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Kamuyu G, Coelho da Silva F, Tenet V, Schussler J, Godi A, Herrero R, Porras C, Mirabello L, Schiller JT, Sierra MS, Kreimer AR, Clifford GM, Beddows S. Global evaluation of lineage-specific human papillomavirus capsid antigenicity using antibodies elicited by natural infection. Nat Commun 2024; 15:1608. [PMID: 38383518 PMCID: PMC10881982 DOI: 10.1038/s41467-024-45807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
Human Papillomavirus (HPV) type variants have been classified into lineages and sublineages based upon their whole genome sequence. Here we have examined the specificity of antibodies generated following natural infection with lineage variants of oncogenic types (HPV16, 18, 31, 33, 45, 52 and 58) by testing serum samples assembled from existing archives from women residing in Africa, The Americas, Asia or Europe against representative lineage-specific pseudoviruses for each genotype. We have subjected the resulting neutralizing antibody data to antigenic clustering methods and created relational antigenic profiles for each genotype to inform the delineation of lineage-specific serotypes. For most genotypes, there was evidence of differential recognition of lineage-specific antigens and in some cases of a sufficient magnitude to suggest that some lineages should be considered antigenically distinct within their respective genotypes. These data provide compelling evidence for a degree of lineage specificity within the humoral immune response following natural infection with oncogenic HPV.
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Affiliation(s)
- Gathoni Kamuyu
- Virus Reference Department, Public Health Microbiology Division, UK Health Security Agency, London, UK
| | - Filomeno Coelho da Silva
- Virus Reference Department, Public Health Microbiology Division, UK Health Security Agency, London, UK
| | - Vanessa Tenet
- International Agency for Research on Cancer (IARC/WHO) Early Detection, Prevention and Infections Branch, Lyon, France
| | - John Schussler
- Information Management Services Inc, Silver Spring, MD, USA
| | - Anna Godi
- Virus Reference Department, Public Health Microbiology Division, UK Health Security Agency, London, UK
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB) formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA (FUNIN), San José, Costa Rica
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas (ACIB) formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA (FUNIN), San José, Costa Rica
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - John T Schiller
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Gary M Clifford
- International Agency for Research on Cancer (IARC/WHO) Early Detection, Prevention and Infections Branch, Lyon, France
| | - Simon Beddows
- Virus Reference Department, Public Health Microbiology Division, UK Health Security Agency, London, UK.
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, London, UK.
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Schuind AE, Rees H, Schiller J, Mugo N, Dull P, Barnabas R, Clifford GM, Liu G, Madhi SA, Morse RB, Moscicki AB, Palefsky JM, Plotkin S, Sierra MS, Slifka MK, Vorsters A, Kreimer AR, Didierlaurent AM. State-of-the-Science of human papillomavirus vaccination in women with human immunodeficiency Virus: Summary of a scientific workshop. Prev Med Rep 2023; 35:102331. [PMID: 37576844 PMCID: PMC10413150 DOI: 10.1016/j.pmedr.2023.102331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/27/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
The burden of cervical cancer is disproportionately distributed globally, with the vast majority of cases occurring in low- and middle-income countries. Women with human immunodeficiency virus (HIV) (WWH) are at increased risk of human papillomavirus (HPV) infection and cervical cancer as compared to HIV-negative individuals. HPV vaccination remains a priority in regions with a high burden of cervical cancer and high HIV prevalence. With HPV vaccines becoming more accessible, optimal use beyond the initial World Health Organization-recommended target population of 9 to 14-year-old girls is an important question. In March 2022, a group of experts in epidemiology, immunology, and vaccinology convened to discuss the state-of-the-science of HPV vaccination in WWH. This report summarizes the proceedings: review of HIV epidemiology and its intersection with cervical cancer burden, immunology, HPV vaccination including reduced-dose schedules and experience with other vaccines in people with HIV (PWH), HPV vaccination strategies and knowledge gaps, and outstanding research questions. Studies of HPV vaccine effectiveness among WWH, including duration of protection, are limited. Until data from ongoing research is available, the current recommendation for WWH remains for a multi-dose HPV vaccination regimen. A focus of the discussion included the potential impact of HIV acquisition following HPV vaccination. With no data currently existing for HPV vaccines and limited information from non-HPV vaccines, this question requires further research. Implementation research on optimal HPV vaccine delivery approaches for WWH and other priority populations is also urgently needed.
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Affiliation(s)
| | - Helen Rees
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - John Schiller
- National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Nelly Mugo
- Kenya Medical Research Institute, Nairobi, Kenya and Department of Global Health, University of Washington, Seattle, United States
| | - Peter Dull
- Vaccine Development, Bill & Melinda Gates Foundation, Seattle, United States
| | - Ruanne Barnabas
- Division of Infectious Diseases, Mass General Hospital, Harvard Medical School, Boston, United States
| | - Gary M. Clifford
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gui Liu
- Department of Global Health, University of Washington, Seattle, United States
| | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
| | | | - Anna-Barbara Moscicki
- Department of Pediatrics, University of California Los Angeles, Los Angeles, United States
| | - Joel M. Palefsky
- University of California, San Francisco School of Medicine, San Francisco, United States
| | - Stanley Plotkin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
| | - Mónica S. Sierra
- National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Mark K. Slifka
- Oregon Health & Science University, Beaverton, United States
| | - Alex Vorsters
- Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
| | - Aimée R. Kreimer
- National Cancer Institute, National Institutes of Health, Bethesda, United States
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Carvajal LJ, Shing JZ, Vanegas JC, González E, Guillén D, Sierra MS, Hildesheim A, Porras C, Herrero R, Torres G, Shiels MS, Calderón A, Kreimer AR. Trends in incidence rates of head and neck squamous cell carcinomas overall and by potential relatedness to human papillomavirus, Costa Rica 2006 to 2015. Int J Cancer 2023; 152:2052-2060. [PMID: 36650690 DOI: 10.1002/ijc.34437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023]
Abstract
In Costa Rica (CR), only one report on head and neck cancer (HNC) incidence trends (1985-2007) has been published and no investigations on the epidemiology of potentially human papillomavirus (HPV)-related and HPV-unrelated HNCs have been done. We examined the age-standardized incidence rates (IRs) and trends of head and neck squamous cell carcinomas (HNSCC) and compared incidence trends of potentially HPV-related and HPV-unrelated HNSCCs. We obtained all available HNC cases for the period 2006-2015 from the Costa Rican National Cancer Registry of Tumors and the population estimates from the Costa Rican National Institute of Statistics and Census. The analysis was restricted to invasive HNSCCs (n = 1577). IRs and incidence rate ratios were calculated using SEER*Stat software and were age-standardized for the 2010 Costa Rican population. Joinpoint regression analysis program was used to calculate trends and annual percent changes (APCs) in rates. For all HNSCCs, the age-standardized IR was 34.0/million person-years; 95% CI 32.4, 35.8. There was a significant decline in the incidence of nasopharyngeal cancer (APC: -5.9% per year; 95% CI -10.8, -0.7) and laryngeal cancer (APC: -5.4% per year; -9.2, 1.5). The incidence trends for hypopharyngeal, oropharyngeal and oral cavity cancers each remained stable over time. HNSCCs were categorized by their potential relatedness to HPV infection. Though the APCs were not statistically significant, IRs of potentially HPV-related HNSCCs trended upward, while HPV-unrelated HNSCCs trended downward. HNSCCs are uncommon in CR and decreased over time. We observed a divergent pattern of decreasing HPV-unrelated with increasing HPV-related HNSCCs that should be further informed by HPV genotyping tumor samples.
