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Deshmukh AA, Lin YY, Damgacioglu H, Shiels M, Coburn SB, Lang R, Althoff KN, Moore R, Silverberg MJ, Nyitray AG, Chhatwal J, Sonawane K, Sigel K. Recent and projected incidence trends and risk of anal cancer among people with HIV in North america. J Natl Cancer Inst 2024:djae096. [PMID: 38713084 DOI: 10.1093/jnci/djae096] [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: 01/18/2024] [Revised: 03/25/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Anal cancer risk is elevated among people with HIV (PWH). Recent anal cancer incidence patterns among PWH in the United States (US) and Canada remain unclear. It is unknown how the incidence patterns may evolve in future years. METHODS Using data from the North American AIDS Cohort Collaboration on Research and Design, we investigated absolute anal cancer incidence and incidence trends in the US, Canada, and different US regions. We further estimated relative risk compared with persons without HIV, relative risk among various subgroups, and projected future anal cancer burden among US PWH. RESULTS During 2001-2016, in the US, age-standardized anal cancer incidence declined 2.2%/year (95%CI=-4.4% to -0.1%), particularly in the Western region (-3.8%/year [95%CI=-6.5% to -0.9%]. In Canada, incidence remained stable. Considerable geographic variation in risk was observed by US regions (eg, over four-fold risk in the Midwest and Southeast compared to the Northeast among men who have sex with men [MSM] with HIV). Anal cancer risk increased with a decrease in nadir CD4 count and was elevated among those with opportunistic illnesses. Anal cancer burden among US PWH is expected to decrease in future years (through 2035), but >70% of cases will continue to occur in MSM with HIV and people with AIDS. CONCLUSION Geographic variation in anal cancer risk and trends may reflect underlying differences in screening practices and HIV epidemic. MSM with HIV and PWH with AIDS will continue to bear most anal cancer burden, highlighting the importance of precision prevention.
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Affiliation(s)
- Ashish A Deshmukh
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, US
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, US
| | - Yueh-Yun Lin
- Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, US
| | - Haluk Damgacioglu
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, US
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, US
| | - Meredith Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Sally B Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, US
| | - Raynell Lang
- Southern Alberta Clinic and Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, US
| | - Richard Moore
- School of Medicine, Johns Hopkins University, Baltimore, MD, US
| | | | - Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, US
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, US
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | - Kalyani Sonawane
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, US
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, US
| | - Keith Sigel
- Department of Medicine, Mt. Sinai Icahn School of Medicine, New York, NY, US
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Nitkowski J, Ridolfi TJ, Lundeen SJ, Giuliano AR, Chiao E, Fernandez ME, Schick V, Smith JS, Bruggink P, Brzezinski B, Nyitray AG. Engagement and factors associated with annual anal human papillomavirus screening among sexual and gender minority individuals. medRxiv 2024:2024.04.22.24306185. [PMID: 38712301 PMCID: PMC11071571 DOI: 10.1101/2024.04.22.24306185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Objectives Annual screening with a provider has been recommended for groups at highest risk for anal cancer. Anal self-sampling could help address screening barriers, yet no studies have examined annual engagement with this method. Methods The Prevent Anal Cancer Self-Swab Study recruited sexual and gender minority individuals 25 years and over who have sex with men in Milwaukee, Wisconsin to participate in an anal cancer screening study. Participants were randomized to a home or clinic arm. Home-based participants were mailed an anal human papillomavirus self-sampling kit at baseline and 12 months, while clinic-based participants were asked to schedule and attend one of five participating clinics at baseline and 12 months. Using Poisson regression, we conducted an intention-to-treat analysis of 240 randomized participants who were invited to screen at both timepoints. Results 58.8% of participants completed annual (median=370 days) anal screening. When stratified by HIV status, persons living with HIV had a higher proportion of home (71.1%) versus clinic (22.2%) annual screening ( p <0.001). Non-Hispanic Black participants had a higher proportion of home-based annual anal screening engagement (73.1%) compared to annual clinic screening engagement (31.6%) ( p =0.01). Overall, annual screening engagement was significantly higher among participants who had heard of anal cancer from an LGBTQ organization, reported "some" prior anal cancer knowledge, preferred an insertive anal sex position, and reported a prior cancer diagnosis. Annual screening engagement was significantly lower for participants reporting a medical condition. Conclusions Annual screening engagement among those at disproportionate anal cancer risk was higher in the home arm.
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Nitkowski J, Ridolfi TJ, Lundeen SJ, Giuliano AR, Chiao EY, Fernandez ME, Schick V, Smith JS, Brzezinski B, Nyitray AG. The influence of home versus clinic anal human papillomavirus sampling on high-resolution anoscopy uptake in the Prevent Anal Cancer Self-Swab Study. Sex Health 2024; 21:SH23210. [PMID: 38683939 DOI: 10.1071/sh23210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
Background Anal cancer disproportionately affects sexual and gender minority individuals living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability. Methods Sexual and gender minority individuals were randomised to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA 1year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ 2 tests. Results A total of 62.8% of 196 participants who engaged in screening attended HRA. Although not significant (P =0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.40, 95% CI 1.07-1.82), and lower among participants preferring a versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53-0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) (P =0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), (P =0.04). No differences in attendance by race or HIV status were observed in the home arm. Conclusions HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm.
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Affiliation(s)
- Jenna Nitkowski
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy J Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah J Lundeen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Elizabeth Y Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; and Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Nitkowski J, Giuliano AR, Ridolfi T, Chiao E, Fernandez ME, Schick V, Swartz MD, Smith JS, Nyitray AG. Concordance of Human Papillomavirus Genotypes in Mailed Home-Based Self-Collected Versus Clinician-Collected Anal Swabs Among Sexual and Gender Minority Individuals. Sex Transm Dis 2024; 51:270-275. [PMID: 38133570 PMCID: PMC10978280 DOI: 10.1097/olq.0000000000001916] [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] [Indexed: 12/23/2023]
Abstract
BACKGROUND Home-based self-sampling may be a viable option for anal cancer screening among sexual minority men (SMM). Yet limited research has compared home-based self-collected with clinician-collected anal swabs for human papillomavirus (HPV) genotyping. METHODS The Prevent Anal Cancer Self-Swab Study recruited SMM and transgender persons 25 years and over in Milwaukee, WI to participate in an anal cancer screening study. Participants were randomized to a home or clinic arm. Home-based participants were mailed an anal self-sampling kit to complete and return via postal mail. They were also asked to attend a clinic appointment where a clinician collected an anal swab. Swabs were HPV-genotyped using the SPF 10 -LiPA 25 assay. We analyzed 79 paired self and clinician swabs to determine HPV prevalence, percent agreement, and sensitivity and specificity of the mailed home-based anal self-swab to detect HPV genotypes using the clinician-collected swab as the reference. RESULTS The median number of days between the home and clinic swab was 19 days (range = 2 to 70). Human papillomavirus was detected in 73.3% of self and 75.0% of clinician anal swabs ( P = 0.99). Prevalence of any HPV, any high-risk HPV, any low-risk HPV, and individual HPV types did not significantly differ between self and clinician anal swabs. Agreement between self and clinician swabs was over 90% for 21 of the 25 HPV genotypes. Mailed home-based self-collected swabs had a sensitivity of 94.1% (95% confidence interval, 82.9-99.0) for detection of high-risk HPV versus clinician-collected sampling. CONCLUSIONS Mailed home-based self-collected and clinician-collected anal swabs demonstrated high concordance for HPV genotyping.
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Affiliation(s)
- Jenna Nitkowski
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tim Ridolfi
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Maria E. Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Jennifer S. Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan G. Nyitray
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Bennis SL, Rohloff CT, Zhang Z, Kohli N, Zoschke IN, Rosser BRS, Nyitray AG, Wilkerson JM, Stull CL, Khariwala SS, Ross MW. Sexual Behavior and Perceived Risk for Oropharyngeal Cancer Among Men Who Have Sex With Men: A Psychometric Scale Validation. Sex Transm Dis 2024; 51:289-294. [PMID: 38430512 DOI: 10.1097/olq.0000000000001923] [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] [Indexed: 03/04/2024]
Abstract
BACKGROUND Men who have sex with men (MSM) are at increased risk for human papillomavirus-associated oropharyngeal cancer (HPV-OPC). The objective of this analysis was to create a psychometrically validated scale to measure perception of risk for HPV-OPC. METHODS We conducted an exploratory and a confirmatory factor analysis to determine and confirm the latent factor structure. We used a path diagram to evaluate the relationship between the validated scale and perceived risk for HPV-OPC. The model was determined to be a good fit if it met all criteria: root mean square error of approximation ≤0.06, standardized root mean residual ≤0.08, Comparative Fit Index ≥0.90, and Tucker-Lewis Index ≥0.90. We report standardized estimates and 95% confidence intervals. RESULTS This cross-sectional study recruited 1315 MSM. A majority (73.33%) of MSM had performed fellatio on ≥20 partners, 36.98% had rimmed ≥20 partners, and 5.31% had performed cunnilingus on ≥10 partners in their lifetime.Six sexual history survey items loaded onto 2 latent factors: sexual risk behaviors: class 1 and sexual risk behaviors: class 2. The final model statistics indicated good fit: root mean square error of approximation = 0.064, standardized root mean residual = 0.059, Comparative Fit Index = 0.996, and Tucker-Lewis Index = 0.993. Sexual risk behaviors: class 1 was associated with greater perceived risk for HPV-OPC (0.217; 95% confidence interval, 0.138-0.295). Age, HIV status, HPV vaccination status, and sexual risk behaviors: class 2 were not associated with perceived risk for HPV-OPC. CONCLUSION Men who have sex with men assessed risk for HPV-OPC based on their lifetime number of cisgender male sexual partners, rimming partners, and fellatio partners but not other sexual behaviors. Men who have sex with men may be responsive to future HPV-OPC educational interventions and opportunities for screening.
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Affiliation(s)
- Sarah L Bennis
- From the Division of Epidemiology and Community Health, School of Public Health
| | - Corissa T Rohloff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN
| | - Ziwei Zhang
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN
| | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN
| | - I Niles Zoschke
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - B R Simon Rosser
- From the Division of Epidemiology and Community Health, School of Public Health
| | | | - J Michael Wilkerson
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Cynthia L Stull
- Department of Primary Dental Care, Division of Dental Hygiene, School of Dentistry
| | | | - Michael W Ross
- Department of Family Medicine, School of Medicine, University of Minnesota, Minneapolis, MN
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Nyitray AG, McAuliffe TL, Liebert C, Swartz MD, Deshmukh AA, Chiao EY, Weaver L, Almirol E, Kerman J, Schneider JA, Wilkerson JM, Hwang LY, Smith D, Hazra A. The accuracy of anal self- and companion exams among sexual minority men and transgender women: a prospective analysis. Lancet Reg Health Am 2024; 31:100704. [PMID: 38440068 PMCID: PMC10910307 DOI: 10.1016/j.lana.2024.100704] [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] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
Background Squamous cell carcinoma of the anus (SCCA) annual incidence among sexual minority men with and without HIV is 85/100,000 and 19/100,000 persons, respectively, which is significantly higher than the overall incidence (2/100,000). Incidence may also be higher in transgender women. Since SCCA tumours average ≥30 mm at diagnosis, we assessed the accuracy of individuals to self-detect smaller anal abnormalities. Methods Using convenience sampling, the study enrolled sexual minority men and transgender women, aged 25-81 years, in Chicago, Illinois and Houston, Texas, USA, during 2020-2022. Individuals were taught the anal self-examination and anal companion examination (ASE/ACE). Then, a clinician performed a digital anal rectal examination (DARE) before participants conducted the ASE or ACE. The sensitivity, specificity and concordance of the ASE/ACE to detect an abnormality were measured along with factors associated with ASE/ACE and DARE concordance. Findings Among 714 enrolled individuals, the median age was 40 years (interquartile range, 32-54), 36.8% (259/703) were living with HIV, and 47.0% (334/710), 23.4% (166/710), and 23.0% (163/710) were non-Hispanic white, non-Hispanic Black, and Hispanic, respectively. A total of 94.1% (671/713) identified as cisgendered men, and 5.9% (42/713) as gender minorities. A total of 658 participants completed an ASE and 28 couples (56 partners) completed an ACE. Clinicians detected abnormalities in 34.3% (245/714) of individuals. The abnormalities were a median of 3 mm in diameter. Sensitivity and specificity of the ASE/ACE was 59.6% (95% CI 53.5-65.7%) and 80.2% (95% CI 76.6-83.8%), respectively. Overall concordance was 0.73 (95% CI 0.70-0.76) between ASE/ACE and DARE and increased with increasing anal canal lesion size (p = 0.02). Concordance was lower when participants were older and received ASE/ACE training from a lay person rather than a clinician. Interpretation Sexual minority men/transgender women may self-detect SCCA when malignant lesions are much smaller than the current mean dimension at presentation of ≥30 mm. Funding National Cancer Institute.
