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Gonçalves-Nobre JG, Matos A, Carreira M, Santos AC, Veiga LC, Ginete C, Brito M, Pires M, Pereira H, Cardoso C, Bicho M, Bicho MC. The interplay between HPV, other Sexually Transmissible Infections and genital microbiome on cervical microenvironment (MicroCervixHPV study). Front Cell Infect Microbiol 2024; 13:1251913. [PMID: 38532749 PMCID: PMC10963500 DOI: 10.3389/fcimb.2023.1251913] [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: 07/02/2023] [Accepted: 12/04/2023] [Indexed: 03/28/2024] Open
Abstract
Background The importance of Cervicovaginal Microbiota in protecting against infections (such as HPV) is already well established, namely through Lactobacillus spp., as well as the mechanism through which HPV leads to Cervical Neoplasia. However, it is not possible to classify HPV as a complete carcinogen. Thus, the importance of exploring Cervicovaginal dysbiosis with the intention of deciphering this interaction with HPV, takes on greater relevance. The main objectives of this study were: 1) Comparison of the MCV composition of women with or without HPV and women with ASCUS or LSIL; 2) Characterization of cytokines present in the vaginal microenvironment; 3) Evaluation of the blood count ratios as prognostic systemic inflammatory biomarkers; 4) Correlation between MCV, HPV serotypes and cytokines. Methods This was a retrospective, observational, multicenter, cross-sectional study. CVM analysis was performed by isolation RNA and sequencing on a NGS platform. Cytokine concentrations of CVM were obtained through Multiplex platform. Statistical analysis was performed in SPSS v 26.0. An α of 0.05 was considered statistically significant. Results Highlighting the core of the study, CVM types of CST I and CST IV were found to influence the emergence of cervical lesions. Neutrophil-to-Lymphocyte ratio was found to impact the prognosis of ASCUS. Within CVM, Lactobacillus prevent the growth of other CST IV species, while the latter express symbiotic relationships with each other and show affinity for specific HPV serotypes. At last, RANTES chemokine is significantly elevated in cervicovaginal infections. Conclusion The importance of using vaginal cytokine profiles and CVM is highlighted in the hypothesis of prevention of Cervical Neoplasia development, as well as in its use as a prognostic biomarker. Taken together, these insights are one step closer to personalized medicine.
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Affiliation(s)
- J. Guilherme Gonçalves-Nobre
- Institute of Environmental Health (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Institute of Preventive Medicine and Public Health (IMPSP), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- PTSurg – Portuguese Surgical Research Collaborative, Lisbon, Portugal
- Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal
| | - Andreia Matos
- Institute of Environmental Health (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Institute of Preventive Medicine and Public Health (IMPSP), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal
- Tumour & Microenvironment Interactions Group i3S- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- ICBAS – Instituto de Ciências Biomédicas Abel Salazar, Universidade de Porto, Porto, Portugal
| | - Mariana Carreira
- Amedes MVZ Müenchen GmbH fier Gynaekologie und Pathologie, Munich, Germany
| | - Ana Carolina Santos
- Institute of Environmental Health (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Institute of Preventive Medicine and Public Health (IMPSP), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal
| | - Luisa Carvalho Veiga
- Health and Technology Research Center, Escola superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Catarina Ginete
- Health and Technology Research Center, Escola superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Miguel Brito
- Health and Technology Research Center, Escola superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Marina Pires
- Joaquim Chaves Saúde, Laboratório de Análises Clínicas, Carnaxide, Portugal
| | - Hermínia Pereira
- Joaquim Chaves Saúde, Laboratório de Análises Clínicas, Carnaxide, Portugal
| | - Carlos Cardoso
- Joaquim Chaves Saúde, Laboratório de Análises Clínicas, Carnaxide, Portugal
| | - Manuel Bicho
- Institute of Environmental Health (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Institute of Preventive Medicine and Public Health (IMPSP), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal
| | - Maria Clara Bicho
- Institute of Environmental Health (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Institute of Preventive Medicine and Public Health (IMPSP), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal
- Joaquim Chaves Saúde, Laboratório de Análises Clínicas, Carnaxide, Portugal