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Affiliation(s)
- Loretto J Carvajal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.,Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Jaimie Z Shing
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Juan C Vanegas
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Emmanuel González
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica.,Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Dr. Enrique Baltodano Briceño, Guanacaste, Costa Rica
| | - Diego Guillén
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica.,Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Max Peralta, Cartago, Costa Rica
| | - Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB-FUNIN), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Guillermo Torres
- Ministerio de Salud, Registro Nacional de Tumores, San José, Costa Rica
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Alejandro Calderón
- Caja Costarricense de Seguro Social, Proyecto de Fortalecimiento de la Atención del Cáncer, San José, Costa Rica
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Carvajal LJ, Herrero R, Angulo MM, Schussler J, Porras C, Ocampo R, Cortés B, Loría V, Castrillo H, Romero B, Barrientos G, Coronado K, Ávila C, Hildesheim A, Rodríguez AC, Jiménez SE, Kreimer AR, Sierra MS. Prevalencia y determinantes de la infección por virus de papiloma humano en mujeres jóvenes de Guanacaste y Puntarenas, Costa Rica, 2004-2005. Salud Publica Mex 2023; 65:253-264. [PMID: 38060880 DOI: 10.21149/14286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/06/2023] [Indexed: 12/18/2023] Open
Abstract
OBJETIVO Estimar la prevalencia e identificar determinantes de la infección por el virus del papiloma humano (VPH) en mujeres jóvenes (18-25 años). Material y métodos. Se analizaron datos de 5 871 mujeres sexualmente activas a quienes se les realizó una entrevista y toma de muestras cervicouterinas para detección de VPH y citología durante la visita de reclutamiento del Ensayo de Vacunación contra VPH16/18 en Costa Rica. Se calculó la prevalencia total para cualquier tipo de VPH y tipos oncogénicos, no oncogénicos y específicos, con intervalos de confianza al 95% (IC95%). Se utilizó regresión logística múltiple paso-a-paso para identificar determinantes asociados con la infección. RESULTADOS La prevalencia total de VPH fue 50.0% (IC95% 48.8,51.3) y por tipos oncogénicos fue 33.8% (IC95% 32.6,35.0). El VPH-16 fue el tipo más prevalente (8.3%, IC95% 7.6,9.0). Los determinantes asociados con un alto riesgo de infección prevalente por VPH oncogénicos fueron no estar casada/unión libre, >1 compañero sexual, infección concomitante por Chlamydia trachomatis, y entre aquéllas con un único compañero sexual en su vida, un compañero con antecedente de múltiples compañeras sexuales. Conclusión. Se confirma la asociación de las infecciones por VPH oncogénicos con el comportamiento sexual de la mujer y se destacan los comportamientos del compañero sexual.
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Affiliation(s)
- Loretto J Carvajal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. Bethesda, Maryland, USA. Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - María M Angulo
- Área Rectora de Salud de Garabito, Ministerio de Salud. Jacó, Puntarenas, Costa Rica..
| | - John Schussler
- Information Management Services, Silver Spring. Maryland, USA,.
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Rebeca Ocampo
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Bernal Cortés
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Viviana Loría
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Hariane Castrillo
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Byron Romero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Gloriana Barrientos
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Karla Coronado
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Carlos Ávila
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA. San José, Costa Rica..
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. Bethesda, Maryland, USA..
| | | | | | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. Bethesda, Maryland, USA..
| | - Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. Bethesda, Maryland, USA..
