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Jailani AS, Balqis-Ali NZ, Tang KF, Fun WH, Samad SA, Jahaya R, Subakir NN, Ismail R, Said ZM, Sararaks S. Prevalence and sociodemographic predictors of high-risk vaginal human papillomavirus infection: findings from a public cervical cancer screening registry. BMC Public Health 2023; 23:2243. [PMID: 37964260 PMCID: PMC10644607 DOI: 10.1186/s12889-023-17132-2] [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: 01/21/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION High-risk human papillomavirus (HPV) screening is vital for early cervical cancer detection and treatment. With the introduction of the national cervical cancer screening programme and screening registry in Malaysia, there is a need to monitor population-based HPV screening uptake and high-risk HPV prevalence as part of cervical cancer surveillance. OBJECTIVE To determine the prevalence and sociodemographic factors predicting high-risk HPV infection in Malaysia based on a public, community-based cervical cancer screening registry targeting women at risk of getting HPV infection. METHODS The study used data from the Malaysian cervical cancer screening registry established by the Family Health Development Division from 2019 to 2021. The registry recorded sociodemographic data, HPV test details and results of eligible women who underwent HPV screening at public primary healthcare facilities. A vaginal sample (via self-sampling or assisted by a healthcare provider) was used for DNA extraction for HPV detection and genotyping. Registry data were extracted and analysed to determine prevalence estimates of high-risk HPV infection. Multifactorial logistic regression analysis was conducted to determine predictors of high-risk HPV infection. All analyses were performed using Stata version 14. RESULTS The programme screened a total of 36,738 women during the study period. Women who attended the screening programme were mainly from urban areas, aged 30-39 years, and of Malay ethnicity. The prevalence of high-risk HPV infection was 4.53% among women screened, with the yearly prevalence ranging from 4.27 to 4.80%. A higher prevalence was observed among urban settling women, those aged 30-49 years, those of Indian ethnicity, and those without children. The results from logistic regression showed that women from urban areas, lower age groups, of Indian or Chinese ethnicity, and who are self-employed were more likely to be infected with high-risk HPV. CONCLUSION Targeted and robust strategies to reach identified high-risk groups are needed in Malaysia. In addition, the registry has the potential to be expanded for an improved cervical cancer elimination plan. TRIAL REGISTRATION Trial registration number: NMRR ID-22-00187-DJU.
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Affiliation(s)
- Anis-Syakira Jailani
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, Shah Alam, Selangor, 40170, Malaysia
| | - Nur Zahirah Balqis-Ali
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, Shah Alam, Selangor, 40170, Malaysia.
| | - Kar Foong Tang
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, Shah Alam, Selangor, 40170, Malaysia
| | - Weng Hong Fun
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, Shah Alam, Selangor, 40170, Malaysia
| | - Shazimah Abdul Samad
- Family Health Section, Family Health Development Division, Ministry of Health, Malaysia, Putrajaya, 62590, Malaysia
| | - Rohaidza Jahaya
- Family Health Section, Family Health Development Division, Ministry of Health, Malaysia, Putrajaya, 62590, Malaysia
| | - Nurun Najihah Subakir
- Family Health Section, Family Health Development Division, Ministry of Health, Malaysia, Putrajaya, 62590, Malaysia
| | - Roziah Ismail
- Family Health Section, Family Health Development Division, Ministry of Health, Malaysia, Putrajaya, 62590, Malaysia
| | - Zakiah Mohd Said
- Family Health Section, Family Health Development Division, Ministry of Health, Malaysia, Putrajaya, 62590, Malaysia
| | - Sondi Sararaks
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, Shah Alam, Selangor, 40170, Malaysia
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Chua B, Lim LM, Ng JSY, Ma Y, Wee HL, Caro JJ. Cost-Effectiveness Analysis of HPV Extended versus Partial Genotyping for Cervical Cancer Screening in Singapore. Cancers (Basel) 2023; 15:1812. [PMID: 36980698 PMCID: PMC10046888 DOI: 10.3390/cancers15061812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Human papillomavirus (HPV) partial genotyping (PGT) identifies HPV16 and HPV18 individually, alongside 12 other high-risk HPV genotypes (hrHPV) collectively. HPV extended genotyping (XGT) identifies four additional hrHPV individually (HPV31, 45, 51, and 52), and reports the remaining eight in three groups (HPV33|58; 56|59|66; 35|39|68). Quality-adjusted life years (QALY), health care resource use, and costs of XGT were compared to PGT for cervical cancer screening in Singapore using DICE simulation. Women with one of the three hrHPV identified by XGT (HPV35|39|68; 56|59|66; 51), and atypical squamous cells of undetermined significance (ASCUS) on cytology, are recalled for a repeat screening in one year, instead of undergoing an immediate colposcopy with PGT. At the repeat screening, the colposcopy is performed only for persistent same-genotype infections in XGT, while with PGT, all the women with persistent HPV have a colposcopy. Screening 500,122 women, aged 30-69, with XGT, provided an incremental cost-effectiveness ratio (ICER) versus PGT of SGD 16,370/QALY, with 7130 (19.4%) fewer colposcopies, 6027 (7.0%) fewer cytology tests, 9787 (1.6%) fewer clinic consultations, yet 2446 (0.5%) more HPV tests. The XGT ICER remains well below SGD 100,000 in sensitivity analyses, (-SGD 17,736/QALY to SGD 50,474/QALY). XGT is cost-effective compared to PGT, utilizes fewer resources, and provides a risk-based approach as the primary cervical cancer screening method.