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Deng S, Welby S, Liu Z, Yang Y, Meng R, Sun Y, Yang J, Liu G, He Y, Jiang N, Wu Z, Liu K, Rosillon D, Cohet C, Borys D, Zhan S. MOnitoring human papillomavirus Vaccine effect on Infection and cErvical diseases (MOVIE): Protocol for a cohort study using electronic health records from Yinzhou, China. Hum Vaccin Immunother 2023; 19:2257989. [PMID: 37813849 PMCID: PMC10997301 DOI: 10.1080/21645515.2023.2257989] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
Cervical cancer is the fourth most common cancer in women, with a high disease burden worldwide. Human papillomavirus (HPV) vaccination reduces HPV-related infection and associated cervical lesions and cancers. Few studies have explored HPV vaccination impact in real-world settings in China. This study aims to monitor HPV vaccine uptake and its effects on HPV-related diseases, evaluating vaccine effectiveness in a real-world context and complementing clinical trial results. Electronic health records (EHRs) from 2010 to 2020 from the Yinzhou Regional Health Information Platform (YRHIP) will be queried/extracted to identify and monitor HPV vaccine uptake in females aged 9-45 years, and HPV-related screening and prevalence (i.e., cervical HPV infection, cervical intraepithelial neoplasia [CIN] grades 1-3, and cervical cancer) in a cohort of females aged 9-70 years. Cervical cancer screening guidelines and expert consultation will be used for intra-database validation, to determine the best algorithm for identifying HPV-related disease. Pre-launch (2010-2016) and post-launch (2018-2020) periods are predefined. A time trend analysis will be performed to describe the vaccination impact on disease prevalence and, if prerequisite conditions are met, vaccine effectiveness will be computed using logistic regression, adjusting for age, calendar year, history of screening and HPV infection. Cohort study design, outcomes validation, data linkage, and multi-step statistical analyses could provide valuable experience for designing other real-world studies in the future. The study outcomes can help inform policy-makers about uptake and HPV vaccination policy in girls and women in Yinzhou District, and provide insights on progress toward achieving goals set by the World Health Organization.
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Affiliation(s)
- Siwei Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Ministry of Education, Key Laboratory of Epidemiology of Major Diseases (Peking University), Beijing, China
| | | | - Zhike Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Ministry of Education, Key Laboratory of Epidemiology of Major Diseases (Peking University), Beijing, China
| | - Yu Yang
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Ruogu Meng
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Yixin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Junting Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Ministry of Education, Key Laboratory of Epidemiology of Major Diseases (Peking University), Beijing, China
| | - Guangxu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | | | | | | | | | | | | | | | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Ministry of Education, Key Laboratory of Epidemiology of Major Diseases (Peking University), Beijing, China
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Institute for Artificial Intelligence, Peking University, Beijing, China
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Chu MMY, Cheung CSY, Ngu SF, Tse KY, Ip PPC, Cheung ANY, Ngan HYS, Chan KKL. The Value of Four-Quadrant Cervical Biopsy in Women with Different Colposcopic Impressions. Diagnostics (Basel) 2023; 13:2384. [PMID: 37510128 PMCID: PMC10378482 DOI: 10.3390/diagnostics13142384] [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: 05/10/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study was to compare the diagnostic efficacy of colposcopic-directed biopsy and four-quadrant biopsy in detecting high-grade cervical intra-epithelial neoplasia (CIN). Women attending three women's clinics for routine cervical screening were recruited. Colposcopy was arranged for women with any cytologic abnormalities greater than atypical squamous cells of undetermined significance (ASCUS), two consecutive ASCUS results or positive HPV testing. During colposcopy, a cervical biopsy was taken from the most suspicious area, but more than one biopsy was allowed. Four-quadrant biopsies at 3, 6, 9 and 12 o'clock and an endocervical curettage were also taken in all cases. A total of 1522 colposcopies were performed in 1311 subjects from June 2010 to August 2017, with 118 cases of high-grade CIN diagnosed. Colposcopic-directed biopsy detected 50.8% of the 118 high-grade CIN, while four-quadrant biopsy detected 86.4% (p < 0.0001). Twenty-seven cases (22.9%) of high-grade CIN were diagnosed in women with normal or unsatisfactory colposcopy. Among the 64 cases with low-grade colposcopic impression, four-quadrant biopsy detected significantly more high-grade CIN (53 cases, 82.8%) than colposcopic-directed biopsy (35 cases, 56.3%) (p = 0.0011). Four-quadrant cervical biopsies should be considered for all women with an abnormal smear or positive HPV testing, especially in patients with low-grade/normal/unsatisfactory colposcopy.