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Sierra MS, Tsang SH, Porras C, Herrero R, Sampson JN, Cortes B, Schussler J, Wagner S, Carvajal L, Quint W, Kreimer AR, Hu S, Rodriguez AC, Romero B, Hildesheim A. Analysis of cervical HPV infections among unvaccinated young adult women to inform vaccine strategies in this age group: the Costa Rica HPV Vaccine Trial. Sex Transm Infect 2022; 99:sextrans-2022-055434. [PMID: 35842229 PMCID: PMC10176398 DOI: 10.1136/sextrans-2022-055434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/28/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccines protect against incident HPV infections, which cause cervical cancer. OBJECTIVES We estimated the prevalence and incidence of HPV infections in young adult women to understand the impact of an HPV vaccination programme in this population. METHODS We collected cervical specimens from 6322 unvaccinated women, aged 18-37 years, who participated in the Costa Rica Vaccine Trial and its long-term follow-up. Women were followed for (median) 4.8 years and had (median) 4.0 study visits. Cervical specimens were tested for the presence/absence of 25 HPV genotypes. For each age band, we estimated the percentage of women with 1+ prevalent or 1+ incident HPV infections using generalised estimating equations. We also estimated the prevalence and incidence of HPV as a function of time since first sexual intercourse (FSI). RESULTS The model estimated HPV incident infections peaked at 28.0% (95% CI 25.3% to 30.9%) at age 20 years then steadily declined to 11.8% (95% CI 7.6% to 17.8%) at age 37 years. Incident oncogenic HPV infections (HPV16/18/31/33/35/39/45/51/52/56/58/59) peaked and then declined from 20.3% (95% CI 17.9% to 22.9%) to 7.7% (95% CI 4.4% to 13.1%); HPV16/18 declined from 6.4% (95% CI 5.1% to 8.1%) to 1.1% (95% CI 0.33% to 3.6%) and HPV31/33/45/52/58 declined from 11.0% (95% CI 9.3% to 13.1%) to 4.5% (95% CI 2.2% to 8.9%) over the same ages. The percentage of women with 1+ incident HPV of any, oncogenic, non-oncogenic and vaccine-preventable (HPV16/18, HPV31/33/45, HPV31/33/45/52/58, and HPV6/11) types peaked <1 year after FSI and steadily declined with increasing time since FSI (p for trends <0.001). We observed similar patterns for model estimated HPV prevalences. CONCLUSION Young adult women may benefit from HPV vaccination if newly acquired vaccine-preventable oncogenic infections lead to cervical precancer and cancer. HPV vaccination targeting this population may provide additional opportunities for primary prevention. TRIAL REGISTRATION NUMBER NCT00128661.
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Affiliation(s)
- Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Sabrina H Tsang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San Jose, Costa Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San Jose, Costa Rica
- Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Bernal Cortes
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San Jose, Costa Rica
| | - John Schussler
- Information Management Services Inc, Silver Spring, Maryland, USA
| | - Sarah Wagner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc, Frederick, Maryland, USA
| | - Loretto Carvajal
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San Jose, Costa Rica
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Shangying Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Byron Romero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San Jose, Costa Rica
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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Shing JZ, Hu S, Herrero R, Hildesheim A, Porras C, Sampson JN, Schussler J, Schiller JT, Lowy DR, Sierra MS, Carvajal L, Kreimer AR. Precancerous cervical lesions caused by non-vaccine-preventable HPV types after vaccination with the bivalent AS04-adjuvanted HPV vaccine: an analysis of the long-term follow-up study from the randomised Costa Rica HPV Vaccine Trial. Lancet Oncol 2022; 23:940-949. [PMID: 35709811 PMCID: PMC9255557 DOI: 10.1016/s1470-2045(22)00291-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In women vaccinated against human papillomavirus (HPV), reductions in cervical disease and related procedures results in more women having intact transformation zones, potentially increasing the risk of cervical lesions caused by non-vaccine-preventable HPV types, a phenomenon termed clinical unmasking. We aimed to evaluate HPV vaccine efficacy against cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and cervical intraepithelial neoplasia grade 3 or worse (CIN3+) attributed to non-preventable HPV types in the long-term follow-up phase of the Costa Rica HPV Vaccine Trial (CVT). METHODS CVT was a randomised, double-blind, community-based trial done in Costa Rica. Eligible participants were women aged 18-25 years who were in general good health. Participants were randomly assigned (1:1) to receive an HPV 16 and 18 AS04-adjuvanted vaccine or control hepatitis A vaccine, using a blocked randomisation method (permuted block sizes of 14, 16, and 18). Vaccines in both groups were administered intramuscularly with 0·5 mL doses at 0, 1, and 6 months. Masking of vaccine allocation was maintained throughout the 4-year randomised trial phase, after which participants in the hepatitis A virus vaccine control group were provided the HPV vaccine and exited the study; a screening-only, unvaccinated control group was enrolled. The unvaccinated control group and HPV vaccine group were followed up for 7 years, during which treatment allocation was not masked. One of the prespecified primary endpoints for the long-term follow-up phase was precancers associated with HPV types not prevented by the vaccine, defined as histologically confirmed incident CIN2+ events or CIN3+ events attributed to any HPV type except HPV 16, 18, 31, 33, and 45. Our primary analytical period was years 7-11. Primary analyses were in all participants with at least one follow-up visit and excluded participants with a previous endpoint (ie, modified intention-to-treat cohort). Safety endpoints have been reported elsewhere. This trial is registered with ClinicalTrials.gov, NCT00128661 and NCT00867464. The randomised, masked trial phase is completed; an unmasked subset of women in the HPV-vaccinated group is under active investigation. FINDINGS Between June 28, 2004, and Dec 21, 2005, 7466 participants were enrolled (HPV vaccine group n=3727 and hepatitis A virus vaccine control group n=3739). Between March 30, 2009, and July 5, 2012, 2836 women enrolled in the new unvaccinated control group. The primary analytical cohort (years 7 to 11) included 2767 participants in the HPV vaccine group and 2563 in the unvaccinated group for the CIN2+ events endpoint assessment and 2826 participants in the HPV vaccine group and 2592 in the unvaccinated control group for the CIN3+ events endpoint assessment. Median follow-up during years 7 to 11 for women included for the CIN2+ events analysis was 52·8 months (IQR 44·0 to 60·7) for the HPV vaccine group and 49·8 months (42·0 to 56·9) for the unvaccinated control group. During years 7 to 11, clinical unmasking was observed with a negative vaccine efficacy against CIN2+ events attributed to non-preventable HPV types (-71·2% [95% CI -164·0 to -12·5]), with 9·2 (95% CI 2·1 to 15·6) additional CIN2+ events attributed to non-preventable HPV types per 1000 HPV-vaccinated participants versus HPV-unvaccinated participants. 27·0 (95% CI 14·2 to 39·9) fewer CIN2+ events irrespective of HPV type per 1000 vaccinated participants were observed during 11 years of follow-up. Vaccine efficacy against CIN3+ events attributed to non-preventable HPV types during years 7 to 11 was -135·0% (95% CI -329·8 to -33·5), with 8·3 (3·0 to 12·8) additional CIN3+ events attributed to non-preventable HPV types per 1000 vaccinated participants versus unvaccinated participants. INTERPRETATION Higher rates of CIN2+ events and CIN3+ events due to non-preventable HPV types in vaccinated versus unvaccinated participants suggests clinical unmasking could attenuate long-term reductions in high-grade disease following successful implementation of HPV vaccination programmes in screened populations. Importantly, the net benefit of vaccination remains considerable; therefore, HPV vaccination should still be prioritised as primary prevention for cervical cancer. FUNDING National Cancer Institute and National Institutes of Health Office of Research on Women's Health. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jaimie Z Shing
