) and 121,226 YPLL (78%) attributable to 9vHPV-targeted types. The estimated PVFLP was $3.3 billion for cancer deaths attributable to 9vHPV-targeted types (86% from women). The highest productivity burden was associated with cervical cancer in women and anal and oropharyngeal cancers in men. Conclusions: HPV-attributable cancer deaths are associated with a substantial economic burden in the US, much of which could be vaccine preventable.
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Affiliation(s)
| | | | | | - Shelby Corman
- Pharmerit - an OPEN Health Company, Bethesda, MD, United States
| | | | | | | | - Evan Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, United States
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Shah S, Xu M, Mehta P, Zetola NM, Grover S. Differences in Outcomes of Chemoradiation in Women With Invasive Cervical Cancer by Human Immunodeficiency Virus Status: A Systematic Review. Pract Radiat Oncol 2021; 11:53-65. [PMID: 32428763 PMCID: PMC7940661 DOI: 10.1016/j.prro.2020.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/23/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Cervical cancer is one of the leading causes of cancer death among women worldwide, and women living with human immunodeficiency virus (HIV) carry the highest burden of disease. Chemoradiation (CRT) is the current standard treatment for locally advanced cervical cancer, without specific treatment modifications based on HIV status. This systematic review evaluates existing literature reporting differences in outcomes between HIV+ and HIV- women with invasive cervical cancer treated with CRT. METHODS AND MATERIALS Searches were conducted through Pubmed, Ovid MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library. Two researchers independently conducted article selection; articles were selected by title, then abstract, and then by full text content. Data were extracted using a structured form. RESULTS Thirteen articles were included in the analysis, all of which were either retrospective or prospective cohort studies published between 2012 and 2018, and most of which were conducted in Sub-Saharan Africa. Treatment outcomes included treatment response, survival, toxicities, and quality of life. The majority of studies (8 of 13) reported no differences in treatment outcomes by HIV status. Out of 8 studies that assessed survival, 6 reported no significant difference based on HIV status. All 4 studies assessing treatment response found no significant differences based on HIV status. Among 6 studies primarily assessing treatment toxicity, 3 showed no differences based on HIV status. Factors affecting treatment outcomes, such as treatment selection bias, pretreatment hemoglobin levels, and antiretroviral therapy administration, were not systematically accounted for. CONCLUSIONS The majority of studies analyzed showed no differences in treatment outcomes, including overall toxicity, treatment response, or mortality, on the basis of HIV infection status. These results suggest CRT should continue to be the treatment of choice for locally invasive cervical cancer regardless of HIV status. Further study is required to more precisely account for other variables that influence treatment outcome.
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Affiliation(s)
- Sidrah Shah
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Melody Xu
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Priyanka Mehta
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Nicola M Zetola
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Shing JZ, Griffin MR, Nguyen LD, Slaughter JC, Mitchel EF, Pemmaraju M, Rentuza AB, Hull PC. Improving Cervical Precancer Surveillance: Validity of Claims-Based Prediction Models in ICD-9 and ICD-10 Eras. JNCI Cancer Spectr 2020; 5:pkaa112. [PMID: 33554035 PMCID: PMC7853170 DOI: 10.1093/jncics/pkaa112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background Human papillomavirus vaccine (HPV) impact on cervical precancer (cervical intraepithelial neoplasia grades 2+ [CIN2+]) is observable sooner than impact on cancer. Biopsy-confirmed CIN2+ is not included in most US cancer registries. Billing codes could provide surrogate metrics; however, the International Classification of Diseases, ninth (ICD-9) to tenth (ICD-10) transition disrupts trends. We built, validated, and compared claims-based models to identify CIN2+ events in both ICD eras. Methods A database of