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Affiliation(s)
- Brandon Chua
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
- Health Economics and Outcomes Research, Becton Dickinson Holdings Pte. Ltd., 2 International Business Park Road, The Strategy #08-08, Singapore 609930, Singapore
| | - Li Min Lim
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynecology, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Joseph Soon Yau Ng
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynecology, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Yan Ma
- Health Economics and Outcomes Research, Becton Dickinson Holdings Pte. Ltd., 2 International Business Park Road, The Strategy #08-08, Singapore 609930, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore
| | - J. Jaime Caro
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
- School of Global and Population Health, McGill University, Suite 1200, 2001 McGill College Avenue, Montréal, QC H3A 1G1, Canada
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
- Evidera, 500 Totten Pond Rd., Waltham, MA 02451, USA
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Wong ELY, Cheung AWL, Chen Z, Wong AYK, Yeung ACM, Yau PSY, Chan PKS. Molecular Epidemiology of Human Papillomavirus Infection Among Chinese Women With Cervical Cytological Abnormalities. Front Public Health 2022; 10:820517. [PMID: 35655449 PMCID: PMC9152134 DOI: 10.3389/fpubh.2022.820517] [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: 11/24/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Virtually all invasive cervical cancers are caused by persistent genital human papillomavirus (HPV) infection. Therefore, HPV-based screening becomes an essential tool as one of the cervical prevention strategies to reduce the disease burden. Population-specific epidemiologic information on HPV infection among women with cytological abnormalities is essential to inform the strategy of HPV-based screening programme. The study also explored the presence of cutaneous HPV types (Beta-β and Gamma-γ) in cervical infections. Methods A cross-sectional study on Chinese women aged ≥25 years who were referred to public specialist out-patient clinics for colposcopy or further management of cervical cytological abnormalities were recruited between 2015 and 2016 in Hong Kong. HPV was detected and typified by the novel PCR-based Next-Generation Sequencing (NGS) strategies. Results The overall HPV infection rate was 74% and detected in 222 of the 300 respondents, with the prevalence of cutaneous HPV infection being 2.3%. The overall prevalence of HPV infection among women with current cytological abnormalities was 79.1% (197/249). The age-specific prevalence of HPV (any-type HPV infection) among women with cytological abnormalities reached the first peak with 87.9% in the age group of 35–39 years and gradually declined to 56.0% at 55–59 years. While a second peak occurred at 65 years or above (92.9%). HPV58 (13.7%), HPV52 (11.7%), HPV53 (11.2%), HPV16 (10.0%), HPV18 (5.2%), and HPV51 (5.2%) were the top five high-risk HPV genotypes among women with cytological abnormalities. Any-HPV type infection was significantly associated with an abnormal cervical smear (OR = 3.7; 95% CI 2.0–7.1), and high-risk HPV infection was also significantly associated with an abnormal cervical smear (OR = 6.3; 95% CI 3.0–13.5). Conclusion New evidence on the second peak of HPV infection at ≥65 years old suggests the necessity to review the current guideline for the cervical screening program extending to age 65 and above. Moreover, the high prevalence of two HPV genotypes—high-risk HPV51 and potential high-risk HPV53, among women with cytological abnormalities—suggests further research work is needed to confirm the contributory role of HPV51 and HPV53 in cervical cancer and the need for inclusion in the next generation of the HPV vaccine.