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Shangying Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación INCIENSA, San José, Costa Rica; Early Detection and Prevention Section, International Agency for Research on Cancer, WHO, Lyon, France
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación INCIENSA, San José, Costa Rica
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - John T Schiller
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Douglas R Lowy
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Loretto Carvajal
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación INCIENSA, San José, Costa Rica
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Porras C, Sampson JN, Herrero R, Gail MH, Cortés B, Hildesheim A, Cyr J, Romero B, Schiller JT, Montero C, Pinto LA, Schussler J, Coronado K, Sierra MS, Kim JJ, Torres CM, Carvajal L, Wagner S, Campos NG, Ocampo R, Kemp TJ, Zuniga M, Lowy DR, Avila C, Chanock S, Castrillo A, Estrada Y, Barrientos G, Monge C, Oconitrillo MY, Kreimer AR. Rationale and design of a double-blind randomized non-inferiority clinical trial to evaluate one or two doses of vaccine against human papillomavirus including an epidemiologic survey to estimate vaccine efficacy: The Costa Rica ESCUDDO trial. Vaccine 2022; 40:76-88. [PMID: 34857420 PMCID: PMC8759448 DOI: 10.1016/j.vaccine.2021.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 01/05/2023]
Abstract
HPV vaccination of adolescent girls is the most effective measure to prevent cervical cancer. The World Health Organization recommends that adolescent girls receive two doses of vaccine but only a small proportion of girls from regions with the highest disease burden are vaccinated because of cost and logistical considerations. Our Costa Rica HPV Vaccine trial suggested that one dose of the bivalent HPV vaccine provides robust and lasting protection against persistent HPV infections for over a decade. Data from a post-licensure trial of the quadrivalent vaccine in India also suggested that a single dose may be effective in reducing cervical cancer risk. To formally compare one versus two doses of the bivalent and nonavalent HPV vaccines, we implemented a large, randomized, double-blind trial to investigate the non-inferiority of one compared to two vaccine doses in the prevention of new HPV16/18 infections that persist 6 or more months. Bivalent and nonavalent vaccines will be evaluated separately. The trial enrolled and randomized (1:1:1:1 to 1- and 2-dose arms of the bivalent and nonavalent vaccines) 20,330 girls 12 to 16 years old residing in Costa Rica. Trial participants are followed every 6 months for up to 5 years. We also aim to estimate vaccine efficacy by comparing the rates of 6 month persistent infection in unvaccinated women with the rates in the follow-up visits of trial participants. We included one survey of unvaccinated women at the start of the study (N = 4452) and will include another survey concomitant with follow up visits of trial participants at year 4.5 (planned N = 3000). Survey participants attend two visits 6 months appart. Herein, we present the rationale, design, and enrolled study population of the ESCUDDO trial. ClinicalTrials.gov Identifier: NCT03180034.
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Affiliation(s)
- Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica.
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Mitchell H Gail
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bernal Cortés
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jean Cyr
- Information Management Services, Silver Spring, MD, USA
| | - Byron Romero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - John T Schiller
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Christian Montero
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Ligia A Pinto
- HPV Serology Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | - Karla Coronado
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jane J Kim
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Loretto Carvajal
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Sarah Wagner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD, USA
| | - Nicole G Campos
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rebecca Ocampo
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Troy J Kemp
- HPV Serology Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Michael Zuniga
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Douglas R Lowy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Carlos Avila
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Stephen Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ariane Castrillo
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Yenory Estrada
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Gloriana Barrientos
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Cindy Monge
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - María Y Oconitrillo
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)-Fundación INCIENSA, San José, Costa Rica
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Sierra MS, Tsang SH, Hu S, Porras C, Herrero R, Kreimer AR, Schussler J, Boland J, Wagner S, Cortes B, Rodríguez AC, Quint W, van Doorn LJ, Schiffman M, Sampson JN, Hildesheim A. Risk Factors for Non-Human Papillomavirus (HPV) Type 16/18 Cervical Infections and Associated Lesions Among HPV DNA-Negative Women Vaccinated Against HPV-16/18 in the Costa Rica Vaccine Trial. J Infect Dis 2021; 224:503-516. [PMID: 33326576 PMCID: PMC8496490 DOI: 10.1093/infdis/jiaa768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Factors that lead human papillomavirus (HPV) infections to persist and progress to cancer are not fully understood. We evaluated co-factors for acquisition, persistence, and progression of non-HPV-16/18 infections among HPV-vaccinated women. METHODS We analyzed 2153 women aged 18-25 years randomized to the HPV-vaccine arm of the Costa Rica HPV Vaccine Trial. Women were HPV DNA negative for all types at baseline and followed for approximately 11 years. Generalized estimating equation methods were used to account for correlated observations. Time-dependent factors evaluated were age, sexual behavior, marital status, hormonally related factors, number of full-term pregnancies (FTPs), smoking behavior, and baseline body mass index. RESULTS A total of 1777 incident oncogenic non-HPV-16/18 infections were detected in 12 292 visits (average, 0.14 infections/visit). Age and sexual behavior-related variables were associated with oncogenic non-HPV-16/18 acquisition. Twenty-six percent of incident infections persisted for ≥1 year. None of the factors evaluated were statistically associated with persistence of oncogenic non-HPV-16/18 infections. Risk of progression to Cervical Intraepithelial Neoplasia grade 2 or worst (CIN2+) increased with increasing age (P for trend = .001), injectable contraceptive use (relative risk, 2.61 [95% confidence interval, 1.19-5.73] ever vs never), and increasing FTPs (P for trend = .034). CONCLUSIONS In a cohort of HPV-16/18-vaccinated women, age and sexual behavior variables are associated with acquisition of oncogenic non-HPV-16/18 infections; no notable factors are associated with persistence of acquired infections; and age, parity, and hormonally related exposures are associated with progression to CIN2+.
