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Tsima BM, Motlhatlhedi K, Sharma K, Rantshabeng P, Ndlovu A, Gaolathe T, Kyokunda LT. The association between smoking and cervical human papillomavirus infection among women from indigenous communities in western Botswana. PLoS One 2024; 19:e0302153. [PMID: 38848414 PMCID: PMC11161041 DOI: 10.1371/journal.pone.0302153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Cervical cancer, a malignancy caused by infection with oncogenic human papillomavirus, disproportionally affects women from low resource settings. Persistence of human papillomavirus infection may mediate an association between tobacco use and cervical cancer. In limited resource settings, women from indigenous communities are often marginalized and do not benefit from evidence-based interventions to prevent tobacco use or cervical cancer due to the limited reach of mainstream healthcare services to these communities. This study determined the association between smoking and high-risk human papillomavirus infection among women from indigenous communities in western Botswana. METHODS A cross-sectional study of women in indigenous communities was conducted between June and October 2022. Demographic, clinical and self-reported smoking data were collected. Cervical cytology and HPV DNA testing for high-risk human papillomavirus genotypes were performed. Multilevel multivariable logistic regression models were fit to evaluate the association between smoking and high-risk human papillomavirus infection while adjusting for potential confounders. RESULTS A total of 171 participants with a median (interquartile range) age of 40 (31-50) years from three settlements and two villages were recruited for the study. Of these, 17% were current smokers, 32.8% were living with HIV and high-risk human papillomavirus DNA was detected in 32.8% of the cervical specimens. Women who were current smokers, were nearly twice as likely to have cervical high-risk human papillomavirus infection compared to non-smokers (Adjusted Odds Ratio (95% CI); 1.74(1.09, 2.79)) after controlling for confounders. CONCLUSION These data underscore the need for effective tobacco control to help mitigate cervical cancer risk in this setting. These findings can help inform decisions about targeted cervical cancer prevention and tobacco cessation interventions for women from indigenous communities.
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Affiliation(s)
- Billy M. Tsima
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | | | - Andrew Ndlovu
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
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2
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Muslin C. Addressing the burden of cervical cancer for Indigenous women in Latin America and the Caribbean: a call for action. Front Public Health 2024; 12:1376748. [PMID: 38807996 PMCID: PMC11130434 DOI: 10.3389/fpubh.2024.1376748] [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: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
Cervical cancer, primarily caused by human papillomavirus (HPV) infection, poses a significant global health challenge. Due to higher levels of poverty and health inequities, Indigenous women worldwide are more vulnerable to cervical cancer than their non-Indigenous counterparts. However, despite constituting nearly 10% of the population in Latin America and the Caribbean (LAC), the true extent of the burden of cervical cancer among Indigenous people in this region remains largely unknown. This article reviews the available information on cervical cancer incidence and mortality, as well as HPV infection prevalence, among Indigenous women in LAC. The limited existing data suggest that Indigenous women in this region face a heightened risk of cervical cancer incidence and mortality compared to non-Indigenous women. Nevertheless, a substantial knowledge gap persists that must be addressed to comprehensively assess the burden of cervical cancer among Indigenous populations, especially through enhancing cancer surveillance across LAC countries. Numerous structural, social and cultural barriers hindering Indigenous women's access to HPV vaccination and cervical cancer screening worldwide have been identified and are reviewed in this article. The discussion highlights the critical role of culturally sensitive education, community engagement, and empowerment strategies in overcoming those barriers. Drawing insights from the success of targeted strategies in certain high-income countries, the present article advocates for research, policies and healthcare interventions tailored to the unique context of LAC countries.
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Affiliation(s)
- Claire Muslin
- One Health Research Group, Faculty of Health Sciences, Universidad de las Américas, Quito, Ecuador
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3
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Rebolj M, Brentnall AR, Cuschieri K. Predictable changes in the accuracy of human papillomavirus tests after vaccination: review with implications for performance monitoring in cervical screening. Br J Cancer 2024; 130:1733-1743. [PMID: 38615108 PMCID: PMC11130303 DOI: 10.1038/s41416-024-02681-z] [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: 12/11/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024] Open
Abstract
Vaccination against human papillomavirus (HPV) is changing the performance of cytology as a cervical screening test, but its effect on HPV testing is unclear. We review the effect of HPV16/18 vaccination on the epidemiology and the detection of HPV infections and high-grade cervical lesions (CIN2+) to evaluate the likely direction of changes in HPV test accuracy. The reduction in HPV16/18 infections and cross-protection against certain non-16/18 high-risk genotypes, most notably 31, 33, and/or 45, will likely increase the test's specificity but decrease its positive predictive value (PPV) for CIN2+. Post-vaccination viral unmasking of non-16/18 genotypes due to fewer HPV16 co-infections might reduce the specificity and the PPV for CIN2+. Post-vaccination clinical unmasking exposing a higher frequency of CIN2+ related to non-16/18 high-risk genotypes is likely to increase the specificity and the PPV of HPV tests. The effect of HPV16/18 vaccination on HPV test sensitivity is difficult to predict based on these changes alone. Programmes relying on HPV detection for primary screening should monitor the frequency of false-positive and false-negative tests in vaccinated (younger) vs. unvaccinated (older) cohorts, to assess the outcomes and performance of their service.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Screening, Prevention, and Early Detection, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Adam R Brentnall
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian Scotland, Edinburgh, UK
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4
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Sarmiento-Medina MI, de Amaya MP, Villamizar-Gómez L, González-Coba AC, Guzmán-Barajas L. High-risk HPV prevalence and vaccination coverage among Indigenous women in the Colombian Amazon: Implications for cervical cancer prevention. Cross-sectional study. PLoS One 2024; 19:e0297579. [PMID: 38315664 PMCID: PMC10843138 DOI: 10.1371/journal.pone.0297579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Cervical cancer, primarily caused by Human Papillomavirus (HPV) transmission through sexual contact, necessitates comprehensive strategies to combat its impact on women's health. Yet, certain underserved populations, such as low socioeconomic and ethnic minority groups, encounter barriers in accessing timely interventions and early diagnosis. This cross-sectional study was conducted with the aim of assessing HPV prevalence, genotype distribution, and co-infections among 280 adult women residing in a Colombian Indigenous Reserve within the Amazon region. The research adhered to a community-centric approach that respected cultural norms, native languages, and Indigenous authorities' permission. The study revealed an overall HPV infection prevalence of 31.1% (n = 87, 95% CI 25.7-36.8), with 22.5% (n = 63, 95% CI 17.7-27.8) of women infected by at least one high-risk HPV genotype and 15.0% (n = 42, 95% CI 11-19.7) infected by at least one LR genotype. These results align with the findings of other Colombian studies. Notable high-frequency genotypes included 16, 52, 66, 56, and 68, with the most common combinations being [66-52] and [66-58]. The study also assessed the prevalence of HPV vaccination, revealing a rate of 22.9%, lower than the national average. In vaccinated women, the prevalence of genotypes 16 and 18 was significantly reduced, as anticipated. Importantly, it was observed that 57.1% of all high-risk HPV infections could have been prevented with the use of the nonavalent vaccine. These findings underscore the critical need to enhance adherence to early cervical cancer detection and monitor positive cases to evaluate high-risk HPV persistence. Efforts should be directed toward continuing vaccination coverage against high-risk HPV 16 and 18 with the quadrivalent vaccine, while also striving to make the nonavalent vaccine accessible for inclusion in large-scale public health programs. Additionally, the study did not identify a specific pattern of co-infection. The study emphasizes the significance of adopting a locally tailored epidemiological approach to guide and promote cervical cancer prevention efforts in Indigenous communities.
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Affiliation(s)
| | - Miryam Puerto de Amaya
- Facultad de Tecnologías en Salud, Fundación Universitaria de Ciencias de la Salud, Bogotá D.C, Colombia
| | - Licet Villamizar-Gómez
- Vicerrectoría de Investigaciones, Fundación Universitaria de Ciencias de la Salud, Bogotá D.C, Colombia
| | | | - Laura Guzmán-Barajas
- Facultad de Tecnologías en Salud, Fundación Universitaria de Ciencias de la Salud, Bogotá D.C, Colombia
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5
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Akbari E, Milani A, Seyedinkhorasani M, Bolhassani A. HPV co-infections with other pathogens in cancer development: A comprehensive review. J Med Virol 2023; 95:e29236. [PMID: 37997472 DOI: 10.1002/jmv.29236] [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: 08/24/2023] [Revised: 10/13/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
High-risk human papillomaviruses (HR-HPVs) cause various malignancies in the anogenital and oropharyngeal regions. About 70% of cervical and oropharyngeal cancers are caused by HPV types 16 and 18. Notably, some viruses including herpes simplex virus, Epstein-Barr virus, and human immunodeficiency virus along with various bacteria often interact with HPV, potentially impacting its replication, persistence, and cancer progression. Thus, HPV infection can be significantly influenced by co-infecting agents that influence infection dynamics and disease progression. Bacterial co-infections (e.g., Chlamydia trachomatis) along with bacterial vaginosis-related species also interact with HPV in genital tract leading to viral persistence and disease outcomes. Co-infections involving HPV and diverse infectious agents have significant implications for disease transmission and clinical progression. This review explores multiple facets of HPV infection encompassing the co-infection dynamics with other pathogens, interaction with the human microbiome, and its role in disease development.
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Affiliation(s)
- Elahe Akbari
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran
| | - Alireza Milani
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran
| | | | - Azam Bolhassani
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran
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6
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Velentzis LS, Hawkes D, Caruana M, Brotherton JML, Smith MA, Roeske L, Karim KA, Garland SM, Wrede CD, Tan J, Wheeler C, Castle PE, Saville M, Canfell K. Exploring monitoring strategies for population surveillance of HPV vaccine impact using primary HPV screening. Tumour Virus Res 2023; 15:200255. [PMID: 36736490 PMCID: PMC9925607 DOI: 10.1016/j.tvr.2023.200255] [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: 10/13/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
Australia's cervical screening program transitioned from cytology to HPV-testing with genotyping for HPV16/18 in Dec'2017. We investigated whether program data could be used to monitor HPV vaccination program impact (commenced in 2007) on HPV16/18 prevalence and compared estimates with pre-vaccination benchmark prevalence. Pre-vaccination samples (2005-2008) (n = 1933; WHINURS), from 25 to 64-year-old women had been previously analysed with Linear Array (LA). Post-vaccination samples (2013-2014) (n = 2989; Compass pilot), from 25 to 64-year-old women, were analysed by cobas 4800 (cobas), and by LA for historical comparability. Age standardised pre-vaccination HPV16/18 prevalence was 4.85% (95%CI:3.81-5.89) by LA; post-vaccination estimates were 1.67% (95%CI:1.21-2.13%) by LA, 1.49% (95%CI:1.05-1.93%) by cobas, and 1.63% (95%CI:1.17-2.08%) for cobas and LA testing of non-16/18 cobas positives (cobas/LA). Age-standardised pre-vaccination oncogenic HPV prevalence was 15.70% (95%CI:13.79-17.60%) by LA; post-vaccination estimates were 9.06% (95%CI:8.02-10.09%) by LA, 8.47% (95%CI:7.47-9.47%) by cobas and cobas/LA. Standardised rate ratios between post-vs. pre-vaccination rates were significantly different for HPV16/18, non-16/18 HPV and oncogenic HPV: 0.34 (95%CI:0.23-0.50), 0.68 (95%CI:0.55-0.84) and 0.58 (95%CI:0.48-0.69), respectively. Additional strategies (LA for all cobas positives; combined cobas and LA results on all samples) had similar results. If a single method is applied consistently, it will provide important data on relative changes in HPV prevalence following vaccination.
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Affiliation(s)
- Louiza S. Velentzis
- The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia,Corresponding author. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia
| | - David Hawkes
- Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia,Department of Biochemistry and Pharmacology, University of Melbourne, Victoria, Australia,Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Julia ML. Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia,Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Megan A. Smith
- The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Lara Roeske
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - Khurram A. Karim
- Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia
| | - Suzanne M. Garland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia,Centre Women's Infectious Diseases Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - C. David Wrede
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia,Department of Oncology & Dysplasia, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Jeffery Tan
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia,Department of Oncology & Dysplasia, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Cosette Wheeler
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - Philip E. Castle
- Division of Cancer Prevention, National Cancer Institute, NIH, Rockville, MD, USA,Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia
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7
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MacDonald SE, Kenzie L, Letendre A, Bill L, Shea-Budgell M, Henderson R, Barnabe C, Guichon JR, Colquhoun A, Ganshorn H, Bedingfield N, Vandenboogaard PD, Bednarczyk RA, Glaze S, Nelson G. Barriers and supports for uptake of human papillomavirus vaccination in Indigenous people globally: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001406. [PMID: 36962871 PMCID: PMC10021254 DOI: 10.1371/journal.pgph.0001406] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023]
Abstract
Despite the availability of effective and safe human papillomavirus (HPV) vaccines that reduce the incidence and impact of cervical cancer and other cancers, HPV vaccine coverage rates remain persistently low and the cervical cancer burden disproportionately high among Indigenous people globally. This study aimed to systematically identify, appraise, and summarize the literature on documented barriers and supports to HPV vaccination in Indigenous populations internationally. Forty-three studies were included and an inductive, qualitative, thematic synthesis was applied. We report on 10 barrier themes and 7 support themes to vaccine uptake, and provide a quantitative summary of metrics. Focusing on Indigenous perspectives reported in the literature, we propose recommendations on community-research collaboration, culturally safe intergenerational and gender-equitable community HPV vaccine education, as well as multi-level transparency to ensure informed consent is secured in the context of reciprocal relationships. Although the voices of key informant groups (e.g., HPV-vaccine eligible youth and community Elders) are underrepresented in the literature, the identification of barriers and supports to HPV vaccination in a global Indigenous context might help inform researchers and health policy makers who aim to improve HPV vaccine uptake in Indigenous populations.