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Affiliation(s)
- Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Annie Wai-Ling Cheung
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zigui Chen
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Amy Yuen-Kwan Wong
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Apple Chung-Man Yeung
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Peter Sen-Yung Yau
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Paul Kay-Sheung Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Lim TSC, Ismail-Pratt I, Goh LH. Cervical cancer screening and vaccination: understanding the latest guidelines. Singapore Med J 2022; 63:125-129. [DOI: 10.11622/smedj.2022045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Han X, Song G, Li Y, Dong Z, Yan X, Wang S, Tian H, Wu X, Li C, Huo Y. Prevalence and genotype distribution of human papillomavirus infection among women aged 30-65 years in Xi'an, China: a population-based study of 14,655 women. Hum Vaccin Immunother 2021; 17:5439-5446. [PMID: 34893010 DOI: 10.1080/21645515.2021.2007709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cervical cancer is the fourth most common cancer among women worldwide in terms of both incidence and mortality. Persistent infection with high-risk human papillomavirus (HPV) has been identified as a cause of cervical intraepithelial neoplasia and invasive cervical cancer. The distribution of human papillomavirus genotypes varies regionally. To acquire baseline data on the population-based prevalence and genotype distribution of HPV infection, we investigated the molecular epidemiology of HPV infection among women in Xi'an, China. The study was conducted from September 2018 to December 2020. A total of 14,655 women aged 30-65 years were screened. The overall prevalence of HPV infection was 13.5% (95% confidence interval [CI]: 13.0-14.1%), with 10.4% of participants being positive for a single HPV type and 3.1% being positive for multiple HPV types. The prevalence of high-risk HPV (HR-HPV), low-risk HPV (LR-HPV) and mixed HPV infection was 10.1% (95% CI: 9.6-10.5%), 2.2% (95% CI: 2.0-2.4%), and 1.3% (95% CI: 1.1-1.5%), respectively. The five most frequently detected HR-HPV types were types 52 (2.6%), 16 (1.9%), 53 (1.8%), 58 (1.4%), and 51 (0.9%). The most frequently detected LR-HPV type was HPV-42 (1.1%). The prevalence and HPV genotype distribution varied by region and age. Age-specific HPV prevalence peaked in the over 60 years age group (18.8%), and Beilin District had the highest HPV prevalence (18.1%). The results of this first population-based study provide a reference for HPV-based cervical cancer screening and HPV vaccination programs in Xi'an.
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Affiliation(s)
- Xiaoxiao Han
- Department of Laboratory Medicine, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Guozhong Song
- Department of Laboratory Medicine, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Yufang Li
- Nuclear Medicine Diagnostic Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Zhaoqiang Dong
- Department of Laboratory Medicine, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Xianchun Yan
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, China
| | - Suqing Wang
- Department of Science and Education, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Huizhen Tian
- Department of Laboratory Medicine, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Xiaohong Wu
- Department of Women's Health, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Chen Li
- Department of Women's Health, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Yi Huo
- Department of Laboratory Medicine, 941 Hospital of Joint Logistics Support Force of PLA, Xining, China.,State Key Laboratory of Cancer Biology, Department of Immunology, Fourth Military Medical University, Xi'an, China
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Mchome BL, Kjaer SK, Manongi R, Swai P, Waldstroem M, Iftner T, Wu C, Mwaiselage J, Rasch V. HPV types, cervical high-grade lesions and risk factors for oncogenic human papillomavirus infection among 3416 Tanzanian women. Sex Transm Infect 2020; 97:56-62. [PMID: 32269071 DOI: 10.1136/sextrans-2019-054263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/29/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The objective of the present study was to assess the prevalence and type-specific distribution of cervical high-risk (HR) human papillomavirus (HPV) among women with normal and abnormal cytology, and to describe risk factors for HR HPV among HIV-positive and HIV-negative women in Tanzania. METHODOLOGY A cross-sectional study was conducted in existing cervical cancer screening clinics in Kilimanjaro and Dar es Salaam. Cervical specimens were obtained from women aged 25-60 years. Samples were shipped to Denmark for cytological examination, and to Germany for HR HPV testing (using Hybrid Capture 2) and genotyping (using LiPaExtra). Risk factors associated with HPV were assessed by multivariable logistic regression analysis. RESULT Altogether, 4080 women were recruited with 3416 women contributing data for the present paper, including 609 HIV-positive women and 2807 HIV-negative women. The overall HR HPV prevalence was 18.9%, whereas the HR HPV prevalence in women with high-grade squamous intraepithelial lesions (HSILs) was 92.7%. Among HPV-positive women with HSIL, HPV16 (32.5%) and HPV58 (19.3%) were the the most common types followed by HPV18 (16.7%) and HPV52 (16.7%). Factors associated with HR HPV included younger age, increasing number of partners and early age at first intercourse. Similar risk factors were found among HIV-positive and HIV-negative women. In addition, among HIV-positive women, those with CD4 counts <200 cells/mm3 had an increased risk of HR HPV (OR 2.2; 95% CI 1.2 to 4.8) compared with individuals with CD4 count ≥500 cells/mm3. CONCLUSION Given the HPV distribution among Tanzanian women, the current HPV vaccination in Tanzania using quadrivalent vaccine may be considered replaced by the nonavalent vaccine in the future. In addition, appropriate antiretroviral treatment management including monitoring of viremia may decrease the burden of HR HPV in HIV-positive women.
