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Varon M, Salcedo MP, Fellman B, Troisi C, Gowen R, Daheri M, Rodriguez AM, Toscano P, Guerra L, Gasca M, Cavazos B, Marin E, Fisher-Hoch S, Fernandez ME, Reininger B, Ruosha L, Baker E, Schmeler K. A Comprehensive Program to Improve Treatment of Precancerous Cervical Lesions in the Rio Grande Valley of Texas. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:89-98. [PMID: 37350621 DOI: 10.1097/phh.0000000000001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To assess the impact of a multicomponent intervention in women with cervical dysplasia who were treated with loop electrosurgical excision procedure (LEEP), as well as the time between colposcopy and treatment. DESIGN Retrospective cohort study. INTERVENTION Clinic participation in a multicomponent cervical cancer prevention program that included community outreach, patient in-reach, and navigation, as well as provider capacity building with in-person training and ongoing telementoring through Project ECHO. MAIN OUTCOME MEASURES Medical records were reviewed to evaluate women with cervical dysplasia undergoing treatment with LEEP within 90 days of colposcopy, as well as time between colposcopy and treatment. Baseline data from year 1 were compared with each subsequent year of implementation. Additional variables examined included patient's age, history of abnormal screening results, and percentage of families living below poverty line based on county of residence, parity, and clinic site. We performed logistic regression and multiple linear regression analyses to assess the programmatic impact in the outcomes of interest by year of program implementation. RESULTS A total of 290 women were included in the study. The proportion of women undergoing treatment within 90 days of colposcopy increased from 76.2% at baseline to 91.3% in year 3 and 92.9% in year 4 of program implementation. The odds of undergoing treatment within 90 days were 5.11 times higher in year 4 of program implementation than at baseline. The mean time between colposcopy and LEEP decreased from 62 days at baseline to 45 days by year 4 of program implementation. CONCLUSIONS Implementation of our multicomponent cervical cancer prevention program increased the proportion of women undergoing LEEP within 90 days of colposcopy and decreased the time between colposcopy and LEEP. This program has the potential to support cervical cancer prevention efforts and could be implemented in other low-resource settings.
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Affiliation(s)
- Melissa Varon
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Drs Varon, Salcedo, Baker, and Schmeler, and Mr Fellman); The University of Texas Health Science Center, School of Public Health, Houston, Texas (Drs Troisi, Fernandez, and Ruosha); The University of Texas Health Science Center, School of Public Health Brownsville Regional Campus, Brownsville, Texas (Ms Gasca, Drs Gowen, Fisher-Hoch, and Reininger); Harris Health, Houston, Texas (Ms Daheri); The University of Texas Medical Branch, Houston, Texas (Dr Rodriguez); McGovern Medical School, Houston, Texas (Mr Toscano) Su Clinica, Harlingen, Texas (Mss Guerra and Cavazos, and Dr Marin)
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Güneş Ö, Özkaya-Parlakay A, Güney AY, Güder L, Mustafaoğlu Ö, Bayraktar P, Kanık-Yüksek S, Gülhan B. A Survey on Parents' Health Literacy on Childhood Human Papilloma Virus Vaccination. J PEDIAT INF DIS-GER 2023. [DOI: 10.1055/s-0042-1760374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Objective The aim of this study is to determine parents' knowledge levels and attitudes about childhood human papillomavirus (HPV) vaccination and reveal the differences between parents who are health care workers and nonhealth care workers. The HPV vaccine can potentially prevent initial HPV infection and HPV-related genital and anal precancerous disorders and cancers.
Methods Questions and attitudes toward childhood HPV vaccination were asked to 564 parents who agreed to participate in the study.
Results In our study, the rate of health care worker parents considering having their children vaccinated against HPV (63.1%) was higher than that of nonhealth care worker parents (11.4%). Only 5% of parents had their children previously vaccinated against HPV; however, there was no difference between parents who were health care workers and those who were not. In addition, this rate was relatively low compared to other paid vaccines (49.8, 35.3, and 18.8%, respectively). Parents who had not previously vaccinated their children against HPV were considering getting their children vaccinated, especially if a pediatrician recommended it.
Conclusion The parents' high level of health literacy may not be effective in deciding to vaccinate their children against HPV. Therefore, adequate information and awareness should be provided to all parents about HPV vaccination as early as possible for all children of appropriate age. Pediatricians should be given important roles in raising the awareness of parents about childhood HPV vaccination by health authorities.
