HPV Genotype Prevalence and Success of Vaccination to Prevent Cervical Cancer

BACKGROUND

Nearly 500,000 new cases of cervical cancer are estimated annually worldwide. Three vaccines are currently licensed to prevent cervical cancer. The success of vaccination depends mainly on the prevalence of HPV genotypes, and many cases of HPV infection have been diagnosed after vaccination. Our aim was to search for HPV genotyping in cervical samples to verify the proportion of women that remain susceptible to infection even after vaccination.

METHODS

21,017 liquid-based cervical (LBC) specimens were received for cytology and HPV detection from 2015 to 2018. Before slide preparations for cytology, a 1,000-μL aliquot was taken from the LBC fixative and subjected to automated DNA extraction and multiplex PCR followed by capillary electrophoresis to detect and classify HPV.

RESULTS

HPV was detected in 895 (4.3%) specimens. The most prevalent genotype was HPV-16, followed by HPV-58 and HPV-66. A total of 258 (28.8%) cases were positive for high-risk (HR)-HPV types (66, 59, 39, 56, 30, 35, 53, 51, 68, 82, and 70) that are not covered by the HPV vaccines.

CONCLUSION

A significant proportion of HPV types detected in cytological specimens are representative of HR-HPV not covered by the available vaccines. The health system should be aware of the considerable percentage of women who are not being immunized and will continue to need cervical cancer screening.

Outcome of Nonpersonalized Human Papillomavirus Vaccinations During Postconization Follow-up: A Report of Two Cases

BACKGROUND

The human papillomavirus (HPV) vaccine was conceived to prevent new HPV infections among uninfected young women. From the initial intentions, its use has been extended to older women and also tested as a therapeutic tool. We report two HPV vaccination outcomes during postconization follow-up.

CASES

Two young women, with different clinical histories, were subjected to HPV vaccine after a loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia (CIN) and persisting low-grade CIN. During follow-up both women experienced a worsening of cervical lesions, which resulted in invasive cervical cancer and severe dysplasia, respectively.

CONCLUSION

Limited to our experience, a nonpersonalized HPV vaccine administration during postconization follow-up was expensive and unnecessary.

Critical Analyses of the Introduction of Liquid-Based Cytology in a Public Health Service of the State of São Paulo, Brazil

OBJECTIVE

The aim of this study was to compare the performance of the current conventional Pap smear with liquid-based cytology (LBC) preparations.

STUDY DESIGN

Women routinely undergoing their cytopathological and histopathological examinations at Fundação Oncocentro de São Paulo (FOSP) were recruited for LBC. Conventional smears were analyzed from women from other areas of the State of São Paulo with similar sociodemographic characteristics.

RESULTS

A total of 218,594 cases were analyzed, consisting of 206,999 conventional smears and 11,595 LBC. Among the conventional smears, 3.0% were of unsatisfactory preparation; conversely, unsatisfactory LBC preparations accounted for 0.3%. The ASC-H (atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion) frequency did not demonstrate any differences between the two methods. In contrast, the incidence of ASC-US (atypical squamous cells of undetermined significance) was almost twice as frequent between LBC and conventional smears, at 2.9 versus 1.6%, respectively. An equal percentage of high-grade squamous intraepithelial lesions were observed for the two methods, but not for low-grade squamous intraepithelial lesions, which were more significantly observed in LBC preparations than in conventional smears (2.2 vs. 0.7%). The index of positivity was importantly enhanced from 3.0% (conventional smears) to 5.7% (LBC).

CONCLUSIONS

LBC performed better than conventional smears, and we are truly confident that LBC can improve public health strategies aimed at reducing cervical lesions through prevention programs.

30 years of preventive studies of uterine cervical cancer 1982-2012

The studies for the prevention of uterine cervical cancer in Panama City began in a private institute, impelled by the high incidence of cancer. The preventive programs were initiated with the support of the Obstetrics and Gynecology Institute of the University of Padua in Italy. In these studies, we applied the methodological diagnostics of this Institute with certain modifications adapted to our needs. The diagnosis, treatment, and follow-up were carried out under the protocol of the University of Padua. We achieved a diagnosis of oncogenic risk (OR) in 6,411 patients which corresponded to 5,498 cases of human papillomavirus (HPV), 1,150 cases of dysplasia, 210 cases of cancer, and 794 cases of OR. From 2011, polymerase chain reaction (PCR) was also applied with the aim to improve the accuracy of the diagnosis. With this method the prevalence of pathologies were HPV infections both in healthy patients or in patients cured from HPV. Patients were treated by means of local destructive treatments (LDT), basically with cryotherapy and cauterization. We can consider these results as successful prevention and suggest to extend a preventive program to all the population.