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Affiliation(s)
| | - Lisa Kenzie
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Angeline Letendre
- Cancer Prevention and Screening Innovation, Alberta Health Services, Edmonton, Canada
| | - Lea Bill
- Alberta First Nations Information Governance Centre, Calgary, Canada
| | | | - Rita Henderson
- Department of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl Barnabe
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Juliet R Guichon
- Department of Community Health Sciences and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy Colquhoun
- Performance Reporting, Alberta Health, Edmonton, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Nancy Bedingfield
- Department of Community Health Sciences and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Robert A Bednarczyk
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Sarah Glaze
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
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Wang WV, Kothari S, Khoury H, Niccolai L, Garland SM, Sundström K, de Pouvourville G, Bonanni P, Chen YT, Franco EL. A review of data systems for assessing the impact of HPV vaccination in selected high-income countries. Expert Rev Vaccines 2023; 22:161-179. [PMID: 36576068 DOI: 10.1080/14760584.2023.2162505] [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: 12/29/2022]
Abstract
INTRODUCTION The introduction of effective human papillomavirus (HPV) vaccination, screening, and treatment programs has led the World Health Organization to call for the global elimination of cervical cancer. Assessing progress toward this goal is supported through monitoring vaccination coverage and its impact. AREAS COVERED We performed a targeted review to assess the characteristics of HPV-related data systems from seven high-income countries (HICs) that represented varied approaches, including Australia, Canada, France, Italy, Scotland, Sweden, and the United States (US). Included data systems focused on preventive and early detection measures: HPV vaccination and cervical screening programs, as well as HPV-related disease outcomes. Differences were observed in approach to development of data systems, along with variation in geographical scope and methods of data collection. EXPERT OPINION A challenge exists in how to best follow-up the ongoing global-scale elimination efforts in a comprehensive manner. These sources provide a wealth of information regarding the strengths and limitations of, and notable variation among, current data systems used in HICs. This review can inform improvements to existing prevention programs and the implementation of new programs in other countries, and thus support optimization of cervical cancer prevention policy.
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Affiliation(s)
- Wei Vivian Wang
- Center for Observational and Real-World Evidence, Merck & Co., Inc., 126 E. Lincoln Ave. Rahway, NJ 07065, USA
| | - Smita Kothari
- Center for Observational and Real-World Evidence, Merck & Co., Inc., 126 E. Lincoln Ave. Rahway, NJ 07065, USA
| | - Hanane Khoury
- Certara Evidence and Access, Montreal, Quebec, Canada
| | - Linda Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, CT, USA
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital (RWH) and Murdoch Children's Research Institute, Locked Bag 300, Cnr Grattan St & Flemington Rd 3052, Parkville, Australia
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | | | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Department of Health Sciences, Department of Health Sciences, Florence, Italy
| | - Ya-Ting Chen
- Center for Observational and Real-World Evidence, Merck & Co., Inc., 126 E. Lincoln Ave. Rahway, NJ 07065, USA
| | - Eduardo L Franco
- Departments of Oncology and Epidemiology & Biostatistics, McGill University; 5100 Maisonneuve Blvd West, Suite 720, H4A3T2 Quebec, Montreal, Canada
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9
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Cervical Intraepithelial Neoplasia Grade 3 in a HPV-Vaccinated Patient: A Case Report. Medicina (B Aires) 2022; 58:medicina58030339. [PMID: 35334516 PMCID: PMC8949814 DOI: 10.3390/medicina58030339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Persistent infection with human papillomavirus (HPV) causes almost all cervical precancerous lesions and cancers. Bivalent, quadrivalent, and nonavalent HPV vaccines effectively prevent high-grade cervical intraepithelial neoplasia (CIN3). The effectiveness of HPV vaccination against CIN3 is 97–100% in HPV-naïve populations and 44–61% in the overall population. Although HPV vaccination has substantially reduced the incidence of cervical cancers, several cases of precancerous cervical lesions in HPV-vaccinated patients have been reported. We report the clinical case of a 19-year-old woman whose first Pap smear was diagnosed as a high-grade squamous intraepithelial lesion (HSIL) after quadrivalent HPV vaccination. Colposcopy and cervical biopsy were performed, revealing HSIL/CIN3. Our multidisciplinary team decided to take a conservative approach with follow-up visits with cervical biopsies of this young patient. After six months, spontaneous regression of high-grade cervical dysplasia was observed. Although HPV immunization has shown to be extremely effective in preventing a high proportion of cervical precancerous lesions and cervical cancers, HPV vaccines do not protect against all oncogenic high-risk HPV genotypes. Consequently, healthcare providers must encourage HPV-vaccinated women to still regularly attend national cervical screening programs.
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Poirier B, Sethi S, Garvey G, Hedges J, Canfell K, Smith M, Ju X, Jamieson L. HPV vaccine: uptake and understanding among global Indigenous communities - a qualitative systematic review. BMC Public Health 2021; 21:2062. [PMID: 34758805 PMCID: PMC8582096 DOI: 10.1186/s12889-021-12147-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous populations have a high prevalence of Human Papillomavirus (HPV) infection and a high incidence of HPV associated cancers, such as cervical and oropharyngeal cancer. There is an effective HPV vaccination program in almost all developed countries to prevent the incidence of cervical cancer, but reports suggest that the uptake of these vaccinations by Indigenous populations is low. The objective of this qualitative systematic review was to explore the knowledge and beliefs of global Indigenous populations regarding HPV vaccines. This review was performed to identify the barriers faced by Indigenous peoples and to provide evidence for more effective and acceptable execution of vaccination policies for Indigenous peoples. METHODS Two investigators independently searched MEDLINE, PubMed, SCOPUS, and Web of Science databases using a pre-specified search strategy to identify qualitative studies on narratives of Indigenous peoples regarding HPV vaccine awareness, knowledge and experiences across all geographic and income-level settings. RESULTS After performing the literature search and quality appraisals 5 papers were included in the final review. Three core synthesised findings were identified: reasons for acceptance or hesitancy, and areas for improvement. Lack of correct knowledge and mistrust in the healthcare system were important categories observed in all papers included in the review. Other categories within the conceptual model included prioritising disease prevention, health professional guidance, family support and supportive community environment. CONCLUSION Qualitative systematic reviews are an excellent means of exploring the gaps in current healthcare practices. Indigenous healthcare research should be grounded in community experiences and feedback. This review provides insights into HPV vaccination understanding and acceptance amongst Indigenous populations, from which recommendations for increasing resonance of vaccination strategies with Indigenous communities can be formed.
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Affiliation(s)
- Brianna Poirier
- Australian Research Centre for Population Oral Health, University of Adelaide, 4 North Terrace, 4 North Terrace, Adelaide, SA, 5000, Australia.
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, University of Adelaide, 4 North Terrace, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, University of Adelaide, 4 North Terrace, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Karen Canfell
- The Daffodil Centre at the University of Sydney, A Joint Venture with Cancer Council, PO Box 572, Kings Cross, NSW, 1340, Australia
| | - Megan Smith
- The Daffodil Centre at the University of Sydney, A Joint Venture with Cancer Council, PO Box 572, Kings Cross, NSW, 1340, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, University of Adelaide, 4 North Terrace, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, University of Adelaide, 4 North Terrace, 4 North Terrace, Adelaide, SA, 5000, Australia
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11
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Sethi S, Poirier B, Canfell K, Smith M, Garvey G, Hedges J, Ju X, Jamieson LM. Working towards a comprehensive understanding of HPV and cervical cancer among Indigenous women: a qualitative systematic review. BMJ Open 2021; 11:e050113. [PMID: 34193502 PMCID: PMC8246376 DOI: 10.1136/bmjopen-2021-050113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Indigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers. OBJECTIVE This is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers. METHODS Two investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a 'meta-study' approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated. RESULTS Five core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation. CONCLUSION The social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers. PROSPERO REGISTRATION NUMBER CRD42020207643.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Brianna Poirier
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Megan Smith
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Brisbane Office, Brisbane, Queensland, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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12
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Sethi S, Ali A, Ju X, Antonsson A, Logan R, Canfell K, Smith M, Garvey G, Hedges J, Jamieson L. A systematic review and meta-analysis of the prevalence of human papillomavirus infection in Indigenous populations - A Global Picture. J Oral Pathol Med 2021; 50:843-854. [PMID: 34008187 DOI: 10.1111/jop.13201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM Recent trends have shown a decline in the rates of human papillomavirus (HPV)-associated cervical cancer in the vaccinated population but there has been a spike in the HPV-associated oropharyngeal, anal and penile cancers in the majority of the unvaccinated population which are young and middle-aged males. Indigenous populations at an international level carry a disproportionate burden of most diseases. The aim of this meta-analysis was to ascertain the worldwide prevalence of HPV infection in Indigenous populations stratified by sex and site and to document the most commonly reported HPV types. METHODS Published articles on HPV infection in Indigenous populations from PubMed, Scopus, EMBASE and Web of Science were systematically searched from inception until 23 December 2019. RESULTS A total of 41 studies were included in the final analysis. The pooled worldwide prevalence of HPV infection (for both oral and genital sites, both males and females) in Indigenous populations was 34.2% (95% CI: 28.9%-39.8%). Subgroup analysis (geographical) showed that the pooled prevalence for African Indigenous, American Indigenous and Asian-Oceanic Indigenous populations were 33.0% (95% CI: 12.8%-57.1%), 33.0% (95% CI: 27.4%-38.9%) and 33.3% (95% CI: 0.17.5%-51.3%), respectively. CONCLUSION There are not enough data on the burden of the infection carried by males especially with respect to highly suspicious sites like oropharynx. Also, we conclude an overall high prevalence of HPV infection in the Indigenous populations and increasing their susceptibility to benign and malignant manifestations of HPV.
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Affiliation(s)
- Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Richard Logan
- Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Karen Canfell
- Cancer Council of New South Wales, Sydney, NSW, Australia
| | - Megan Smith
- Cancer Council of New South Wales, Sydney, NSW, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
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13
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Atchison S, Shilling H, Balgovind P, Machalek DA, Hawkes D, Garland SM, Saville M, Murray G, Molano M, Danielewski J, Phillips S. Evaluation of the Roche MagNA Pure 96 nucleic acid extraction platform for the Seegene Anyplex II HPV28 detection assay. J Appl Microbiol 2021; 131:2592-2599. [PMID: 33942451 DOI: 10.1111/jam.15126] [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] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
AIM Validate the Roche, MagNAPure96 (MP96) nucleic acid extraction platform for Seegene Anyplex II HPV28 (Anyplex28) detection of Human Papillomavirus. METHODS AND RESULTS Comparisons were made for Anyplex28 genotyping from 115 cervical samples extracted on the Hamilton, STARlet and the MP96. Two DNA concentrations were used for the MP96, one matched for sample input to the STARlet and another 5× concentration (laboratory standard). Agreement of HPV detection was 89·8% (κ = 0·798; P = 0·007), with HPV detected in 10 more samples for the MP96. There was a high concordance of detection for any oncogenic HPV genotype (κ = 0·77; P = 0·007) and for any low-risk HPV genotype (κ = 0·85; P = 0·008). DNA extracted at laboratory standard had a lower overall agreement 85·2% (κ = 0·708; P < 0·001), with 17/115 discordant positive samples that tested negative after STARlet extraction. Of the discordant genotypes, 72·7% were detected in the lowest signal range for Anyplex28 ('+'). CONCLUSIONS MP96 performed with high concordance to STARlet, although produced DNA with a higher analytical sensitivity on the Anyplex28. SIGNIFICANCE AND IMPACT OF THE STUDY This analysis supports the use of samples extracted on the MP96 for HPV genotyping using the Anyplex28. Furthermore, an increase in DNA concentration increased analytical sensitivity of the Anyplex28, particularly appropriate for prevalence studies.