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Affiliation(s)
- Mandy Man-Yee Chu
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Charleen Sze-Yan Cheung
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Siew-Fei Ngu
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ka-Yu Tse
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Philip Pun-Ching Ip
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Annie Nga-Yin Cheung
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hextan Yuen-Sheung Ngan
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Karen Kar-Loen Chan
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Sabrina F, Ilkka K, Mervi HN, Charles R, Simon L, Ameli T, Esther M, Maria K, Eeva P, Pekka N. Fostering Prevention of Cervical Cancer by a Correct Diagnosis of Precursors: A Structured Case-Based Colposcopy Course in Finland, Norway and UK. Cancers (Basel) 2020; 12:E3201. [PMID: 33143157 DOI: 10.3390/cancers12113201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
High-quality colposcopy is essential in cervical cancer prevention. We performed a multicentre prospective interventional pilot-study, evaluating the effect of a six-hour case-based colposcopy course on short- and long-term learning of colposcopy-related knowledge, diagnostic accuracy levels and confidence. We recruited 213 colposcopists participating in three European Federation of Colposcopy (EFC) basic colposcopy courses (Finland, Norway, UK). The study consisted of three tests with identical content performed before, after and 2 months after the course, including ten colposcopic images, ten patient cases and scales for marking confidence in the answers. Outcome measures where mean scores in correct case-management, diagnosis (including high-grade lesion recognition), transformation-zone recognition and confidence in answers. Results were compared between the three tests and stratified according to experience. Mean test scores improved after the course for all participants. The increase was highest for beginners. Confidence in answers improved and the number of colposcopists showing high confidence with low scores decreased. A structured case-based course improves skills and confidence especially for inexperienced colposcopists; however, trainers should be aware of the risk of overconfidence. To complement theoretical training, further hands-on training including high-quality feedback is recommended. Conclusions drawn from long-term learning are limited due to the low participation in the follow-up test.
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Baasland I, Hagen B, Vogt C, Valla M, Romundstad PR. Colposcopy and additive diagnostic value of biopsies from colposcopy-negative areas to detect cervical dysplasia. Acta Obstet Gynecol Scand 2017; 95:1258-1263. [PMID: 27564523 PMCID: PMC5129518 DOI: 10.1111/aogs.13009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
Abstract
Introduction We evaluated colposcopy in the routine diagnostic workup of women with abnormal cervical cytology, as well as the diagnostic value of endocervical curettage material and biopsies taken from colposcopy‐positive and colposcopy‐negative quadrants of the cervix. Material and methods This cross‐sectional study included 297 nonpregnant women with abnormal cervical cytology and no prior treatment for cervical dysplasia or cancer. All women underwent gynecological examination, colposcopy, endocervical curettage, and had cervical biopsies taken. Colposcopy was considered satisfactory if the squamocolumnar junction was fully visible, and biopsies were taken from all four quadrants of the cervix, regardless of colposcopy results. Results In all, 130 of the women in our study had satisfactory colposcopy results and were diagnosed with cervical intraepithelial neoplasia grade 2 or worse (CIN2+), 61% via a colposcopy‐positive biopsy and 39% via a colposcopy‐negative biopsy. Eighty‐seven of them had positive colposcopy results, but CIN2+ was histologically verified from colposcopy‐positive biopsies in 91% (n = 79) and from colposcopy‐negative biopsies in 9% (n = 8). The remaining 43 women with CIN2+ had negative colposcopy findings, so their diagnosis was verified in colposcopy‐negative biopsies. The sensitivity of colposcopy alone to detect CIN2+ was 61% (95% CI 52–69). Conclusions In the present study, colposcopy was not a stand‐alone diagnostic method. Colposcopy‐negative biopsies had a clear additive value, identifying a substantial proportion of women with both positive and negative colposcopy results with treatment‐worthy cervical dysplasia. Endocervical curettage material had little diagnostic value in this study.