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Affiliation(s)
- Ömer Güneş
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Aslınur Özkaya-Parlakay
- Department of Pediatric Infectious Diseases, Yildirim Beyazit University, Ankara City Hospital, Ankara, Türkiye
| | - Ahmet Yasin Güney
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Latife Güder
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Özlem Mustafaoğlu
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Pınar Bayraktar
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Saliha Kanık-Yüksek
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
| | - Belgin Gülhan
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
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Kaczmarek M, Baj-Krzyworzeka M, Bogucki Ł, Dutsch-Wicherek M. HPV-Related Cervical Cancer and Extracellular Vesicles. Diagnostics (Basel) 2022; 12:2584. [PMID: 36359429 PMCID: PMC9689649 DOI: 10.3390/diagnostics12112584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/03/2023] Open
Abstract
Cervical cancer is the fourth most common type of cancer in females worldwide. Infection with a human papillomavirus is crucial to the etiopathogenesis of cervical cancer. The natural trajectory of HPV infection comprises HPV acquisition, HPV persistence versus clearance, and progression to precancer and invasive cancer. The majority of HPV infections are cleared and controlled by the immune system within 2 years, but some infections may become quiescent or undetectable. The persistence of high-risk HPV infection for a longer period of time enhances the risk of malignant transformation of infected cells; however, the mechanisms responsible for the persistence of infection are not yet well-understood. It is estimated that 10-15% of infections do persist, and the local microenvironment is now recognized as an important cofactor promoting infection maintenance. Extracellular vesicles (EVs) are small membrane vesicles derived from both normal cells and cancer cells. EVs contain various proteins, such as cytoskeletal proteins, adhesion molecules, heat shock proteins, major histocompatibility complex, and membrane fusion proteins. EVs derived from HPV-infected cells also contain viral proteins and nucleic acids. These biologically active molecules are transferred via EVs to target cells, constituting a kind of cell-to-cell communication. The viral components incorporated into EVs are transmitted independently of the production of infectious virions. This mode of transfer makes EVs a perfect vector for viruses and their components. EVs participate in both physiological and pathological conditions; they have also been identified as one of the mediators involved in cancer metastasis. This review discusses the potential role of EVs in remodeling the cervical cancer microenvironment which may be crucial to tumor development and the acquisition of metastatic potential. EVs are promising as potential biomarkers in cervical cancer.
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Affiliation(s)
- Magdalena Kaczmarek
- Department of Endoscopic Otorhinolaryngology, Centre of Postgraduate Medical Education (CMKP), 01-813 Warsaw, Poland
| | - Monika Baj-Krzyworzeka
- Department of Clinical Immunology, Institute of Paediatrics, Jagiellonian University Medical College, 30-663 Kraków, Poland
| | - Łukasz Bogucki
- Department of Endoscopic Otorhinolaryngology, Centre of Postgraduate Medical Education (CMKP), 01-813 Warsaw, Poland
| | - Magdalena Dutsch-Wicherek
- Department of Endoscopic Otorhinolaryngology, Centre of Postgraduate Medical Education (CMKP), 01-813 Warsaw, Poland
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4
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Chaberek K, Mrowiec M, Kaczmarek M, Dutsch-Wicherek M. The Creation of the Suppressive Cancer Microenvironment in Patients with HPV-Positive Cervical Cancer. Diagnostics (Basel) 2022; 12:diagnostics12081906. [PMID: 36010256 PMCID: PMC9406692 DOI: 10.3390/diagnostics12081906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
The development of malignancy is closely connected with the process of cancer microenvironment remodeling. As a malignancy develops, it stimulates the creation of the suppressive microenvironment of the tumor through the presence of cells that express membrane proteins. These proteins are secreted into the cancer microenvironment, where they enable tumor growth. In patients with cancer of the cervix, the development of the disease is also linked to high-risk HPV (hr-HPV) infection. Such infections are common, and most clear spontaneously; however, a small percentage of these infections can persist and progress into precancerous cervical intraepithelial neoplasia and invasive cervical carcinoma. Consequently, it is assumed that the presence of hr-HPV infection alone is not sufficient for the development of cancer. However, chronic HPV infection is associated with the induction of the remodeling of the microenvironment of the epithelium. Furthermore, the local microenvironment is recognized as a cofactor that participates in the persistence of the HPV infection and disease progression. This review presents the selected immune evasion mechanisms responsible for the persistence of HPV infection, beginning with the delay in the virus replication process prior to the maturation of keratinocytes, the shift to the suppressive microenvironment by a change in keratinocyte immunomodulating properties, the alteration of the Th1/Th2 polarization of the immune response in the microenvironment, and, finally, the role of HLA-G antigen expression.