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Affiliation(s)
- Bariki Lawrence Mchome
- Obstetric and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Susanne Krüger Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Juliane Marie Center, Gynecologic Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rachel Manongi
- Community Health Department, Kilimanjaro Christian Medical College, Moshi, Kilimanjaro, Tanzania
| | - Patricia Swai
- Obstetric and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | | | - Thomas Iftner
- Medical Virology, University Hospital of Tübingen, Tübingen, Germany
| | - Chunsen Wu
- Department of Obstetric and Gynaecology, Odense University Hospital, Odense, Denmark
| | - Julius Mwaiselage
- Division of Cancer Prevention, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Vibeke Rasch
- Department of Obstetric and Gynaecology, Odense University Hospital, Odense, Denmark
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Tay SK, Hsu TY, Pavelyev A, Walia A, Kulkarni AS. Clinical and economic impact of school-based nonavalent human papillomavirus vaccine on women in Singapore: a transmission dynamic mathematical model analysis. BJOG 2019; 125:478-486. [PMID: 29266694 DOI: 10.1111/1471-0528.15106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the epidemiological and economic impact of a nine-valent (nonavalent) human papillomavirus (HPV) 6/11/16/18/31/33/45/52/58 vaccine programme for young teenagers in Singapore. DESIGN Mathematical modelling. SETTING Pharmaco-economic simulation projection. POPULATION Singapore demography. METHODS Clinical, epidemiological and financial data from Singapore were used in a validated HPV transmission dynamic mathematical model to analyse the impact of nonavalent HPV vaccination over quadrivalent and bivalent vaccines in a school-based 2-dose vaccination for 11- to 12-year-old girls in the country. The model assumed routine cytology screening in the current rate (50%) and vaccine coverage rate of 80%. MAIN OUTCOME MEASURES Changes over a 100-year time period in the incidence and mortality rates of cervical cancer, case load of genital warts, and incremental cost-effectiveness ratio (ICER). RESULTS Compared with bivalent and quadrivalent HPV vaccination programmes, nonavalent HPV universal vaccination resulted in an additional reduction of HPV31/33/45/52/58 related CIN1 of 40.5%, CIN 2/3 of 35.4%, cervical cancer of 23.5%, and cervical cancer mortality of 20.2%. Compared with bivalent HPV vaccination, there was an additional reduction in HPV-6/11 related CIN1 of 75.7%, and genital warts of 78.9% in women and 73.4% in men. Over the 100 years, after applying a discount of 3%, disease management cost will be reduced by 32.5% (versus bivalent) and 7.5% (versus quadrivalent). The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained was SGD 929 compared with bivalent vaccination and SGD 9864 compared with quadrivalent vaccination. CONCLUSION Universal two-dose nonavalent HPV vaccination for 11- to 12-year-old adolescent women is very cost-effective in Singapore. TWEETABLE ABSTRACT Nonavalent HPV vaccination of 11- to 12-year-old girls is cost-effective in Singapore.