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Affiliation(s)
- Alan G. Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy L. McAuliffe
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cameron Liebert
- School of Medicine and Public Health, University of Wisconsin–Madison, USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Cancer Control Program, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Lou Weaver
- MD Anderson Cancer Center, Houston, TX, USA
| | - Ellen Almirol
- University of Chicago, Section of Infectious Diseases and Global Health, Chicago, USA
| | - Jared Kerman
- University of Chicago, Section of Infectious Diseases and Global Health, Chicago, USA
| | - John A. Schneider
- University of Chicago, Section of Infectious Diseases and Global Health, Chicago, USA
| | - J. Michael Wilkerson
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Derek Smith
- The Crofoot Research Center, Houston, TX, USA
| | - Aniruddha Hazra
- University of Chicago, Section of Infectious Diseases and Global Health, Chicago, USA
| | - The Prevent Anal Cancer Palpation Study Team
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- School of Medicine and Public Health, University of Wisconsin–Madison, USA
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Cancer Control Program, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- MD Anderson Cancer Center, Houston, TX, USA
- University of Chicago, Section of Infectious Diseases and Global Health, Chicago, USA
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- The Crofoot Research Center, Houston, TX, USA
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Sonawane K, Garg A, Meissner EG, Damgacioglu H, Hill E, Nyitray AG, Deshmukh AA. Human Papillomavirus Vaccination Among Young Adults Before and During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e2356875. [PMID: 38376844 PMCID: PMC10879942 DOI: 10.1001/jamanetworkopen.2023.56875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/27/2023] [Indexed: 02/21/2024] Open
Abstract
This cross-sectional survey study assesses the self-reported human papillomavirus vaccination rate by sociodemographic characteristics in adults aged 18 to 26 years from 2018 to 2022.
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Affiliation(s)
- Kalyani Sonawane
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
- MUSC Hollings Cancer Center, Charleston, South Carolina
| | - Ashvita Garg
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
- MUSC Hollings Cancer Center, Charleston, South Carolina
| | - Eric G. Meissner
- Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston
| | - Haluk Damgacioglu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
- MUSC Hollings Cancer Center, Charleston, South Carolina
| | - Elizabeth Hill
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
- MUSC Hollings Cancer Center, Charleston, South Carolina
| | - Alan G. Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
- MUSC Hollings Cancer Center, Charleston, South Carolina
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Garg A, Nyitray AG, Roberts JR, Shungu N, Ruggiero KJ, Chandler J, Damgacioglu H, Zhu Y, Brownstein NC, Sterba KR, Deshmukh AA, Sonawane K. Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context. J Med Internet Res 2024; 26:e49749. [PMID: 38224476 PMCID: PMC10825763 DOI: 10.2196/49749] [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: 06/07/2023] [Revised: 11/01/2023] [Accepted: 12/10/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Nearly 70% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known. OBJECTIVE We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics. METHODS We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public's interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms "HPV" and "HPV vaccine" on YouTube. RESULTS In 2022, 59.6% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4% in 2017 to 59.8% in 2022; P<.001) and rural (from 22.4% in 2017 to 58% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term "HPV" was more frequently searched on YouTube compared with "HPV vaccine." Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine. CONCLUSIONS The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics.
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Affiliation(s)
- Ashvita Garg
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | - Alan G Nyitray
- Medical College of Wisconsin, Milwaukee, IL, United States
- Medical College of Wisconsin Cancer Center, Milwaukee, IL, United States
| | - James R Roberts
- Medical University of South Carolina, Charleston, SC, United States
| | - Nicholas Shungu
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | | | - Jessica Chandler
- Medical University of South Carolina, Charleston, SC, United States
- Applications Center for Healthful Lifestyles, Charleston, SC, United States
| | - Haluk Damgacioglu
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | - Yenan Zhu
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | | | - Katherine R Sterba
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | - Ashish A Deshmukh
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
| | - Kalyani Sonawane
- Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Charleston, SC, United States
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9
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Nitkowski J, Fernandez ME, Ridolfi T, Chiao E, Giuliano AR, Schick V, Swartz MD, Smith JS, Nyitray AG. The impact of body mass index and physical disability on home-based anal self-sampling. Cancer Causes Control 2024; 35:161-166. [PMID: 37632577 DOI: 10.1007/s10552-023-01775-y] [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: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Self-sampling is increasingly being used in screening programs, yet no studies to date have examined the impact of bodily characteristics on self-sampling experiences. Our objective was to assess whether body mass index (BMI) and physical disability were associated with anal self-sampling difficulty. METHODS We recruited sexual minority men (SMM) and trans persons in Milwaukee, Wisconsin to participate in an anal cancer screening study. Between January 2020 and August 2022, 240 participants were randomized to a home (n = 120) or clinic (n = 120) screening arm. Home participants received a mailed at-home anal self-sampling kit and were asked to attend a baseline clinic visit where biometric measurements were collected. Participants were asked to complete a survey about their experience with the kit. This research utilized data from participants who used the at-home kit and completed a baseline clinic visit and post-swab survey (n = 82). We assessed the impact of BMI and physical disability on reported body or swab positioning difficulty. RESULTS Most participants reported no or little difficulty with body positioning (90.3%) or swab positioning (82.9%). Higher BMI was significantly associated with greater reported difficulty with body positioning (aOR = 1.10, 95% CI 1.003-1.20, p = 0.04) and swab positioning (aOR = 1.11, 95% CI 1.02-1.20, p = 0.01). Although not significant, participants who said body positioning was difficult had 2.79 higher odds of having a physical disability. Specimen adequacy did not differ by BMI category (p = 0.76) or physical disability (p = 0.88). CONCLUSION Anal self-sampling may be a viable option to reach obese persons who may be more likely to avoid screening due to weight-related barriers.
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Affiliation(s)
- Jenna Nitkowski
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI, 53202, USA.
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Tim Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI, 53202, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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10
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Nitkowski J, Giuliano AR, Ridolfi T, Chiao E, Fernandez ME, Schick V, Swartz MD, Smith JS, Nyitray AG. Acceptability of Anal Human Papillomavirus Home Self-Sampling and Clinician Sampling Among Sexual and Gender Minority Individuals in Milwaukee, Wisconsin: The Prevent Anal Cancer Self-Swab Study. LGBT Health 2024; 11:47-56. [PMID: 37870947 DOI: 10.1089/lgbt.2023.0012] [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] [Indexed: 10/25/2023] Open
Abstract
Purpose: Anal cancer has disproportionately high incidence among sexual minority men. We compared acceptability of home versus clinic human papillomavirus (HPV) anal swabbing. Methods: The Prevent Anal Cancer Self-Swab Study recruited sexual and gender minority individuals in Milwaukee, Wisconsin. Eligible participants were randomized to a home or clinic arm. Home participants received a mailed anal HPV self-sampling kit. Clinic participants attended a clinic appointment where a clinician collected an anal HPV swab. We examined acceptability (overall thoughts, comfort with method, pain, and future willingness to swab) of home versus clinic swabbing using postswab survey responses. Results: A total of 191 individuals completed swabbing and a postswab survey (home = 53.4%, clinic = 46.6%). Mean age was 47 years (range = 25-78). Reported overall thoughts about home (71.6%) and clinic (69.7%) swabbing were mostly positive (p = 0.83). Overall thoughts about the home kit did not differ by participant characteristics, but overall thoughts about clinician swabbing differed by race (p = 0.04) and HIV status (p = 0.002). Nearly all participants (98.4%) reported they were comfortable receiving the kit or getting the swabbing in the clinic, reported little or no pain (98.4%), and reported willingness to undergo swabbing in the future (97.9%). After swabbing, clinic participants reported greater trust that swabbing can give accurate information about anal cancer risk (89.9%) than home participants (69.6%) (p < 0.001), and that swabbing will help them avoid anal cancer (clinic = 79.8%, home = 59.8%) (p = 0.01). Conclusion: Anal swabbing acceptability was high and did not differ between home and clinic. Participants reported high confidence and knowledge using the mailed anal self-sampling kit. Clinical Trial Registration number is NCT03489707.
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Affiliation(s)
- Jenna Nitkowski
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tim Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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11
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Stull C, Bennis SL, Rosser BRS, Wilkerson JM, Zoschke IN, Jiang Z, Nyitray AG, Khariwala SS, Ross MW. Correlates of human papillomavirus vaccination intent for oropharyngeal cancer prevention among gay and bisexual men living in the United States. J Am Dent Assoc 2024; 155:26-38.e1. [PMID: 37988048 DOI: 10.1016/j.adaj.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Gay and bisexual men (GBM) are at increased risk of developing human papillomavirus (HPV)-associated oropharyngeal cancer (OPC). Vaccination may prevent OPC in GBM; however, vaccination rates are low. The authors explored the correlates associated with HPV vaccination intent for OPC prevention among GBM. METHODS The authors conducted a cross-sectional study in which they surveyed 1,700 adult GBM with a profile on 2 online dating sites. Eligibility criteria included self-identified GBM living in the United States, aged 18 through 45 years who had sex with a man in the past 5 years. Factors associated with participants' HPV vaccination status and intent to vaccinate were assessed via the online questionnaire using the Health Belief Model. RESULTS Most of the 1,108 eligible GBM had not received 1 dose or more of the HPV vaccine (54.2%), were aged 27 through 37 years (52.3%), were White (58.3%), identified as cisgender men (93.4%), were gay (79.3%), were in a monogamous relationship (99.4%), and had a bachelor's degree (29.4%) or higher college education (26.1%). Among unvaccinated GBM, 25.3% reported intent to receive the vaccine. In the multivariable model, independent associations (P < .05) were found for the Health Belief Model constructs (perceived benefits and perceived barriers) with HPV vaccine intent, after adjusting for all other predictor variables in the model. CONCLUSIONS The benefits of HPV vaccination for the prevention of OPC is associated with intent to vaccinate among GBM. Dental care providers can use this information to educate patients in this high-risk population on prevention of HPV-associated OPC. PRACTICAL IMPLICATIONS Dentists can advocate for HPV vaccination uptake among GBM patients by means of discussing the benefits of vaccination in the prevention of HPV-associated OPC.
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12
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Nitkowski J, Ridolfi TJ, Lundeen SJ, Giuliano AR, Chiao E, Fernandez ME, Schick V, Smith JS, Brzezinski B, Nyitray AG. The influence of home versus clinic anal human papillomavirus sampling on high-resolution anoscopy uptake in the Prevent Anal Cancer Self-Swab Study. medRxiv 2023:2023.12.27.23300457. [PMID: 38234718 PMCID: PMC10793519 DOI: 10.1101/2023.12.27.23300457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Anal cancer disproportionately affects men who have sex with men (MSM) living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability. Method MSM and trans persons 25 years and older were randomized to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA one year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ 2 tests. Results 62.8% of 196 participants who engaged in screening attended HRA. Although not significant ( p =0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.44, 95% CI 1.11 - 1.87) and lower among participants preferring versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53 - 0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) ( p =0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), ( p =0.04); however, no differences in attendance by race or HIV status were observed in the home arm. Conclusions HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm.
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13
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Ferreira MT, Mendoza López RV, Gonçalves MG, Ferreira S, Sirak B, Baggio ML, Lazcano-Ponce E, Nyitray AG, Giuliano AR, Villa LL, Sichero L. Human Papillomavirus 16 Lineage A Variants Associated With Persistent Genital Infections in Men: The HPV Infection in Men (HIM) Study. J Infect Dis 2023; 228:1748-1757. [PMID: 37279655 PMCID: PMC10733738 DOI: 10.1093/infdis/jiad204] [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: 02/18/2023] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) 16 non-A lineage variants have higher carcinogenic potential for cervical cancer. HPV-16 variants natural history among males is not established. We evaluated HPV-16 variants prevalence and persistence in the external genitalia of men enrolled in the prospective HPV Infection in Men (HIM) Study. METHODS The HIM Study included men from the United States, Brazil, and Mexico. HPV-16 variants were distinguished using polymerase chain reaction sequencing. The prevalence of HPV-16 variants was assessed, and associations with infection persistence were estimated. RESULTS We characterized the HPV-16 variants for 1700 genital swab samples from 753 men and 22 external genital lesions in 17 men. The prevalence of HPV-16 lineages differed by country and marital status (P < .001). Overall, 90.9% of participants harbored lineage A variants. The prevalence of non-A lineages was heterogenous among countries. HPV-16 lineage A variants were associated with a 2.69-fold increased risk of long-term persistent infections compared with non-A lineages. All high-grade penile intraepithelial neoplasia harbored lineage A variants and occurred in the context of long-term persistent infections with the same variants. CONCLUSIONS The prevalence and persistence of HPV-16 variants observed at the male external genitalia suggest differences in the natural history of these variants between men and women, which may be associated with intrinsic differences in the infected genital epithelia.