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Affiliation(s)
- S Atchison
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - H Shilling
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - P Balgovind
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - D A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia.,The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D Hawkes
- VCS Foundation, Melbourne, Vic, Australia.,Department of Biochemistry and Pharmacology, University of Melbourne, Melbourne, Vic, Australia.,Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia
| | - S M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
| | - M Saville
- VCS Foundation, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - G Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
| | - M Molano
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia
| | - J Danielewski
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - S Phillips
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
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14
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Dasgupta P, Aitken JF, Condon J, Garvey G, Whop LJ, DeBats C, Baade PD. Temporal and area-level variation in prevalence of high-grade histologically confirmed cervical abnormalities among Indigenous and non-Indigenous women, Queensland, Australia, 2008-2017. J Med Screen 2021; 28:341-348. [PMID: 33476212 DOI: 10.1177/0969141320984199] [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: 11/17/2022]
Abstract
OBJECTIVE Despite Australia's National Cervical Screening Program, Indigenous women have a disproportionately high burden of cervical cancer. We describe temporal and area-level patterns in prevalence of histologically conformed high-grade cervical abnormalities (hHGA) among cytologically screened women by Indigenous status. METHODS This was a population-based study of 2,132,925 women, aged 20-69, who underwent cervical screening between 2008 and 2017, in Queensland, Australia. Of these, 47,136 were identified as Indigenous from linked hospital records. Overall patterns in hHGA prevalence by Indigenous status were quantified using prevalence rate ratios (PrRR) from negative binomial models. Bayesian spatial models were used to obtain smoothed prevalence estimates of hHGA across 528 small areas compared to the state average. Results are presented as maps and graphs showing the associated uncertainty of the estimates. RESULTS Overall, screened Indigenous women had significantly higher hHGA prevalence than non-Indigenous women. However, the magnitude of the difference reduced over time (p < 0.001). Adjusted for age and area-level variables, Indigenous women had 36% higher hHGA prevalence (PrRR 1.36, 95% confidence interval [1.21-1.52]) than non-Indigenous women between 2013 and 2017. The overall effect of age decreased over time (p = 0.021). Although there was evidence of moderate spatial variation in 10-year prevalence estimates for both groups of women, the high levels of uncertainty for many estimates, particularly for Indigenous women, limited our ability to draw definitive conclusions about the spatial patterns. CONCLUSIONS While the temporal reduction in Indigenous: non-Indigenous differential in hHGA prevalence is encouraging, further research into the key drivers of the continuing higher risk among Indigenous women is warranted.
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Affiliation(s)
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - John Condon
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Lisa J Whop
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Claire DeBats
- Cancer Screening Unit, Prevention Division, Queensland Health, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane QLD, Australia
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15
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Jamieson LM, Antonsson A, Garvey G, Ju X, Smith M, Logan RM, Johnson NW, Hedges J, Sethi S, Dunbar T, Leane C, Hill I, Brown A, Roder D, De Souza M, Canfell K. Prevalence of Oral Human Papillomavirus Infection Among Australian Indigenous Adults. JAMA Netw Open 2020; 3:e204951. [PMID: 32511719 PMCID: PMC7280951 DOI: 10.1001/jamanetworkopen.2020.4951] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Human papillomavirus (HPV) infection is associated with oropharyngeal squamous cell carcinoma. International estimates suggest overall oral HPV prevalence is 7.5%, with prevalence of oral HPV types 16 and 18 being 1.6%; prior Australian estimates suggest oral HPV prevalence is 2.3%, with HPV-16 and HPV-18 being 1.3%. OBJECTIVES To estimate the prevalence of oral HPV infection among Indigenous Australians and to report the prevalence of factors associated with high-risk HPV types (ie, HPV-16 and HPV-18) and HPV types linked with Heck disease (ie, HPV-13 and HPV-32). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed HPV screening results from saliva samples collected from 1011 Indigenous Australians between February 2018 and January 2019. Data were analyzed from May 2018 to May 2019. Recruitment occurred through Aboriginal Community Controlled Health Organisations in South Australia. Eligibility included identifying as Indigenous, residing in South Australia, and being aged 18 years or older. MAIN OUTCOMES AND MEASURES Saliva samples were collected, with microbial DNA for genotyping extracted. Sociodemographic parameters, health-related behaviors, and sexual history data were collected. Analyses were stratified by sex as well as by HPV types 13 and 32 (Heck disease) and 16 and 18 (high risk of oropharyngeal squamous cell carcinoma). Multivariable analyses were conducted to obtain adjusted odds ratios (ORs). RESULTS Data were obtained for 910 participants (median [interquartile range] age, 37 [27-51] years); 595 participants (65%) were female and 572 (63%) resided in nonmetropolitan locations. In all, 321 saliva samples (35.3%; 95% CI, 32.2%-38.4%) were positive for oral HPV (106 [33.7%] men; 215 [36.1%] women). The highest prevalence was found for HPV types 13 and 32 (207 [22.7%] total; 60 [19.0%] men; 147 [24.7%] women) followed by HPV types 16 and 18 (30 [3.3%] total; 9 [2.9%] men; 21 [3.5%] women). After multivariable analysis, risk factors associated with HPV types 13 and 32 included nonmetropolitan residential status (OR, 2.06; 95% CI, 1.10-3.88) and not having had a tonsillectomy (OR, 2.74; 95% CI, 1.05-7.16). Among women, having obtained a high school education or less was associated with lower odds of HPV-16 and HPV-18 infection (OR, 0.16; 95% CI, 0.03-0.97). CONCLUSIONS AND RELEVANCE Prevalence of oral HPV infection in a large sample of Indigenous Australians was high, with one-third testing positive. The most prevalent HPV types were those associated with Heck disease. The prevalence of HPV types associated with oropharyngeal squamous cell carcinoma exceeded both Australian and international population-level estimates.
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Affiliation(s)
- Lisa M. Jamieson
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Australia
| | - Gail Garvey
- Menzies School of Health Research, Spring Hill, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - Megan Smith
- Cancer Council New South Wales, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Newell W. Johnson
- Menzies Health Institute Queensland, Griffith University and Faculty of Dentistry, Queensland, Australia
- Oral and Craniofacial Sciences, King’s College, London, United Kingdom
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - Terry Dunbar
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Australian Capital Territory, Australia
| | - Cathy Leane
- Strategic Partnerships, Aboriginal Health Division Women's and Children's Health Network, Adelaide, Adelaide, Australia
| | - Isaac Hill
- Aboriginal Health Council of South Australia, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - David Roder
- University of South Australia School of Health Sciences, Adelaide, Australia
| | - Marjorie De Souza
- QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Australia
| | - Karen Canfell
- Cancer Council New South Wales, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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16
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Prevalence of HPV infection among sexually active adolescents and young adults in Brazil: The POP-Brazil Study. Sci Rep 2020; 10:4920. [PMID: 32188884 PMCID: PMC7080737 DOI: 10.1038/s41598-020-61582-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/13/2020] [Indexed: 12/02/2022] Open
Abstract
For Brazil, there are no nationwide data on HPV prevalence against which the impact of the HPV immunization program can be measured in the future. Therefore, we aim to evaluate the prevalence of genital HPV infection among adolescents and young adults in Brazil. A cross-sectional, multicentric, nationwide survey was conducted between September 2016 and November 2017. Sexually active unvaccinated women and men aged 16 to 25 years old were recruited from 119 public primary care units, including all 26 state capitals and the Federal District. All participants answered a face-to-face interview and provided biological samples for genital HPV analysis. We used an automated DNA extraction method and HPV genotyping was performed using the Linear Array genotyping test (Roche). Of 7,694 participants, 53.6% (95% CI 51.4–55.8) were positive for any HPV type. The prevalence of high-risk HPV types was significantly higher in women (38.6% vs. 29.2%, P < 0·001). The HPV types included in the quadrivalent vaccine were detected in 1002 (14.8%) specimens, with a different pattern of HPV infection between sexes. Characteristics associated with overall HPV detection included female gender, self-declaration of race as brown/pardo, lower socioeconomic class, single or dating, current smoking and having 2 or more sex partners in the past year. We found a high prevalence of HPV, with significant differences between regions. Our data provide information that may be considered when developing HPV prevention policies and constitute a baseline against which the impact of the HPV immunization program in Brazil can be measured in future years.
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17
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Subasinghe AK, Wark JD, Phillips S, Cornall A, Brotherton JML, Garland SM. Quadrivalent human papillomavirus vaccination successfully reduces the prevalence of vaccine-targeted genotypes in a young, vaccine-eligible-age sample of Australian females. Sex Health 2020; 17:510-516. [PMID: 33341122 DOI: 10.1071/sh20033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022]
Abstract
Background The prevalence of genital tract vaccine-type human papillomavirus (HPV) is on the decline due to high vaccine uptake through the national HPV immunisation program in Australia. The aim of this study was to investigate HPV vaccine coverage and factors associated with HPV in a vaccine-eligible sample of young Australian females. METHODS Females aged 16-25 years were recruited into the Young Female Health Initiative study, a young women's health study, via Facebook advertising from 2012 to 2017. Sexually active participants were asked to provide a self-collected vaginal swab for the detection of HPV DNA; positive samples were genotyped. Self-reported HPV vaccination status was confirmed by the National HPV Vaccination Program Register. Outcomes of the study were HPV acquisition and genotype, HPV vaccination status and factors associated with HPV. RESULTS Overall, 22.8% of samples (95% confidence interval (CI) 17.8-27.8%; n = 62/272) were positive for any HPV DNA, of which 19.1% (95% CI 14.4-23.8%; n = 52/272) were oncogenic types. HPV 16 was detected in three samples (1.1%; 95% CI -0.1%, 2.3%; two not HPV vaccinated and one vaccinated after sexual debut). Early sexual debut (<16 years) and multiple sexual partners were independently associated with an increased risk of any HPV. CONCLUSIONS In a community sample of vaccine-eligible-age females with a high vaccine uptake, the prevalence of vaccine-related HPV genotypes is extremely low. Early sexual debut and multiple sexual partners are positively associated with HPV, underscoring the importance of vaccination at the routinely recommended age of 12-13 years for best vaccine impact.
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Affiliation(s)
- Asvini K Subasinghe
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Present address: Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia; and Corresponding author.
| | - John D Wark
- The University of Melbourne Department of Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia; and Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia
| | - Samuel Phillips
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia
| | - Alyssa Cornall
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne, Vic. 3002, Australia; and Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3053, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
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18
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Monitoring human papillomavirus prevalence among young Australian women undergoing routine chlamydia screening. Vaccine 2019; 38:1186-1193. [PMID: 31767467 DOI: 10.1016/j.vaccine.2019.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/21/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Australia has recently implemented major changes in cervical cancer prevention policies including introduction of primary human papillomavirus (HPV) screening starting at age 25, and replacement of the quadrivalent HPV vaccine with the nonavalent vaccine in the national school-based program. We assessed the feasibility and utility of conducting HPV testing in residual clinical specimens submitted for routine Chlamydia trachomatis screening, as a means of tracking HPV vaccine program impact among young sexually active women. METHODS De-identified residual specimens from women aged 16-24 years submitted for chlamydia testing were collected from three pathology laboratories in Victoria and New South Wales. Limited demographic information, and chlamydia test results were also collected. Patient identifiers were sent directly from the laboratories to the National HPV Vaccination Program Register, to obtain HPV vaccination histories. Samples underwent HPV genotyping using Seegene Anyplex II HPV 28 assay. RESULTS Between April and July 2018, 362 residual samples were collected, the majority (60.2%) of which were cervical swabs. Demographic data and vaccination histories were received for 357 (98.6%) women (mean age 21.8, SD 2.0). Overall, 65.6% of women were fully vaccinated, 9.8% partially, and 24.7% unvaccinated. The majority (86.0%) resided in a major city, 35.9% were classified in the upper quintile of socioeconomic advantage and chlamydia positivity was 7.8%.The prevalence of quadrivalent vaccine-targeted types (HPV6/11/16/18) was 2.8% (1.5-5.1%) overall with no differences by vaccination status (p = 0.729). The prevalence of additional nonavalent vaccine-targeted types (HPV31/33/45/52/58) was 19.3% (15.6-23.8%). One or more oncogenic HPV types were detected in 46.8% (95% CI 41.6-52.0%) of women. CONCLUSIONS HPV testing of residual chlamydia specimens provides a simple, feasible method for monitoring circulating genotypes. Applied on a larger scale this method can be utilised to obtain a timely assessment of nonavalent vaccine impact among young women not yet eligible for cervical screening.
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Machalek DA, Garland SM, Brotherton JML, Bateson D, McNamee K, Stewart M, Rachel Skinner S, Liu B, Cornall AM, Kaldor JM, Tabrizi SN. Very Low Prevalence of Vaccine Human Papillomavirus Types Among 18- to 35-Year Old Australian Women 9 Years Following Implementation of Vaccination. J Infect Dis 2019; 217:1590-1600. [PMID: 29425358 DOI: 10.1093/infdis/jiy075] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction A quadrivalent human papillomavirus vaccination program targeting females aged 12-13 years commenced in Australia in 2007, with catch-up vaccination of 14-26 year olds through 2009. We evaluated the program's impact on HPV prevalence among women aged 18-35 in 2015. Methods HPV prevalence among women aged 18-24 and 25-35 was compared with prevalence in these age groups in 2005-2007. For women aged 18-24, we also compared prevalence with that in a postvaccine study conducted in 2010-2012. Results For the 2015 sample, Vaccination Register-confirmed 3-dose coverage was 53.3% (65.0% and 40.3% aged 18-24 and 25-35, respectively). Prevalence of vaccine HPV types decreased from 22.7% (2005-2007) and 7.3% (2010-2012), to 1.5% (2015) (P trend < .001) among women aged 18-24, and from 11.8% (2005-2007) to 1.1% (2015) (P = .001) among those aged 25-35. Conclusions This study, reporting the longest surveillance follow-up to date, shows prevalence of vaccine-targeted HPV types has continued to decline among young women. A substantial fall also occurred in women aged 25-35, despite lower coverage. Strong herd protection and effectiveness of less than 3 vaccine doses likely contributed to these reductions.