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Affiliation(s)
- S K Tay
- Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore
| | - T-Y Hsu
- Medical Affairs, MSD Pharma (Singapore) Pte. Ltd., Singapore
| | | | - A Walia
- Department of Medical Affairs, MSD International GmbH (Singapore Branch), Singapore
| | - A S Kulkarni
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Tan LSY, Fredrik P, Ker L, Yu FG, Wang DY, Goh BC, Loh KS, Lim CM. High-risk HPV genotypes and P16INK4a expression in a cohort of head and neck squamous cell carcinoma patients in Singapore. Oncotarget 2018; 7:86730-86739. [PMID: 27893418 PMCID: PMC5349949 DOI: 10.18632/oncotarget.13502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022] Open
Abstract
Human papillomavirus (HPV), especially HPV16 genotype, is associated with oropharyngeal squamous cell carcinoma (OPSCC). We aim to determine the prevalence and characterize the high-risk (HR)-HPV genotypes in head and neck SCC (HNSCC) in a South-East Asian multi-ethnic society in Singapore and examine its prognostic significance.159 HNSCC archival tissue samples were retrieved and tumour DNA was screened for 18 HR-HPV genotypes using a PCR-based assay (Qiagen, digene HPV genotyping RH test). P16 protein overexpression was identified using immunohistochemistry (IHC). Statistical correlation between clinical outcomes were performed between HPV-positive and negative HNSCC patients.Six HR-HPVs (HPV16, 18, 31, 45, 56, 68) were detected in 90.6% of HNSCC; and 79.9% had multiple HPV genotypes detected. HPV31 and HPV45 were the most prevalent (79.2% and 87.4%, respectively); and HPV16 was predominantly found in OPSCC (p < 0.001). HPV-DNA PCR assay yielded a high sensitivity (96%) but low specificity (11%) when compared to p16 immunohistochemistry as the reference standard.P16-positive HNSCC was predominantly observed in OPSCC (73.7%; p = 0.005); and p16-positive OPSCC exhibited improved overall survival compared to p16-negative OPSCC (p = 0.022). Similarly, smoking and alcohol consumption were poor prognostic factors of overall survival (p = 0.007; p = 0.01) in OPSCC patients.HR-HPVs were identified in 90.6% of HNSCC patients using the HPV-DNA PCR assay. This test had a poor specificity when compared to p16 IHC; making it an unreliable detection technique in selecting patients for radiation dose de-escalation treatment protocol. P16-positive tumor was predominantly found in the oropharynx these patients demonstrated better overall survival than those with p16-negative OPSCC.
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Affiliation(s)
- Louise Soo Yee Tan
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore 119228
| | - Petersson Fredrik
- Department of Pathology, National University Health System Singapore, Singapore 119228
| | - Liang Ker
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore 119228
| | - Feng Gang Yu
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore 119228
| | - De Yun Wang
- Department of Otolaryngology, National University of Singapore, Singapore 119228
| | - Boon Cher Goh
- Department of Medical Oncology, National University Health System Singapore, Singapore 119228
| | - Kwok Seng Loh
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore 119228.,Department of Otolaryngology, National University of Singapore, Singapore 119228
| | - Chwee Ming Lim
- Department of Otolaryngology-Head and Neck Surgery, National University Health System Singapore, Singapore 119228.,Department of Otolaryngology, National University of Singapore, Singapore 119228
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Khoo SP, Bhoo-Pathy N, Yap SH, Anwar Shafii MK, Hairizan Nasir N, Belinson J, Subramaniam S, Goh PP, Zeng M, Tan HD, Gravitt P, Woo YL. Prevalence and sociodemographic correlates of cervicovaginal human papillomavirus (HPV) carriage in a cross-sectional, multiethnic, community-based female Asian population. Sex Transm Infect 2017; 94:277-283. [DOI: 10.1136/sextrans-2017-053320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/17/2017] [Accepted: 11/11/2017] [Indexed: 12/29/2022] Open
Abstract
ObjectivesCervical cancer is a largely preventable disease, and the strategic implementation of a cervical cancer prevention programme is partly dependent on the impact of human papillomavirus (HPV) infection interpreted within the context of the country’s sociodemographic attributes. The objective of this study is to determine the prevalence of cervicovaginal HPV infection among a healthy, community-based, multiethnic Malaysian population. The HPV prevalence was subsequently correlated to the individual’s sociodemographics and sexual/reproductive history. Of significance, the observed prevalence captured was in a birth cohort not included in the national school-based HPV vaccination programme.MethodsThis was a cross-sectional study where 1293 healthy women aged between 18 and 60 years were recruited via convenience sampling from five community-based clinics in Selangor, Malaysia. Cervicovaginal self-samples were obtained and DNA was extracted for HPV detection and genotyping. A comprehensive questionnaire was administered to determine the sociodemographics and behavioural patterns of participants.ResultsThe median age at enrolment was 37 years old (IQR: 30–47). In total, 86/1190 (7.2%) of the samples collected were positive for HPV infection, with the highest HPV prevalence (11.9%) detected in the subgroup of 18–24 years old. The top three most prevalent HPV genotypes were HPV 16, 52 and 58. The independent risk factors associated with higher rates of HPV infection included Indian ethnicity, widowed status and women with partners who are away from home for long periods and/or has another sexual partner.ConclusionsThe overall prevalence of HPV infection in this Malaysian multiethnic population was 7.2%, with 6.5% being high-risk genotypes. The top three most common high-risk HPV types were HPV 16, 52 and 58. This information is important for the planning of primary (HPV vaccination) and secondary (screening) cervical cancer prevention programmes in Malaysia.