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Affiliation(s)
- Matthew Thomas Ferreira
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Rossana Veronica Mendoza López
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Milena Giulia Gonçalves
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Silvaneide Ferreira
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, and Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Maria Luizai Baggio
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Eduardo Lazcano-Ponce
- Center for Population Health Research, Instituto Nacional de Salud Pública, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
| | - Alan G Nyitray
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, and Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Luisa L Villa
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Laura Sichero
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
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14
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Ross MW, Bennis SL, Zoschke N, Simon Rosser BR, Stull CL, Nyitray AG, Khariwala SS, Nichols M, Flash C, Wilkerson M. Screening for HPV-Related Oropharyngeal Cancer in Gay and Bisexual Men: Acceptability and Predicting Possible Use of "Oral Selfies" by Smartphone as a Secondary Prevention Approach. Venereology (Basel) 2023; 2:180-193. [PMID: 38515606 PMCID: PMC10956645 DOI: 10.3390/venereology2040016] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Oropharyngeal cancers (OPCa) caused by HPV have emerged as one of the leading causes of malignancies caused by HPV infection. They are also significantly more likely to occur in males and in people with a history of oral sex with multiple partners. Gay and bisexual men are disproportionately affected by HPV-positive oropharyngeal cancers. We studied 1699 gay and bisexual men on 2 major dating sites in the US to assess their knowledge about HPV-related OPCa, attitudes toward screening for it, beliefs about oropharyngeal cancer screening based on the Health Belief Model, and attitudes toward possible screening approaches for OPCa. Knowledge on a 12-item scale was low, with a median of 5 items correct: 72% knew of the benefits of HPV vaccination. Significant predictors of needing OPCa screening included perception of risk for OPCa, seeing it as severe, having lower barriers, fewer reasons to avoid screening, higher knowledge, and being HPV vaccinated were significant predictors, explaining half the total variance. Most participants would accept routine, virtual/online doctor or dental appointments, and over half would accept an in-person screening. Nearly two-thirds stated that they would accept getting checked for OPCa if they could do self-screening at home, and half were prepared to use an online screening tool or app, where they could take an "oral selfie" and send it to a healthcare provider for examination. One-third stated that they would trust the results of a home screening completed by themselves and posted to a website equally as cancer screening completed online by a healthcare provider. Data indicate that despite low OPCA knowledge levels, the risk of HPV-associated OPCa was known. Being at personal risk and having knowledge of disease severity had 70% of the sample thinking about, or preparing to get, screening. Self-screening by a smartphone "oral selfie" transmitted to a screening website was acceptable to many gay and bisexual men, and online screening by a doctor or dentist was acceptable to most. OPCa screening in this population using electronic technology, together with the increasing incidence of HPV-associated OPCa in gay and bisexual men, brings together an opportunity to detect OPCa early.
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Affiliation(s)
- Michael W. Ross
- Institute of Sexual and Gender Health, Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN 55454, USA
| | - Sarah L. Bennis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Niles Zoschke
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Brian R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Cyndee L. Stull
- School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alan G. Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI 53202, USA
| | - Samir S. Khariwala
- Department of Otolaryngology, Head and Neck Surgery, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mark Nichols
- Avenue360 Health Services, Houston, TX 77008, USA
| | | | - Michael Wilkerson
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Nyitray AG, McAuliffe TL, Liebert C, Swartz MD, Deshmukh AA, Chiao EY, Weaver L, Almirol E, Kerman J, Schneider JA, Wilkerson JM, Hwang LY, Smith D, Hazra A. The accuracy of anal self- and companion exams among sexual minority men and transgender women: The Prevent Anal Cancer Palpation Study. medRxiv 2023:2023.10.19.23297209. [PMID: 37905024 PMCID: PMC10615006 DOI: 10.1101/2023.10.19.23297209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background Squamous cell carcinoma of the anus (SCCA) annual incidence among sexual minority men (SMM) with and without HIV is 85/100,000 and 19/100,000 persons, respectively, which is significantly higher than the overall incidence (2/100,000). Since SCCA tumours average ≥30 mm at diagnosis, we assessed the accuracy of individuals to self-detect anal abnormalities. Methods The study enrolled 714 SMM and transgender women (SMM/TW), aged 25 to 81 years, in Chicago, Illinois and Houston, Texas during 2020-2022. Individuals were taught the anal self- and companion examinations (ASE/ACE). Then, a clinician performed a digital anal rectal examination (DARE) before participants conducted the ASE or ACE. Accuracy was measured along with factors associated with ASE/ACE and DARE concordance. Findings The median age was 40 years (interquartile range, 32-54), 36.8% were living with HIV, and 47.0%, 23.4%, and 23.0% were non-Hispanic white, non-Hispanic Black, and Hispanic. Clinicians detected 245 individuals with abnormalities (median diameter 3 mm). Sensitivity and specificity of the ASE/ACE was 59.6% (95%CI 53.5-65.7%) and 80.2% (95%CI 76.6-83.8%), respectively. Overall concordance was 0.73 (95% CI 0.70-0.76) between ASE/ACE and DARE and increased with increasing anal canal lesion size (p=0.02). However, concordance was lower for participants aged ≥55 years (compared to 25-34 years) and when the ASE/ACE trainer was a lay person rather than a clinician. Interpretation SMM/TW who complete an ASE or ACE are likely to detect SCCA at an early stage when malignant lesions are much smaller than the current median dimension at presentation of ≥30 mm. Funding National Cancer Institute. Research in context Evidence before this study: While squamous cell carcinoma of the anus (SCCA) incidence is substantially elevated in people with HIV, there are currently no consensus recommendations on how to screen for it, nor is there widespread technological infrastructure for one prevailing method, high-resolution anoscopy. In the absence of screening programs, the size of SCCA tumours at diagnosis are > 30 mm. We searched PubMed for articles between January 1, 2000 and June 15, 2023 using the search terms 'anus neoplasm' and 'self-examination'. We found no studies assessing the accuracy of self-examinations to detect anal masses other than our prior feasibility study.Added value of this study: The primary goal of the Prevent Anal Cancer Palpation Study was to assess the accuracy of lay self-examinations and companion examinations to recognise abnormalities in the anal region. Clinicians conducted a digital anal rectal examination and recorded all lesions observed at the perianus or anal canal. The median size of lesions was 3 mm. Participants conducted lay examinations and these results were judged against a clinician's examination. The sensitivity and specificity of the lay examinations, for any lesion at the anal canal or perianal region was 59.6% and 80.1%, respectively. As lesions increased in size, concordance increased between clinician's exam and the lay exam.Implications of all the available evidence: It is now known that high-resolution anoscopy can reduce the risk for SCCA but the infrastructure using this technology is very limited in high-resource settings and almost non-existent in low resource settings, especially where HIV prevalence is highest. The evidence suggests that self- and partner examination of the anal region is feasible and that lay persons can detect lesions that are much smaller than the prevailing size of SCCA tumours.
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16
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Flores RA, Wilkerson JM, Travis A, Almirol E, Washington D, Weaver L, Liebert C, Chiao E, Hazra A, Nyitray AG. Men who have sex with men experience low anxiety and few barriers to performing anal self or companion examinations: a qualitative study of the Prevent Anal Cancer Palpation Study. Cult Health Sex 2023:1-16. [PMID: 37812464 PMCID: PMC11001786 DOI: 10.1080/13691058.2023.2263500] [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] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023]
Abstract
While rare in the larger population, anal cancer incidence is significantly higher in groups such as sexual minority men and people living with HIV. This qualitative analysis examined participants' experiences and perceptions of barriers to anal self-examination and anal companion examination through interviews completed as a part of a larger clinical trial. Interviews were conducted online with participants (n = 131) within a week of their baseline appointment between January 2020 and October 2021. Content analysis denoted participants' thoughts and perceptions about anal self-examination and anal companion examinations. Of the 131 cisgender men interviewed (mean age 49.9 years, SD 12.7), 92.4% identified as gay, 54.9% identified as white, 22.1% identified as Black, 19.9% identified as Latino, and 44.3% of participants were living with HIV. Participants did not report feelings of excessive anxiety when an abnormality was detected. However, three salient themes emerged as to why participants may not perform an anal self-examination or anal companion examination: (1) physical limitation(s), (2) potential sexualisation of the examination, and (3) level of comfort discussing anal health. Future work must continue to explore methods that not only decrease stigma surrounding anal health but also bolster feelings of accessibility to perform self and couple examinations.
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Affiliation(s)
- Rey A. Flores
- Department of Family and Community Medicine, The University of Illinois at Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
| | - J. Mike Wilkerson
- School of Public Health, Department of Health Promotion and Behavioral Science, The University of Texas Health Science Center, Houston, TX, USA
| | - Andrew Travis
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
| | - Ellen Almirol
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
| | - DeJuan Washington
- School of Medicine, Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Lou Weaver
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Cameron Liebert
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Aniruddha Hazra
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Infectious Diseases & Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Alan G. Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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17
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Ross MW, Bennis SL, Nichols CM, Zoschke IN, Wilkerson JM, Rosser BRS, Stull CL, Nyitray AG, Flash C, Khariwala SS. Oral/oropharyngeal "selfies" in gay and bisexual men: a pilot study exploring oropharyngeal screening for HPV-related possible malignancies. Front Public Health 2023; 11:1233274. [PMID: 37780435 PMCID: PMC10537951 DOI: 10.3389/fpubh.2023.1233274] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/16/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives This study aims to determine the potential uptake and quality of oropharyngeal "selfies" taken by gay/bisexual men as a screening approach for HPV-associated oropharyngeal cancer. Methods From 1,699 gay/bisexual men in the US, surveyed about knowledge and attitudes to HPV-associated oropharyngeal cancer, a random sample of 320 men were invited to take an oropharyngeal "selfie" by smartphone and send it to the study website: 113 (35.5%) did so. Images were rated for quality by three healthcare professional raters blinded to each other's rating, with an otolaryngologist as the gold standard. In the second wave, those whose images were rated as unacceptable were sent a short instructional video and asked to send another image. Of the 65 invited, 46 did so. An additional 15.2% sent acceptable images, and a total of 28.3% of the sample was acceptable. Results A total of 1,121 men willing to participate in the future study who believed they could take a quality "oral selfie" were potentially eligible for this activity. A random sample of 320 participated: 153 participants started (47.8%) and 113 participants (35.3%) submitted an image. Responders were more likely to be younger, have higher knowledge scores on oropharyngeal HPV-related cancer, and have had HPV vaccination. There was high agreement between the three raters. Images of good/acceptable quality were 22.1%; oropharynx partially occluded images were 29.2%; oropharynx not visible images were 18.6%; images too dark were 21.2%; and images too small were 8.8%. From the second wave of requests with instructional videos, an additional 15.2% sent in quality images, with the remaining issues being partial occlusion of the tonsils by the tongue. Conclusion One-third of the invited gay and bisexual men sent oropharyngeal selfie images to the study website and a total of 28.3% were of clinically acceptable quality. Following an instructional video on poorer-quality images, additional quality images were received. One barrier, i.e., partial occlusion of the oropharynx by the tongue remained. Quality oropharyngeal "selfies" are obtainable online.
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Affiliation(s)
- Michael W. Ross
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Sarah L. Bennis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | | | - I. Niles Zoschke
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - J. Michael Wilkerson
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Cyndee L. Stull
- School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Alan G. Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Samir S. Khariwala
- Department of Otolaryngology, Head and Neck Surgery, Medical School, University of Minnesota, Minneapolis, MN, United States
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Carnalla M, Rojas-Martínez R, Barrientos-Gutiérrez T, Allen-Leigh B, León-Maldonado L, Gutiérrez-Xicoténcatl L, Portillo-Romero AJ, Nyitray AG, Salmerón J, Giuliano AR, Lazcano-Ponce E. Prevalence and development of a risk score for oral human papillomavirus infection in men who have sex with men in Mexico. J Oral Pathol Med 2023; 52:751-757. [PMID: 37525481 DOI: 10.1111/jop.13474] [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: 08/29/2022] [Revised: 05/23/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk for oral human papillomavirus (HPV infection). There are no specific screening guidelines to facilitate the identification of people at risk for oral HPV infection. We aimed to estimate the prevalence of oral high-risk HPV and create a risk score to identify MSM at higher risk for prevalent oral HPV. METHODS We collected baseline data from a clinical trial from a subsample of 500 MSM attending sexually transmitted disease treatment clinics; they provided an oral gargle sample for high-risk HPV detection. We calculated oral high-risk HPV prevalence and 95% confidence intervals (CIs), used a logistic regression model to identify factors associated with high-risk HPV infection, and created a risk score. RESULTS The prevalence of any oral high-risk HPV among MSM was 11.1% (95% CI: 8.6-14.2), with a higher prevalence observed among men living with HIV (14.8%). Factors independently associated with oral high-risk HPV were age ≥40 years (OR = 2.71, 95% CI: 1.28-5.73 compared to <40 years), being HIV-positive with CD4 count 200-499 (OR = 2.76, 95% CI: 1.34-5.65 compared to HIV-negative), and recent recreational use of vasodilators (poppers/sildenafil) (OR = 2.02, 95% CI: 1.02-2.97). The risk score had good discriminatory power (AUC = 0.70, 95% CI: 0.63-0.77). CONCLUSIONS MSM have specific predictors for prevalent oral high-risk HPV, and a risk score could be used by clinicians to target men with vaccine recommendations and counseling, and identify those who could benefit from primary interventions given the available resources, or for referral to dental services for follow-up when available.