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Affiliation(s)
- Katarzyna Chaberek
- 2nd Department of Obstetrics and Gynaecology, Center of Postgraduate Medical Education (CMKP), 01-813 Warsaw, Poland
| | - Martyna Mrowiec
- Department of Endoscopic Otorhinolaryngology, Center of Postgraduate Medical Education (CMKP), 01-813 Warsaw, Poland
| | - Magdalena Kaczmarek
- Department of Endoscopic Otorhinolaryngology, Center of Postgraduate Medical Education (CMKP), 01-813 Warsaw, Poland
| | - Magdalena Dutsch-Wicherek
- Department of Endoscopic Otorhinolaryngology, Center of Postgraduate Medical Education (CMKP), 01-813 Warsaw, Poland
- Correspondence:
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Daniels V, Saxena K, Patterson-Lomba O, Gomez-Lievano A, Saah A, Luxembourg A, Velicer C, Chen YT, Elbasha E. Modeling the health and economic implications of adopting a 1-dose 9-valent human papillomavirus vaccination regimen in a high-income country setting: An analysis in the United Kingdom. Vaccine 2022; 40:2173-2183. [PMID: 35232593 DOI: 10.1016/j.vaccine.2022.02.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/19/2021] [Accepted: 02/18/2022] [Indexed: 02/07/2023]
Abstract
Although no human papillomavirus (HPV) vaccine is indicated for single-dose administration, some observational evidence suggests that a 1-dose regimen might reduce HPV infection risk to that achieved with 2 doses. This study estimated the potential health and economic outcomes associated with switching from a 2-dose HPV vaccination program for girls and boys aged 13-14 years to an off-label 9-valent (9vHPV), 1-dose regimen, accounting for the uncertainty of the effectiveness and durability of a single dose. A dynamic HPV transmission infection and disease model was adapted to the United Kingdom and included a probabilistic sensitivity analysis using estimated distributions for duration of protection of 1-dose and degree of protection of 1 relative to 2 doses. One-way sensitivity analyses of key inputs were performed. Outcomes included additional cancer and disease cases and the difference in net monetary benefit (NMB). The 1-dose program was predicted to result in 81,738 additional HPV-related cancer cases in males and females over 100 years compared to the 2-dose program, ranging from 36,673 to 134,347 additional cases (2.5% and 97.5% quantiles, respectively), and had a 7.8% probability of being cost-effective at the £20,000/quality-adjusted life years willingness-to-pay (WTP) threshold. In one-way sensitivity analyses, the number of additional cancer cases was sensitive to the median of the duration of protection distribution and coverage rates. The differences in NMBs were sensitive to the median of the duration of protection distribution, dose price and discount rate, but not coverage variations. Across sensitivity analyses, the probability of 1 dose being cost-effective vs 2 doses was < 50% at the standard WTP threshold. Adoption of a 1-dose 9vHPV vaccination program resulted in more vaccine-preventable HPV-related cancer and disease cases in males and females, introduced substantial uncertainty in health and economic outcomes, and had a low probability of being cost-effective compared to the 2-dose program.
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Affiliation(s)
- Vincent Daniels
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Kunal Saxena
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | | | | | - Alfred Saah
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Alain Luxembourg
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Christine Velicer
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Ya-Ting Chen
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Elamin Elbasha
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
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Prabhu VS, Roberts CS, Kothari S, Niccolai L. Median Age at HPV Infection Among Women in the United States: A Model-Based Analysis Informed by Real-world Data. Open Forum Infect Dis 2021; 8:ofab111. [PMID: 34888404 PMCID: PMC8653628 DOI: 10.1093/ofid/ofab111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background The US Advisory Committee for Immunization Practices (ACIP) recommended
shared clinical decision-making for human papillomavirus (HPV) vaccination
of individuals aged 27 to 45 years (mid-adults) in June 2019. Determining
the median age at causal HPV infection and CIN2+ diagnosis based on the
natural history of HPV disease can help elucidate the incidence of HPV
infections and the potential benefits of vaccination in mid-adults. Methods Real-world data on CIN2+ diagnosis from the prevaccine era were sourced
from a statewide surveillance registry in Connecticut. Age distribution of
CIN2+ diagnosis in 2008 and 2009 was estimated. A discrete event
simulation model was developed to predict the age distribution of causal HPV
infection. The optimal age distribution of causal HPV infection provided the
best goodness-of-fit statistic to compare the predicted vs real-world age
distribution of CIN2+ diagnosis. Results The median age at CIN2+ diagnosis from 2008 through 2009 in Connecticut
was 28 years. The predicted median age at causal HPV infection was estimated
to be 23.9 years. There was a difference of 5.2 years in the median age at
acquisition of causal HPV infection and the median age at CIN2+
diagnosis. Conclusions Real-world data on CIN2+ diagnosis and model-based analysis indicate a
substantial burden of infection and disease among women aged 27 years or
older, which supports the ACIP recommendation to vaccinate some mid-adults.
When natural history is known, this novel approach can also help determine
the timing of causal infections for other commonly asymptomatic infectious
diseases.
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Affiliation(s)
| | | | | | - Linda Niccolai
- Yale School of Public Health and Connecticut Emerging Infections Program, New Haven, Connecticut, USA
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7
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Ngune I, Kalembo F, Loessl B, Kivuti-Bitok LW. Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa. PLoS One 2020; 15:e0237745. [PMID: 32817627 PMCID: PMC7446823 DOI: 10.1371/journal.pone.0237745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 11/20/2022] Open
Abstract
Background Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034. Methods Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398). Findings Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p<0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p<0.001). Conclusions A considerable proportion of young women in Kenya are unaware of cervical cancer which is associated with a variety of social and psychological factors. We argue that the high prevalence of cervical cancer and poor screening rates will continue to prevail among older women if issues that affect young women’s awareness of cervical cancer are not addressed. Given that the Kenyan youth are exposed to HPV due to early sexual encounters and a high prevalence of HIV, targeted interventions are urgently needed to increase the uptake of HPV vaccination and screening.