Davidson County (Nashville), Tennessee, pathology-confirmed CIN2+ from the HPV Vaccine Impact Monitoring Project (HPV-IMPACT) provided gold standard events. Using Tennessee Medicaid 2008-2017, cervical diagnostic procedures (N = 8549) among Davidson County women aged 18-39 years were randomly split into 60% training and 40% testing sets. Relevant diagnosis, procedure, and screening codes were used to build models from CIN2+ tissue diagnosis codes alone, least absolute shrinkage and selection operator (LASSO), and random forest. Model-classified index events were counted to estimate incident events. Results HPV-IMPACT identified 983 incident CIN2+ events. Models identified 1007 (LASSO), 1245 (CIN2+ tissue diagnosis codes alone), and 957 (random forest) incident events. LASSO performed well in ICD-9 and ICD-10 eras: 77.3% (95% confidence interval [CI] = 72.5% to 81.5%) vs 81.1% (95% CI = 71.5% to 88.6%) sensitivity, 93.0% (95% CI = 91.9% to 94.0%) vs 90.2% (95% CI = 87.2% to 92.7%) specificity, 61.3% (95% CI = 56.6% to 65.8%) vs 60.3% (95% CI = 51.0% to 69.1%) positive predictive value, 96.6% (95% CI = 95.8% to 97.3%) vs 96.3% (95% CI = 94.1% to 97.8%) negative predictive value, 91.0% (95% CI = 89.9% to 92.1%) vs 88.8% (95% CI = 85.9% to 91.2%) accuracy, and 85.1% (95% CI = 82.9% to 87.4%) vs 85.6% (95% CI = 81.4% to 89.9%) C-indices, respectively; performance did not statistically significantly differ between eras (95% confidence intervals all overlapped). Conclusions Results confirmed model utility with good performance across both ICD eras for CIN2+ surveillance. Validated claims-based models may be used in future CIN2+ trend analyses to estimate HPV vaccine impact where population-based biopsies are unavailable.
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Affiliation(s)
- Jaimie Z Shing
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Linh D Nguyen
- Data Science Institute, Vanderbilt University, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Edward F Mitchel
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manideepthi Pemmaraju
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alyssa B Rentuza
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pamela C Hull
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Incorporating Stakeholder Feedback in Guidelines Development for the Management of Abnormal Cervical Cancer Screening Tests. J Low Genit Tract Dis 2020; 24:167-177. [PMID: 32243312 PMCID: PMC7147423 DOI: 10.1097/lgt.0000000000000524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The 2019 ASCCP Risk-Based Management Consensus Guidelines present a paradigm shift from results- to risk-based management. Patient and provider factors can affect guideline adoption. We sought feedback from stakeholders to inform guideline development. MATERIALS AND METHODS To solicit provider feedback, we surveyed attendees at the 2019 ASCCP annual meeting regarding readiness to adopt proposed changes and used a web-based public comment period to gauge agreement/disagreement with preliminary guidelines. We elicited patient feedback via a brief survey on preferences around proposed recommendations for treatment without biopsy. Surveys and public comment included both closed-ended and free-text items. Quantitative results were analyzed using descriptive statistics; qualitative results were analyzed using content analysis. Results were incorporated into guideline development in real time. RESULTS Surveys indicated that 98% of providers currently evaluate their patients' past results to determine management; 88% felt formally incorporating history into management would represent an improvement in care. Most providers supported expedited treatment without biopsy: 22% currently perform expedited treatment and 60% were willing to do so. Among patients, 41% preferred expedited treatment, 32% preferred biopsy before treatment, and the remainder were undecided. Responses from the public comment period included agreement/disagreement with preliminary guidelines, reasons for disagreement, and suggestions for improvement. CONCLUSIONS Stakeholder feedback was incorporated into the development of the 2019 ASCCP Risk-Based Management Consensus Guidelines. Proposed recommendations with less than two-thirds agreement in the public comment period were considered for revision. Findings underscore the importance of stakeholder feedback in developing guidelines that meet the needs of patients and providers.