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Affiliation(s)
- Martha Carnalla
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Rosalba Rojas-Martínez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Betania Allen-Leigh
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Leith León-Maldonado
- Centro de Investigación en Salud Poblacional, National Institute of Public Health, Cuernavaca, Mexico
| | - Lourdes Gutiérrez-Xicoténcatl
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | | | - Alan G Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
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19
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Nyitray AG, Ridolfi TJ, Nitkowski J, McAuliffe TL, Deshmukh AA, Giuliano AR, Chiao EY. Digital Anal Rectal Examination Usage Among Individuals at Increased Risk for Anal Cancer. J Low Genit Tract Dis 2023; 27:242-247. [PMID: 36961479 PMCID: PMC10313742 DOI: 10.1097/lgt.0000000000000734] [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] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Multiple organizations recommend an annual digital anal rectal examination (DARE) for people at highest risk for anal cancer. The authors assessed DARE usage among sexual minority men and transgender women. METHODS Community-recruited and asymptomatic individuals from a mid-sized US city were enrolled into the Prevent Anal Cancer Self-Swab Study, a longitudinal clinical trial of anal cancer screening. Self-reported data from the baseline survey were used to assess usage of DARE in the last year and during the lifetime. Adjusted odds ratios (aORs) and CIs for factors associated with each outcome were determined using multivariable logistic regression. RESULTS Among 241 participants, median age was 46 years (interquartile range, 33-57 years), 27.0% were living with HIV, and 24.5% reported a previous diagnosis of anal warts. A total of 13.7% (95% CI = 9.4%-18.0%) of individuals reported a DARE in the previous year, whereas 53.9% (95% CI = 47.7%-60.2%) reported a DARE during the lifetime. The following were associated with a DARE in the previous year: increasing age (aOR = 1.04; 95% CI = 1.01-1.08 for each additional year), any previous anal cytology (aOR = 2.62; 95% CI = 1.19-5.80, compared with no previous test or no knowledge of a test), and preferred receptive position during anal sex (aOR = 4.93; 95% CI = 1.17-20.86 compared with insertive). CONCLUSIONS Despite guidelines recommending an annual DARE, it was uncommonly reported. There is an urgent need to understand barriers to conducting DARE among individuals most vulnerable to anal cancer and their health care providers.
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Affiliation(s)
- Alan G. Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
| | | | - Jenna Nitkowski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
| | - Timothy L. McAuliffe
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
- Cancer Control Program, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, USA
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20
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Nyitray AG, Nitkowski J, McAuliffe TL, Brzezinski B, Swartz MD, Fernandez ME, Deshmukh AA, Ridolfi TJ, Lundeen SJ, Cockerham L, Wenten D, Petroll A, Hilgeman B, Smith JS, Chiao EY, Giuliano AR, Schick V. Home-based self-sampling vs clinician sampling for anal precancer screening: The Prevent Anal Cancer Self-Swab Study. Int J Cancer 2023. [PMID: 37158105 DOI: 10.1002/ijc.34553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/23/2023] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
Sexual minority men are at increased risk for anal squamous cell carcinoma. Our objective was to compare screening engagement among individuals randomized to self-collect an anal canal specimen at home or to attend a clinic appointment. Specimen adequacy was then assessed for human papillomavirus (HPV) DNA genotyping. A randomized trial recruited cisgendered sexual minority men and transgender people in the community and assigned them to use a home-based self-collection swabbing kit or attend a clinic-based swabbing. Swabs were sent for HPV genotyping. The proportions of participants completing screening in each study arm and the adequacy of their specimens for HPV genotyping were assessed. Relative risks were estimated for factors associated with screening. A total of 240 individuals were randomized. Age (median, 46 years) and HIV status (27.1% living with HIV) did not differ by study arm. A total of 89.2% and 74.2% of home-arm and clinic-arm individuals returned the swab, respectively (P = .003), difference between groups, 15.0% (95% CI 5.4%-24.6%). Among black individuals, 96.2% and 63.2% in the home and clinic arms screened (P = .006). Among individuals with HIV, 89.5% and 51.9% in the home and clinic arms screened (P < .001). Self-collected swabs and clinician-collected swabs were comparable in adequacy for HPV genotyping (96.3% and 93.3%, respectively). People at highest risk for anal cancer may be more likely to screen if they are able to self-collect swabs at home rather than attend a clinic.
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Affiliation(s)
- Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jenna Nitkowski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
| | - María E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Cancer Control Program, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy J Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sarah J Lundeen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Dave Wenten
- Holton Street Clinic, Milwaukee, Wisconsin, USA
| | - Andrew Petroll
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian Hilgeman
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Vanessa Schick
- Department of Management, Policy, and Community Health, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
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21
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Nitkowski J, Fernandez ME, Ridolfi T, Chiao E, Giuliano AR, Schick V, Swartz MD, Smith JS, Nyitray AG. The Impact of Body Mass Index and Medical Conditions on Home-based Anal Self-Sampling. Res Sq 2023:rs.3.rs-2748914. [PMID: 37034807 PMCID: PMC10081437 DOI: 10.21203/rs.3.rs-2748914/v1] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Purpose. Self-sampling is increasingly being used in screening programs, yet no studies to date have examined the impact of bodily characteristics on self-sampling experiences. Our objective was to assess whether body mass index (BMI) and physical disability were associated with anal self-sampling difficulty. Methods. We recruited sexual minority men (SMM) and trans persons in Milwaukee, Wisconsin to participate in an anal cancer screening study. Between January 2020 and August 2022, 240 participants were randomized to a home (n=120) or clinic (n=120) screening arm. Home participants received a mailed at-home anal self-sampling kit and were asked to attend a baseline clinic visit where biometric measurements were collected. Participants were asked to complete a survey about their experience with the kit. This research utilizes data from participants who used the kit and completed a baseline clinic visit and post-swab survey (n=82). We assessed the impact of BMI and physical disability on reported body or swab positioning difficulty. Results. Most participants reported no or little difficulty with body positioning (90.3%) or swab positioning (82.9%). Higher BMI was significantly associated with greater reported difficulty with body positioning (aOR=1.10, 95% CI 1.003-1.20, p =.04) and swab positioning (aOR=1.11, 95% CI 1.02-1.20, p =.01). Physical disability was not significantly associated with body or swab positioning difficulty. Specimen adequacy did not differ by BMI category ( p =.76) or physical disability ( p =.88). Conclusion. Anal self-sampling may be a viable option to reach obese persons who may be more likely to avoid screening due to weight-related barriers.
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Affiliation(s)
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston School of Public Health
| | | | | | | | - Vanessa Schick
- The University of Texas Health Science Center at Houston School of Public Health
| | - Michael D Swartz
- The University of Texas Health Science Center at Houston School of Public Health
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22
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Damgacioglu H, Lin YY, Ortiz AP, Wu CF, Shahmoradi Z, Shyu SS, Li R, Nyitray AG, Sigel K, Clifford GM, Jay N, Lopez VC, Barnell GM, Chiao EY, Stier EA, Ortiz-Ortiz KJ, Ramos-Cartagena JM, Sonawane K, Deshmukh AA. State Variation in Squamous Cell Carcinoma of the Anus Incidence and Mortality, and Association With HIV/AIDS and Smoking in the United States. J Clin Oncol 2023; 41:1228-1238. [PMID: 36441987 PMCID: PMC9937095 DOI: 10.1200/jco.22.01390] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Squamous cell carcinoma of the anus (SCCA) incidence and mortality rates are rising in the United States. Understanding state-level incidence and mortality patterns and associations with smoking and AIDS prevalence (key risk factors) could help unravel disparities and provide etiologic clues. METHODS Using the US Cancer Statistics and the National Center for Health Statistics data sets, we estimated state-level SCCA incidence and mortality rates. Rate ratios (RRs) were calculated to compare incidence and mortality in 2014-2018 versus 2001-2005. The correlations between SCCA incidence with current smoking (from the Behavioral Risk Factor Surveillance System) and AIDS (from the HIV Surveillance system) prevalence were evaluated using Spearman's rank correlation coefficient. RESULTS Nationally, SCCA incidence and mortality rates (per 100,000) increased among men (incidence, 2.29-3.36, mortality, 0.46-0.74) and women (incidence, 3.88-6.30, mortality, 0.65-1.02) age ≥ 50 years, but decreased among men age < 50 years and were stable among similar-aged women. In state-level analysis, a marked increase in incidence (≥ 1.5-fold for men and ≥ two-fold for women) and mortality (≥ two-fold) for persons age ≥ 50 years was largely concentrated in the Midwestern and Southeastern states. State-level SCCA incidence rates in recent years (2014-2018) among men were correlated (r = 0.47, P < .001) with state-level AIDS prevalence patterns. For women, a correlation was observed between state-level SCCA incidence rates and smoking prevalence (r = 0.49, P < .001). CONCLUSION During 2001-2005 to 2014-2018, SCCA incidence and mortality nearly doubled among men and women age ≥ 50 years living in Midwest and Southeast. State variation in AIDS and smoking patterns may explain variation in SCCA incidence. Improved and targeted prevention is needed to combat the rise in SCCA incidence and mitigate magnifying geographic disparities.
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Affiliation(s)
- Haluk Damgacioglu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
| | - Yueh-Yun Lin
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
| | - Ana Patricia Ortiz
- University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Chi-Fang Wu
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX
| | - Zahed Shahmoradi
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
| | - Shiang Shiuan Shyu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | - Ruosha Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | - Alan G. Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | - Keith Sigel
- Department of General Internal Medicine, Department of Medicine, Mt Sinai Icahn School of Medicine, New York, NY
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Naomi Jay
- Anal Neoplasia Clinic, Research, and Education Center, University of California San Francisco, San Francisco, CA
| | - Vivian Colon Lopez
- University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Gregory M. Barnell
- Kaiser Permanente, Oakland Medical Center, Department of Surgery, Oakland, CA
| | | | - Elizabeth A. Stier
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, MA
| | - Karen J. Ortiz-Ortiz
- University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Jeslie M. Ramos-Cartagena
- The University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, San Juan, Puerto Rico
| | - Kalyani Sonawane
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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23
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Amboree TL, Nyitray AG, Schneider J, Gargurevich N, Kuo J, Chiao EY, Hwang LY, Fujimoto K. Are human papillomavirus knowledge and vaccine uptake associated with HIV status and social determinants of health in young sexual minority men? Prev Med Rep 2023; 32:102132. [PMID: 36798795 PMCID: PMC9925951 DOI: 10.1016/j.pmedr.2023.102132] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
This brief report examines the relationship, if any, between human immunodeficiency virus (HIV) status, and individual-level and socio-sexual partner-level factors of social determinants of health (SDOH) that are associated with human papillomavirus (HPV) knowledge and vaccine uptake in young sexual minority men (YSMM). We used data from 126 YSMM recruited by network-based sampling during 2015-2016 in Houston, Texas. Descriptive statistics and regression analyses were conducted to test the association between HIV status, SDOH, and HPV knowledge and vaccine uptake. Those living with HIV had lower odds of knowledge of HPV-associated anal cancer (OR: 0.43, 95% CI: 0.18-0.97) and knowledge of HPV spreading via sexual contact (OR: 0.11, 95% CI: 0.01-0.64), and higher odds of HPV vaccine uptake (OR: 2.90, 95% CI: 1.11-8.02). HPV knowledge and vaccine uptake in YSMM was not associated with partner's attributes or individuals' SDOH factors in our study yet was significantly associated with HIV status. Future interventions are needed to increase HPV knowledge among individuals living with HIV and vaccine uptake particularly among YSMM living without HIV that are not engaged in healthcare.
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Affiliation(s)
- Trisha L. Amboree
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, 6620 Main St, Houston, TX 77030, USA,Corresponding author.