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Affiliation(s)
- Irene Ngune
- Faculty of Health Sciences, School of Nursing Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Fatch Kalembo
- Faculty of Health Sciences, School of Nursing Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Barbara Loessl
- College of Science, Health, Engineering and Education (SHEE), Discipline of Nursing, Murdoch University, Murdoch, Western Australia, Australia
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Topazian HM, Dizon AM, Di Bona VL, Levitz L, Ramos S, Morgan K, Kim CJ, Richter K, De Sanjose S, Smith JS. Adolescent providers' knowledge of human papillomavirus vaccination age guidelines in five countries. Hum Vaccin Immunother 2019; 15:1672-1677. [PMID: 30625017 DOI: 10.1080/21645515.2018.1558688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Purpose: To examine provider knowledge of HPV vaccination age guidelines in five countries. Methods: A total of 151 providers of adolescent vaccinations in Argentina, Malaysia, South Africa, South Korea, and Spain were interviewed between October 2013 and April 2014. Univariate analyses compared providers' understanding of recommended age groups for HPV vaccination to that of each country's national guidelines. Results: In three of five countries surveyed, most providers (97% South Africa, 95% Argentina, 87% Malaysia) included all nationally recommended ages in their target age group. However, a relatively large proportion of vaccinators in some countries (83% Malaysia, 55% Argentina) believed that HPV vaccination was recommended for women above age 26, far exceeding national guidelines, and beyond the maximum recommended age in the United States. National median minimum and maximum age recommendations cited by the respondents for HPV vaccination were 11 and 29 years in Argentina (national guideline: 11-14), 13 and 48 years in Malaysia (guideline 13-14), 8 and 14 years in South Africa (guideline 9-14), 10 and 20 years in South Korea (guideline 11-14), and 11 and 12 years in Spain (guideline 11-14). In all countries, a higher percentage of vaccinators included all nationally recommended ages for vaccination, as compared to providers who did not administer HPV vaccination. Conclusions: Overall, a substantial proportion of providers incorrectly reported their country's age guidelines for HPV vaccination, particularly the upper age limit. As provider recommendation is among the strongest predictors of successful vaccination uptake among adolescents, improved education and clarification of national guidelines for providers administering HPV vaccination is essential to optimize prevention of infection and associated disease.
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Affiliation(s)
- Hillary M Topazian
- a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
| | - A Mitch Dizon
- a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,b Department of Obstetrics and Gynecology, University of North Carolina School of Medicine , Chapel Hill , NC , USA
| | - Vito L Di Bona
- c Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
| | - Lauren Levitz
- a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
| | - Silvina Ramos
- d Centro de Estudios de Estado y Sociedad , Buenos Aires , Argentina
| | - Karen Morgan
- e Perdana University, Royal College of Surgeons in Ireland School of Medicine , Kuala Lumpur , Malaysia
| | - Chan Joo Kim
- f Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine , St. Paul's Hospital , Seoul , Korea
| | - Karin Richter
- g Department of Medical Virology, University of Pretoria, National Health Laboratory Service , Pretoria , South Africa
| | - Silvia De Sanjose
- h Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Institut Català d'Oncologia , Barcelona , Spain
| | - Jennifer S Smith
- a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,i Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC , USA
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Castle PE, Silva VRS, Consolaro MEL, Kienen N, Bittencourt L, Pelloso SM, Partridge EE, Pierz A, Dartibale CB, Uchimura NS, Scarinci IC. Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil. Cancer Prev Res (Phila) 2019; 12:159-170. [PMID: 30651294 DOI: 10.1158/1940-6207.capr-18-0419] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 11/16/2022]
Abstract
Most cervical cancers occur in women who do not participate in cervical-cancer screening. We therefore evaluated adherence to screening for clinic-based Pap testing, self-collected sampling for HPV testing, and choice of the 2 among 483 unscreened/underscreened women in Brazil. Three public Basic Health Units (BHU) were each randomly assigned to three arms: (i) Pap testing at the BHU (N = 160), (ii) "Self&HPV" (self-collection for HPV testing) (N = 161), and (iii) "Choice" between self-collection and HPV testing and Pap test at the local BHU (N = 162). The theory-based (PEN-3 and Health Belief Model) intervention in all three arms was implemented by trained Community Health Workers (CHW) at participants' home. With the first invitation, 60.0% in the Pap arm, 95.1% [154 of 161 (95.7%) who selected Self&HPV and 0 of 1 (0.0%) who selected Pap] in the Choice arm, and 100% in the Self&HPV arm completed screening. By the second invitation to choose a method of screening in the Choice arm, 100% completed screening. After three invitations, 75.0% of women in the Pap arm completed screening. Adherence to screening differed by study arm (P < 0.001). In conclusion, Self&HPV testing is a promising strategy for unscreened/underscreened women who are recalcitrant or unable to undergo clinic-based cervical screening to complement the screening modality used in the general population. In Brazil, where Pap testing is recommended for routine cervical screening, training CHWs in behavior change strategies and offering Self&HPV or Choice could greatly improve screening population coverage by reaching the unscreened/underscreened populations.