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An Update on Screening and Prevention for Breast and Gynecological Cancers in Average and High Risk Individuals. Am J Med Sci 2020; 360:489-510. [DOI: 10.1016/j.amjms.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 11/21/2022]
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Mix JM, Van Dyne EA, Saraiya M, Hallowell BD, Thomas CC. Assessing Impact of HPV Vaccination on Cervical Cancer Incidence among Women Aged 15-29 Years in the United States, 1999-2017: An Ecologic Study. Cancer Epidemiol Biomarkers Prev 2020; 30:30-37. [PMID: 33082207 DOI: 10.1158/1055-9965.epi-20-0846] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/24/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To date, the impact of the human papillomavirus (HPV) vaccine on invasive cervical cancers in the United States has not been documented due, in part, to the time needed for cancer to develop and to recent changes to cervical cancer screening guidelines and recommendations, which complicate data interpretation. METHODS We examined incidence rates of cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) among women aged 15-29 years diagnosed during 1999-2017 using population-based cancer registry data covering 97.8% of the U.S. POPULATION Trends were stratified by age and histology. The annual percent change in cervical cancer incidence per year was calculated using joinpoint regression. RESULTS During 1999-2017, SCC rates decreased 12.7% per year among women aged 15-20 years, 5.5% among women aged 21-24 years, and 2.3% among women aged 25-29 years. The declines in SCC rates were largest among women aged 15-20 years during 2010-2017, with a decrease of 22.5% per year. Overall, AC rates decreased 4.1% per year among women aged 15-20 years, 3.6% per year among women aged 21-24 years, and 1.6% per year among women aged 25-29 years. AC rates declined the most among women aged 15-20 years during 2006-2017, decreasing 9.4% per year. CONCLUSIONS Since HPV vaccine introduction, both SCC and AC incidence rates declined among women aged 15-20 years, a group not typically screened for cervical cancer, which may suggest HPV vaccine impact. IMPACT Timely vaccination and improved screening and follow-up among recommended age groups could result in further reductions in invasive cervical cancer.
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Affiliation(s)
- Jacqueline M Mix
- Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Elizabeth A Van Dyne
- Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, Georgia.
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Khan MS, Savoy M. Impact of Human Papillomavirus Vaccination in Reducing Cancer. Prim Care 2020; 47:529-537. [DOI: 10.1016/j.pop.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, Guerra CE, Oeffinger KC, Shih YCT, Walter LC, Kim JJ, Andrews KS, DeSantis CE, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC, Smith RA. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin 2020; 70:321-346. [PMID: 32729638 DOI: 10.3322/caac.21628] [Citation(s) in RCA: 416] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022] Open
Abstract
The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) (strong recommendation). The ACS recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening (qualified recommendation). These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration-approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow-up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.
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Affiliation(s)
| | - Andrew M D Wolf
- Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Timothy R Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health and Masonic Cancer Center, Minneapolis, Minneapolis
| | - Ruth Etzioni
- Public Health Sciences Division, the Fred Hutchinson Cancer Research Center, Seattle, Washington
- Biostatistics, University of Washington Seattle, Seattle, Washington
| | - Christopher R Flowers
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abbe Herzig
- University of Albany School of Public Health, Albany, New York
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Kevin C Oeffinger
- Duke Cancer Institute Center for Onco-Primary Care, Durham, North Carolina
| | - Ya-Chen Tina Shih
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Louise C Walter
- Division of Geriatrics, University of California-San Francisco, San Francisco, California
- Division of Geriatrics, San Francisco VA Health Care System, San Francisco, California
| | - Jane J Kim
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kimberly S Andrews
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia
| | - Carol E DeSantis
- Surveillance Research, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Surveillance Research, American Cancer Society, Atlanta, Georgia
| | | | - Debbie Saslow
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia
| | - Richard C Wender
- Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert A Smith
- Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia
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Abstract
PURPOSE OF REVIEW This review updates progress in the human papillomavirus (HPV)-based revolution in cervical screening and vaccination predicted to eventually eliminate cervical cancer. RECENT FINDINGS HPV PCR, patented by the author in 1987, has recently begun to replace cytology for primary cervical screening. I highlight the findings from large randomized clinical trials that have brought about this change, and progress with implementation. Australia was the first to introduce a national, publicly-funded HPV PCR-based program of primary screening, on 1 December 2017. The United Kingdom is set to follow, as are other countries. The widespread preference of self-sampling by under-screened women in particular will increase the effectiveness of population screening when using HPV tests. Coupled with improved vaccination now that more effective (nonavalent) HPV vaccines are being introduced, recent modeling predicts that cervical cancer will be markedly reduced, or even eliminated, in coming decades. SUMMARY The recent or pending change to more accurate cervical screening by HPV detection using PCR in various countries means less frequent screening for women. Women with an aversion to having their sample collected by a physician can collect their sample themselves, either at the doctor's rooms or at home, the sample then being mailed to the testing laboratory.