| | - Alan G. Nyitray
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA,Clinical Cancer Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - John Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Ave, Chicago, IL 60637, USA,Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, Chicago, IL 60637 USA
| | - Nick Gargurevich
- Department of Statistics, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Jacky Kuo
- School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA
| | - Elizabeth Y. Chiao
- The University of Texas MD Anderson Cancer Center, Departments of Epidemiology and Medical Oncology, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Lu-Yu Hwang
- School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA
| | - Kayo Fujimoto
- School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA
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24
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Wei F, Goodman MT, Xia N, Zhang J, Giuliano AR, D’Souza G, Hessol NA, Schim van der Loeff MF, Dai J, Neukam K, de Pokomandy A, Poynten IM, Geskus RB, Burgos J, Etienney I, Moscicki AB, Donà MG, Gillison ML, Nyitray AG, Nowak RG, Yunihastuti E, Zou H, Hidalgo-Tenorio C, Phanuphak N, Molina JM, Schofield AM, Kerr S, Fan S, Lu Y, Ong JJ, Chikandiwa AT, Teeraananchai S, Squillace N, Wiley DJ, Palefsky JM, Georges D, Alberts CJ, Clifford GM. Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies. Clin Infect Dis 2023; 76:e692-e701. [PMID: 35869839 PMCID: PMC10226739 DOI: 10.1093/cid/ciac581] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 05/16/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programs but has not been systematically characterized. METHODS We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants. RESULTS Human papillomavirus (HPV) 16 had the highest incidence-clearance ratio of the hrHPV types. MSMWH had the highest hrHPV incidence (eg, 15.5% newly HPV-16 infected within 2 years), followed by HIV-negative MSM (7.5%), WWH (6.6%), HIV-negative women (2.9%), MSWWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV-16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behavior for MSM only. HPV-16 clearance was lower for people with HIV (PWH) and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV-16 infection. CONCLUSIONS This robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programs on anal cancer prevention, particularly in MSM and PWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Marc T Goodman
- Cancer Prevention and Control Program, Cedars Cancer, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, Florida, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of CaliforniaSan Francisco, California, USA
| | | | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Medicina Preventiva, UCEIMP, Instituto de Biomedicina de Sevilla, CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - I Mary Poynten
- The Kirby Institute, University of New South Wales, Kensington, Sydney, New South Wales, Australia
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Joaquin Burgos
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Maria Gabriella Donà
- Sexually Transmitted Infections (STI)/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maura L Gillison
- Thoracic Head and Neck Medical Oncology Department, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research and Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Carmen Hidalgo-Tenorio
- Early Clinical Trial Unit. Biosanitary Institute (IBS.Granada). Infectious Diseases Unit. University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Jean-Michel Molina
- Department of Infectious diseases, University of Paris Cité, St-Louis Hospital, Paris, France
| | - Alice M Schofield
- Institute of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Stephen Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, and Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Yong Lu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
| | - Admire T Chikandiwa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Nicola Squillace
- Infectious Diseases Unit ASST-Monza, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Dorothy J Wiley
- School of Nursing, University of California, Los Angeles, California, USA
| | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Damien Georges
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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Sonawane K, Shyu SS, Damgacioglu H, Li R, Nyitray AG, Deshmukh AA. Prevalence and concordance of oral and genital HPV by sexual orientation among US men. JNCI Cancer Spectr 2023; 7:pkac088. [PMID: 36519821 PMCID: PMC9825748 DOI: 10.1093/jncics/pkac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/19/2022] [Revised: 10/13/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
The objective of our study was to describe oral and genital human papillomavirus (HPV) infection prevalence and concordance by sexual orientation among US men using a nationally representative sample. We conducted a retrospective cross-sectional analysis of the 2013-2016 National Health and Nutrition Examination Survey. The survey conducts a physical examination and collects oral rinse and genital swab specimens; demographic and health behaviors are self-reported. We used descriptive statistics and multivariate regression models to estimate HPV infection prevalence and the likelihood of HPV infection, respectively. All analyses were adjusted for National Health and Nutrition Examination Survey design and weights, and statistical significance was tested at a 2-sided P value of less than .05. Men who have sex with men had a statistically significantly higher prevalence of oral HPV (high-risk, 9-valent, 4-valent, and HPV 16 and 18), genital HPV (9-valent, 4-valent, and HPV 16 and 18), and concordant oral and genital HPV (high-risk and 9-valent) infections compared with heterosexual men. Improved HPV prevention among men is needed.
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Affiliation(s)
- Kalyani Sonawane
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Shiang Shiuan Shyu
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX, USA
| | - Haluk Damgacioglu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Ruosha Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX, USA
| | - Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ashish A Deshmukh
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
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Zoschke IN, Bennis SL, Wilkerson JM, Stull CL, Nyitray AG, Khariwala SS, Nichols CM, Rosser BRS, Flash C, Ross MW. HPV-related oropharyngeal cancer early detection in gay and bisexual men is an "orphan" practice: A qualitative analysis among healthcare providers. Front Public Health 2023; 11:1165107. [PMID: 37151584 PMCID: PMC10162013 DOI: 10.3389/fpubh.2023.1165107] [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: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Among US men, oropharyngeal cancer (cancer of the back of the mouth and throat) is the 8th most common cancer. If detected early, human papillomavirus (HPV)-16-associated oropharyngeal cancer has a high 5-year survival rate. Risk factors such as high numbers of oral sex partners, disparities in smoking and drinking, and low rates of HPV vaccination may put gay and bisexual men at even higher risk for oropharyngeal cancer. Methods We recruited 21 healthcare providers in Minneapolis-St. Paul, Minnesota and Houston, Texas to participate in semi-structured interviews. Nurses, physician assistants, dental hygienists, and dentists were asked about their clinical experiences serving gay and bisexual men and opinions on potential interventions for the early detection of oropharyngeal cancer. Results Providers typically did not tailor health screenings and examinations for gay and bisexual men. Participants lacked confidence in their ability to effectively implement routine screening for oropharyngeal cancer. The extent to which oropharyngeal cancer screening was incorporated into clinical practice varied by specialty, and practices necessary to detect it were scattered across clinical environments. HIV- and LGBTQ-focused healthcare providers were more aware of HPV-associated oropharyngeal cancer in gay and bisexual men, and appeared readier to act and lead on this issue. Discussion Further studies should (1) evaluate protocols for oropharyngeal cancer detection; (2) identify and assess the acceptability of screening in the community; and (3) study how to best close gaps in health services for gay and bisexual men which might contribute to low early detection rates of oropharyngeal cancer.
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Affiliation(s)
- I. Niles Zoschke
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sarah L. Bennis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - J. Michael Wilkerson
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cynthia L. Stull
- Department of Primary Dental Care, Division of Dental Hygiene, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Alan G. Nyitray
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Samir S. Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, United States
| | | | - B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Charlene Flash
- Avenue 360 Health and Wellness, Houston, TX, United States
- Baylor College of Medicine, Division of Infectious Disease, Houston, TX, United States
- Tilman J. Fertitta Family College of Medicine at the University of Houston, Houston, TX, United States
| | - Michael W. Ross
- Department of Family Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Michael W. Ross
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Fujimoto K, Nyitray AG, Kuo J, Zhao J, Hwang LY, Chiao E, Giuliano AR, Schneider JA, Khanna A. Social networks, high-risk anal HPV and coinfection with HIV in young sexual minority men. Sex Transm Infect 2022; 98:557-563. [PMID: 35184046 PMCID: PMC9388701 DOI: 10.1136/sextrans-2021-055283] [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: 09/02/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Young sexual minority men (SMM) exhibit a high prevalence and incidence of high-risk genotypes of human papillomavirus (hrHPV) anal infections and a confluence of a high prevalence of HIV and rectal STIs. Social determinants of health (SDOHs) are linked to social network contexts that generate and maintain racial disparities in HIV and STIs. A network perspective was provided to advance our knowledge of drivers of genotype-specific hrHPV infection and coinfection with HIV. The study also examined whether socially connected men are infected with the same high-risk HPV genotypes and, if so, whether this tendency is conditioned on coinfection with HIV. METHODS Our sample included 136 young SMM of predominantly black race and their network members of other races and ethnicities, aged 18-29 years, who resided in Houston, Texas, USA. These participants were recruited during 2014-2016 at the baseline recruitment period by network-based peer referral, where anal exfoliated cells and named social and sexual partners were collected. Exponential random graph models were estimated to assess similarity in genotype-specific hrHPV anal infection in social connections and coinfection with HIV in consideration of the effects of similarity in sociodemographic, sexual behavioural characteristics, SDOHs and syphilis infection. RESULTS Pairs of men socially connected to each other tend to be infected with the same hrHPV genotypes of HPV-16, HPV-45 and HPV-51 or HPV-16 and/or HPV-18. The tendency of social connections between pairs of men who were infected with either HPV-16 or HPV-18 were conditioned on HIV infection. CONCLUSIONS Networked patterns of hrHPV infection could be amenable to network-based HPV prevention interventions that engage young SMM of predominantly racial minority groups who are out of HIV care and vulnerable to high-risk HPV acquisition.
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Affiliation(s)
- Kayo Fujimoto
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacky Kuo
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jing Zhao
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lu-Yu Hwang
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth Chiao
- Department of Epidemiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, Florida, USA
| | - John A Schneider
- Department of Medicine and Health Studies, University of Chicago, Chicago, Illinois, USA
| | - Aditya Khanna
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA
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Nitkowski J, Giuliano A, Ridolfi T, Chiao E, Fernandez ME, Schick V, Swartz MD, Smith JS, Schneider EA, Brzezinski B, Nyitray AG. Effect of the environment on home-based self-sampling kits for anal cancer screening. J Virol Methods 2022; 310:114616. [PMID: 36096333 PMCID: PMC9645463 DOI: 10.1016/j.jviromet.2022.114616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/27/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Anal cancer incidence has increased in Western countries in recent decades and currently there are no consensus screening guidelines. Home-based self-sampling kits might facilitate screening for anal precancer/cancer but could require travel through postal mail where they may experience extreme temperatures or long transport times. OBJECTIVE To determine the effect of the environment on specimen adequacy for HPV genotyping of a mailed home-based self-sampling anal cancer screening kit. STUDY DESIGN The Prevent Anal Cancer (PAC) Study in Milwaukee, Wisconsin recruited men who have sex with men (MSM) and transgender persons 25 years of age and older. Participants were randomized to receive a mailed self-sampling kit or attend a clinic for screening. Kits were insulated with foam and included a device to record temperature every twenty minutes. Samples were returned via mail and underwent HPV genotyping using the SPF10-LiPA25 assay which also detected human RNase P to determine specimen adequacy by qPCR. For the first 93 kits, logistic regression assessed associations between specimen inadequacy and temperature, freeze-thaw cycle, presence of fecal matter, and number of days in an uncontrolled environment. RESULTS Most specimens (92.5%) were adequate for HPV genotyping. Specimen inadequacy was not associated with temperature, freeze-thaw cycle, or transit time. Fecal matter was present more often in inadequate (71.4%) compared to adequate specimens (16.3%) (p = .004). CONCLUSIONS These real-world data from mailed home-based anal self-sampling kits found that environmental conditions did not affect specimen adequacy. While over 90% of specimens were adequate, presence of fecal matter predicted specimen inadequacy.
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Affiliation(s)
- Jenna Nitkowski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA,Correspondence to: 2071 N. Summit Ave., Milwaukee, WI 53202, USA., (J. Nitkowski)
| | - Anna Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Tim Ridolfi
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Maria E. Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Jennifer S. Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ellen A. Schneider
- Department of Pathology, MCW Tissue Bank, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alan G. Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA,Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Nyitray AG, Quinn KG, John SA, Walsh JL, Schim van der Loeff MF, Wu R, Eastwood D, McAuliffe TL. Sexually Transmitted Infections Diagnosed Among Sexual and Gender Minority Communities During the First 11 Months of the COVID-19 Pandemic in Midwest and Southern Cities in the United States. Sex Transm Dis 2022; 49:687-694. [PMID: 35858473 PMCID: PMC9477706 DOI: 10.1097/olq.0000000000001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected sexual health services. Given the burden of sexually transmitted infections (STIs) on sexual and gender minorities (SGMs), we estimated incidence of self-reported STI diagnoses and factors associated with STI diagnoses among SGMs during the pandemic's first year. METHODS A cohort of 426 SGM persons, 25 years or older, recruited in Chicago, Milwaukee, Detroit, Minneapolis, and Houston completed 5 online surveys from April 2020 to February 2021. Persons self-reported on each survey all health care provider STI diagnoses. Kaplan-Meier was used to estimate the cumulative risk of STI diagnoses, stratified by human immunodeficiency virus (HIV) status. Factors associated with STI diagnoses were assessed with a longitudinal negative binomial regression. RESULTS Median age was 37 years, and 27.0% were persons living with HIV (PLH). Participants reported 63 STIs for a cumulative incidence for PLH and HIV-negative persons of 0.19 (95% confidence interval [CI], 0.13-0.29) and 0.12 (95% CI, 0.09-0.17), respectively. Regardless of HIV, a younger age and changes in health care use were associated with STI diagnoses. Among HIV-negative persons, the rate of STI diagnoses was higher in Houston than the Midwest cities (adjusted relative risk, 2.37; 95% CI, 1.08-5.20). Among PLH, a decrease in health care use was also associated with STI diagnoses (adjusted relative risk, 3.53; 95% CI, 1.01-12.32 vs no change in health care services), as was Hispanic ethnicity and using a dating app to meet a sex partner. CONCLUSIONS Factors associated with STI diagnoses during the COVID-19 pandemic generally reflected factors associated with STI incidence before the pandemic like geography, HIV, age, and ethnicity.
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Affiliation(s)
- Alan G. Nyitray
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Katherine G. Quinn
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Steven A. John
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Jennifer L. Walsh
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Maarten F. Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Institute for Infection and Immunity
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ruizhe Wu
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Daniel Eastwood
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy L. McAuliffe
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
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Umutoni V, Schabath MB, Nyitray AG, Wilkin TJ, Villa LL, Lazcano-Ponce E, Giuliano AR, Sudenga SL. The Association between Smoking and Anal Human Papillomavirus in the HPV Infection in Men Study. Cancer Epidemiol Biomarkers Prev 2022; 31:1546-1553. [PMID: 35653709 PMCID: PMC9350906 DOI: 10.1158/1055-9965.epi-21-1373] [Citation(s) in RCA: 2] [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: 11/30/2021] [Revised: 03/24/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Previous studies show an association between smoking and anal cancer. The objective of this study was to assess the association between smoking and anal HPV (human papillomavirus) prevalence, incidence, and persistence in men. METHODS The HPV Infection in Men (HIM) Study is a multinational study that enrolled HIV-negative men. At baseline and follow-up visits, anal specimens were collected. HPV genotyping was assessed by linear array. Prevalence ratios (PR) were used to assess the association between smoking and anal HPV prevalence. Odds ratios (OR) were used to assess the association between smoking and anal HPV incidence and ≥12-months persistence. RESULTS Current smokers have a higher prevalence [adjusted PR (aPR), 1.36; 95% confidence interval (CI), 1.06-1.73) and incidence [adjusted OR (aOR), 1.74; 95% CI, 1.26-2.39] and ≥12-months persistence (aOR, 1.67; 95% CI, 1.19-2.33) of any anal HPV compared with never smokers. There were no differences in the prevalence, incidence, or persistence of anal HPV between former and never smokers. Smoking status was not associated with the prevalence or persistence of anal HPV among men who have sex with men but was associated with higher incidence of HR-HPV. Among men that have sex with women (MSW), current smokers had an increased prevalence and incidence of LR-HPV compared with never smokers. CONCLUSIONS Current smokers had a higher prevalence, persistence, and incidence of HPV compared with never smokers. Further research is needed to assess the role smoking in anal HPV persistence and progression to disease. IMPACT Prevention initiatives should raise awareness about smoking and the risk factor of anal HPV infection and anal cancer.