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College women, HPV genotyping and sexual behavior before HPV vaccination: Results from samples stored for a long time. J Infect Public Health 2017; 11:286-289. [PMID: 28993170 DOI: 10.1016/j.jiph.2017.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/03/2017] [Accepted: 08/04/2017] [Indexed: 11/21/2022] Open
Abstract
HPV is the sexually transmitted agent most common among young people, like college students. The aim of study was to associate sexual behavior characteristics of women with HPV, detected in genital samples taken before the introduction of the HPV vaccine. Female students during 2001-2005 donated genital samples and the samples were re-analyzed in 2013 for HPV genotyping by RT-PCR. The frozen storage of the students' genital samples allowed the detection of HPV DNA and its genotyping after years of sample collection. HPV prevalence was 22%, HPV16 3.9%, and HPV18 1.1%. Age, multiple sexual partners and the partner's age at first sexual intercourse were significantly associated to HPV. Students with ≥ 3 sexual partners and who did not use condom had 12.8 higher odds of being HPV positive. These results made possible the analysis of HPV prevalence changes, before HPV vaccine introduction.
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Tay SK, Lin LEO, Goh RCH. Detection Rate of High-Grade Cervical Neoplasia and Cost-Effectiveness of High-Risk Human Papillomavirus Genotyping with Reflex Liquid-based Cytology in Cervical Cancer Screening. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2017. [DOI: 10.47102/annals-acadmedsg.v46n7p267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: This study aimed to determine the prevalence of cervical intraepithelial neoplasia grade 3 or worse (≥CIN3) and cost-effectiveness of human papillomavirus (HPV) genotyping with reflex liquid-based cytology (LBC) for cervical cancer screening in Singapore. Materials and Methods: Women who were ≥25 years old and undertook co-testing with LBC and HPV-genotyping (Cobas-4800, Roche, USA) for HPV-16, HPV-18 and 12 high-risk HPV types in a single institution were studied retrospectively. A single cervical smear in ThinPrep® PreservCyt® solution (Hologic, USA) was separated for tests in independent cytology and molecular pathology laboratories. The results were reviewed by a designated gynaecologist according to institutional clinical management protocols. Those who tested positive for HPV-16 and/or HPV-18 (regardless of cytology results), cytology showing low-grade squamous intraepithelial lesions (LSIL) or high-grade SIL (HSIL), or atypical squamous cells of undetermined significance (ASCUS) with positive 12 high-risk HPV types were referred for colposcopy. Colposcopy was performed by experienced colposcopists. Cervical biopsy, either directed punch biopsies or excisional biopsy, was determined by a colposcopist. The diagnosis of ≥CIN3 was reviewed by a gynaecologic pathologist. Cost-effectiveness of HPV-based screening in terms of disease and financial burden was analysed using epidemiological, clinical and financial input data from Singapore. Results: Of 1866 women studied, 167 (8.9%) had abnormal cytology (≥ASCUS) and 171 (9.2%) tested positive for high-risk HPV. Twenty-three CIN were detected. Three of the 10 ≥CIN3 cases had negative cytology but positive HPV-16. Compared to cytology, HPV genotyping detected more ≥CIN3 (OR: 1.43). HPV+16/18 genotyping with reflex LBC was superior in terms of cost-effectiveness to LBC with reflex HPV, both for disease detection rate and cost per case of ≥CIN2 detected. Conclusion: Compared to cytology, HPV+16/18 genotyping with reflex LBC detected more ≥CIN3 and was cost-effective for cervical screening in Singapore.