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Song F, Du H, Xiao A, Wang C, Huang X, Liu Z, Zhao M, Men H, Wu R. Type-specific Distribution of Cervical hrHPV Infection and the Association with Cytological and Histological Results in a Large Population-based Cervical Cancer Screening Program: Baseline and 3-year Longitudinal Data. J Cancer 2020; 11:6157-6167. [PMID: 32922555 PMCID: PMC7477419 DOI: 10.7150/jca.48357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/16/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: This study aimed to describe the study design, and to analyze the type-specific distribution of cervical high-risk human papillomavirus (hrHPV) infection and its association with cytological and histological results in a large population-based screening program in Buji Street, Shenzhen, China. Methods: A total of 10,186 women aged 21-70 years were co-tested by Cobas4800 HPV assay and liquid-based cytology. Women were referred to colposcopy by virtue of being HPV16/18-positive, Other hrHPV-positive/ cytology ≥ASCUS, or HPV-negative/ cytology ≥LSIL. Three-year histological follow-up data were recorded. Results: The overall prevalence of hrHPV infection was 11.1%; among them, the highest type was Other hrHPV (8.9%), followed by HPV16 (1.6%) and HPV18 (0.6%). Moreover, the prevalence of hrHPV and that of HPV16 increased with cytological severity (Ptrend <0.001). In the baseline phase, 106 women had cervical intraepithelial neoplasia 2/3 (CIN2/3) and six had cervical cancers. During 3-year follow-up, 12 cases of CIN2/3 and no cancers were identified. For HPV16-positive women with normal cytology, the baseline risks of CIN2/3 or worse (CIN2+/CIN3+) were 15.5% (7.0-23.9%) and 4.2% (1.4-8.5%) respectively. For Other hrHPV-positive women with normal cytology, the cumulative 3-year risks of CIN2+/CIN3+ were 3.1% (1.0-5.2%) and 0.7% (0.3-2.1%) respectively. Strikingly, 75.8% (322/425) of abnormal cytology and 50.9% (29/57) HSIL cytology were attributed to Other hrHPV infection in HPV-positive women. Similarly, Other hrHPV infection led to large proportions of CIN2 (62.7%) and CIN3+ (43.9%) over 3-year follow-up. Conclusions: The co-testing modality is a feasible, effective and safe option for cervical cancer screening in urban population. Great importance should also be attached to 'genotypes excluding HPV16/18' and separate detection of each genotype when considering screening and vaccination strategy.
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Affiliation(s)
- Fangbin Song
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Aimin Xiao
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Zhihong Liu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
| | - Meifang Zhao
- Buji Street Family Planning Service Center, Buji Street, Longgang District, Shenzhen 518129, PR China
| | - Hongjian Men
- Buji Street Family Planning Service Center, Buji Street, Longgang District, Shenzhen 518129, PR China
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, PR China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen 518036, Guangdong, PR China
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Cornall AM, Saville M, Pyman J, Callegari ET, Tan FH, Brotherton JML, Malloy MJ, Tabrizi SN, Wrede CD, Garland SM. HPV16/18 prevalence in high-grade cervical lesions in an Australian population offered catch-up HPV vaccination. Vaccine 2020; 38:6304-6311. [PMID: 32736938 DOI: 10.1016/j.vaccine.2020.07.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Using laser capture microdissection (LCM) and sensitive human papillomavirus (HPV) genotyping, we aimed to determine the distribution of vaccine-preventable types in cervical intraepithelial neoplasia grade 3 (CIN3) lesions and adenocarcinoma in situ (AIS) in young women in Victoria, Australia, offered catch-up HPV vaccination, as a baseline for ongoing vaccine impact monitoring. We also compared findings with available pre-vaccination estimates from women with HPV detected on concurrently-collected cytology samples. METHODS Consecutive histologically-confirmed CIN3/AIS biopsies were collected between May 2011 and December 2014 from vaccine-eligible women (born after 30th June 1981). Genotypes present in whole tissue sections (WTS) were determined by a sensitive reverse hybridisation assay; RHA kit HPV SPF10-LiPA25, v1 (Labo Bio-medical Products). Where multiple genotypes were detected, lesions were isolated using LCM and genotyped. Cervical cytology samples from a pre-vaccine cohort had been previously collected and genotyped using HPV Linear Array HPV Genotyping Test (Roche Diagnostics). Mixed-genotype detections in this cohort were resolved to single-lesion-attributable genotypes using hierarchical attribution. RESULTS Overall, 213 and 530 cases were included from pre- and post-vaccine time-periods, respectively. In 18-25 year-olds, the proportion of HPV16/18-positive CIN3/AIS decreased significantly over time from 69% in 2001-2005 (pre-vaccine), to 62% in 2011-2012 (post-vaccine), to 47% in 2013-2014 (p-trend = 0.004). There was no significant change in HPV16/18 in 26-32 year-olds (p-trend = 0.15). In 2013/14, nonavalent vaccine types accounted for 80% of CIN3/AIS in 18-25 year old women and 90% in 26-32 year old women. CONCLUSION Four to 8 years following implementation of HPV vaccination in Australia, approximately 70% of CIN3/AIS in young women was due to HPV16/18. Our data, despite some limitations due to change in methods between pre- and post-vaccine periods, suggests that for vaccine-eligible women aged 18-25 at the time of biopsy, the proportion of HPV16/18-attributable CIN3/AIS lesions is significantly declining post-vaccination.