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Affiliation(s)
- Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Sabrina H Tsang
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Shangying Hu
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
- Prevention and Implementation Group, International Agency
for Research on Cancer, Lyon, France
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - John Schussler
- Information Management Services, Silver
Spring, Maryland, USA
| | - Joseph Boland
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National
Laboratory for Cancer Research, Leidos Biomedical Research Inc,
Frederick, Maryland, USA
| | - Sarah Wagner
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National
Laboratory for Cancer Research, Leidos Biomedical Research Inc,
Frederick, Maryland, USA
| | - Bernal Cortes
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
| | | | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk,
The Netherlands
| | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
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Kreimer AR, Sampson JN, Porras C, Schiller JT, Kemp T, Herrero R, Wagner S, Boland J, Schussler J, Lowy DR, Chanock S, Roberson D, Sierra MS, Tsang SH, Schiffman M, Rodriguez AC, Cortes B, Gail MH, Hildesheim A, Gonzalez P, Pinto LA. Evaluation of Durability of a Single Dose of the Bivalent HPV Vaccine: The CVT Trial. J Natl Cancer Inst 2020; 112:1038-1046. [PMID: 32091594 PMCID: PMC7566548 DOI: 10.1093/jnci/djaa011] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/18/2019] [Accepted: 12/19/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The authors investigated the durability of vaccine efficacy (VE) against human papillomavirus (HPV)16 or 18 infections and antibody response among nonrandomly assigned women who received a single dose of the bivalent HPV vaccine compared with women who received multiple doses and unvaccinated women. METHODS HPV infections were compared between HPV16 or 18-vaccinated women aged 18 to 25 years who received one (N = 112), two (N = 62), or three (N = 1365) doses, and age- and geography-matched unvaccinated women (N = 1783) in the long-term follow-up of the Costa Rica HPV Vaccine Trial. Cervical HPV infections were measured at two study visits, approximately 9 and 11 years after initial HPV vaccination, using National Cancer Institute next-generation sequencing TypeSeq1 assay. VE and 95% confidence intervals (CIs) were estimated. HPV16 or 18 antibody levels were measured in all one- and two-dose women, and a subset of three-dose women, using a virus-like particle-based enzyme-linked immunosorbent assay (n = 448). RESULTS Median follow-up for the HPV-vaccinated group was 11.3 years (interquartile range = 10.9-11.7 years) and did not vary by dose group. VE against prevalent HPV16 or 18 infection was 80.2% (95% CI = 70.7% to 87.0%) among three-dose, 83.8% (95% CI = 19.5% to 99.2%) among two-dose, and 82.1% (95% CI = 40.2% to 97.0%) among single-dose women. HPV16 or 18 antibody levels did not qualitatively decline between years four and 11 regardless of the number of doses given, although one-dose titers continue to be statistically significantly lower compared with two- and three-dose titers. CONCLUSION More than a decade after HPV vaccination, single-dose VE against HPV16 or 18 infection remained high and HPV16 or 18 antibodies remained stable. A single dose of bivalent HPV vaccine may induce sufficiently durable protection that obviates the need for more doses.
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Affiliation(s)
| | | | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | | | - Troy Kemp
- HPV Immunology Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Rolando Herrero
- Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Sarah Wagner
- National Cancer Institute, NIH, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD, USA
| | - Joseph Boland
- National Cancer Institute, NIH, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD, USA
| | | | | | | | - David Roberson
- National Cancer Institute, NIH, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD, USA
| | | | | | | | | | - Bernal Cortes
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | | | | | - Paula Gonzalez
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Formerly Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Ligia A Pinto
- HPV Immunology Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
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Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2017; 66:683-691. [PMID: 26818619 DOI: 10.1136/gutjnl-2015-310912] [Citation(s) in RCA: 2887] [Impact Index Per Article: 412.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 12/08/2022]
Abstract
OBJECTIVE The global burden of colorectal cancer (CRC) is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. In this study, we aim to describe the recent CRC incidence and mortality patterns and trends linking the findings to the prospects of reducing the burden through cancer prevention and care. DESIGN Estimates of sex-specific CRC incidence and mortality rates in 2012 were extracted from the GLOBOCAN database. Temporal patterns were assessed for 37 countries using data from Cancer Incidence in Five Continents (CI5) volumes I-X and the WHO mortality database. Trends were assessed via the annual percentage change using joinpoint regression and discussed in relation to human development levels. RESULTS CRC incidence and mortality rates vary up to 10-fold worldwide, with distinct gradients across human development levels, pointing towards widening disparities and an increasing burden in countries in transition. Generally, CRC incidence and mortality rates are still rising rapidly in many low-income and middle-income countries; stabilising or decreasing trends tend to be seen in highly developed countries where rates remain among the highest in the world. CONCLUSIONS Patterns and trends in CRC incidence and mortality correlate with present human development levels and their incremental changes might reflect the adoption of more western lifestyles. Targeted resource-dependent interventions, including primary prevention in low-income, supplemented with early detection in high-income settings, are needed to reduce the number of patients with CRC in future decades.