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Affiliation(s)
- Victoria Umutoni
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew B. Schabath
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Alan G. Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Luisa L. Villa
- School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Anna R. Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Staci L. Sudenga
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Corresponding Author: Staci L. Sudenga, Ph.D., Vanderbilt University Medical Center, 2525 West End Ave, Suite 800, Nashville, TN 37203, Telephone: 615-343-0953,
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Nyitray AG, Masunaga KIA, Nyoni J, Ross MW. Prevalence of and factors associated with anal high-risk human papillomavirus in urban Tanzanian men who have sex with men, 2011-2012. Int J STD AIDS 2022; 33:672-679. [PMID: 35531601 PMCID: PMC9189599 DOI: 10.1177/09564624221094456] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Anal cancer is primarily caused by high-risk human papillomavirus (hrHPV), is associated with HIV infection, and has a very high incidence among men who have sex with men (MSM). We assessed prevalence of hrHPV, and factors associated with hrHPV in anal canal specimens collected in Dar es Salaam, Tanzania from HIV-positive and HIV-negative MSM. Methods: MSM were recruited using respondent-driven sampling in this cross-sectional study. The primary outcome in this ancillary analysis of 116 MSM was prevalence of HPV-16 and other hrHPV types. Prevalence ratios (PR) estimated the association between hrHPV and HIV-negative participants' demographics, sexual behaviour and sexually transmitted infections. Results: Median age was 23 years and 33.6% of participants were HIV-positive. HrHPV and HPV-16 prevalence was 54.3% and 17.2%, respectively, with HPV-16 prevalence highest among HIV-positive MSM identifying as gay (36.1%) and lowest among HIV-negative MSM identifying as bisexual (2.9%). Having two or more receptive anal sex partners in the past month was associated with hrHPV (PR 3.20, 95%CI 1.69-6.07, vs. 0 partners) among HIV-negative MSM.Conclusions: HrHPV prevalence was high among MSM in Dar es Salaam and highest among HIV-positive MSM identifying as gay. These estimates may be used to support HPV vaccination and screening initiatives.
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Affiliation(s)
- Alan G Nyitray
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioural Medicine, 5506Medical College of Wisconsin, Milwaukee, WI, USA.,Clinical Cancer Center, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ka Imi Aina Masunaga
- Department of Developmental and Surgical Sciences, 12269University of Minnesota Physicians, Minnesota Children's Hospital, MN, USA
| | - Joyce Nyoni
- Department of Sociology and Anthropology, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Michael W Ross
- Program in Human Sexuality, Department of Family Medicine, 12269University of Minnesota Medical School, Minneapolis, MN, USA
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Gonçalves MG, Ferreira MT, Lopéz RVM, Ferreira S, Sirak B, Baggio ML, Lazcano-Ponce E, Nyitray AG, Giuliano AR, Villa LL, Sichero L. Prevalence and persistence of HPV-16 molecular variants in the anal canal of men: The HIM Study. J Clin Virol 2022; 149:105128. [DOI: 10.1016/j.jcv.2022.105128] [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] [Received: 12/16/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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Portillo-Romero AJ, Allen-Leigh B, Nyitray AG, Carnalla M, Salmerón J, León-Maldonado L, Yunes E, Rivera L, Magis-Rodríguez C, Vargas G, Giuliano AR, Esquivel-Ocampo EA, Lazcano-Ponce E. Sex Work and High-Risk Anal Human Papillomavirus Infection Among Transgender Women: The Condesa Study. Transgend Health 2022; 6:315-324. [PMID: 34993304 DOI: 10.1089/trgh.2020.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The prevalence of high-risk human papillomavirus (hrHPV) infection among transgender women has been reported to be very high and sexually transmitted infection (STI) prevention strategies have focused on transgender women who engage in sex work. The purpose of our study was to describe hrHPV infection prevalence among a group of transgender women and to explore the differences according to sex work history (SW). Methods: The Condesa Study, an HPV vaccine, and screening study, recruited 207 transgender women without previous HPV vaccination, ages 18-60, from two clinics in Mexico City that provide HIV and transgender health care (May 2018-December 2019). At enrollment, they completed a questionnaire on sociodemographic and sexual behavior data. The hrHPV DNA genotyping was done on self-collected anal samples. Factors associated with hrHPV, stratified by presence or absence of SW, were assessed with multiple logistic regression. Results: A total of 43.5% of participants reported a history of SW. Anal hrHPV prevalence was 62.0% among participants with a history of SW and 52.0% among those without. Overall, 1 in 4 (26.6%) participants were living with HIV. Independent risk factors associated with hrHPV among transgender women with a history of SW were younger age, younger age at first anal intercourse (15-17 years), and greater number of sexual partners in the last 3 months. Among transgender women who had not done SW, greater number of sexual partners in the last 3 months and self-reported STIs were associated with hrHPV. Conclusions: Prevalence of anal infection with hrHPV was high among transgender women. Our results support that other sexual behaviors different from participating in SW contribute to the high prevalence of HPV and that there is an urgent need to include all transgender women in prevention programs for HPV and associated cancers, regardless of SW.
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Affiliation(s)
| | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alan G Nyitray
- Clinical Cancer Center, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Martha Carnalla
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Jorge Salmerón
- Center for Research in Policy, Population and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Leith León-Maldonado
- National Council of Science and Technology (CONACYT)-National Institute of Public Health, Cuernavaca, Mexico
| | - Elsa Yunes
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Leonor Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Galileo Vargas
- Center for the Prevention and Comprehensive Care of HIV/AIDS in Mexico City, Condesa Clinic, Mexico City, Mexico
| | - Anna R Giuliano
- Center for Infection in Cancer Research, Moffitt Cancer Center, Tampa, Florida, USA
| | - Eiberth A Esquivel-Ocampo
- Coloproctology Unit of General Hospital of Cuernavaca, "Dr. José G. Parres," Cuernavaca, Morelos, México
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Sudenga SL, Lotspeich SC, Nyitray AG, Sirak B, Shepherd BE, Messina J, Sereday KA, Silva RC, Abrahamsen M, Baggio ML, Quiterio M, Lazcano-Ponce E, Villa L, Giuliano AR. The Role of External Genital Lesions in Human Immunodeficiency Virus Seroconversion Among Men Participating in a Multinational Study. Sex Transm Dis 2022; 49:55-58. [PMID: 34282740 PMCID: PMC8722569 DOI: 10.1097/olq.0000000000001516] [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] [Indexed: 01/03/2023]
Abstract
BACKGROUND Studies in women have shown an increased risk of human immunodeficiency virus (HIV) acquisition with prior human papilloma virus (HPV) infection; however, few studies have been conducted among men. Our objective was to assess whether HPV-related external genital lesions (EGLs) increase risk of HIV seroconversion among men. METHODS A total of 1379 HIV-negative men aged 18 to 70 years from the United States, Mexico, and Brazil were followed for up to 7 years and underwent clinical examination for EGLs and blood draws every 6 months. Human immunodeficiency virus seroconversion was assessed in archived serum. Cox proportional hazards and marginal structural models assessed the association between EGL status and time to HIV seroconversion. RESULTS Twenty-nine participants HIV seroconverted during follow-up. Older age was associated with a lower hazard of HIV seroconversion. We found no significant difference in the risk of HIV seroconversion between men with and without EGLs (adjusted hazard ratio, 0.94; 95% confidence interval, 0.32-2.74). Stratified analyses focusing on men that have sex with men found no association between EGLs and HIV seroconversion risk (hazards ratio, 0.63; 95% confidence interval, 0.00-1.86). CONCLUSIONS External genital lesions were not associated with higher risk for HIV seroconversion in this multinational population, although statistical power was limited as there were few HIV seroconversions. Results may differ in populations at higher risk for HIV.
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Affiliation(s)
- Staci L. Sudenga
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah C. Lotspeich
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan G. Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jane Messina
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Karen A. Sereday
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Roberto Carvalho Silva
- Centro de Referência e Treinamento DST/AIDS and Centro Universitário FAM, São Paulo, Brazil
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Maria Luiza Baggio
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Luisa Villa
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Wei F, Gaisa MM, D'Souza G, Xia N, Giuliano AR, Hawes SE, Gao L, Cheng SH, Donà MG, Goldstone SE, Schim van der Loeff MF, Neukam K, Meites E, Poynten IM, Dai J, Combes JD, Wieland U, Burgos J, Wilkin TJ, Hernandez AL, Iribarren Díaz M, Hidalgo-Tenorio C, Valencia Arredondo M, Nyitray AG, Wentzensen N, Chow EP, Smelov V, Nowak RG, Phanuphak N, Woo YL, Choi Y, Hu Y, Schofield AM, Woestenberg PJ, Chikandiwa AT, Hickey AC, de Pokomandy A, Murenzi G, Péré H, Del Pino M, Ortiz AP, Charnot-Katsikas A, Liu X, Chariyalertsak S, Strong C, Ong JJ, Yunihastuti E, Etienney I, Ferré VM, Zou H, Segondy M, Chinyowa S, Alberts CJ, Clifford GM. Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies. Lancet HIV 2021; 8:e531-e543. [PMID: 34339628 PMCID: PMC8408042 DOI: 10.1016/s2352-3018(21)00108-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robust age-specific estimates of anal human papillomavirus (HPV) and high-grade squamous intraepithelial lesions (HSIL) in men can inform anal cancer prevention efforts. We aimed to evaluate the age-specific prevalence of anal HPV, HSIL, and their combination, in men, stratified by HIV status and sexuality. METHODS We did a systematic review for studies on anal HPV infection in men and a pooled analysis of individual-level data from eligible studies across four groups: HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive men who have sex with women (MSW), and HIV-negative MSW. Studies were required to inform on type-specific HPV infection (at least HPV16), detected by use of a PCR-based test from anal swabs, HIV status, sexuality (MSM, including those who have sex with men only or also with women, or MSW), and age. Authors of eligible studies with a sample size of 200 participants or more were invited to share deidentified individual-level data on the above four variables. Authors of studies including 40 or more HIV-positive MSW or 40 or more men from Africa (irrespective of HIV status and sexuality) were also invited to share these data. Pooled estimates of anal high-risk HPV (HR-HPV, including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68), and HSIL or worse (HSIL+), were compared by use of adjusted prevalence ratios (aPRs) from generalised linear models. FINDINGS The systematic review identified 93 eligible studies, of which 64 contributed data on 29 900 men to the pooled analysis. Among HIV-negative MSW anal HPV16 prevalence was 1·8% (91 of 5190) and HR-HPV prevalence was 6·9% (345 of 5003); among HIV-positive MSW the prevalences were 8·7% (59 of 682) and 26·9% (179 of 666); among HIV-negative MSM they were 13·7% (1455 of 10 617) and 41·2% (3798 of 9215), and among HIV-positive MSM 28·5% (3819 of 13 411) and 74·3% (8765 of 11 803). In HIV-positive MSM, HPV16 prevalence was 5·6% (two of 36) among those age 15-18 years and 28·8% (141 of 490) among those age 23-24 years (ptrend=0·0091); prevalence was 31·7% (1057 of 3337) among those age 25-34 years and 22·8% (451 of 1979) among those age 55 and older (ptrend<0·0001). HPV16 prevalence in HIV-negative MSM was 6·7% (15 of 223) among those age 15-18 and 13·9% (166 of 1192) among those age 23-24 years (ptrend=0·0076); the prevalence plateaued thereafter (ptrend=0·72). Similar age-specific patterns were observed for HR-HPV. No significant differences for HPV16 or HR-HPV were found by age for either HIV-positive or HIV-negative MSW. HSIL+ detection ranged from 7·5% (12 of 160) to 54·5% (61 of 112) in HIV-positive MSM; after adjustment for heterogeneity, HIV was a significant predictor of HSIL+ (aPR 1·54, 95% CI 1·36-1·73), HPV16-positive HSIL+ (1·66, 1·36-2·03), and HSIL+ in HPV16-positive MSM (1·19, 1·04-1·37). Among HPV16-positive MSM, HSIL+ prevalence increased with age. INTERPRETATION High anal HPV prevalence among young HIV-positive and HIV-negative MSM highlights the benefits of gender-neutral HPV vaccination before sexual activity over catch-up vaccination. HIV-positive MSM are a priority for anal cancer screening research and initiatives targeting HPV16-positive HSIL+. FUNDING International Agency for Research on Cancer.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Michael M Gaisa
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Stephen E Hawes
- Department of Epidemiology, Department of Health Services, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Maria Gabriella Donà
- Sexually Transmitted Infections/HIV Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Stephen E Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Department of Internal Medicine, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Medicina Preventiva, UCEIMP, Instituto de Biomedicina de Sevilla, CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Elissa Meites
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - I Mary Poynten
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Xinjiang, Urumqi, China
| | - Jean-Damien Combes
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Ulrike Wieland
- Institute of Virology, University of Cologne, National Reference Center for Papilloma and Polyomaviruses, Cologne, Germany
| | - Joaquin Burgos
- Department of infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Timothy J Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra L Hernandez
- Department of Medicine, University of California, San Francisco, CA, USA; Public Health Program, College of Education and Health Sciences, Touro University, Vallejo, CA, USA
| | - Mauricio Iribarren Díaz
- Department of Surgery, Complexo Hospitalario Universitario de Vigo-Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Carmen Hidalgo-Tenorio
- Infectious Disease Unit, Biosanitary Research Institute Granada, University Hospital Virgen de las Nieves, Granada, Spain
| | - Marleny Valencia Arredondo
- Universidad de Antioquia, Escuela de Microbiología, Grupo de investigación Salud Sexual y Cáncer, Medellín, Antioquia, Colombia
| | - Alan G Nyitray