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Affiliation(s)
- Alyssa M Cornall
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville 3050, Victoria, Australia.
| | - Marion Saville
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; VCS Pathology, VCS Foundation, Carlton 3053, Victoria, Australia.
| | - Jan Pyman
- Department of Anatomical Pathology, The Royal Women's Hospital, Parkville 3052, Victoria, Australia.
| | - Emma T Callegari
- Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville 3050, Victoria, Australia.
| | - Fiona H Tan
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia.
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Michael J Malloy
- VCS Population Health, VCS Foundation, East Melbourne 3002, Victoria, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Sepehr N Tabrizi
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville 3050, Victoria, Australia.
| | - C David Wrede
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville 3050, Victoria, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3052, Victoria, Australia.
| | - Suzanne M Garland
- Regional HPV LabNet Reference Laboratory, Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville 3052, Victoria, Australia; Murdoch Childrens Research Institute, Parkville 3052, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville 3050, Victoria, Australia.
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48
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Zhao W, Liu Y, Zhang L, Ding L, Li Y, Zhang H, Wang T, Hao M. MicroRNA-154-5p regulates the HPV16 E7-pRb pathway in Cervical Carcinogenesis by targeting CUL2. J Cancer 2020; 11:5379-5389. [PMID: 32742484 PMCID: PMC7391205 DOI: 10.7150/jca.45871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023] Open
Abstract
Cervical cancer, induced by persistent HPV infection, has a high mortality rate. The E3 ubiquitin ligase Cullin 2 (CUL2) is critical for HPV16 E7-mediated degradation of retinoblastoma protein (pRb). Dysregulation of microRNAs (miRNAs) is induced during tumorigenesis; however, the association between miRNA networks and CUL2, specific to cervical cancer, remains unknown. Herein, we determined miRNA profiles in cervical cancer tissues using an Affymetrix miRNA array. We found that miR-154-5p was downregulated during cancer progression using real-time quantitative reverse transcription PCR in 130 biopsy specimens. Bioinformatics analysis and dual-luciferase reporter assays indicated that miR-154-5p directly targets the CUL2 3'UTR. To determine the functional consequences of modulating miR-154-5p and CUL2 levels, HPV16-positive cervical cancer cell line (SiHa) was transfected with miR-154-5p mimic, miR-154-5p inhibitor, or CUL2 siRNA. The proliferation, migration, and invasion of transfected cells were evaluated using CCK8 cell counting kit, wound-healing assay, and Transwell invasion assay. Increased miR-154-5p expression promoted significantly reduced SiHa cell proliferation, migration, and invasion, whereas the miR-154-5p inhibitor had the opposite effect. CUL2 silencing had similar effects to those of the miR-154-5p mimic. Consistent with the inverse correlation between miR-154-5p and CUL2 levels, CUL2 silencing also increased pRb expression. To our knowledge, this is the first study to demonstrate that miR-154-5p regulates pRb expression by targeting CUL2 3'UTR, thereby playing a tumor-suppressive role in HPV16 E7-induced cervical carcinogenesis.