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Affiliation(s)
- Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Mónica S Sierra
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Di Sibio A, Abriata G, Forman D, Sierra MS. Female breast cancer in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S110-S120. [PMID: 27678313 DOI: 10.1016/j.canep.2016.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 07/31/2016] [Accepted: 08/05/2016] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVE The burden of breast cancer has increased worldwide. Breast cancer mortality has been increasing in Central and South America (CSA) in the last few decades. We describe the current burden of breast cancer in CSA and review the current status of disease control. METHODS We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence and mortality rates per 100,000 person-years for 2003-2007 and the estimated annual percentage change to describe time trends. RESULTS In the most recent 5-year period, Argentina, Brazil, and Uruguay had the highest incidence rates (67.7-71.9) and Bolivia and El Salvador had the lowest (7.9-12.7). For most countries, mortality rates were ≤12.3, except in Uruguay, Argentina and Cuba (14.9-20.5). Age-specific rates increased after the age of 40-50 years and reached a maximum after age 65 years (mean age at diagnosis 56-62 years). Most countries have developed national screening guidelines; however, there is limited capacity for screening. CONCLUSION The geographic variation of breast cancer rates may be explained by differences in the prevalence of reproductive patterns, lifestyle factors, early detection, and healthcare access. Extending early-detection programs is challenging because of inequalities in healthcare access and coverage, limited funding, and inadequate infrastructure, and thus it may not be feasible. Given the current status of breast cancer in CSA, data generated by population-based cancer registries is urgently needed for effective planning for cancer control.
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Affiliation(s)
| | | | - David Forman
- The International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mónica S Sierra
- The International Agency for Research on Cancer, Section of Cancer Surveillance, France.
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12
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Sierra MS, Forman D. Cancer in Central and South America: Methodology. Cancer Epidemiol 2016; 44 Suppl 1:S11-S22. [PMID: 27678312 DOI: 10.1016/j.canep.2016.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/04/2016] [Accepted: 07/31/2016] [Indexed: 11/20/2022]
Abstract
Statistics on cancer incidence from Central and South American countries are scarce because of the small number of population-based cancer registries that continuously collect data. Similarly, comparable statistics on cancer mortality are sparse in spite of efforts made to improve coverage in the last decade. The aim of this study is to describe geographical patterns and trends in cancer incidence and mortality in Central and South America in the 21st century. The primary objective was to obtain the best quality cancer data available from each country within the region. Cancer incidence data were obtained from population-based cancer registries within the region and, in countries where these did not exist, from hospital-based registries; national mortality data were obtained from the World Health Organization mortality database. Given the variability in data quality - mainly due to the age and development in maturity of the registries, an exhaustive review of the data was necessary in order to appropriately analyze, describe and interpret patterns of cancer incidence and mortality between countries and within cancer-specific sites. This paper presents the methods employed in the collection, quality control and analysis of the datasets received for the project.
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Affiliation(s)
- Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Sierra MS, Soerjomataram I, Forman D. Thyroid cancer burden in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S150-S157. [PMID: 27678317 DOI: 10.1016/j.canep.2016.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 07/15/2016] [Accepted: 07/24/2016] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVE Incidence of thyroid cancer (TC) is rapidly increasing worldwide, but little is known about the TC burden in Central and South America (CSA). We describe the geographic patterns and trends of TC by sex in CSA. METHODS We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and nationwide cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and age-standardized mortality rates (ASMRs) per 100,000 person-years. We calculated ASRs by histological subtype. We estimated the annual percentage change (EAPC) to describe time trends. RESULTS Between CSA countries, TC incidence and mortality rates varied from 8-fold to 12-fold and from 2-fold to 5-fold, respectively. In 2003-2007, the highest TC ASRs in females and males were in Ecuador (16.0 and 3.5, respectively), Brazil (14.4 and 3.4), Costa Rica (12.6 and 2.1) and Colombia (10.7 and 2.5). The highest ASMRs were in Ecuador, Colombia, Mexico, Peru and Panama (0.68-0.91 in females and 0.41-0.48 in males). Papillary TC was the most commonly diagnosed histological subtype, following the same incidence pattern as overall TC. In Argentinean, Brazilian, Chilean and Costa Rican females TC incidence increased by 2.2-17.9% annually, and papillary TC increased by 9.1-15.0% annually, while mortality remained stable between 1997 and 2008. In males, trends in TC were stable. CONCLUSION TC occurred more frequently in females than in males. The overall high incidence and low mortality of TC suggest identification of subclinical disease due to improved detection methods.
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Affiliation(s)
- Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France.
| | - Isabelle Soerjomataram
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
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14
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Sierra MS, Soerjomataram I, Antoni S, Laversanne M, Piñeros M, de Vries E, Forman D. Cancer patterns and trends in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S23-S42. [PMID: 27678320 DOI: 10.1016/j.canep.2016.07.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/15/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVE Cancer burden is increasing in Central and South America (CSA). We describe the current burden of cancer in CSA. METHODS We obtained regional and national-level cancer incidence data from 48 population-based registries (13 countries) and nation-wide cancer mortality data from the WHO (18 countries). We estimated world population age-standardized incidence and mortality rates per 100,000 person-years. RESULTS The leading cancers diagnosed were prostate, lung, breast, cervix, colorectal, and stomach, which were also the primary causes of cancer mortality. Countries of high/very high human development index (HDI) in the region experienced a high burden of prostate and breast cancer while medium HDI countries had a high burden of stomach and cervical cancers. Between countries, incidence and mortality from all cancers combined varied by 2-3-fold. French Guyana, Brazil, Uruguay, and Argentina had the highest incidence of all cancers while Uruguay, Cuba, Argentina, and Chile had the highest mortality. Incidence of colorectum, prostate and thyroid cancers increased in Argentina, Brazil, Chile and Costa Rica from 1997 to 2008, while lung, stomach and cervical cancers decreased. CONCLUSION CSA carries a double-burden of cancer, with elevated rates of infection- and lifestyle-related cancers. Encountered variation in cancer rates between countries may reflect differences in registration practices, healthcare access, and public awareness. Resource-dependent interventions to prevent, early diagnose, and treat cancer remain an urgent priority. There is an overwhelming need to improve the quality and coverage of cancer registration to guide and evaluate future cancer control policies and programs.