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Affiliation(s)
- Dorothy A Machalek
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,School of Population and Global Health, University of Melbourne, Victoria
| | - Suzanne M Garland
- Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
| | - Julia M L Brotherton
- School of Population and Global Health, University of Melbourne, Victoria.,National HPV Vaccination Program Register, Victorian Cytology Service, East Melbourne, Victoria
| | - Deborah Bateson
- Family Planning New South Wales, Sydney.,Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney
| | - Kathleen McNamee
- Family Planning Victoria, Melbourne.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria
| | | | - S Rachel Skinner
- Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead
| | - Bette Liu
- School of Public Health and Community Medicine
| | - Alyssa M Cornall
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
| | - John M Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
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20
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Ioannides S, Beard F, Larter N, Clark K, Wang H, Hendry A, Hull B, Dey A, Chiu C, Brotherton J, Jayasinghe S, Macartney K, McIntyre P. Vaccine Preventable Diseases and Vaccination Coverage in Aboriginal and Torres Strait Islander People, Australia, 2011–2015. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Brotherton JM, Winch KL, Chappell G, Banks C, Meijer D, Ennis S, Peterson K, Webby R, Whop LJ. HPV vaccination coverage and course completion rates for Indigenous Australian adolescents, 2015. Med J Aust 2019; 211:31-36. [PMID: 31179546 DOI: 10.5694/mja2.50221] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/18/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate human papillomavirus (HPV) vaccination coverage and course completion rates for Indigenous adolescents in four Australian states and territories. PARTICIPANTS, SETTING Adolescents who were 12 years old in 2015 and received the quadrivalent HPV vaccine (three doses: 0, 2, 6 months) as part of the National HPV Vaccination Program in 2015 or 2016 in New South Wales, Queensland, the Northern Territory, or the Australian Capital Territory. MAIN OUTCOME MEASURES Estimated HPV vaccination coverage by dose and by Indigenous status and sex, based on National HPV Vaccination Program Register data; vaccination course completion rates (proportion of dose 1 recipients who received dose 3) for 12-year-olds vaccinated during 2013-2016, by sex, jurisdiction, and Indigenous status. RESULTS Dose 1 coverage exceeded 80% for all Indigenous status/jurisdiction/sex groups (range, 83.3-97.7%). Coverage was similar for Indigenous and non-Indigenous girls in Queensland (87.3% v 87.0%), lower for Indigenous girls in the ACT (88.7% v 97.7%) and the NT (91.1% v 97.0%), and higher in NSW (95.9% v 89.9%); it was similar for Indigenous and non-Indigenous boys in all jurisdictions except the NT (88.6% v 96.3%). Dose 3 coverage (range, 61.2-87.7%) was markedly lower for Indigenous than non-Indigenous 12-year-olds in all jurisdictions, except for girls in NSW (82.6% v 83.6%). CONCLUSION HPV vaccine coverage is high, but course completion is generally lower for Indigenous adolescents. Strategies for improving completion rates for Indigenous Australians are needed to end the higher burden of cervical cancer among Indigenous than non-Indigenous women.
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Affiliation(s)
- Julia Ml Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service, Melbourne, VIC
| | - Karen L Winch
- National HPV Vaccination Program Register, Victorian Cytology Service, Melbourne, VIC
| | - Genevieve Chappell
- National HPV Vaccination Program Register, Victorian Cytology Service, Melbourne, VIC
| | | | | | | | | | - Rosalind Webby
- Department of Immunisation, Northern Territory Government, Darwin, NT
| | - Lisa J Whop
- Menzies School of Health Research, Charles Darwin University, Brisbane, QLD
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Rosales BM, Langton-Lockton J, Cornall AM, Roberts JM, Hillman RJ, Webster AC. Transplant Recipients and Anal Neoplasia Study: Design, Methods, and Participant Characteristics of a Prevalence Study. Transplant Direct 2019; 5:e434. [PMID: 30993188 PMCID: PMC6445652 DOI: 10.1097/txd.0000000000000873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/22/2019] [Indexed: 01/23/2023] Open
Abstract
Supplemental digital content is available in the text. Kidney recipients have anal cancer rates 3 times higher than the general population in Australia and New Zealand. High-risk human papillomavirus (HPV) genotypes are implicated in the majority of anal cancers. Establishing the epidemiology of anal HPV infection and precursors of anal cancer in transplant recipient populations is 1 consideration in any potential screening program. The Transplant and Anal Neoplasia Study is a cross-sectional study of the prevalence of anal cytological abnormalities and HPV deoxyribonucleic acid in kidney transplant recipients, as well as evaluating the acceptability of an anal cancer screening intervention. The study aims to recruit 100 kidney transplant recipients, older than 18 years, in Australia. Transplant recipients attending for a protocol biopsy at 3 and 12 months and annually posttransplant are approached to participate. Participants undergo an anal swab, which is then analyzed using liquid-based cytological examination and tested for the detection of 37 anogenital HPV deoxyribonucleic acid genotypes. Participants also complete a demographic and behavioral questionnaire that covers sexual behavior, history of anal symptoms, and possible anal cancer risk factors. Associations will be tested using multiple regression analysis. Recruitment for the study began in 2015 and is ongoing. To date, 96 (77%) of 125 kidney transplant recipients approached have consented to the study. The mean age is 48 (median, 47 y; range, 20–76 y), 59% are male, and Northwest European (58%) represented the largest ethnic group. No participants self-identified as Aboriginal or Torres Strait Islander. High consent rates and positive qualitative results suggest that a larger screening program may be well received by kidney transplant recipients, with increased resources and some modification to the timing of approach. Further results of the study will inform the possible implementation of a larger screening trial for prevention of anal cancers in kidney and other solid organ transplant recipients.
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Affiliation(s)
- Brenda Maria Rosales
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Alyssa M Cornall
- HPV LabNet Regional Reference Laboratory, Royal Women's Hospital, Parkville, Australia.,Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | | | - Richard J Hillman
- HIV, Immunology and Infectious Disease, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Angela Claire Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Renal Medicine and Transplantation at Westmead Hospital, Westmead, Australia
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Brotherton JM, Hawkes D, Sultana F, Malloy MJ, Machalek DA, Smith MA, Garland SM, Saville M. Age-specific HPV prevalence among 116,052 women in Australia's renewed cervical screening program: A new tool for monitoring vaccine impact. Vaccine 2018; 37:412-416. [PMID: 30551987 DOI: 10.1016/j.vaccine.2018.11.075] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 11/20/2022]
Abstract
Australia's transition to primary human papillomavirus (HPV) based cervical screening, has for the first time, provided a passive mechanism for monitoring the impact of vaccination on infection prevalence among women attending screening. We assessed oncogenic HPV prevalence by single year of age in the first 7 months of the program, using data collected from a large screening laboratory in Victoria, Australia, which is routinely screening using cobas 4800, cobas 6800 and Seegene assays. Among 116,052 primary screening samples from women aged 25-74, 9.25% (95%CI: 9.09-9.42%) had oncogenic HPV detected: 2.14% (95%CI: 2.05-2.22%) were 16/18 positive and 7.12% (95%CI: 6.97-7.27%) were positive for only non-16/18 HPV. Prevalence peaked at age 25-29 then decreased with age, but this was driven by non-16/18 types. HPV16/18 prevalence remained low and flat across ages, contrasting with pre-vaccination epidemiology when HPV16/18 peaked in young women. HPV-based screening can precisely monitor HPV prevalence.
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Affiliation(s)
- Julia Ml Brotherton
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, Victoria 3053, Australia.
| | - David Hawkes
- VCS Pathology, VCS Foundation, 265 Faraday Street, Carlton South, Victoria 3053, Australia; Department of Pharmacology and Therapeutics, The University of Melbourne, Victoria 3010, Australia.
| | - Farhana Sultana
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, Victoria 3053, Australia.
| | - Michael J Malloy
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, Victoria 3053, Australia.
| | - Dorothy A Machalek
- Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, Victoria 3053, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Cnr Grattan St & Flemington Rd, Parkville, Victoria 3052, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Cnr Grattan St & Flemington Rd, Parkville, Victoria 3052, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Marion Saville
- VCS Pathology, VCS Foundation, 265 Faraday Street, Carlton South, Victoria 3053, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria 3010, Australia.
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Li M, Roder D, Whop LJ, Diaz A, Baade PD, Brotherton JM, Canfell K, Cunningham J, Garvey G, Moore SP, O'Connell DL, Valery PC, Condon JR. Aboriginal women have a higher risk of cervical abnormalities at screening; South Australia, 1993-2016. J Med Screen 2018; 26:104-112. [PMID: 30419778 DOI: 10.1177/0969141318810719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cervical cancer mortality has halved in Australia since the national cervical screening program began in 1991, but elevated mortality rates persist for Aboriginal and Torres Strait Islander women (referred to as Aboriginal women in this report). We investigated differences by Aboriginal status in abnormality rates predicted by cervical cytology and confirmed by histological diagnoses among screened women. METHODS Using record linkage between cervical screening registry and public hospital records in South Australia, we obtained Aboriginal status of women aged 20-69 for 1993-2016 (this was not recorded by the registry). Differences in cytological abnormalities were investigated by Aboriginal status, using relative risk ratios from mixed effect multinomial logistic regression modelling. Odds ratios were calculated for histological high grade results for Aboriginal compared with non-Aboriginal women. RESULTS Of 1,676,141 linkable cytology tests, 5.8% were abnormal. Abnormal results were more common for women who were younger, never married, and living in a major city or socioeconomically disadvantaged area. After adjusting for these factors and numbers of screening episodes, the relative risk of a low grade cytological abnormality compared with a normal test was 14% (95% confidence interval 5-24%) higher, and the relative risk of a high grade cytological abnormality was 61% (95% confidence interval 44-79%) higher, for Aboriginal women. The adjusted odds ratio of a histological high grade was 76% (95% confidence interval 46-113%) higher. CONCLUSIONS Ensuring that screen-detected abnormalities are followed up in a timely way by culturally acceptable services is important for reducing differences in cervical cancer rates between Aboriginal and non-Aboriginal women.
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Affiliation(s)
- Ming Li
- 1 School of Health Sciences, University of South Australia, Adelaide, Australia
| | - David Roder
- 1 School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Lisa J Whop
- 2 Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Abbey Diaz
- 2 Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | | | - Julia Ml Brotherton
- 4 Victorian Cytology Service, Carlton, Australia
- 5 School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Karen Canfell
- 6 Cancer Council NSW, Cancer Research Division, Kings Cross, Australia
- 7 School of Public Health, University of Sydney, Sydney, Australia
- 8 Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | - Joan Cunningham
- 2 Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Gail Garvey
- 2 Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Suzanne P Moore
- 2 Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Dianne L O'Connell
- 6 Cancer Council NSW, Cancer Research Division, Kings Cross, Australia
- 7 School of Public Health, University of Sydney, Sydney, Australia
| | - Patricia C Valery
- 2 Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
- 9 QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - John R Condon
- 2 Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
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Garland SM, Dimech W, Collignon P, Cooley L, Nimmo GR, Smith DW, Baird R, Rawlinson W, Costa A, Higgins G. The new screening program to prevent cervical cancer using HPV DNA: getting the balance right in maintaining quality. J Pathol Clin Res 2018; 4:207-212. [PMID: 30058126 PMCID: PMC6175713 DOI: 10.1002/cjp2.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 01/26/2023]
Abstract
Along with the reduction in human papillomavirus (HPV) infection and cervical abnormalities as a result of the successful HPV vaccination program, Australia is adopting a new screening strategy. This involves a new paradigm moving from cervical cytological screening to molecular nucleic acid technology (NAT), using HPV DNA assays as primary screening methodology for cervical cancer prevention. These assays must strike a balance between sufficient clinical sensitivity to detect or predict high-grade cervical intraepithelial lesions, the precursor to cervical cancer, without being too sensitive and detecting transient infection not destined for disease. Ensuring the highest quality HPV NAT is thus a priority in order to reduce the possibility of falsely negative screens and manage the risk associated with false positive HPV NAT test results. How to do this needs informed discussion and on-going refinement of the screening algorithm. This is of relevance as more countries move to more sensitive HPV NAT tests for secondary prevention of cervical cancer and as more HPV assays become available.