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Affiliation(s)
- Weihong Zhao
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Yatao Liu
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Lili Zhang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Ling Ding
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Yaqin Li
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Honglei Zhang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Tong Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Min Hao
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
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Morris CP, Chowsilpa S, Mustafa S, Chan I, Miller D, Maleki Z, Rodriguez EF. Impact of the Current US Preventive Services Task Force Recommendations for Cervical Cancer Screening in Young Women 21 to 29 Years Old. Am J Clin Pathol 2020; 153:734-742. [PMID: 32221518 DOI: 10.1093/ajcp/aqaa012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In 2012, the US Preventive Services Task Force decreased the recommended frequency of cervical cytology screening to once every 3 years and recommended against testing women younger than 21 years regardless of sexual history. We evaluated the impact of this in 21 to 29-year-old women at a tertiary care academic medical center in 2011 and 2017. METHODS We retrospectively analyzed Papanicolaou test results at two time points in 21- to 29-year-old women. RESULTS There was a decrease in the number of high-grade lesions in 21- to 25-year-old women (odds ratio [OR], 0.36) from 2011 to 2017. Within the 26- to 29-year-old patient group, there was a trend toward a higher percentage of high-grade squamous intraepithelial lesion (HSIL) in 2017 compared to 2011 on cytology, which did not reach statistical significance (OR, 1.46). However, follow-up histologic specimens showed a higher percentage of HSIL in 2017 compared to 2011 in this age group (OR, 2.16). CONCLUSIONS Our findings suggest that the cervical cancer screening guidelines introduced in 2012 have not had a detrimental impact on the outcomes of cervical cancer screening for 21- to 25-year-old women. However, we need to continue monitoring the effects of decreased screening in 26- to 29-year-old women.
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Affiliation(s)
- C Paul Morris
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
- National Institute of Allergy and Infectious Disease, Bethesda, MD
| | - Sayanan Chowsilpa
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sara Mustafa
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
| | - Isaac Chan
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD
| | - Daniel Miller
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
| | - Zahra Maleki
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD
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50
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Brackney MM, Gargano JW, Hannagan SE, Meek J, Querec TD, Niccolai LM. Human Papillomavirus 16/18-Associated Cervical Lesions: Differences by Area-Based Measures of Race and Poverty. Am J Prev Med 2020; 58:e149-e157. [PMID: 32001053 DOI: 10.1016/j.amepre.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This analysis evaluates trends in cervical lesions with human papillomavirus 16/18 detected by area-based measures of race, ethnicity, and poverty during 2008-2015. METHODS Trends in the proportion of lesions with human papillomavirus 16/18 detected among residents of New Haven County, Connecticut were examined by area-based measures of race, ethnicity, and poverty. Area-based measures are aggregate descriptors of census tract characteristics useful for measuring differences in health outcomes in the context of where people live. Multivariable logistic regression modeling was conducted, adjusted for individual-level race, ethnicity, and insurance status to assess the independent effects of area-based measures. Data were analyzed in 2018-2019. RESULTS Among women aged 21-24 years and 25-29 years, significant declines in the proportion of lesions with human papillomavirus 16/18 were observed. Among women aged 21-24 years, declines began earlier and were greater in magnitude in areas of lower poverty (OR=0.55, 95% CI=0.36, 0.85 for 2010-2012 vs 2008-2009 and OR=0.30, 95% CI=0.18, 0.51 for 2013-2015 vs 2008-2009) compared with higher poverty (OR=1.66, 95% CI=0.86, 3.21 and OR=0.48, 95% CI=0.19, 1.20). Similar patterns were observed for women aged 25-29 years, and for area-based measures of race and ethnicity. CONCLUSIONS Differences were observed in declines in the proportion of human papillomavirus 16/18 lesions by area-based measures since the introduction of human papillomavirus vaccines, with greater and earlier declines in areas with fewer residents living in poverty and racial minorities. Ongoing human papillomavirus vaccine impact monitoring is necessary to track differences by sociodemographic characteristics.
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Affiliation(s)
- Monica M Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut.
| | - Julia W Gargano
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan E Hannagan
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Troy D Querec
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda M Niccolai
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
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