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Affiliation(s)
| | | | | | - Nádia Kienen
- Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | | | | | | | - Amanda Pierz
- Albert Einstein College of Medicine, Bronx, New York
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Doubeni CA, Gabler NB, Wheeler CM, McCarthy AM, Castle PE, Halm EA, Schnall MD, Skinner CS, Tosteson ANA, Weaver DL, Vachani A, Mehta SJ, Rendle KA, Fedewa SA, Corley DA, Armstrong K. Timely follow-up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium. CA Cancer J Clin 2018; 68:199-216. [PMID: 29603147 PMCID: PMC5980732 DOI: 10.3322/caac.21452] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/09/2018] [Accepted: 02/21/2018] [Indexed: 12/19/2022] Open
Abstract
Timely follow-up for positive cancer screening results remains suboptimal, and the evidence base to inform decisions on optimizing the timeliness of diagnostic testing is unclear. This systematic review evaluated published studies regarding time to follow-up after a positive screening for breast, cervical, colorectal, and lung cancers. The quality of available evidence was very low or low across cancers, with potential attenuated or reversed associations from confounding by indication in most studies. Overall, evidence suggested that the risk for poorer cancer outcomes rises with longer wait times that vary within and across cancer types, which supports performing diagnostic testing as soon as feasible after the positive result, but evidence for specific time targets is limited. Within these limitations, we provide our opinion on cancer-specific recommendations for times to follow-up and how existing guidelines relate to the current evidence. Thresholds set should consider patient worry, potential for loss to follow-up with prolonged wait times, and available resources. Research is needed to better guide the timeliness of diagnostic follow-up, including considerations for patient preferences and existing barriers, while addressing methodological weaknesses. Research is also needed to identify effective interventions for reducing wait times for diagnostic testing, particularly in underserved or low-resource settings. CA Cancer J Clin 2018;68:199-216. © 2018 American Cancer Society.
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Affiliation(s)
- Chyke A. Doubeni
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Nicole B. Gabler
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Cosette M. Wheeler
- Departments of Pathology, and Obstetrics and Gynecology, University of New Mexico Health Science Center, Albuquerque, NM
| | - Anne Marie McCarthy
- General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ethan A. Halm
- Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mitchell D. Schnall
- Department of Radiology, Breast Imaging Section, University of Pennsylvania, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Celette S. Skinner
- Department of Clinical Sciences and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Donald L. Weaver
- Department of Pathology, UVM Cancer Center, University of Vermont, Burlington, VT
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shivan J. Mehta
- Department of Medicine, Perelman School of Medicine and Penn Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society. Atlanta, GA
| | - Douglas A. Corley
- Kaiser Permanente Division of Research, Oakland, CA, and San Francisco Medical, Kaiser Permanente Northern California, San Francisco, CA
| | - Katrina Armstrong
- General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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11
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Abstract
PURPOSE OF REVIEW Human papillomaviruses (HPVs) account for a number of distinct disease entities in pediatrics, ranging from common warts to the stigmatizing condyloma acuminata to life-threatening respiratory papillomatosis. Although there is still a lack of consensus on treatment for each of these HPV-related diseases, scientific investigation continues to progress. Increasing prevention of HPV-related disease with further vaccination and development of new vaccines continues to be the best medical strategy. RECENT FINDINGS Although high-quality evidence for treatment of HPV-related disease is still lacking, several new studies have been published in recent years that have refined opinions on therapy. Novel treatments continue to be developed, including new vaccines to further coverage for other strains. SUMMARY HPV-related disease in pediatrics is associated with societal stigmatization and a high level of morbidity. Greater understanding of the distinct diseases and high-quality research is necessary to enhance treatment selection in the coming future.