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Affiliation(s)
- Suzanne M Garland
- Department of Microbiology and Infectious DiseasesRoyal Women's HospitalParkvilleAustralia
- Infection and Immunity Murdoch Children's Research InstituteParkvilleAustralia
- Department of Obstetrics and GynaecologyUniversity of MelbourneParkvilleAustralia
| | - Wayne Dimech
- National Serology Reference Laboratory, Australia (NRL)FitzroyAustralia
| | - Peter Collignon
- Infectious Diseases and MicrobiologyCanberra HospitalGarranAustralia
- Medical SchoolAustralian National UniversityAustralia
| | - On behalf of the Australian Clinical Microbiologists Infectious Diseases Group
- Department of Microbiology and Infectious DiseasesRoyal Hobart HospitalHobartAustralia
- Department of Microbiology, Pathology Queensland Central LaboratoryHerstonAustralia
- Department of Microbiology, Griffith University School of MedicineSouthportAustralia
- Department of Microbiology, PathWest Laboratory Medicine WANedlandsAustralia
- Faculty of Health and Medical SciencesUniversity of Western AustraliaNedlandsAustralia
- Territory Pathology, Infectious Diseases, Royal Darwin HospitalDepartment of Health and FamiliesTiwiAustralia
- Virology, Serology and OTDS Laboratories, NSW Health PathologyRandwickAustralia
- Department of Microbiology, The Royal Children's HospitalParkvilleAustralia
- Microbiology and Infectious Disease, South Australia PathologyNorth TerraceAustralia
| | - Louise Cooley
- Department of Microbiology and Infectious DiseasesRoyal Hobart HospitalHobartAustralia
| | - Graeme R Nimmo
- Department of Microbiology, Pathology Queensland Central LaboratoryHerstonAustralia
- Department of Microbiology, Griffith University School of MedicineSouthportAustralia
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine WANedlandsAustralia
- Faculty of Health and Medical SciencesUniversity of Western AustraliaNedlandsAustralia
| | - Rob Baird
- Territory Pathology, Infectious Diseases, Royal Darwin HospitalDepartment of Health and FamiliesTiwiAustralia
| | - William Rawlinson
- Virology, Serology and OTDS Laboratories, NSW Health PathologyRandwickAustralia
| | - Anna‐Maria Costa
- Department of Microbiology and Infectious DiseasesRoyal Women's HospitalParkvilleAustralia
- Department of Microbiology, The Royal Children's HospitalParkvilleAustralia
| | - Geoff Higgins
- Microbiology and Infectious Disease, South Australia PathologyNorth TerraceAustralia
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Phillips A, Patel C, Pillsbury A, Brotherton J, Macartney K. Safety of Human Papillomavirus Vaccines: An Updated Review. Drug Saf 2018; 41:329-346. [PMID: 29280070 DOI: 10.1007/s40264-017-0625-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Human papillomavirus (HPV) vaccines are now included in immunisation programmes in 71 countries. Unfortunately, uptake has been impacted in some countries by reduced confidence in the safety of the HPV vaccine. In 2013, we published an extensive review demonstrating a reassuring safety profile for bivalent (2vHPV) and quadrivalent (4vHPV) vaccines. A nonavalent (9vHPV) vaccine is now available and HPV immunisation programmes have been extended to males in 11 countries. The aim of this updated narrative review was to examine the evidence on HPV vaccine safety, focusing on the 9vHPV vaccine, special populations and adverse events of special interest (AESI). The previous searches were replicated to identify studies to August 2016, including additional search terms for AESI. We identified 109 studies, including 15 population-based studies in over 2.5 million vaccinated individuals across six countries. All vaccines demonstrated an acceptable safety profile; injection-site reactions were slightly more common for 9vHPV vaccine than for 4vHPV vaccine. There was no consistent evidence of an increased risk of any AESI, including demyelinating syndromes or neurological conditions such as complex regional pain or postural orthostatic tachycardia syndromes. The risk-benefit profile for HPV vaccines remains highly favourable.
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Affiliation(s)
| | - Cyra Patel
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, The Sydney Children's Hospitals Network, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia
| | - Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, The Sydney Children's Hospitals Network, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia
| | - Julia Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service, Level 6, 176 Wellington Parade, East Melbourne, Carlton, VIC, 3002, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Kristine Macartney
- The University of Sydney, Sydney, NSW, Australia.
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, The Sydney Children's Hospitals Network, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
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Decline in prevalence of human papillomavirus infection following vaccination among Australian Indigenous women, a population at higher risk of cervical cancer: The VIP-I study. Vaccine 2018; 36:4311-4316. [PMID: 29880245 DOI: 10.1016/j.vaccine.2018.05.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/08/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cervical cancer occurrence and mortality are strongly correlated with socioeconomic disadvantage, largely due to unequal access to screening and treatment. Universal human papillomavirus (HPV) vaccination provides the opportunity to greatly reduce this global health disparity. Australian Indigenous women have substantially higher rates of cervical cancer than non-Indigenous women, primarily due to under-screening. We investigated HPV infection rates in Indigenous women 7 years after implementation of the national HPV vaccination program. METHODS We used a repeat cross-sectional design, with the baseline being provided by an HPV prevalence survey among Indigenous women attending clinics for cervical cytology screening, prior to the start of the vaccination program in 2007. We returned to clinics in four locations during 2014-15, and invited women aged 18-26 years attending for screening to provide a cervical specimen for HPV testing, as well as to complete a short questionnaire and consent to allow access of their records in the National HPV Vaccination Program Register. We used well-established laboratory methods to test specimens for specific HPV genotypes. RESULTS A total of 142 women were recruited at participating sites and compared to 155 who had been recruited at the same locations in the 2007 pre-vaccine survey. The two groups were identical in regard to age, with the more recent group having a higher proportion of hormonal contraception users, and a lower proportion of smokers. The proportion found to have any HPV type fell from 58 to 36% with the decline being entirely due to reductions in vaccine types, which fell by 94% from 24 to 1.4%. CONCLUSION Australia's national HPV vaccination program appears to be successfully protecting a very high proportion of Indigenous women against vaccine targeted HPV types, who have in the past been at elevated risk of cervical cancer.
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Final analysis of a study assessing genital human papillomavirus genoprevalence in young Australian women, following eight years of a national vaccination program. Vaccine 2018; 36:3221-3230. [PMID: 29724506 DOI: 10.1016/j.vaccine.2018.04.080] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The VACCINE [Vaccine Against Cervical Cancer Impact and Effectiveness] study evaluated the prevalence of quadrivalent vaccine-targeted human papillomavirus (HPV) genotypes (HPV 6, 11, 16, 18) amongst young women of vaccine-eligible age. METHODS Between October 2011 - June 2015, women aged 18-25 years from Victoria, Australia, were recruited through targeted advertising on the social networking website Facebook. Participants completed an online questionnaire and provided a self-collected vaginal swab for HPV DNA detection and genotyping (Linear Array HPV genotyping assay). Self-reported HPV vaccination details were verified with the National HPV Vaccination Program Register (NHVPR). RESULTS Of 1223 who agreed to participate, 916 (74.9%) completed the survey and, for 1007 (82.3%) sexually-active participants, 744 (73.9%) returned the self-collected swab, of which 737 contained detectable DNA. 184/737 (25.0%) were positive for HPV. Vaccine-targeted HPV genotypes were detected in only 13 (1.7%) women: 11 HPV 16 (six vaccinated after sexual debut, five unvaccinated) and two HPV 6. Prevalence of any of HPV 31/33/45 collectively was 2.9%, varying significantly by vaccination status (fully 2.0%, unvaccinated 6.8%; p = 0.01). Vaccination rates among the sexually-active cohort were high, with 65.6%, 71.6% and 74.2% of participants having received three, at least two or at least one dose of vaccine, respectively. Of women self-reporting HPV vaccination, the NHVPR confirmed one or more doses were received in 90%. Strong associations were observed between vaccination status, age, language spoken at home and country of birth, as well as between HPV detection and the number of male sexual partners. CONCLUSION Surveillance five to eight years' post-initiation of a national HPV vaccination program demonstrated a consistent and very low prevalence of vaccine-related HPV genotypes and some evidence of cross protection against related types amongst vaccine-eligible women from Victoria, Australia.
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MacPhail C, McKay K. Social determinants in the sexual health of adolescent Aboriginal Australians: a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:131-146. [PMID: 27125476 DOI: 10.1111/hsc.12355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Abstract
While research indicates that Aboriginal and Torres Strait Islander adolescents may be at increased risk of some sexually transmitted infections, there is limited information about factors that may place these young people at more risk of adverse sexual health than their non-Indigenous counterparts. Current research has tended to focus on surveillance-type data, but there is an increasing need to understand social determinants of sexual health risk. This systematic review assessed the evidence of social determinants impacting on Aboriginal and Torres Strait Islander adolescents' sexual health in Australia. Published, English-language literature was searched across key databases from 2003 to 2015. Fourteen studies were included in the qualitative synthesis. Findings suggest that social determinants such as access to healthcare, poverty, substance use, educational disadvantage, sociocultural context, gender inequalities, status and identity, and social disadvantage impacted on Indigenous adolescents' sexual behaviours and sexual health risk. Evidence from the literature included in the review suggests that peer education may be an acceptable and appropriate approach for addressing such issues. There remains a need for programmes and services to be community-developed and community-led, thus ensuring cultural appropriateness and relevance. However, there is also a significant need for such programmes to be effectively and rigorously evaluated with data that goes beyond surveillance, and seeks to unpack how sexual norms are experienced by Indigenous adolescents, particularly outside of remote Australia - and how these experiences act as either risk or protective factors to good sexual health and positive social and emotional well-being.
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Affiliation(s)
- Catherine MacPhail
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Kathy McKay
- School of Health, University of New England, Armidale, New South Wales, Australia
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30
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McLachlan E, Anderson S, Hawkes D, Saville M, Arabena K. Completing the cervical screening pathway: Factors that facilitate the increase of self-collection uptake among under-screened and never-screened women, an Australian pilot study. ACTA ACUST UNITED AC 2018; 25:e17-e26. [PMID: 29507491 DOI: 10.3747/co.25.3916] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objectives To examine factors that enhance under-screened and never-screened women's completion of the self-collection alternative pathway of the Renewed National Cervical Screening Program (ncsp) in Victoria, Australia. Background With the Australian ncsp changing, starting on 1 December 2017, the Medical Services Advisory Committee (msac) recommended implementing human papillomavirus (hpv) testing using a self-collected sample for under-screened and never-screened populations. In response, a multi-agency group implemented an hpv self-collection pilot project to trial self-collection screening pathways for eligible women. Methods Quantitative data were collected on participation rates and compliance rates with follow-up procedures across three primary health care settings. Forty women who self-collected were interviewed in a semi-structured format, and seven agency staff completed in-depth interviews. Qualitative data were used to identify and understand clinical and personal enablers that assisted women to complete self-collection cervical screening pathways successfully. Results Eighty-five per cent (10 women) of participants who tested positive for hpv successfully received their results and completed follow-up procedures as required. Two remaining participants also received hpv-positive results. However, agencies were unable to engage them in follow-up services and procedures. The overall participation rate in screening (self-collection or Pap test) was 85.7% (84 women), with 79 women self-collecting. Qualitative data indicated that clear explanations on self-collection, development of trusting, empathetic relationships with health professionals, and recognition of participants' past experiences were critical to the successful completion of the self-collection pathway. When asked about possible inhibitors to screening and to following up on results and appointments, women cited poor physical and mental health, as well as financial and other structural barriers. Conclusion A well-implemented process, led by trusted, knowledgeable, and engaged health care professionals who can provide appropriate support and information, can assist under-screened and never-screened women to complete the hpv self-collection pathway successfully.
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Affiliation(s)
- E McLachlan
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne
| | - S Anderson
- Ballarat and District Aboriginal Cooperative, Baarlinjan Medical Clinic
| | - D Hawkes
- Victorian Cytology Service; Department of Pharmacology and Therapeutics, University of Melbourne
| | - M Saville
- Victorian Cytology Service, Department of Obstetrics and Gynaecology, University of Melbourne
| | - K Arabena
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne
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The role of TLRs in cervical cancer with HPV infection: a review. Signal Transduct Target Ther 2017; 2:17055. [PMID: 29263932 PMCID: PMC5668671 DOI: 10.1038/sigtrans.2017.55] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 01/01/2023] Open
Abstract
The main cause of cervical cancer is persistent infection with high-risk human papilloma virus (HR-HPV), but not all human papilloma virus (HPV) infections lead to cervical cancer. The key factors that determine the outcome of HPV infection remain poorly understood, and how the host immune system protects against HPV infection is unclear. Toll-like receptors (TLRs) are a group of pattern recognition receptors present in the cytoplasm and cell membrane, and can specifically recognize pathogen-associated molecular patterns. As the key molecules of innate and acquired immunity, TLRs not only play important roles in the immune defense against infectious diseases, but also are involved in the occurrence and development of a variety of malignant tumors. In cervical cancer caused by HR-HPV infection, TLRs have been found to regulate the local immune microenvironment. The role of TLRs in HR-HPV infection and HPV-induced cervical cancer and its relationship with HPV vaccine are reviewed in this article.