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Affiliation(s)
- Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | | | - Sébastien Antoni
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mathieu Laversanne
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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15
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Sierra MS, Soerjomataram I, Forman D. Prostate cancer burden in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S131-S140. [PMID: 27678315 DOI: 10.1016/j.canep.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/24/2016] [Accepted: 06/27/2016] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVE The incidence of prostate cancer has increased in Central and South America (CSA) in the last few decades. We describe the geographical patterns and trends of prostate cancer in CSA. METHODS We obtained regional and national-level cancer incidence data from 48 population-based registries in 13 countries and nation-wide cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years for 2003-2007 and the estimated annual percent change (EAPC) to describe time trends. RESULTS Prostate cancer was the most common cancer diagnosis and one of the leading causes of cancer deaths among males in most CSA countries. From 2003-2007, ASRs varied between countries (6-fold) and within countries (Brazil: 3-6-fold). French Guyana (147.1) and Brazil (91.4) had the highest ASRs whereas Mexico (28.9) and Cuba (24.3) had the lowest. ASMRs varied by 4-fold. Belize, Uruguay and Cuba (24.1-28.9) had the highest ASMRs while Peru, Nicaragua, and El Salvador (6.8-9.7) had the lowest. In Argentina, Brazil, Chile and Costa Rica prostate cancer incidence increased by 2.8-4.8% annually whereas mortality remained stable between 1997 and 2008. CONCLUSION The geographic and temporal variation of prostate cancer rates observed in CSA may in part reflect differences in diagnostic and registration practices, healthcare access, treatment and death certification, and public awareness. The incidence of prostate cancer is expected to increase given recent early detection activities and increased public awareness; however, the impact of these factors on mortality remains to be elucidated.
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Affiliation(s)
- Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | | | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Perdomo S, Martin Roa G, Brennan P, Forman D, Sierra MS. Head and neck cancer burden and preventive measures in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S43-S52. [PMID: 27678322 DOI: 10.1016/j.canep.2016.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVE Central and South America comprise one of the areas characterized by high incidence rates for head and neck cancer. We describe the geographical and temporal trends in incidence and mortality of head and neck cancers in the Central and South American region in order to identify opportunities for intervention on the major identified risk factors: tobacco control, alcohol use and viral infections. METHODS We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. Age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years were estimated. RESULTS Brazil had the highest incidence rates for oral and pharyngeal cancer in the region for both sexes, followed by Cuba, Uruguay and Argentina. Cuba had the highest incidence and mortality rates of laryngeal cancer in the region for males and females. Overall, males had rates about four times higher than those in females. Most countries in the region have implemented WHO recommendations for both tobacco and alcohol public policy control. CONCLUSION Head and neck squamous-cell cancer (HNSCC) incidence and mortality rates in the Central and South America region vary considerably across countries, with Brazil, Cuba, French Guyana, Uruguay and Argentina experiencing the highest rates in the region. Males carry most of the HNSCC burden. Improvement and implementation of comprehensive tobacco and alcohol control policies as well as the monitoring of these factors are fundamental to prevention of head and neck cancers in the region.
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Affiliation(s)
- Sandra Perdomo
- International Agency for Research on Cancer, Section of Genetics, France.
| | | | - Paul Brennan
- International Agency for Research on Cancer, Section of Genetics, France
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Kusminsky G, Abriata G, Forman D, Sierra MS. Hodgkin lymphoma burden in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S158-S167. [PMID: 27678318 DOI: 10.1016/j.canep.2016.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVE Hodgkin lymphoma (HL) is largely curable owing to improvements in treatment since the 1960s; nevertheless, high mortality rates have been reported in Central and South America. We describe the current burden of HL in the Central and South American region. METHODS We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries, and national-level mortality data from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and age-standardized mortality rates (ASMRs) per 100,000 person-years for 2003-2007 and present distributions by histological subtype. RESULTS HL incidence rates varied 7-fold in males and 11-fold in females (male-to-female ratio 1:1-2.5:1). The highest ASRs were seen Argentina, Brazil, Costa Rica (males), Cuba (males) and Uruguay (females), whereas the lowest were in Bolivia and El Salvador. ASMRs varied by 4-fold in males and 6-fold in females (male-to-female ratio 1:1-4.3:1), with ASMRs <0.7 for most countries, except Cuba (≥1.0). In most countries, age-specific incidence rates of HL showed a bimodal pattern. Trends in HL in Argentina, Brazil, Chile, and Costa Rica remained stable in 1997-2008. Of all HL cases, 48% were unspecified as to histological subtype. Nodular sclerosis and mixed cellularity were the most frequent histologies. CONCLUSION The geographic variation in HL across the region may in part reflect differences in data quality and coverage, and differences in the adoption of modern therapies and healthcare access. Our results highlight the need for high-quality data and increased coverage in order to provide vital guidance for future cancer control activities.
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Affiliation(s)
| | | | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
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Piñeros M, Sierra MS, Izarzugaza MI, Forman D. Descriptive epidemiology of brain and central nervous system cancers in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S141-S149. [PMID: 27678316 DOI: 10.1016/j.canep.2016.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVE Although malignant tumors of the brain and central nervous system (CNS) represent less than 3% of new cancer cases estimated worldwide, they cause significant morbidity and in the case of gliomas, the most common histological type, have a poor prognosis. We describe patterns and trends in brain and CNS incidence and mortality in Central and South America. METHODS We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and mortality rates (ASMRs) per 100,000 person-years, and present incidence by histological subtypes. RESULTS In general, incidence rates were higher in males than in females. The highest incidence ASRs were observed for Cuba (5.1 males, 3.6 females) in Central America, and for Brazil (6.4 males, 4.8 females) and Uruguay (6.2 and 4.0) in South America. Mortality rates closely followed the pattern of incidence rates. Argentina, Brazil and Chile showed increasing mortality trends, although these were not statistically significant. Glioma and unspecified tumors were the most common histological types, accounting for 55.4% and 32.8%, respectively. The proportion of microscopically verified diagnoses was 47-70% in most countries. CONCLUSION Although incidence and mortality rates in general were low, some countries displayed high- to intermediate-level incidence rates; under-reporting and under-ascertainment of cases could contribute to the geographic variations observed. There is a need to improve both the ascertainment of cases and the accuracy of histological diagnosis. Monitoring of brain and CNS cancers along with etiological research remain priorities.