Key words: Co-Testing, Incidence trend, Mortality, Intraepithelial neoplasia, Pap smear
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12
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Teo I, Cheung YB, Lim TYK, Namuduri RP, Long V, Tewani K. The relationship between symptom prevalence, body image, and quality of life in Asian gynecologic cancer patients. Psychooncology 2017; 27:69-74. [DOI: 10.1002/pon.4457] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/11/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Irene Teo
- Lien Centre for Palliative Care; Duke-NUS Medical School; Singapore
- Department of Psychosocial Oncology; National Cancer Centre Singapore; Singapore
| | - Yin Bun Cheung
- Centre for Quantitative Medicine; Duke-NUS Medical School; Singapore
- Center for Child Health Research; University of Tampere and Tampere University Hospital; Tampere Finland
| | | | | | | | - Komal Tewani
- Department of Gynaecology Oncology; KK Women's and Children's Hospital; Singapore
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Delory T, Ngo-Giang-Huong N, Rangdaeng S, Chotivanich N, Limtrakul A, Putiyanun C, Suriyachai P, Matanasarawut W, Jarupanich T, Liampongsabuddhi P, Heard I, Jourdain G, Lallemant M, Le Coeur S. Human Papillomavirus infection and cervical lesions in HIV infected women on antiretroviral treatment in Thailand. J Infect 2017; 74:501-511. [PMID: 28254419 DOI: 10.1016/j.jinf.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To estimate the prevalence and factors associated with Human Papillomavirus (HPV) infection, HPV genotypes and cytological/histological high-grade (HSIL+/CIN2+) lesions. METHODS We conducted a cross-sectional study within a prospective cohort of HIV-infected women on combination antiretroviral therapy (cART). Cervical specimens were collected for cytology and HPV genotyping (Papillocheck®). Any women with High-Risk-HPV (HR-HPV), and/or potentially HR-HPV (pHR-HPV) and/or ASC-US or higher (ASC-US+) lesions were referred for colposcopy. Factors associated with HR-HPV infection and with HSIL+/CIN2+ lesions were investigated using mixed-effects logistic regression models. RESULTS 829 women were enrolled: median age 40.4 years, on cART for a median of 6.9 years, median CD4 cell-count 536 cells/mm3, and 788 (96%) with HIV-viral load<50copies/mL. Of 214 (26%) infected with HPV: 159 (19%) had ≥1 HR-HPV, of whom 38 (5%) HPV52, 22 (3%) HPV16, 9 (1%) HPV18; 21 (3%) had pHR-HPV, 34 (4%) low risk-HPV infection, and 56 (26%) had multiple genotypes. Younger age, low CD4 cell-counts and low education were independently associated with HR-HPV infection. 72 women (9%) had ASC-US+ and 28 (3%) HSIL+/CIN2+ lesions. HR-HPV infection was independently associated with HSIL+/CIN2+ lesions. CONCLUSION The prevalence of HPV infection and of cervical lesions was low. The HPV genotype distribution supports the use of 9-valent vaccine in Thailand.
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Affiliation(s)
- Tristan Delory
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; APHP, Service de maladies infectieuses et tropicales, hôpital Saint Louis, F-75010, Paris, France; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France.
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Samreung Rangdaeng
- Faculty of Medicine, Department of Pathology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Aram Limtrakul
- Ministry of Public Health, Nakornping Hospital, Chiang Mai, Thailand
| | - Chaiwat Putiyanun
- Ministry of Public Health, Chiang Kham Hospital, Chiang Kham, Thailand
| | | | | | | | | | - Isabelle Heard
- HPV National Reference Center, Pasteur Institute, Paris, France; APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France; Harvard T.H. Chan School of Public Health, Boston, MA, United States
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14
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Patel H, Pčolkina K, Strazdina K, Viberga I, Sherman SM, Tincello DG, Redman CW, Rezeberga D, Moss EL. Awareness of HPV infection and attitudes toward HPV vaccination among Latvian adolescents. Int J Gynaecol Obstet 2017; 137:138-144. [PMID: 28171702 DOI: 10.1002/ijgo.12117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/30/2016] [Accepted: 02/03/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate awareness of HPV and its vaccine among Latvian adolescents. METHODS A cross-sectional survey was conducted in a 2-week period in September 2015 among 270 adolescents attending a secondary school in Riga, Latvia. All students present during sexual-health classes (grades 10-12 [aged 16-21 years]) were included. A self-administered paper-based survey assessed sociodemographic factors, sexual behaviours, smear history and knowledge of sexually transmitted infections, HPV and HPV vaccine knowledge, and sources of information. RESULTS Overall, 121 surveys were completed (62 by male students and 59 by female students). Latvian adolescents lacked awareness of HPV: only 26 (21.5%) had heard of HPV (21 [35.6%] female students vs 5 [8.1%] male students; P<0.001) and 12 (9.9%) of the HPV vaccine. Eighty (66.1%) participants felt inadequately informed about HPV. However, the adolescents partook in high-risk behaviours: 70 (57.9%) students were sexually active, 26 (37.1%) of whom had already had three or more sexual partners. CONCLUSION Despite the high prevalence of HPV in Latvia, poor knowledge about HPV infection among adolescents could explain low uptake of the HPV vaccine by this high-risk population. Therefore, educational strategies that highlight the consequences of HPV could promote acceptance of vaccination.