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Affiliation(s)
- Ingrid Baasland
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Bjørn Hagen
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christina Vogt
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit Valla
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pål R Romundstad
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Blain G, Richards A, Pather S, Carter J, Saidi S. A retrospective observational study for the outcomes of women presenting to a colposcopy clinic with a high-grade Pap smear - Implications for a 'see and treat' approach to management. Aust N Z J Obstet Gynaecol 2016; 56:207-11. [PMID: 26864141 DOI: 10.1111/ajo.12450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/16/2015] [Accepted: 01/14/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The current Australian National Health and Medical Research Council guidelines discourage the use of 'see and treat' colposcopic management due to concerns regarding over-treatment. However, this approach has been shown to have benefits in several studies, including cost savings, elimination of loss to follow up and decreased patient anxiety. AIMS To provide Australian data on treatment outcomes for women presenting with a high-grade Pap smear to a large metropolitan colposcopy unit and to determine whether a 'see and treat' approach would meet specified standards. MATERIALS AND METHODS Retrospective review of women referred to the Royal Prince Alfred Hospital colposcopy unit with a high-grade smear. Patient data, colposcopy findings, treatment and pathology results were collated and analysed to determine treatment outcomes using the current 'biopsy and treat' approach. The feasibility of 'see and treat' was assessed by determining which women with high-grade colposcopy findings had high-grade disease confirmed on biopsy or excisional specimens. RESULTS One hundred and thirty-seven women underwent either excisional or ablative treatment. Of those undergoing excisional procedures, 81.3% had high-grade dysplasia or invasive cancer, 11.6% had CIN1 and 7.1% had no dysplasia on histopathology. One hundred and twenty-one with high-grade colposcopy findings had histopathology results available. Using a 'see and treat' approach, 92.6% would have had confirmed dysplasia of any grade, while 91.7% had confirmed high-grade dysplasia. CONCLUSIONS 'See and treat' colposcopy is feasible in the Australian setting when applied to selected patients with high-grade cytology and high-grade colposcopic findings.
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Affiliation(s)
- Gemma Blain
- RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Selvan Pather
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan Carter
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Sam Saidi
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
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Valasoulis G, Stasinou SM, Nasioutziki M, Athanasiou A, Zografou M, Spathis A, Loufopoulos A, Karakitsos P, Paraskevaidis E, Kyrgiou M. Expression of HPV-related biomarkers and grade of cervical intraepithelial lesion at treatment. Acta Obstet Gynecol Scand 2014; 93:194-200. [PMID: 24175665 DOI: 10.1111/aogs.12298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 08/10/2013] [Accepted: 10/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES New human papillomavirus (HPV)-related biomarkers may allow better identification of clinically significant lesions that warrant excision and, conversely, identification of the false positive cases that have been overreported by traditional techniques. The aim of this study was to investigate how the expression of several HPV-related biomarkers correlates to the severity of the lesion at treatment. DESIGN Prospective observational study. SETTING University Hospital (2009-2011). POPULATION All women submitted for excisional treatment. METHODS A liquid-based cytology sample was obtained before treatment and was tested for HPV typing, mRNA E6 & E7 with NASBA or flow cytometry and p16. All women had histological diagnosis in the form of excisional cone (gold standard). MAIN OUTCOME MEASURES Correlation of HPV biomarker positivity rates to the grade of the lesion at treatment histology. RESULTS Two hundred women were recruited: 23 were found to have negative histology (11.5%), 79 (39.5%) CIN1, 50 (25.0%) CIN2 and 48 (24.0%) CIN3. All biomarkers (HPV DNA typing, HR HPV, single HPV 16/18, mRNA E6 & E7 expression and p16) revealed an increased linear positivity rate with increasing severity and grade of the lesion (chi-squared test for trend p < 0.05). This was stronger for HPV (all and high-risk) followed by mRNA with NASBA, flow cytometry, HPV 16/18 and ultimately p16 immunostaining. CONCLUSIONS The linear correlation between various HPV-related biomarkers and the grade of the lesion suggests that these biomarkers may prove to be useful in the prediction of CIN grade and, as a result, the need for treatment.
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Affiliation(s)
- George Valasoulis
- Department of Obstetrics & Gynaecology - Gynaecologic Oncology, University Hospital of Ioannina, Ioannina, Greece
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Yoshikawa H, Nagata C, Noda K, Nozawa S, Yajima A, Sekiya S, Sugimori H, Hirai Y, Kanazawa K, Sugase M, Shimizu H, Kawana T. Human papillomavirus infection and other risk factors for cervical intraepithelial neoplasia in Japan. Br J Cancer 1999; 80:621-4. [PMID: 10408876 PMCID: PMC2362329 DOI: 10.1038/sj.bjc.6690401] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Various risk factors were investigated in 167 cervical intra-epithelial neoplasia (CIN) case and control pairs in Japan. CIN cases showed evidence of nine known risk factors including smoking and sexual behaviour. However, after adjustment for papillomavirus infection, the highest determinant, the only remaining risk factors were: being married, early age at first pregnancy and multiparity.
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Affiliation(s)
- H Yoshikawa
- Department of Obstetrics and Gynecology, University of Tokyo, Japan
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