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Canfell K, Caruana M, Gebski V, Darlington-Brown J, Heley S, Brotherton J, Gertig D, Jennett CJ, Farnsworth A, Tan J, Wrede CD, Castle PE, Saville M. Cervical screening with primary HPV testing or cytology in a population of women in which those aged 33 years or younger had previously been offered HPV vaccination: Results of the Compass pilot randomised trial. PLoS Med 2017; 14:e1002388. [PMID: 28926579 PMCID: PMC5604935 DOI: 10.1371/journal.pmed.1002388] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/10/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Using primary human papillomavirus (HPV) testing for cervical screening increases detection of high-grade cervical intraepithelial neoplastic lesions and invasive cancer (cervical intraepithelial neoplasia grade 2+ [CIN2+]) compared to cytology, but no evaluation has been conducted in a population previously offered HPV vaccination. We aimed to assess colposcopy referral and CIN2+ detection rates for HPV-screened versus cytology-screened women in Australia's HPV-vaccinated population (by 2014, resident women ≤33 years had been age-eligible for HPV vaccination, with 3-dose uptake across age cohorts being about 50%-77%). METHODS AND FINDINGS Compass is an open-label randomised trial of 5-yearly HPV screening versus 2.5-yearly liquid-based cytology (LBC) screening. In the first phase, consenting women aged 25-64 years presenting for routine screening at 47 primary practices in Victoria, Australia, provided a cervical sample and were randomised at a central laboratory at a 1:2:2 allocation to (i) image-read LBC screening with HPV triage of low-grade cytology ('LBC screening'), (ii) HPV screening with those HPV16/18 positive referred to colposcopy and with LBC triage for other oncogenic (OHR) types ('HPV+LBC triage'), or (iii) HPV screening with those HPV16/18 positive referred to colposcopy and with dual-stained cytology triage for OHR types ('HPV+DS triage'). A total of 5,006 eligible women were recruited from 29 October 2013 to 7 November 2014 (recruitment rate 58%); of these, 22% were in the group age-eligible for vaccination. Data on 4,995 participants were analysed after 11 withdrawals; 998 were assigned to, and 995 analysed (99.7%) in, the LBC-screened group; 1,996 assigned to and 1,992 analysed (99.8%) in the HPV+LBC triage group; and 2,012 assigned to and 2,008 analysed (99.8%) in the HPV+DS triage group. No serious trial-related adverse events were reported. The main outcomes were colposcopy referral and detected CIN2+ rates at baseline screening, assessed on an intention-to-treat basis after follow-up of the subgroup of triage-negative women in each arm referred to 12 months of surveillance, and after a further 6 months of follow-up for histological outcomes (dataset closed 31 August 2016). Analysis was adjusted for whether women had been age-eligible for HPV vaccination or not. For the LBC-screened group, the overall referral and detected CIN2+ rates were 27/995 (2.7% [95% CI 1.8%-3.9%]) and 1/995 (0.1% [95% CI 0.0%-0.6%]), respectively; for HPV+LBC triage, these were 75/1,992 (3.8% [95% CI 3.0%-4.7%]) and 20/1,992 (1.0% [95% CI 0.6%-1.5%]); and for HPV+DS triage, these were 79/2,008 (3.9% [95% CI 3.1%-4.9%]) and 24/2,008 (1.2% [95% CI 0.8%-1.6%]) (p = 0.09 for difference in referral rate in LBC versus all HPV-screened women; p = 0.003 for difference in CIN2+ detection rate in LBC versus all HPV-screened women, with p = 0.62 between HPV screening groups). Limitations include that the study population involved a relatively low risk group in a previously well-screened and treated population, that individual women's vaccination status was unknown, and that long-term follow-up data on disease detection in screen-negative women are not yet available. CONCLUSIONS In this study, primary HPV screening was associated with significantly increased detection of high-grade precancerous cervical lesions compared to cytology, in a population where high vaccine uptake was reported in women aged 33 years or younger who were offered vaccination. It had been predicted that increased disease detection might be associated with a transient increase in colposcopy referral rates in the first round of HPV screening, possibly dampened by HPV vaccine effect; in this study, although the point estimates for referral rates in women in each HPV-screened group were 41%-44% higher than in cytology-screened women, the difference in referral rate between cytology- and HPV-screened women was not significant. These findings provide initial support for the implementation of primary HPV screening in vaccinated populations. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613001207707.
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Affiliation(s)
- Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
| | - Michael Caruana
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Stella Heley
- Victorian Cytology Service, Melbourne, Victoria, Australia
| | - Julia Brotherton
- Victorian Cytology Service, Melbourne, Victoria, Australia
- School of Public Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dorota Gertig
- School of Public Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chloe J. Jennett
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
| | - Annabelle Farnsworth
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
| | - Jeffrey Tan
- Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Oncology & Dysplasia, Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - C. David Wrede
- Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Oncology & Dysplasia, Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Philip E. Castle
- Albert Einstein College of Medicine, New York, New York, United States of America
| | - Marion Saville
- Victorian Cytology Service, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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Brotherton JML, Tabrizi SN, Phillips S, Pyman J, Cornall AM, Lambie N, Anderson L, Cummings M, Payton D, Scurry JP, Newman M, Sharma R, Saville M, Garland SM. Looking beyond human papillomavirus (HPV) genotype 16 and 18: Defining HPV genotype distribution in cervical cancers in Australia prior to vaccination. Int J Cancer 2017; 141:1576-1584. [PMID: 28677147 DOI: 10.1002/ijc.30871] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/27/2017] [Accepted: 06/12/2017] [Indexed: 01/08/2023]
Abstract
Australia has implemented a high-coverage HPV vaccination program but has not, to date, established the distribution of HPV types that occur in cervical cancers in Australia. This information is important for determining the potential for cervical cancer prevention with both current and broader spectrum HPV vaccines. We analysed 847 cervical cancers diagnosed 2005 to 2015 in tertiary centres in the three most populous Australian states with resolution of specimens containing multiple HPV types using laser-capture microdissection. Archived FFPE tissue was reviewed by specialist pathologists, sandwich sectioned, and initially whole-tissue sections genotyped for HPV. Samples were first genotyped using SPF10-LiPA25 (version 1). Negative samples were screened with DNA ELISA kit HPV SPF10, followed by genotyping with SPF+ LiPA if ELISA positive. If still negative, samples were tested on a qPCR assay targeting the E6 region of HPV16, 18, 45 and 33. Of the 847 cancers (65.1% squamous, 28.7% adenocarcinoma, 4.3% adenosquamous, 2.0% other), 92.9% had HPV detected. Of the HPV-positive cancers, 607 of 787 (77.1%) contained HPV16 or 18, 125 of 787 (15.9%) contained HPV31/33/45/52 or 58, and 55 (7.0%) another HPV type. There was a strong correlation between HPV type and age, with younger women most likely to have HPV16/18 detected and least likely HPV negative. Our findings indicate that cervical cancers diagnosed in Australia more frequently contain HPV16/18 than in international series. This could be due to cervical screening in Australia increasing the proportion of adenocarcinomas, in which types 18 and 16 more strongly predominate, due to prevention of squamous cancers.
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Affiliation(s)
- Julia M L Brotherton
- Victorian Cytology Service Registries, East Melbourne, VIC, Australia.,School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, Regional HPV Reference Laboratory Network, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Samuel Phillips
- Department of Microbiology and Infectious Diseases, Regional HPV Reference Laboratory Network, The Royal Women's Hospital, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jan Pyman
- Department of Anatomical Pathology, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Alyssa M Cornall
- Department of Microbiology and Infectious Diseases, Regional HPV Reference Laboratory Network, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Neil Lambie
- Department of Anatomical Pathology, SEALS Pathology, Randwick, NSW, Australia
| | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, The University of Sydney, NSW, Australia
| | - Margaret Cummings
- Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Diane Payton
- Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - James P Scurry
- Department of Anatomical Pathology, Pathology North-Hunter, New Lambton Heights, NSW, Australia
| | - Marsali Newman
- Department of Anatomical Pathology, Austin Hospital, Heidelberg, VIC, Australia
| | - Raghwa Sharma
- Sydney Medical School, The University of Sydney, NSW, Australia.,Department of Anatomical Pathology, ICPMR Pathology, Westmead, NSW, Australia
| | - Marion Saville
- Victorian Cytology Service Registries, East Melbourne, VIC, Australia.,VCS Pathology, Victorian Cytology Service, Carlton, VIC, Australia
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, Regional HPV Reference Laboratory Network, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
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Garland SM, Kjaer SK, Muñoz N, Block SL, Brown DR, DiNubile MJ, Lindsay BR, Kuter BJ, Perez G, Dominiak-Felden G, Saah AJ, Drury R, Das R, Velicer C. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clin Infect Dis 2016; 63:519-27. [PMID: 27230391 PMCID: PMC4967609 DOI: 10.1093/cid/ciw354] [Citation(s) in RCA: 314] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022] Open
Abstract
This systematic review assessed the global impact and effectiveness of quadrivalent human papillomavirus (HPV) vaccination on HPV infection and disease in real-world settings over a decade of use. Substantial reductions in HPV 6/11/16/18 infection, anogenital warts, and cervical lesions have been achieved. Prophylactic human papillomavirus (HPV) vaccination programs constitute major public health initiatives worldwide. We assessed the global effect of quadrivalent HPV (4vHPV) vaccination on HPV infection and disease. PubMed and Embase were systematically searched for peer-reviewed articles from January 2007 through February 2016 to identify observational studies reporting the impact or effectiveness of 4vHPV vaccination on infection, anogenital warts, and cervical cancer or precancerous lesions. Over the last decade, the impact of HPV vaccination in real-world settings has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. Maximal reductions of approximately 90% for HPV 6/11/16/18 infection, approximately 90% for genital warts, approximately 45% for low-grade cytological cervical abnormalities, and approximately 85% for high-grade histologically proven cervical abnormalities have been reported. The full public health potential of HPV vaccination is not yet realized. HPV-related disease remains a significant source of morbidity and mortality in developing and developed nations, underscoring the need for HPV vaccination programs with high population coverage.
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Affiliation(s)
- Suzanne M Garland
- Royal Women's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Victoria, Australia
| | - Susanne K Kjaer
- Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
| | - Nubia Muñoz
- Colombian National Institute of Cancer, Bogota
| | - Stan L Block
- Kentucky Pediatric and Adult Research, Bardstown
| | | | | | | | | | - Gonzalo Perez
- Merck & Co, Inc, Kenilworth, New Jersey Universidad del Rosario, Bogota, Colombia
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Lew JB, Simms K, Smith M, Lewis H, Neal H, Canfell K. Effectiveness Modelling and Economic Evaluation of Primary HPV Screening for Cervical Cancer Prevention in New Zealand. PLoS One 2016; 11:e0151619. [PMID: 27187495 PMCID: PMC4871332 DOI: 10.1371/journal.pone.0151619] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/05/2016] [Indexed: 11/18/2022] Open
Abstract
Background New Zealand (NZ) is considering transitioning from 3-yearly cervical cytology screening in women 20–69 years (current practice) to primary HPV screening. We evaluated HPV-based screening in both HPV-unvaccinated women and cohorts offered HPV vaccination in New Zealand (vaccination coverage ~50%). Methods A complex model of HPV transmission, vaccination, cervical screening, and invasive cervical cancer was extensively validated against national population-based datasets. Sixteen potential strategies for HPV screening were considered. Results Most primary HPV strategies were more effective than current practice, for both unvaccinated women and cohorts offered vaccination. The optimal strategy for both groups was 5-yearly HPV screening in women aged 25–69 years with partial genotyping for HPV 16/18 and referral to colposcopy, and cytological triage of other oncogenic types. This is predicted to reduce cervical cancer incidence and mortality by a further 12–16% and to save 4–13% annually in program costs (excluding overheads). The findings are sensitive to assumptions about future adherence to initiating screening at 25 years. Conclusion Primary HPV screening with partial genotyping would be more effective and less costly than the current cytology-based screening program, in both unvaccinated women and cohorts offered vaccination. These findings have been considered in a review of cervical screening in NZ.