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Affiliation(s)
- Hersha Patel
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kristine Pčolkina
- Department of Obstetrics and Gynecology, University of Latvia, Riga, Latvia
| | - Kristine Strazdina
- Department of Obstetrics and Gynecology, University of Latvia, Riga, Latvia
| | - Ilza Viberga
- Department of Obstetrics and Gynecology, University of Latvia, Riga, Latvia
| | - Susan M Sherman
- School of Psychology, Keele University, Newcastle-under-Lyme, UK
| | | | - Charles W Redman
- Department of Gynecology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Dace Rezeberga
- Department of Obstetrics and Gynecology, Riga Stradiņš University, Riga, Latvia
| | - Esther L Moss
- Department of Cancer Studies, University of Leicester, Leicester, UK
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Krishnan K, Thomas A. Correlation of cervical cytology with high-risk HPV molecular diagnosis, genotypes, and histopathology-A four year study from the UAE. Diagn Cytopathol 2015; 44:91-7. [DOI: 10.1002/dc.23391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/01/2015] [Accepted: 11/09/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Kavita Krishnan
- Specialist Anatomic Pathology; Premier Diagnostic Center (Prime Healthcare Group); Dubai UAE
| | - Antony Thomas
- Specialist Pathologist and Laboratory Director; Premier Diagnostic Center (Prime Healthcare Group); Dubai UAE
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Young D, Xiao CC, Murphy B, Moore M, Fakhry C, Day TA. Increase in head and neck cancer in younger patients due to human papillomavirus (HPV). Oral Oncol 2015; 51:727-30. [PMID: 26066977 DOI: 10.1016/j.oraloncology.2015.03.015] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023]
Abstract
The face of head and neck cancer has changed dramatically over the past 30 years. There has been a steady decline in the number of tobacco and alcohol related squamous cell carcinomas over the past 30 years, but and increasing incidence of human papillomavirus (HPV) related cancers. Some estimates suggest that 70-90% of new oropharyngeal cancers have evidence of HPV. These patients have different demographic patterns, in that they are more likely to be younger, white adults in their 40s and 50s who are never smokers or have reduced tobacco exposure. Studies have shown that a higher number of lifetime oral sex partners (>5) and a higher number of lifetime vaginal sex partners (>25) have been associated with increased risk of HPV positive head and neck cancer. People can also reduce their risk of HPV linked head and neck cancer by receiving the HPV vaccine series prior to becoming sexually active. Recent evidence suggests HPV related head and neck cancers present with different symptoms than those caused by tobacco. The most popular test for HPV status is the p16 immunohistochemical stain because it is cheap, simple, and studies have shown it to have comparable sensitivity and specificity to the previous standards. It is widely recommended that all cancers of the oropharynx be tested for the presence of HPV, and some recommend it for all head and neck cancers. Overall 2-year and 5-year survival for HPV positive head and neck cancer is significantly greater than for HPV negative cancers, likely due to HPV positive cancers being more responsive to treatment.
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Affiliation(s)
- David Young
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, United States
| | - Christopher C Xiao
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, United States
| | - Benjamin Murphy
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, United States
| | - Michael Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 1120 W. Michigan Street Suite 200, Indianapolis, IN, United States
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, United States
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, United States.
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Tay K, Tay SK, Tesalona KC, Rashid NMR, Tai EYS, Najib SJM. Factors affecting the uptake of cervical cancer screening among nurses in Singapore. Int J Gynaecol Obstet 2015; 130:230-4. [PMID: 26032624 DOI: 10.1016/j.ijgo.2015.03.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/03/2015] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify factors other than socioeconomic status that influence participation in cervical cancer screening. METHODS A prospective, questionnaire-based, cross-sectional study was conducted among all female nurses working at Singapore General Hospital, Singapore, between November 1 and December 15, 2013. Characteristics assessed included age, knowledge score (0-10, on the basis of 10 true-or-false statements), perceived risk of cervical cancer, and health facility use. RESULTS Among 2000 nurses, 1622 (81.1%) responded. The mean knowledge score was 4.70±1.76. Among 1593 nurses who reported on self-perception of risk, 97 (6.1%) reported high risk, 675 (42.4%) reported low risk, and 821 (51.5%) reported uncertainty. Of the 815 nurses reporting on their history of screening, 344 (42.2%) were screened regularly, 103 (12.6%) underwent opportunistic screening, and 368 (45.2%) had never undergone screening. The likelihood of screening was increased among women aged 35-4years, those who had recent experience of medical screening, those who had recently had a specialist consultation, or those who had recently had a consultation with a gynecologist (P<0.001 for all). Nurses undergoing regular screening reported positive effects of a doctor's recommendation, husband's encouragement, people talking about screening, and people close to the respondent undergoing screening. CONCLUSION Advocacy and herd signaling positively influenced the cervical cancer screening rate.
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Affiliation(s)
- Kaijun Tay
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Sun K Tay
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore.
| | | | - Nadia M R Rashid
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Esther Y S Tai
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Sitti J M Najib
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
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