- Clinical Cancer Center and Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Eric Pf Chow
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Vitaly Smelov
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France; Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand; Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| | - Yin Ling Woo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yoojin Choi
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Yifei Hu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China
| | - Alice M Schofield
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Admire T Chikandiwa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew C Hickey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Gad Murenzi
- Rwanda Military Hospital and Research for Development Rwanda, Kigali, Rwanda
| | - Hélène Péré
- Assistance Publique Hôpitaux de Paris-Centre, Service de Microbiologie (Unité de virologie), Hôpital Européen Georges Pompidou, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Functional Genomics of Solid Tumors Laboratory, Equipe Labellisée Ligue Nationale contre le Cancer, Labex OncoImmunology, Paris, France
| | - Marta Del Pino
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Gynecology Oncology Unit, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Medicine Faculty, Barcelona University, Barcelona, Spain
| | - Ana P Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA; Graduate School of Public Health, University of Puerto Rico, San Juan, PR, USA
| | - Angella Charnot-Katsikas
- Department of Pathology, The University of Chicago, Chicago, IL, USA; MolDx Program, Palmetto GBA, Columbia, SC, USA
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Suwat Chariyalertsak
- Faculty of Public Health, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Evy Yunihastuti
- Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Valentine M Ferré
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Service de Virologie, Hôpital Bichat, Paris, France; Decision Science in Infectious Disease Prevention, Control and Care, INSERM, Université de Paris, Paris, France
| | - Huachun Zou
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, China; Melbourne Sexual Health Centre, Sydney, NSW, Australia
| | - Michel Segondy
- Pathogenesis and Control of Chronic Infections, INSERM, CHU, University of Montpellier, Montpellier, France
| | - Simbarashe Chinyowa
- Department of Surgery, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
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Nyitray AG, Schick V, Swartz MD, Giuliano AR, Fernandez ME, Deshmukh AA, Ridolfi TJ, Ajala C, Brzezinski B, Sandoval M, Nedjai B, Smith JS, Chiao EY. Rationale and design of the Prevent Anal Cancer Self-Swab Study: a protocol for a randomised clinical trial of home-based self-collection of cells for anal cancer screening. BMJ Open 2021; 11:e051118. [PMID: 34187833 PMCID: PMC8245463 DOI: 10.1136/bmjopen-2021-051118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Squamous cell carcinoma of the anus is a common cancer among sexual minority men, especially HIV-positive sexual minority men; however, there is no evidenced-based national screening protocol for detection of anal precancers. Our objective is to determine compliance with annual anal canal self-sampling or clinician-sampling for human papillomavirus (HPV) DNA. METHODS AND ANALYSIS This is a prospective, randomised, two-arm clinical study to evaluate compliance with annual home-based versus clinic-based HPV DNA screening of anal canal exfoliated cells. The setting is primary care community-based clinics. Recruitment is ongoing for 400 HIV-positive and HIV-negative sexual minority men and transgender persons, aged >25 years, English or Spanish speaking, no current use of anticoagulants other than nonsteroidal anti-inflammatory drugs and no prior diagnosis of anal cancer. Participants are randomised to either receive a swab in the mail for home-based collection of an anal canal specimen at 0 and 12 months (arm 1) or attend a clinic for clinician collection of an anal canal specimen at 0 and 12 months (arm 2). Persons will receive clinic-based Digital Anal Rectal Examinations and high-resolution anoscopy-directed biopsy to assess precancerous lesions, stratified by study arm. Anal exfoliated cells collected in the study are assessed for high-risk HPV persistence and host/viral methylation. The primary analysis will use the intention-to-treat principle to compare the proportion of those who comply with 0-month and 12-month sampling in the home-based and clinic-based arms. The a priori hypothesis is that a majority of persons will comply with annual screening with increased compliance among persons in the home-based arm versus clinic-based arm. ETHICS AND DISSEMINATION The study has been approved by the Medical College of Wisconsin Human Protections Committee. Results will be disseminated to communities where recruitment occurred and through peer-reviewed literature and conferences. TRIAL REGISTRATION NUMBER NCT03489707.
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Affiliation(s)
- Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vanessa Schick
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Insitute, Tampa, Florida, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Timothy J Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher Ajala
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Micaela Sandoval
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Belinda Nedjai
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Jennifer S Smith
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Elizabeth Y Chiao
- Department Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Deshmukh AA, Suk R, Shiels MS, Sonawane K, Nyitray AG, Liu Y, Gaisa MM, Palefsky JM, Sigel K. Recent Trends in Squamous Cell Carcinoma of the Anus Incidence and Mortality in the United States, 2001-2015. J Natl Cancer Inst 2021; 112:829-838. [PMID: 31742639 DOI: 10.1093/jnci/djz219] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [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: 08/19/2019] [Revised: 10/03/2019] [Accepted: 10/31/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Squamous cell carcinoma of the anus (SCCA) incidence is rising in the United States. Study of incidence trends by stage at diagnosis, age-specific and birth cohort patterns, and trends in mortality could provide evidence for a true increase and etiological clues for the increase in incidence. METHODS Using the US Cancer Statistics dataset, we examined trends in SCCA incidence (2001-2015) and mortality (2001-2016) rates. Join-point regression was used to compute annual and average annual percentage change (AAPC). Incidence patterns by 5-year age group and birth cohort were evaluated using incidence rate ratios (IRRs) and age-period-cohort modeling. RESULTS SCCA incidence increased 2.7% per year (95% confidence interval [CI] = 2.1% to 3.3%), with pronounced increases in age groups 50 years and older. Distant-stage SCCA incidence tripled (AAPC = 8.6%, 95% CI = 5.4% to 12.0%, among men and AAPC = 7.5%, 95% CI = 4.8% to 10.2%, among women) and regional-stage SCCA incidence nearly doubled (AAPC = 4.7% for men and women) in both sexes; the AAPC for localized stage was 1.3% (95% CI = 0.6% to 2.0%) in men and 2.3% (95% CI = 1.8% to 2.8%) in women. Compared with adults born circa 1946, recently born black men (born circa 1986) had a nearly fivefold higher risk (IRR = 4.7, 95% CI = 2.1 to 10.2) of SCCA, and the risk doubled among white men (IRR = 2.0, 95% CI = 1.7 to 2.2) and white women (IRR = 2.1, 95% CI = 1.9 to 2.3) born after circa 1960. Anal cancer mortality rates increased 3.1% per year (95% CI = 2.6% to 3.5%) with statistically significant increases in age groups 50 years and older. SCCA incidence-based mortality increased 1.9% annually (95% CI = 0.5% to 3.4%), with a notable (4.9%, 95% CI = 2.4% to 7.3%, per year) rise in adults ages 60-69 years. CONCLUSION The increase in SCCA incidence, particularly advanced-stage disease, and a similar increase in mortality suggest a true increase in the occurrence of SCCA. Future research and improved prevention are urgently needed to mitigate the increasing disease burden.
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Affiliation(s)
| | - Ryan Suk
- Center for Health Services Research and Center for Healthcare Data
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Kalyani Sonawane
- Center for Health Services Research and Center for Healthcare Data
| | - Alan G Nyitray
- Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
- Clinical Cancer Center/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | | | - Michael M Gaisa
- Department of Pathology (YL) and Division of Infectious Diseases, Department of Medicine
| | - Joel M Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Keith Sigel
- Department of General Internal Medicine, Department of Medicine (KSi), Mt. Sinai Icahn School of Medicine, New York, NY
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Abstract
As communities struggle with how to cope with the health and social consequences of coronavirus disease 2019 (COVID-19), sexual and gender minority men living with or affected by the HIV/AIDS epidemic have important insights into how to cope with uncertainty, public health protocols, and grief. We recruited sexual and gender minority men using online networking apps from April 18-24, 2020 to enroll a longitudinal cohort. We analyzed baseline qualitative data from open-ended responses using content analysis to examine how the HIV/AIDS epidemic has helped sexual minority men with the current COVID-19 pandemic. Of the 437 participants who completed the survey, 155 (35%) indicated that HIV/AIDS had helped them cope with COVID-19. Free-response data from those 135 of those participants clustered around four themes: (1) experience having lived through a pandemic, (2) experience coping with stigma, (3) familiarity with public health protocols, and (4) belief in collective action. Based on the experiences of these men, public health approaches centered on resilience and collective action could be particularly helpful in responding and coping with COVID-19-especially if the pandemic persists over longer periods of time.
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Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53208, USA.
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53208, USA
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53208, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53208, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Abstract
OBJECTIVE The purpose of this study was to assess knowledge of human papillomavirus (HPV) as a cause of anal cancer among at-risk gay, bisexual, and other men who have sex with men (GBM). MATERIALS AND METHODS Secondary analysis was conducted of cross-sectional data from 3 cycles of the Health Information National Trends Survey (2017, 2018, 2019). Results were reported for the subset of adults who identified as GBM (N = 212). Knowledge that HPV can cause anal cancer was the main outcome. Differences in knowledge were evaluated (using χ2 and multiple logistic regression) by demographic, health information factors, and access to care. RESULTS Sixty-eight percent of GBM were aware of HPV. Knowledge that HPV causes anal cancer was low (<20%) in the overall sample and sample of GBM (17.9%; 95% CI = 11.0-24.7). Gay, bisexual, and other men who have sex with men were no more knowledgeable that HPV causes anal cancer than heterosexual men (14.8%; 95% CI = 12.9-16.9; p = .376). College-educated GBM had higher odds (adjusted odds ratio = 3.50; 95% CI = 1.02-11.97) of knowing HPV causes anal cancer than GBM with no college degree. No other factors were associated with knowledge. CONCLUSIONS Gay, bisexual, and other men who have sex with men are largely unaware that HPV can cause anal cancer, despite high awareness of HPV itself. This is concerning given that GBM are at increased risk of HPV-associated anal cancer than the general population. Our findings suggest that information about anal cancer and health information about the benefits of HPV vaccination for anal cancer prevention are only reaching a small subset of college-educated GBM. Targeted anal cancer education programs are needed.
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Affiliation(s)
- Christopher W Wheldon
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA
| | | | - Jessica Y Islam
- University of North Carolina Chapel Hill Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Ashish A Deshmukh
- Center for Health Services Research, UT Health School of Public Health, Houston, TX
| | - Alan G Nyitray
- Clinical Cancer Center/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
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Nyitray AG. Abstract IA10: The Prevent Anal Cancer Study: the assessment of novel opportunities for anal cancer screening during COVID-19. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-ia10] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Cervical cancer screening began 70 years ago in high-resource settings and it has substantially lowered cervical cancer incidence in those settings; even so, incidence remains very high in many low and middle-income settings. As screening for other human papillomavirus-associated cancers is considered, self-screening approaches may lower some barriers to screening including cost, reluctance to access clinics, and examination embarrassment. The Prevent Anal Cancer (PAC) Study is recruiting men who have sex with men (MSM) and transgender people who have sex with men, aged ≥25 years in three cities in the United States (Chicago, Houston, and Milwaukee) to test anal self-exams and compliance with home-based self-swabbing. The PAC Study is comprised of two randomized clinical trials: NCT03489707 and NCT04090060. It is recruiting 1200 HIV+ and HIV- persons through 2023: 400 in Milwaukee to test home-based self-swabbing and 400 each in Chicago and Houston to test anal self-exams (ASEs). The Milwaukee cohort will evaluate compliance with annual home-based self-swabbing vs clinic-based HPV DNA specimen collection and determine factors associated with annual screening compliance; estimate the influence that home-based vs clinic-based screening has on the uptake of high-resolution anoscopy; estimate the association between high-risk HPV persistence and anal high-grade squamous intraepithelial lesions (HSIL); and estimate the association between HPV-16/host DNA methylation and anal HSIL. The Chicago/Houston cohort will be taught about anal anatomy, pathology, and the procedure for an ASE. The primary objective is to compare the participant’s ASE result with the clinician’s gold-standard Digital Anal Rectal Exam (DARE) to determine concordance, sensitivity and specificity. A secondary objective uses mathematical modeling to estimate the cost-effectiveness, impact on survival and health-related quality-of-life of ASE and DARE. Enrollment in both studies was suspended due to COVID-19. Due to concerns about potential COVID-19-related confounding of key associations, a 437-person online cohort of the same target populations was enrolled to assess COVID-19 impact over 5 longitudinal surveys. This presentation will provide an overview of anal cancer incidence, the PAC Study protocols, how COVID-19 may impact the studies’ results, and data collected to date to assess that impact. This study is supported by grants from the National Cancer Institute, National Institutes of Health (US).