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Affiliation(s)
- Jie-Bin Lew
- Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia
- * E-mail:
| | - Kate Simms
- Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia
| | - Megan Smith
- Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia
| | - Hazel Lewis
- Public Health Physician, Wellington, New Zealand
| | - Harold Neal
- National Screening Unit, Ministry of Health, Wellington, New Zealand
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Whop LJ, Baade P, Garvey G, Cunningham J, Brotherton JML, Lokuge K, Valery PC, O’Connell DL, Canfell K, Diaz A, Roder D, Gertig DM, Moore SP, Condon JR. Cervical Abnormalities Are More Common among Indigenous than Other Australian Women: A Retrospective Record-Linkage Study, 2000-2011. PLoS One 2016; 11:e0150473. [PMID: 27064273 PMCID: PMC4827842 DOI: 10.1371/journal.pone.0150473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
Indigenous Australian women have much higher incidence of cervical cancer compared to non-Indigenous women. Despite an organised cervical screening program introduced 25 years ago, a paucity of Indigenous-identified data in Pap Smear Registers remains. Prevalence of cervical abnormalities detected among the screened Indigenous population has not previously been reported. We conducted a retrospective cohort study of population-based linked health records for 1,334,795 female Queensland residents aged 20–69 years who had one or more Pap smears during 2000–2011; from linked hospital records 23,483 were identified as Indigenous. Prevalence was calculated separately for Indigenous and non-Indigenous women, for cytology-detected low-grade (cLGA) and high-grade abnormalities (cHGA), and histologically confirmed high-grade abnormalities (hHGA). Odds ratios (OR) were estimated from logistic regression analysis. In 2010–2011 the prevalence of hHGA among Indigenous women (16.6 per 1000 women screened, 95% confidence interval [CI] 14.6–18.9) was twice that of non-Indigenous women (7.5 per 1000 women screened, CI 7.3–7.7). Adjusted for age, area-level disadvantage and place of residence, Indigenous women had higher prevalence of cLGA (OR 1.4, CI 1.3–1.4), cHGA (OR 2.2, CI 2.1–2.3) and hHGA (OR 2.0, CI 1.9–2.1). Our findings show that Indigenous women recorded on the Pap Smear Register have much higher prevalence for cLGA, cHGA and hHGA compared to non-Indigenous women. The renewed cervical screening program, to be implemented in 2017, offers opportunities to reduce the burden of abnormalities and invasive cancer among Indigenous women and address long-standing data deficiencies.
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Affiliation(s)
- Lisa J. Whop
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
- * E-mail:
| | - Peter Baade
- Cancer Council Queensland, Brisbane, Australia
| | - Gail Garvey
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - Joan Cunningham
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - Julia M. L. Brotherton
- Victorian Cytology Service Inc, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kamalini Lokuge
- National Centre of Epidemiology and Public Health, Australian National University, Canberra, Australia
| | - Patricia C. Valery
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Abbey Diaz
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - David Roder
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Dorota M. Gertig
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Suzanne P. Moore
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - John R. Condon
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
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Handler NS, Handler MZ, Majewski S, Schwartz RA. Human papillomavirus vaccine trials and tribulations: Vaccine efficacy. J Am Acad Dermatol 2016; 73:759-67; quiz 767-8. [PMID: 26475535 DOI: 10.1016/j.jaad.2015.05.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/27/2015] [Accepted: 05/14/2015] [Indexed: 11/19/2022]
Abstract
As of December 2014, there were 3 approved vaccines for human papillomavirus (HPV): bivalent Cervarix (GlaxoSmithKline, New York, NY), quadrivalent Gardasil (Merck and Co, Kenilworth, NJ), and 9-valent Gardasil-9 (Merck and Co). The average cost per dose is $120, with a recommended 3-dose course. The quadrivalent vaccine is the most widely administered worldwide. As with the bivalent and 9-valent vaccines, the vaccine is considered safe, although concerns have been raised. In addition to immunization against the targeted HPV types, there is evidence that there is cross protection against other types of HPV. This continuing medical education review evaluates the differences in vaccines that are currently on the market; part II focuses on the cost-effectiveness of vaccination, the HPV vaccination programs currently instituted around the globe, efficacy, and safety.
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Affiliation(s)
- Nancy S Handler
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey; University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska
| | - Marc Z Handler
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey
| | - Slawomir Majewski
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Robert A Schwartz
- Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey; Pathology, Rutgers University New Jersey Medical School, Newark, New Jersey; Pediatrics, Rutgers University New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers University New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers University New Jersey Medical School, Newark, New Jersey.
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Lawson JS, Glenn WK, Salyakina D, Clay R, Delprado W, Cheerala B, Tran DD, Ngan CC, Miyauchi S, Karim M, Antonsson A, Whitaker NJ. Human Papilloma Virus Identification in Breast Cancer Patients with Previous Cervical Neoplasia. Front Oncol 2016; 5:298. [PMID: 26779441 PMCID: PMC4705232 DOI: 10.3389/fonc.2015.00298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/14/2015] [Indexed: 11/13/2022] Open
Abstract
Purpose Women with human papilloma virus (HPV)-associated cervical neoplasia have a higher risk of developing breast cancer than the general female population. The purpose of this study was to (i) identify high-risk HPVs in cervical neoplasia and subsequent HPV positive breast cancers which developed in the same patients and (ii) determine if these HPVs were biologically active. Methods A range of polymerase chain reaction and immunohistochemical techniques were used to conduct a retrospective cohort study of cervical precancers and subsequent breast cancers in the same patients. Results The same high-risk HPV types were identified in both the cervical and breast specimens in 13 (46%) of 28 patients. HPV type 18 was the most prevalent. HPVs appeared to be biologically active as demonstrated by the expression of HPV E7 proteins and the presence of HPV-associated koilocytes. The average age of these patients diagnosed with breast cancer following prior cervical precancer was 51 years, as compared to 60 years for all women with breast cancer (p for difference = 0.001). Conclusion These findings indicate that high-risk HPVs can be associated with cervical neoplasia and subsequent young age breast cancer. However, these associations are unusual and are a very small proportion of breast cancers. These outcomes confirm and extend the observations of two similar previous studies and offer one explanation for the increased prevalence of serious invasive breast cancer among young women.
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Affiliation(s)
- James S Lawson
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Wendy K Glenn
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Daria Salyakina
- Center for Computational Science, University of Miami , Miami, FL , USA
| | - Rosemary Clay
- Douglass Hanly Moir - Pathology , Macquarie Park, NSW , Australia
| | - Warick Delprado
- Douglass Hanly Moir - Pathology , Macquarie Park, NSW , Australia
| | | | - Dinh D Tran
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Christopher C Ngan
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Shingo Miyauchi
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Martha Karim
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute , Brisbane, QLD , Australia
| | - Noel J Whitaker
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
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Lawson JS, Glenn WK, Salyakina D, Delprado W, Clay R, Antonsson A, Heng B, Miyauchi S, Tran DD, Ngan CC, Lutze-Mann L, Whitaker NJ. Human Papilloma Viruses and Breast Cancer. Front Oncol 2015; 5:277. [PMID: 26734565 PMCID: PMC4679879 DOI: 10.3389/fonc.2015.00277] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/26/2015] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Human papillomaviruses (HPV) may have a role in some breast cancers. The purpose of this study is to fill important gaps in the evidence. These gaps are: (i) confirmation of the presence of high risk for cancer HPVs in breast cancers, (ii) evidence of HPV infections in benign breast tissues prior to the development of HPV-positive breast cancer in the same patients, (iii) evidence that HPVs are biologically active and not harmless passengers in breast cancer. METHODS RNA-seq data from The Cancer Genome Atlas (TCGA) was used to identify HPV RNA sequences in breast cancers. We also conducted a retrospective cohort study based on polymerase chain reaction (PCR) analyses to identify HPVs in archival specimens from Australian women with benign breast biopsies who later developed breast cancer. To assess whether HPVs in breast cancer were biologically active, the expression of the oncogenic protein HPV E7 was assessed by immunohistochemistry (IHC). RESULTS Thirty (3.5%) low-risk and 20 (2.3%) high-risk HPV types were identified in 855 breast cancers from the TCGA database. The high risk types were HPV 18 (48%), HPV 113 (24%), HPV 16 (10%), HPV 52 (10%). Data from the PCR cohort study indicated that HPV type 18 was the most common type identified in breast cancer specimens (55% of 40 breast cancer specimens) followed by HPV 16 (13%). The same HPV type was identified in both the benign and subsequent breast cancer in 15 patients. HPV E7 proteins were identified in 72% of benign breast specimens and 59% of invasive breast cancer specimens. CONCLUSION There were four observations of particular interest: (i) confirmation by both NGS and PCR of the presence of high-risk HPV gene sequences in breast cancers, (ii) a correlation between high-risk HPV in benign breast specimens and subsequent HPV-positive breast cancer in the same patient, (iii) HPVs in breast cancer are likely to be biologically active (as shown by transcription of HPV DNA to RNA plus the expression of HPV E7 proteins), (iv) HPV oncogenic influences may occur early in the development of breast cancer.
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Affiliation(s)
- James S Lawson
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Wendy K Glenn
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Daria Salyakina
- Center for Computational Science, University of Miami , Miami, FL , USA
| | - Warick Delprado
- Douglass Hanly Moir Pathology , Macquarie Park, NSW , Australia
| | - Rosemary Clay
- Douglass Hanly Moir Pathology , Macquarie Park, NSW , Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute , Brisbane, QLD , Australia
| | - Benjamin Heng
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Shingo Miyauchi
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Dinh D Tran
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Christopher C Ngan
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Louise Lutze-Mann
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
| | - Noel J Whitaker
- School of Biotechnology and Biomolecular Science, University of New South Wales , Sydney, NSW , Australia
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Kang YJ, Lewis H, Smith MA, Simonella L, Neal H, Bromhead C, Canfell K. Pre-vaccination type-specific HPV prevalence in confirmed cervical high grade lesions in the Māori and non-Māori populations in New Zealand. BMC Infect Dis 2015; 15:365. [PMID: 26297490 PMCID: PMC4546322 DOI: 10.1186/s12879-015-1034-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/16/2015] [Indexed: 11/17/2022] Open
Abstract
Background New Zealand initiated HPV vaccination in 2008, and has attained 3-dose coverage of ~50 % in 12–13 year old girls. Due to the success of program initiatives in Māori girls, higher coverage rates of ~60 % have been achieved in this group. We have previously reported a benchmark overall pre-vaccination prevalence of oncogenic HPV infection in high grade cervical lesions in New Zealand. The current extended analysis provides separate pre-vaccination benchmark prevalence for Māori and non-Māori women. Methods The National Cervical Screening Programme Register (NCSP-R) was used to identify any woman aged 20–69 years of age with an index high grade cytology report from 2009–2011. Extended recruitment was performed until 2012 in clinics with a high proportion of Māori women. Ethnicity status was based on self-reported information by participating women through phone contact supplemented by recordings on the study questionnaire (the NCSP-R was not used to extract ethnicity status). A total of 730 women consented to participate and had a valid HPV test result; 418 of these had histologically-confirmed cervical intraepithelial neoplasia (CIN) 2/3 lesions (149 Māori, 269 non-Māori). The prevalence of any cervical oncogenic HPV infection, HPV16, and HPV18 was calculated in women with CIN2/3. Results In confirmed CIN2/3, the prevalence of any oncogenic HPV, HPV16 and HPV18 was 96 % (95 % CI:91–99 %), 54 % (95 % CI:46–63 %), 11 % (95 % CI:7–18 %) in Māori and 96 % (95 % CI:93–98 %), 54 % (95 % CI:48–60 %), 11 % (95 % CI:7–15 %) in non-Māori women, respectively. Age-specific patterns of infection for HPV16/18 in confirmed CIN2/3 differed between the two groups (Pinteraction = 0.02), with a lower prevalence in younger vs. older Māori women (57 % in 20–29 years vs 75 % in 40–69 years) but a higher prevalence in younger vs. older non-Māori women (70 % in 20–29 years vs 49 % in 40–69 years); the difference in the age-specific patterns of infection for HPV16/18 was not significant either when considering confirmed CIN2 alone (p = 0.09) or CIN3 alone (p = 0.22). Conclusions The overall prevalence of vaccine-included types in CIN2/3 was similar in Māori and non-Māori women, implying that the long-term effects of vaccination will be similar in the two groups. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1034-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoon-Jung Kang
- Prince of Wales Clinical School, UNSW, Sydney, NSW, 2052, Australia. .,Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia.
| | - Hazel Lewis
- National Cervical Screening Programme, Ministry of Health, Wellington, New Zealand. .,, Current address: 59 Normandale Rd, Lower Hutt, New Zealand.
| | - Megan A Smith
- Prince of Wales Clinical School, UNSW, Sydney, NSW, 2052, Australia. .,Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia.
| | - Leonardo Simonella
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia. .,Current address: MORSE (modelling outcomes research, statistics and epidemiology) group, Roche, Basel, Switzerland.
| | - Harold Neal
- National Cervical Screening Programme, Ministry of Health, Wellington, New Zealand.
| | - Collette Bromhead
- Molecular Biology, Aotea Pathology, CMC Building 89 Courtenay Place, Wellington, New Zealand. .,Current address: Institute of Food and Nutrition, College of Health, Massey University Wellington, Wellington, New Zealand.
| | - Karen Canfell
- Prince of Wales Clinical School, UNSW, Sydney, NSW, 2052, Australia. .,Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia.