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Gage JC, Hunt WC, Schiffman M, Katki HA, Cheung LA, Myers O, Cuzick J, Wentzensen N, Kinney W, Castle PE, Wheeler CM. Similar Risk Patterns After Cervical Screening in Two Large U.S. Populations: Implications for Clinical Guidelines. Obstet Gynecol 2016; 128:1248-1257. [PMID: 27824767 PMCID: PMC5247269 DOI: 10.1097/aog.0000000000001721] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the risks of histologic high-grade cervical intraepithelial neoplasia (CIN) or worse after different cervical cancer screening test results between two of the largest U.S. clinical practice research data sets. METHODS The New Mexico Human Papillomavirus (HPV) Pap Registry is a statewide registry representing a diverse population experiencing varied clinical practice delivery. Kaiser Permanente Northern California is a large integrated health care delivery system practicing routine HPV cotesting since 2003. In this retrospective cohort study, a logistic-Weibull survival model was used to estimate and compare the cumulative 3- and 5-year risks of histologic CIN 3 or worse among women aged 21-64 years screened in 2007-2011 in the New Mexico HPV Pap Registry and 2003-2013 in Kaiser Permanente Northern California. Results were stratified by age and baseline screening result: negative cytology, atypical squamous cells of undetermined significance (ASC-US) (with or without HPV triage), low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion. RESULTS There were 453,618 women in the New Mexico HPV Pap Registry and 1,307,528 women at Kaiser Permanente Northern California. The 5-year CIN 3 or worse risks were similar within screening results across populations: cytology negative (0.52% and 0.30%, respectively, P<.001), HPV-negative and ASC-US (0.72% and 0.49%, respectively, P=.5), ASC-US (3.4% and 3.4%, respectively, P=.8), HPV-positive and ASC-US (7.7% and 7.1%, respectively, P=.3), low-grade squamous intraepithelial lesion (6.5% and 5.4%, respectively, P=.009), and high-grade squamous intraepithelial lesion (53.1% and 50.4%, respectively, P=.2). Cervical intraepithelial neoplasia grade 2 or worse risks and 3-year risks had similar trends across populations. Age-stratified analyses showed more variability, especially among women aged younger than 30 years, but patterns of risk stratification were comparable. CONCLUSION Current U.S. cervical screening and management recommendations are based on comparative risks of histologic high-grade CIN after screening test results. The similar results from these two large cohorts from different real-life clinical practice settings support risk-based management thresholds across U.S. clinical populations and practice settings.
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Affiliation(s)
- Julia C. Gage
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - William C. Hunt
- Department of Pathology, University of New Mexico Health
Sciences Center, Albuquerque, NM, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Li A. Cheung
- Information Management Services Inc., Calverton, MD,
USA
| | - Orrin Myers
- Department of Internal Medicine, University of New Mexico
Health Sciences Center, Albuquerque, NM, USA
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of
Preventive Medicine, Queen Mary University of London, Charterhouse Square, London,
UK
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Walter Kinney
- Division of Gynecologic Oncology, Kaiser Permanente Medical
Care Program, Oakland, CA, USA
| | | | - Cosette M. Wheeler
- Department of Pathology, University of New Mexico Health
Sciences Center, Albuquerque, NM, USA
- Department of Obstetrics and Gynecology, University of New
Mexico Health Sciences Center, Albuquerque, NM, USA
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Soares GR, Vieira RDR, Pellizzer EP, Miyahara GI. Indications for the HPV vaccine in adolescents: A review of the literature. J Infect Public Health 2015; 8:105-16. [DOI: 10.1016/j.jiph.2014.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/13/2014] [Accepted: 08/24/2014] [Indexed: 11/16/2022] Open
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Castle P. RE: Population-Level Impact of the Bivalent, Quadrivalent, and Candidate Nonavalent Human Papillomavirus Vaccines: A Comparative Model-Based Analysis. J Natl Cancer Inst 2013; 105:1254. [DOI: 10.1093/jnci/djt187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Catallozzi M, Auslander BA, Rosenthal SL. Contextual Factors Associated with Sexually Transmitted Infections. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.00004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Adegoke O, Kulasingam S, Virnig B. Cervical cancer trends in the United States: a 35-year population-based analysis. J Womens Health (Larchmt) 2012; 21:1031-7. [PMID: 22816437 PMCID: PMC3521146 DOI: 10.1089/jwh.2011.3385] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To analyze trends in invasive cervical cancer incidence by age, histology, and race over a 35-year period (1973-2007) in order to gain insight into changes in the presentation of cervical cancer. METHODS Data from the nine Surveillance, Epidemiology, and End Results (SEER) registries that continuously collected information on invasive cervical cancer were analyzed for trends. Standardized to the 2000 U.S population, annual age-adjusted incidence rates were estimated by race and histologic subtype. Histologic subtype was classified into squamous, adenocarcinoma, and adenosquamous. RESULTS Overall incidence rates for invasive cervical cancer decreased by 54% over the 35 years, from 13.07/100,000 (1973-1975) to 6.01/100,000 (2006-2007), and the incidence rates declined by 51% and 70.2%, respectively, among whites and blacks. The incidence rates for squamous carcinoma decreased by 61.1% from 10.2/100,000 (1973-1975) to 3.97/100,000 (2006-2007). Incidence rates for adenosquamous cell carcinomas decreased by 16% from 0.27/100,000 (1973-1975) to 0.23/100,000 (2006-2007), and incidence rates for adenocarcinomas increased by 32.2% from 1.09/100,000 (1973-1975) to 1.44/100,000 (2006-2007). This increase in adenocarcinomas was due to an increase in incidence in white women; a decrease in incidence was observed for black women. CONCLUSIONS Although marked reductions in the overall and race-specific incidence rates of invasive cervical cancer have been achieved, they mask important variation by histologic subtype. These findings suggest that alternatives to Pap smear-based screening, such as human papillomavirus (HPV) testing and HPV vaccination, need to be prioritized if adenocarcinomas of the cervix are to be controlled.