Citation Format: Alan G. Nyitray. The Prevent Anal Cancer Study: the assessment of novel opportunities for anal cancer screening during COVID-19 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA10.
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Deshmukh AA, Suk R, Shiels MS, Damgacioglu H, Lin YY, Stier EA, Nyitray AG, Chiao EY, Nemutlu GS, Chhatwal J, Schmeler K, Sigel K, Sonawane K. Incidence Trends and Burden of Human Papillomavirus-Associated Cancers Among Women in the United States, 2001-2017. J Natl Cancer Inst 2020; 113:792-796. [PMID: 32833021 DOI: 10.1093/jnci/djaa128] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023] Open
Abstract
Human papillomavirus (HPV)-associated anal and oropharyngeal cancer incidence has increased in recent years among US women. However, trends in incidence and burden (annual number of cases) of noncervical HPV-associated cancers relative to cervical cancer remain unclear. Using the 2001-2017 US cancer statistics dataset, we evaluated contemporary incidence trends and burden (annual number of cases) of HPV-associated cancers among women by anatomic site, race or ethnicity, and age. Overall, cervical cancer incidence plateaued among White women but continued to decline among Black and Hispanic women. Anal cancer incidence surpassed cervical cancer incidence among White women aged 65-74 years of age (8.6 and 8.2 per 100 000 in 2015) and 75 years or older (6.2 and 6.0 per 100 000 in 2014). The noncervical cancer burden (n = 11 871) surpassed the cervical cancer burden (n = 11 527) in 2013. Development of efficacious screening strategies for noncervical cancers and continued improvement in cervical cancer prevention are needed to combat HPV-associated cancers among women.
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Affiliation(s)
- Ashish A Deshmukh
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Ryan Suk
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Haluk Damgacioglu
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Yueh-Yun Lin
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
| | - Elizabeth A Stier
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Alan G Nyitray
- Clinical Cancer Center/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth Y Chiao
- Department of General Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Gizem S Nemutlu
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Kathleen Schmeler
- Department of Gynecological Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Keith Sigel
- Department of General Internal Medicine, Mt. Sinai Icahn School of Medicine, New York, NY, USA.,Department of Medicine, Mt. Sinai Icahn School of Medicine, New York, NY, USA
| | - Kalyani Sonawane
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA.,Center for Healthcare Data, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, USA
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Zhang X, Pang L, Sharma SV, Li R, Nyitray AG, Edwards BJ. Malnutrition and overall survival in older patients with cancer. Clin Nutr 2020; 40:966-977. [PMID: 32665101 DOI: 10.1016/j.clnu.2020.06.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/24/2019] [Revised: 04/15/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS In this study, we assessed the prevalence of malnutrition and its association with overall survival among patients with cancer aged 65 years and older. METHODS In this retrospective cohort study, patients receiving cancer care underwent a comprehensive geriatric assessment (CGA). Malnutrition status was determined through the CGA. We used univariate and multivariable Cox regression survival analyses to assess the association between baseline malnutrition and survival. RESULTS A total of 454 patients with cancers were included in the analysis. The median age was 78 years and men and women were equally represented. Forty-two percent (n = 190) were malnourished at baseline, and 33% died during the follow-up (range 0.2-51.1 month). Univariate analysis showed that malnutrition increased the risk of all-cause mortality in older patients with cancer (HR, 1.49; 95% CI, 1.08-2.05; p = 0.01). In the multivariate Cox regression model, malnutrition increased the risk of all-cause mortality (HR, 1.87; 95% CI, 1.10-3.17; p = 0.02) in older patients with solid tumors. However, malnutrition did not increase the risk of all-cause mortality for hematologic malignancies. CONCLUSIONS In our study, we found that malnutrition was a risk factor for mortality in older cancer patients, especially in older patients with solid tumors. Prospective inter ventional studies are recommended.
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Affiliation(s)
- Xiaotao Zhang
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, USA; Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas, Health Science Center at Houston, USA
| | - Linda Pang
- General Internal Medicine, University of Texas, MD Anderson Cancer Center, USA
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas, Health Science Center at Houston, USA
| | - Ruosha Li
- Department of Biostatistics and Data Science, University of Texas, Health Science Center at Houston, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin Cancer Center, USA
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Hicks JT, Hwang LY, Baraniuk S, White M, Chiao EY, Onwuka N, Ross MW, Nyitray AG. Factors associated with self-reported anal cancer screening history in men who have sex with men. Sex Health 2020; 16:96-98. [PMID: 30517839 DOI: 10.1071/sh18039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/31/2018] [Indexed: 11/23/2022]
Abstract
Background Men who have sex with men (MSM) are at greater risk of developing anal cancer caused by human papillomavirus (HPV) than the rest of the general population. Currently, there are no formal national guidelines in the US advising men how and when to get anal cancer screening. We sought to assess differences in demographics, familiarity and anxiety about anal cancer among men who report having had anal cancer screening (i.e. anal cytology and/or a digital anorectal examination (DARE)). METHODS MSM were recruited to participate in a study to assess the feasibility of teaching self and partner anal examinations as a means of screening for anal cancer. Data for this secondary analysis were obtained using a written pre-test and a computer-assisted self-interview. Factors associated with screening were assessed with multivariable logistic regression to allow calculation of adjusted odds ratios (aORs). RESULTS Of the 197 participants with data, 145 (73.6%) reported having had anal cancer screening (either anal cytology, DARE or both) during their lifetime. Men who were younger, Black and HIV-negative were associated with decreased odds of reporting any type of anal cancer screening. For example, compared with White men, Black men were 80% less likely to report screening (aOR 0.2; 95% confidence interval (CI) 0.1-0.5). Self-perception of anal cancer knowledge was not associated with screening in multivariable analysis (aOR 1.6; 95% CI 0.6-3.9). CONCLUSIONS Age, race and HIV status were independently associated with a history of anal cancer screening.
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Affiliation(s)
- Joseph T Hicks
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, 501 D.W. Brooks Drive, Athens, GA 30602, USA
| | - Lu-Yu Hwang
- Center for Infectious Diseases, Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health at Houston, 1200 Pressler Street, Houston, TX 77030, USA
| | - Sarah Baraniuk
- Coordinating Center for Clinical Trials, Department of Biostatistics, The University of Texas School of Public Health at Houston, 1200 Pressler Street, Houston, TX 77030, USA
| | - Margaret White
- Gordon E. Crofoot MD, PA, 3701 Kirby Drive, Suite 1230, Houston, TX 77098, USA
| | - Elizabeth Y Chiao
- Department of Internal Medicine, Baylor College of Medicine, 6620 Main Street, Houston, TX 77030, USA
| | - Nkechi Onwuka
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health at Houston, 1200 Pressler Street, Houston, TX 77030, USA
| | - Michael W Ross
- University of Minnesota, Program in Human Sexuality, 1300 South 2nd Street, Suite 180, Minneapolis, MN 55454, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Shewale JB, Corsini EM, Correa AM, Brown EL, Leon-Novelo LG, Nyitray AG, Antonoff MB, Hofstetter WL, Mehran RJ, Rice DC, Roth J, Walsh GL, Vaporciyan AA, Swisher SG, Sepesi B. Time trends and predictors of survival in surgically resected early-stage non-small cell lung cancer patients. J Surg Oncol 2020; 122:495-505. [PMID: 32356321 DOI: 10.1002/jso.25966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/11/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND The improvement in the management of lung cancer have the potential to improve survival in patients undergoing resection for early-stage (stage I and II) non-small cell lung cancer (NSCLC), but few studies have evaluated time trends and identified predictors of overall survival (OS). METHODS We identified surgically resected early-stage NSCLC between 1998 and 2016. The 3-year OS (1998-2014) and 5-year OS (1998-2012) rates were calculated for each year. Joinpoint regression was used to calculate annual percentage changes (APC) and to test time trends in OS. Multivariable Cox regression was used to identify predictors of OS. RESULTS There was a significant upward trend in the 3-year (1998, 56%; 2014, 83%; APC = 1.8) and 5-year (1998, 47%; 2012, 76%; APC = 3.1) OS. Older age; male sex; history of diabetes, coronary artery disease, and chronic obstructive pulmonary disease; high ASA score; smoking pack-years; high-grade tumor; pneumonectomy; thoracotomy; neoadjuvant therapy; nodal disease; and positive tumor margin were predictors of poor OS. CONCLUSION The upward time trend in OS suggests that improved staging, patient selection, and management have conferred a survival benefit in early-stage NSCLC patients. The prediction model of OS could be used to refine selection criteria for resection and improve survival outcomes.
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Affiliation(s)
- Jitesh B Shewale
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas (UTHealth) School of Public Health, Houston, Texas
| | - Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric L Brown
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas (UTHealth) School of Public Health, Houston, Texas
| | - Luis G Leon-Novelo
- Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas
| | - Alan G Nyitray
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas (UTHealth) School of Public Health, Houston, Texas.,Clinical Cancer Center and Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abstract
OBJECTIVES There are no uniform screening recommendations for anal cancer. Medical practice guidelines are now available on the use of Digital Anal Rectal Examinations (DARE) for the detection of anal cancer; however, because screening can result in more harm than benefit, our objective was to assess the evidence for use of DARE as a public health screening tool. MATERIALS AND METHODS We conducted a current critical appraisal of anal cancer literature using World Health Organization criteria for assessing the potential utility of a public health screening program. RESULTS Digital Anal Rectal Examination satisfies most, but not all, World Health Organization criteria for a public health program that seeks to detect early invasive anal cancer in populations at high risk for anal cancer, most notably HIV-positive men who have sex with men; however, DARE is not appropriate when facilities for treatment are nonexistent. In addition, there are insufficient data on DARE sensitivity and specificity. CONCLUSIONS The mildly invasive nature of DARE, limited likelihood of adverse procedure-related events, cost-effectiveness and patient acceptability, as well as wide availability of DARE support consideration of its integration into screening for populations at high risk of anal cancer, especially HIV-positive men who have sex with men.
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Affiliation(s)
- Alan G. Nyitray
- Clinical Cancer Center and Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth A. Stier
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA
| | - Gary Clifford
- International Agency for Research on Cancer, Lyon, France
| | - Elizabeth Y. Chiao
- Section Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
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Shewale JB, Correa AM, Brown EL, Leon-Novelo LG, Nyitray AG, Antonoff MB, Hofstetter WL, Mehran RJ, Rice DC, Walsh GL, Roth J, Vaporciyan AA, Swisher SG, Sepesi B. Time Trends of Perioperative Outcomes in Early Stage Non-Small Cell Lung Cancer Resection Patients. Ann Thorac Surg 2020; 109:404-411. [DOI: 10.1016/j.athoracsur.2019.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/23/2022]
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Abstract
This cross-sectional study investigates the prevalence of human papillomavirus (HPV) infection among US women who received between 0 and 3 doses of HPV vaccine.
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Affiliation(s)
- Kalyani Sonawane
- Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Alan G. Nyitray
- Center for AIDS Intervention Research, Clinical Cancer Center, Medical College of Wisconsin, Milwaukee
| | - Gizem S. Nemutlu
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Michael D. Swartz
- Department and Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
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Zhang X, Tang T, Pang L, Sharma SV, Li R, Nyitray AG, Edwards BJ. Malnutrition and overall survival in older adults with cancer: A systematic review and meta-analysis. J Geriatr Oncol 2019; 10:874-883. [DOI: 10.1016/j.jgo.2019.03.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/23/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023]
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Suk R, Montealegre JR, Nemutlu GS, Nyitray AG, Schmeler KM, Sonawane K, Deshmukh AA. Public Knowledge of Human Papillomavirus and Receipt of Vaccination Recommendations. JAMA Pediatr 2019; 173:1099-1102. [PMID: 31524931 PMCID: PMC6749539 DOI: 10.1001/jamapediatrics.2019.3105] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cross-sectional survey study assesses knowledge of human papillomavirus by age and sex.
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Affiliation(s)
- Ryan Suk
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, Texas
| | | | - Gizem S. Nemutlu
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Alan G. Nyitray
- Clinical Cancer Center/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Kalyani Sonawane
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, Texas,Center for Healthcare Data, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, Texas
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Zhang X, Pang L, Sharma SV, Li R, Nyitray AG, Edwards BJ. Prevalence and factors associated with malnutrition in older patients with cancer. J Geriatr Oncol 2019; 10:763-769. [DOI: 10.1016/j.jgo.2019.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/12/2018] [Accepted: 01/28/2019] [Indexed: 02/08/2023]
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