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Velentzis LS, Sitas F, O'Connell DL, Darlington-Brown J, Egger S, Sinha R, Banks E, Frazer IH, Canfell K. Human papillomavirus 16/18 seroprevalence in unvaccinated women over 30 years with normal cytology and with high grade cervical abnormalities in Australia: results from an observational study. BMC Infect Dis 2014; 14:3861. [PMID: 25528152 PMCID: PMC4299782 DOI: 10.1186/s12879-014-0676-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/01/2014] [Indexed: 01/28/2023] Open
Abstract
Background Australia commenced human papillomavirus (HPV) vaccination in 2007, with a two-year catch-up to the age of 26; catch-up cohorts are thus now entering their thirties. Plans for monitoring vaccine impact involve pre- and post-vaccination assessment of cervical HPV DNA in the general population and in high grade abnormalities. Although HPV serology is less sensitive than DNA genotyping, it assesses lifetime exposure and may be easier to measure in the general population. However, benchmark pre-vaccination seroprevalence of vaccine-included types in unvaccinated women with high grade abnormalities has not previously been reported. Methods We assessed seroprevalence for HPV16/18 from a population-based sample of 3,729 women with normal cytology and 971 women with confirmed high grade abnormalities (CIN2/3), aged 30–64 years, unvaccinated, and recruited in New South Wales in 2006–2010. We examined the variation in HPV16/18 seropositivity by age and in relation to a range of reproductive and behavioural characteristics in the subgroup of normal cytology women with no recent history of high grade cervical disease. Results The HPV 16, 18 and combined seroprevalence was 19%, 7% and 24% among women with normal cytology, and 39%, 13% and 44% among women with CIN2/3, respectively. For both groups, HPV16/18 seroprevalence was highest at age 30–39 years and decreased with age. In multivariable analysis for women with normal cytology, HPV16 and HPV18 seropositivity were each associated with the number of lifetime sexual partners (p-trend <0.001 and 0.052, respectively) and for HPV16 this was also associated with age (p-trend <0.001) and prior diagnosis of Chlamydia (adjusted OR 1.89, 95% CI 1.27-2.80). Conclusions The findings of this study inform pre-vaccination estimates of HPV seropositivity in women with normal cytology and women with high grade abnormalities. Almost a quarter of unvaccinated women aged over 30 years with normal cytology, and more than 40% of those with CIN2/3, had seroconverted to HPV 16 or 18. These findings provide a potential additional benchmark for assessing the effects of HPV vaccination. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0676-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louiza S Velentzis
- Cancer Research Division, Cancer Council NSW, King's Cross, NSW, 1340, Australia.
| | - Freddy Sitas
- Cancer Research Division, Cancer Council NSW, King's Cross, NSW, 1340, Australia.
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, King's Cross, NSW, 1340, Australia.
| | - Jessica Darlington-Brown
- Cancer Research Division, Cancer Council NSW, King's Cross, NSW, 1340, Australia. .,Present address: Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, NSW Sydney, 2052, NSW, Australia.
| | - Sam Egger
- Cancer Research Division, Cancer Council NSW, King's Cross, NSW, 1340, Australia.
| | - Rohit Sinha
- The University of Queensland Diamantina Institute, Brisbane, QLD, 4102, Australia.
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 0200, Australia.
| | - Ian H Frazer
- The University of Queensland Diamantina Institute, Brisbane, QLD, 4102, Australia.
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, King's Cross, NSW, 1340, Australia. .,Present address: Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, NSW Sydney, 2052, NSW, Australia.
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Rodrigues DA, Pereira ÉR, Oliveira LSDS, Speck NMDG, Gimeno SGA. Prevalência de atipias citológicas e infecção pelo papilomavírus humano de alto risco em mulheres indígenas Panará, povo indígena do Brasil Central. CAD SAUDE PUBLICA 2014. [DOI: 10.1590/0102-311x00152713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi analisar a prevalência das atipias citológicas e infecção pelo papilomavírus humano em mulheres indígenas Panará no período de 2006 a 2007. Trata-se de estudo observacional transversal, com dados obtidos por coleta de amostras cérvico-vaginais para colpocitologia oncótica e captura híbrida, exame de colposcopia e biópsia. O trabalho incluiu 86 mulheres com idades de 12 anos ou mais, com história de vida sexual ativa ou pregressa. Os resultados mostraram que 10,7% das mulheres tinham atipias citológicas e que 28,6% estavam infectadas pelo HPV de alto risco oncogênico, principalmente entre as mais jovens (média = 25,6 anos). Dessas, 41,7% foram positivas para um ou mais dos tipos de HPV de alto risco dos genótipos 16, 18 ou 45, e a maioria, 58,3%, para outros tipos de HPV de alto risco. Conclui-se que é uma população especial, susceptível ao desenvolvimento das lesões precursoras do câncer do colo do útero e vulnerável às DST. Medidas preventivas como o rastreamento populacional sistemático para o câncer cervical e imunização contra o HPV são necessárias.
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Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia: a repeat cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2014; 14:958-66. [DOI: 10.1016/s1473-3099(14)70841-2] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kaderli R, Schnüriger B, Brügger LE. The impact of smoking on HPV infection and the development of anogenital warts. Int J Colorectal Dis 2014; 29:899-908. [PMID: 24935346 DOI: 10.1007/s00384-014-1922-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The worldwide prevalence of human papillomavirus (HPV) infection is estimated at 9-13 %. Persistent infection can lead to the development of malignant and nonmalignant diseases. Low-risk HPV types are mostly associated with benign lesions such as anogenital warts. In the present systematic review, we examined the impact of smoking on HPV infection and the development of anogenital warts, respectively. METHODS A systematic literature search was performed using MEDLINE database for peer-reviewed articles published from January 01, 1985 to November 30, 2013. Pooled rates of HPV prevalence were compared using the χ (2) test. RESULTS In both genders, smoking is associated with higher incidence and prevalence rates for HPV infection, whereas the latter responds to a dose-effect relationship. The overall HPV prevalence for smoking patients was 48.2 versus 37. 5 % for nonsmoking patients (p < 0.001) (odds ratio (OR) = 1.5, 95 % confidence interval (CI) 1.4-1.7). Smoking does also increase persistence rates for high-risk HPV infection, while this correlation is debatable for low-risk HPV. The incidence and recurrence rates of anogenital warts are significantly increased in smokers. CONCLUSIONS Most current data demonstrate an association between smoking, increased anogenital HPV infection, and development of anogenital warts. These data add to the long list of reasons for making smoking cessation a keystone of patient health.
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Affiliation(s)
- Reto Kaderli
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010, Bern, Switzerland,
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Callegari ET, Tabrizi SN, Pyman J, Saville M, Cornall AM, Brotherton JM, Garland SM. How best to interpret mixed human papillomavirus genotypes in high-grade cervical intraepithelial neoplasia lesions. Vaccine 2014; 32:4082-8. [DOI: 10.1016/j.vaccine.2014.05.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/02/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
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Tabrizi SN, Brotherton JM, Stevens MP, Condon JR, McIntyre P, Smith D, Garland SM. HPV genotype prevalence in Australian women undergoing routine cervical screening by cytology status prior to implementation of an HPV vaccination program. J Clin Virol 2014; 60:250-6. [DOI: 10.1016/j.jcv.2014.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/10/2014] [Accepted: 04/15/2014] [Indexed: 11/17/2022]
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Korostil IA, Regan DG. The potential impact of HPV-16 reactivation on prevalence in older Australians. BMC Infect Dis 2014; 14:312. [PMID: 24906851 PMCID: PMC4061121 DOI: 10.1186/1471-2334-14-312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some regional cross-sectional human papillomavirus (HPV) DNA prevalence data show an increase in prevalence in older women, the reasons for which are as yet unknown. A recently published study suggests that the increase may be at least partly due to reactivation of latent HPV in menopausal women. METHODS We developed a dynamic mathematical model of HPV-16 transmission to estimate the key consequences of hypothetical HPV-16 reactivation in the Australian heterosexual population. We only consider a worst case scenario with regard to reactivation in the Australian setting when all women who are latently infected reactivate and, wherever feasible, we choose model parameter values which may lead to a more pronounced reactivation. The ongoing National HPV vaccination program covering both women and men is incorporated in the model. RESULTS We estimate that about 1 in 10 women and men who appear to have cleared HPV-16 infection may be latently infected. The prevalence of HPV-16 in older Australian women will increase by a factor of up to 3.1 between now and 2025 which will be accompanied by an increase by a factor of around 1.9 in older men. However, the long-term impact of the HPV vaccination is not significantly altered by reactivation. CONCLUSIONS If the reactivation hypothesis we consider is substantiated, the public health response should be focused on further improvement of cervical screening coverage for older women. Our study also highlights the urgent need for surveillance of HPV prevalence in older Australians.
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Affiliation(s)
- Igor A Korostil
- The Kirby Institute, University of New South Wales, 2052 Sydney, Australia
| | - David G Regan
- The Kirby Institute, University of New South Wales, 2052 Sydney, Australia
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Foliaki S, Brewer N, Pearce N, Snijders PJF, Meijer CJLM, Waqatakirewa L, Clifford GM, Franceschi S. Prevalence of HPV infection and other risk factors in a Fijian population. Infect Agent Cancer 2014; 9:14. [PMID: 24891876 PMCID: PMC4040509 DOI: 10.1186/1750-9378-9-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/20/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer is among the leading contributors to morbidity and mortality in the Pacific, but the magnitude of the problem and the potential for prevention have not been comprehensively studied. Over the past decade, cervical cancer has been the most common cancer among women in Fiji with an age standardised cervical cancer incidence rate of 51 per 100,000. This rate is among the highest in the South Pacific region and in the world. This high cervical cancer incidence rate is likely linked to the low cervical screening rate, but it points also to the possibility of a high burden of human papillomavirus (HPV) infection. METHODS We conducted a population-based survey in Fiji to provide information on human papillomavirus (HPV) prevalence, and the distribution of individual HPV types in a Fijian health-sub-district. We included 1,261 women aged between 16 and 64 years. A general primer GP5+/6+ mediatedpolymerase chain reaction (PCR) assay was used for HPV testing of 44 HPV types. RESULTS The crude HPV prevalence in 1,244 women with an adequate HPV sample was 24.0% (95% confidence interval (CI), 21.7-26.4%) and the corresponding age standardised prevalence was 25.5% (95% CI, 23.1-28.1%). The prevalence of high-risk HPV types was 13.6% (95% CI, 11.8-15.6%). Among 1,192 women with adequate cytological results, 13 (1.1%) showed cervical abnormalities, the majority of which were high-grade intraepithelial lesions or worse. HPV prevalence declined from 35.8% in women aged <25 years to 18.6% in those aged 55-64 years of age. After adjustment, the only variables significantly associated with HPV-positivity were age (ranging from odds ratio (OR) 0.57 (95% CI, 0.36-0.89) for 25-34 year-old-women to OR 0.43 (95% CI, 0.20-0.89) for 55-64 year-old-women) and 'husband's extramarital sexual relationships' (OR 1.69; 95% CI, 1.17-2.34). CONCLUSION These findings on HPV provide key information for future policy decisions on the most appropriate methods of cervical cancer prevention in Fiji and in the Pacific region.
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Affiliation(s)
- Sunia Foliaki
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Naomi Brewer
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Neil Pearce
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
- London School of Hygiene & Tropical Medicine, London, UK
| | - Peter JF Snijders
- Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Chris JLM Meijer
- Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Smith MA, Canfell K. Testing previous model predictions against new data on human papillomavirus vaccination program outcomes. BMC Res Notes 2014; 7:109. [PMID: 24568634 PMCID: PMC3938033 DOI: 10.1186/1756-0500-7-109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 02/21/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Vaccination against human papillomavirus (HPV), predominantly targeting young females, has been introduced in many countries. Decisions to implement programs, which have involved substantial investment by governments, have in part been based on findings from cost-effectiveness models. Now that vaccination programs have been in place for some years, it is becoming possible to observe their effects, and compare these with model effectiveness predictions made previously. FINDINGS Australia introduced a publicly-funded HPV vaccination program in 2007. Recently reported Australian data from a repeat cross-sectional survey showed a substantial (77%) fall in HPV16 prevalence in women aged 18-24 years in 2010-2011, compared to pre-vaccination levels. We have previously published model predictions for the population-wide reduction in incident HPV16 infections post-vaccination in Australia. We compared prior predictions from the same model (including the same assumed uptake rates) for the reduction in HPV16 prevalence in women aged 18-24 years by the end of 2010 with the observed data. Based on modelled vaccine uptake which is consistent with recent data on three-dose uptake (78% at 12-13 years; lower uptake in older catch-up age cohorts), we had predicted a 70% reduction in prevalence in 18-24 year old females by the end of 2010. Based on modelled vaccine uptake consistent with recent national data for two-dose coverage and similar to that reported by women in the cross-sectional study, we had predicted a 79% reduction. CONCLUSIONS A close correspondence was observed between the prior model predictions and the recently reported findings on the rapid drop in HPV prevalence in Australia. Because broadly similar effectiveness predictions have been reported from other models used for cost-effectiveness predictions, this provides reassurance that the substantial public investment in HPV vaccination has been grounded in valid estimates of the effects of vaccination.
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Affiliation(s)
- Megan A Smith
- Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Karen Canfell
- Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
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The Australian Experience With the Human Papillomavirus Vaccine. Clin Ther 2014; 36:17-23. [DOI: 10.1016/j.clinthera.2013.12.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/11/2013] [Accepted: 12/11/2013] [Indexed: 11/22/2022]
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