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Affiliation(s)
- Olusola Adegoke
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Beth Virnig
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Human papillomavirus vaccination in low-resource countries: lack of evidence to support vaccinating sexually active women. Br J Cancer 2012; 107:1445-50. [PMID: 22955856 PMCID: PMC3493757 DOI: 10.1038/bjc.2012.404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Vaccines against the human papillomaviruses (HPV) that cause around 70% of cervical cancer cases worldwide are highly efficacious when administered before infection with the viruses, which occurs soon after initiation of sexual activity. Despite recommendations from key public health bodies that the primary target population for HPV vaccination should be young adolescent girls, numerous articles have suggested widening the target age group to include older adolescent girls and adult women. These articles cite evidence of efficacy and cost-effectiveness when making recommendations, and they rarely take into account the difficult resource-allocation issues faced by decision makers in low-income countries. Authors and sponsors of these articles are usually from high-income countries and sometimes include vaccine manufacturers. This review discusses the strengths and weaknesses of several types of evidence offered by these papers in support of vaccination of a broad age range of girls and women. It concludes that the greatest public health benefit and value for resources will come from vaccinating girls before sexual debut and exposure to HPV, particularly in low-resource areas.
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Trimble CL. Preventing human papillomavirus disease. J Clin Oncol 2012; 30:3037-8. [PMID: 22851562 DOI: 10.1200/jco.2012.42.9787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Castle PE, Gravitt PE, Wentzensen N, Schiffman M. A descriptive analysis of prevalent vs incident cervical intraepithelial neoplasia grade 3 following minor cytologic abnormalities. Am J Clin Pathol 2012; 138:241-6. [PMID: 22904136 DOI: 10.1309/ajcpntk6g2pxwhoo] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Cervical intraepithelial neoplasia grade 3 (CIN 3) is the best proxy in research and screening for invasive cancer risk. Yet the timing of CIN 3 development is uncertain because of measurement errors integral to its diagnosis. We were interested in estimating the proportions of prevalent vs incident CIN 3 within 2 years of finding a minor cytologic abnormality. We estimate that only 17 (2.8%) of 613 CIN 3 cases diagnosed during the 2-year duration of the atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) triage study (ALTS) were incident CIN 3 following an incident human papillomavirus (HPV) infection that persisted until the CIN 3 diagnosis was made. Using prevalent high-grade cytology as a marker of prevalent CIN 3, we estimated that another approximately 23% of CIN 3 cases were incident CIN 3 following a prevalently detected HPV infection that persisted until the CIN 3 diagnosis was made. We concluded that most CIN 3 cases diagnosed within the 2-year time frame were prevalent cases, and most incident CIN 3 cases followed a prevalently detected HPV infection.
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Affiliation(s)
- Philip E. Castle
- American Society for Clinical Pathology Institute, Washington, DC
| | - Patti E. Gravitt
- Departments of Epidemiology and Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Rapiti E, Usel M, Neyroud-Caspar I, Merglen A, Verkooijen H, Vlastos A, Pache J, Kumar N, Bouchardy C. Omission of excisional therapy is associated with an increased risk of invasive cervical cancer after cervical intraepithelial neoplasia III. Eur J Cancer 2012; 48:845-52. [DOI: 10.1016/j.ejca.2011.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/02/2011] [Accepted: 05/06/2011] [Indexed: 11/27/2022]
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The impact of human papillomavirus and human papillomavirus vaccination among rheumatology patients. J Clin Rheumatol 2011; 16:355. [PMID: 20921856 DOI: 10.1097/rhu.0b013e3181f60fb9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and the leading cause of cervical cancer. The Food and Drug Administration approved the first human papillomavirus vaccine and has recommended routine vaccination of 11 to 12 year old girls with catch-up vaccination for females 13 to 26 years of age. This primary prevention tool for cervical cancer could significantly reduce cervical cancer, but broad vaccination coverage will be required. Health care providers are in a position to educate parents and teens about the benefits of receiving the recommended HPV vaccine. Mandating the HPV vaccine can be effective in increasing vaccine rates, reducing disease disparities, and decreasing rates of cervical cancer.