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Affiliation(s)
- Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | - Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | | | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Piñeros M, Sierra MS, Forman D. Descriptive epidemiology of lung cancer and current status of tobacco control measures in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S90-S99. [PMID: 27678327 DOI: 10.1016/j.canep.2016.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVE Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the world. In Central and South America lung cancer is now one of most frequent cancers and the leading cause of cancer-related death in both sexes. We describe patterns and trends in lung cancer incidence and mortality in Central and South America and give a brief overview of the current status of tobacco control measures based on the most recent MPOWER report. METHODS We obtained regional and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence and mortality rates per 100,000 person-years. Incidence of lung cancer by histological subtype were only available from high-quality population-based cancer registries for the period 2003-2007. RESULTS The highest incidence and mortality rates in the region were seen among males in Argentina, Cuba, Chile and Uruguay. Adenocarcinoma was the most frequent histological type overall, though squamous carcinoma was more frequent in Antofagasta-Chile and Villa Clara-Cuba. Smoke-free policies and warnings are widely implemented tobacco control measures; cessation is offered but the costs are not covered by health systems in the majority of countries. CONCLUSION The high burden of lung cancer in the region highlights the need to improve long term information and strengthen current tobacco control policies including aggressive taxing measures and supporting smoking cessation in order to achieve the targeted reductions in smoking prevalence.
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Affiliation(s)
- Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | - Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Murillo R, Herrero R, Sierra MS, Forman D. Cervical cancer in Central and South America: Burden of disease and status of disease control. Cancer Epidemiol 2016; 44 Suppl 1:S121-S130. [PMID: 27678314 DOI: 10.1016/j.canep.2016.07.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/14/2016] [Accepted: 07/21/2016] [Indexed: 01/27/2023]
Abstract
RATIONALE AND OBJECTIVE More than 20 years after cytology-based screening was introduced in Central and South America (CSA), cervical cancer remains a leading cause of cancer incidence and mortality in the region. Although several population-based registries exist in the region, few comprehensive analyses have been conducted to describe the status of cervical cancer control. METHODS Population-based data from cancer registries in 13 countries and mortality data from 18 countries in CSA were analyzed. Standardized incidence and mortality rates were estimated and time trend analysis performed when information was available. In addition, a search of available data on HPV vaccination and cervical cancer screening was carried out. RESULTS Cervical cancer incidence and mortality have decreased in some CSA countries, with an annual percentage change from -4.2 to -6.7 for incidence and -0.2 to -8.3 for mortality. In total, seven countries have age-standardized mortality rates over 10 per 100,000 women, generally corresponding to those with the lowest income levels. All countries have implemented screening programs with different extents of coverage and levels of organization. To date, nine countries have introduced HPV vaccination in national immunization programs. CONCLUSIONS Despite incidence declines observed in some countries, cervical cancer mortality remained almost stable in most countries in the region. Decreases in mortality trends in Chile and Costa Rica are probably the result of early detection programs. Better organized programs might favor greater impact on cancer incidence and mortality, but technological developments offer more suitable opportunities for prevention and alternative approaches for screening of precancerous lesions.
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Affiliation(s)
- Raúl Murillo
- Section of Early Detection and Prevention, Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France.
| | - Rolando Herrero
- Section of Early Detection and Prevention, Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Mónica S Sierra
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
| | - David Forman
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
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Izarzugaza MI, Fernández L, Forman D, Sierra MS. Burden of gallbladder cancer in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S82-S89. [PMID: 27678326 DOI: 10.1016/j.canep.2016.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 07/26/2016] [Accepted: 07/31/2016] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVE Gallbladder carcinoma (GBC) is a rare neoplasm yet it is the most common malignancy of the biliary tract and its prognosis is poor. Incidence of GBC is high in some areas of Central and South America and the Caribbean. We described the current burden of GBC in Central and South America (CSA). METHODS We obtained GBC incidence data from 48 population-based cancer registries in 13 countries in CSA, and national level cancer death data from the WHO mortality data base for 18 countries. We estimated World population age-standardized incidence and mortality rates per 100,000 persons-years, including distribution and incidence rates by anatomic subsite. RESULTS GBC rates were the highest in countries located in the Andean region. In 2003-2007, Chile had the highest incidence and mortality rates in CSA (17.1 and 12.9 in females and 7.3 and 6.0 in males, respectively). Females had higher GBC rates than males. The most frequently diagnosed anatomic subsite was gallbladder (60%). Unspecified subsite represented 21% of all cases. Trends in incidence and mortality of GBC remained unchanged in Argentina, Brazil, Chile and Costa Rica in 1998-2008. CONCLUSION GBC rates varied extensively across the CSA region reflecting, in part, differences in data quality, coverage and healthcare access. Chile had the highest GBC rates in CSA and the world. The large proportion of unspecified cases indicates low precision in diagnosis/registration and highlights the need to promote and improve cancer registration in the region to better understand the burden of GBC in CSA.
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Affiliation(s)
| | - Leticia Fernández
- National School of Public Health of Cuba, Biostatistics Department, Cuba
| | - David Forman
- The International Agency for Research on Cancer, Cancer Surveillance Section, Lyon, France
| | - Mónica S Sierra
- The International Agency for Research on Cancer, Cancer Surveillance Section, Lyon, France.
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Abstract
Policy analysis shows that H. pylori test and treat strategies targeting adults at moderate to high risk of H. pylori-induced disease is likely to be cost-effective for preventing digestive diseases responsible for a large global disease burden. Little is known, however, about health benefits to children from eliminating this infection. We conducted a systematic review of the evidence regarding health benefits to children from treatment to eliminate H. pylori infection. We systematically searched Ovid MEDLINE for pertinent review articles published through 2012. We excluded reviews focused on treatment efficacy and scrutinized reference lists of selected reviews to identify additional eligible reviews. Fifteen reviews met specified inclusion criteria. Overall, they show that few reported studies investigating pediatric health effects of treatment for H. pylori infection were well designed with adequate statistical power. Thus, there is insufficient evidence for drawing conclusions about health benefits to children from treatment to eliminate H. pylori infection.
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Sierra MS, Goodman KJ, Phillips CV, Aragaki C. Predictors of Follow-Up Compliance in a Us-Mexico Birth Cohort. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s33-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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