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Castle PE, Schiffman M, Wheeler CM, Wentzensen N, Gravitt PE. Human papillomavirus genotypes in cervical intraepithelial neoplasia grade 3. Cancer Epidemiol Biomarkers Prev 2010; 19:1675-81. [PMID: 20615885 DOI: 10.1158/1055-9965.epi-10-0251] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There are few large case series describing the human papillomavirus (HPV) genotypes found in women diagnosed with rigorously reviewed cervical intraepithelial neoplasia grade 3 (CIN3), cervical precancer. METHODS The Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-Grade Squamous Intraepithelial Lesion (LSIL) Triage Study (ALTS) was a clinical trial to evaluate the best management strategies for women with equivocal (ASCUS) or mildly abnormal (LSIL) Pap tests. During enrollment and the 2-year follow-up, 608 women had a histopathologic diagnosis of CIN3 and PCR-based HPV genotyping results on cervical specimens. The genotyping results were ranked hierarchically according to cancer risk: HPV16 > other carcinogenic HPV > noncarcinogenic HPV > PCR negative. RESULTS Among the 608 women diagnosed with CIN3, 601 (98.8%) cases were positive for any HPV genotype and 95.4% for any carcinogenic HPV. HPV16 (59.9%), HPV31 (18.1%), HPV52 (14.8%), HPV51 (14.0%), and HPV18 (13.2%) were the five most common HPV genotypes detected. Younger age, consensus histologic confirmation, smoking, and multiparity increased the likelihood of testing HPV 16 positive. Specifically, HPV16-positive CIN3 occurred at a younger age than CIN3 positive for other carcinogenic HPV genotypes (median of 23.5 years versus 25 years, respectively; P = 0.0003, Kruskal-Wallis). CONCLUSIONS HPV16-positive CIN3 was more commonly diagnosed in younger women (versus older women), with consensus diagnosis (versus some disagreement between reviewers), and in smokers (versus nonsmokers), and was less commonly diagnosed in multiparous women compared CIN3 positive for other carcinogenic HPV genotypes. IMPACT In populations vaccinated against HPV16 (and HPV18), the median age of CIN3 in women with ASCUS and LSIL cytology should shift to older ages, possibly permitting later age at first screening.
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Affiliation(s)
- Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Room 5004, MSC 7234, Bethesda, MD 20892-7234, USA.
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Kinney W, Stoler MH, Castle PE. Special commentary: patient safety and the next generation of HPV DNA tests. Am J Clin Pathol 2010; 134:193-9. [PMID: 20660320 DOI: 10.1309/ajcpri8xpqueaa3k] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Human papillomavirus (HPV) testing is more sensitive for the detection of cervical precancer and cancer than cervical cytology. The increased sensitivity of HPV testing and cytology combined ("cotesting") compared to cytology alone permitted professional societies to recommend 3-year screening intervals among the cotest-negative results. However, there is an increasing recognition that both clinical sensitivity and specificity of cervical cancer screening are important to patient safety and must be considered in the context of using current and future HPV DNA tests. Exquisite analytic sensitivity for HPV does not increase clinical sensitivity of an HPV test but does result in excessive test positivity and decreased clinical specificity. A recent US Food and Drug Administration (FDA)-approved HPV test, Cervista (Hologic, Bedford, MA), demonstrated excessive test positivity-2 to 4 times more positive than the other FDA-approved HPV test-from its premarketing approval trial. The poor specificity of Cervista raises questions about the safety and applicability of using this test in routine cervical cancer screening. These data provide a didactic example of the potential dangers of mistaking excellent analytic sensitivity and even clinical sensitivity for good clinical performance.
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Scarinci IC, Garcia FAR, Kobetz E, Partridge EE, Brandt HM, Bell MC, Dignan M, Ma GX, Daye JL, Castle PE. Cervical cancer prevention: new tools and old barriers. Cancer 2010; 116:2531-42. [PMID: 20310056 DOI: 10.1002/cncr.25065] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cervical cancer is the second most common female tumor worldwide, and its incidence is disproportionately high (>80%) in the developing world. In the United States, in which Papanicolaou (Pap) tests have reduced the annual incidence to approximately 11,000 cervical cancers, >60% of cases are reported to occur in medically underserved populations as part of a complex of diseases linked to poverty, race/ethnicity, and/or health disparities. Because carcinogenic human papillomavirus (HPV) infections cause virtually all cervical cancer, 2 new approaches for cervical cancer prevention have emerged: 1) HPV vaccination to prevent infections in younger women (aged < or =18 years) and 2) carcinogenic HPV detection in older women (aged > or =30 years). Together, HPV vaccination and testing, if used in an age-appropriate manner, have the potential to transform cervical cancer prevention, particularly among underserved populations. Nevertheless, significant barriers of access, acceptability, and adoption to any cervical cancer prevention strategy remain. Without understanding and addressing these obstacles, these promising new tools for cervical cancer prevention may be futile. In the current study, the delivery of cervical cancer prevention strategies to these US populations that experience a high cervical cancer burden (African-American women in South Carolina, Alabama, and Mississippi; Haitian immigrant women in Miami; Hispanic women in the US-Mexico Border; Sioux/Native American women in the Northern Plains; white women in the Appalachia; and Vietnamese-American women in Pennsylvania and New Jersey) is reviewed. The goal was to inform future research and outreach efforts to reduce the burden of cervical cancer in underserved populations.
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Affiliation(s)
- Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-4410, USA.
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Solomon D, Castle P, Hildesheim A, Katki HA, Schiffman M, Wacholder S. HPV vaccination in women aged 24-45 years. Lancet 2009; 374:1239; author reply 1239-40. [PMID: 19819386 PMCID: PMC2946099 DOI: 10.1016/s0140-6736(09)61782-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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