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Cervical Cancer and Its Precursors: A Preventative Approach to Screening, Diagnosis, and Management. Prim Care 2018; 46:117-134. [PMID: 30704652 DOI: 10.1016/j.pop.2018.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cervical cancer affects the cells lining the cervix, most commonly occurring in the cells of the transformation zone. Screening for cervical cancer looks to detect preinvasive disease, allowing for intervention before invasive disease develops. an assessment of individual risk factors, Selection of screening method depends on patient age, her screening history and results, and resources available. Screening has resulted in well-documented declines in cervical cancer incidence and mortality in the United States. Guidelines continue to evolve as new data emerge. Although cervical cancer prevention strategies include interventions directed toward limiting number of sexual partners, condom use, and reduction in cigarette smoking, vaccination represents the most direct targeted strategy.
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Chatzistamatiou K, Moysiadis T, Vryzas D, Chatzaki E, Kaufmann AM, Koch I, Soutschek E, Boecher O, Tsertanidou A, Maglaveras N, Jansen-Duerr P, Agorastos T. Cigarette Smoking Promotes Infection of Cervical Cells by High-Risk Human Papillomaviruses, but not Subsequent E7 Oncoprotein Expression. Int J Mol Sci 2018; 19:ijms19020422. [PMID: 29385075 PMCID: PMC5855644 DOI: 10.3390/ijms19020422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 12/21/2022] Open
Abstract
Persistent cervical infection with high-risk human papillomaviruses (hrHPVs) is a necessary, but not sufficient, condition for the development of cervical cancer. Therefore, there are other co-factors facilitating the hrHPV carcinogenic process, one of which is smoking. To assess the effect of smoking on high-risk (hr) HPV DNA positivity and on the expression of HPV E7 oncoprotein, as a surrogate of persistent hrHPV infection, we used data from women recruited for the PIPAVIR project, which examined the role of E7 protein detection in cervical cancer screening. Women were tested for hrHPV DNA, using Multiplex Genotyping (MPG), and E7 protein, using a novel sandwich ELISA method, and gave information on their smoking habits. Among 1473 women, hrHPV prevalence was 19.1%. The odds ratio (OR) for hrHPV positivity of smokers compared to non-smokers was 1.785 (95% confidence intervals (CI): 1.365–2.332, p < 0.001). The ORs for E7 positivity, concerning hrHPV positive women, ranged from 0.720 to 1.360 depending on the E7 detection assay used, but this was not statistically significant. Smoking increases the probability of hrHPV infection, and smoking intensity is positively associated to this increase. Smoking is not related to an increased probability of E7 protein positivity for hrHPV positive women.
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Affiliation(s)
- Kimon Chatzistamatiou
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, 54642 Thessaloniki, Greece.
| | - Theodoros Moysiadis
- Institute of Applied Biosciences, Centre for Research & Technology-Hellas, 57001 Thessaloniki, Greece.
| | - Dimos Vryzas
- Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Ekaterini Chatzaki
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Andreas M Kaufmann
- Department of Gynecology, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, 10117 Berlin, Germany.
| | | | | | | | - Athena Tsertanidou
- 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, 54642 Thessaloniki, Greece.
| | - Nikolaos Maglaveras
- Lab of Computing and Medical Informatics, Department of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
| | - Pidder Jansen-Duerr
- Research Institute for Biomedical Aging Research, University of Innsbruck, A-6020 Innsbruck, Austria.
| | - Theodoros Agorastos
- 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, 54642 Thessaloniki, Greece.
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Moore TO, Moore AY, Carrasco D, Vander Straten M, Arany I, Au W, Tyring SK. Human Papillomavirus, Smoking, and Cancer. J Cutan Med Surg 2016. [DOI: 10.1177/120347540100500408] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The effect of smoking on human papillomavirus (HPV) activity and subsequent dysplasia and neoplasia remains controversial Objective: To determine any reported effects of smoking on either HPV activity or HPV-related dysplasia/cancer using retrospective analysis of the literature from 1966 through 1998 via Toxline and PubMed to search for “smoking,” “papillomavirus,” and “cancer.” Conclusion: Several recent large studies demonstrated that smoking was associated with a greater incidence of cervical, vulvar, penile, anal, oral, and head and neck cancer in a dose-dependent fashion, while other studies did not show any correlation between smoking and cervical dysplasia after multivariate adjustment. Recent studies have also indicated that smoking may be more closely related to high-grade lesions of the cervix and vulva. These data provide evidence of an association between HPV, smoking, and cancer. Progression of dysplasia likewise seems to be associated with smoking. Several groups have attempted to discern whether the connection between smoking and cervical cancer is from local immunosuppression and/or from direct carcinogenic effects.
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Affiliation(s)
- Todd O. Moore
- Department of Surgery, Baylor University Hospital, Dallas, Texas, USA
| | - Angela Yen Moore
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Daniel Carrasco
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Melody Vander Straten
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Istvan Arany
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
| | - William Au
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Stephen K. Tyring
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
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Mahmoodi P, Motamedi H, Seyfi Abad Shapouri MR, Bahrami Shehni M, Kargar M. Molecular Detection and Typing of Human Papillomaviruses in Paraffin-Embedded Cervical Cancer and Pre-Cancer Tissue Specimens. IRANIAN JOURNAL OF CANCER PREVENTION 2016; 9:e3752. [PMID: 27366309 PMCID: PMC4922202 DOI: 10.17795/ijcp-3752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/11/2015] [Accepted: 01/17/2016] [Indexed: 12/22/2022]
Abstract
Background: Cervical cancer is one of the important reasons of mortality among females. Prevention, early diagnosis and immediate treatment can affect the rate of mortality in this cancer and several epidemiological studies have shown a strong relationship between human papilloma viruses (HPVs) and cervical cancer. Objectives: The present study was conducted to survey HPV infections in a women population with cervical cancer and cervical dysplasia/metaplasia in southwest of Iran. Materials and Methods: 72 paraffin-embedded cervical biopsies which had been previously archived from women with cervical cancer and cervical dysplasia were examined by polymerase chain reaction (PCR). Afterward, the detected HPV strains were typed by restriction fragment length polymorphism (RFLP) analysis of PCR amplicons. Results: 60 out of 72 samples had necessary requirements and HPV DNA was detected in 43.3% of these samples. Most HPV positive samples belonged to women aged from 48 to 63 years. On the other hand, HPV infection among patients with squamous cell carcinoma (SCC) was 48.78% and in women with dysplasia/metaplasia was 26.66%. The most prevalent type of the human papilloma virus was HPV16 (100%). Conclusions: Knowing the most prevalent type of the human papilloma viruses circulating in the population (HPV16) can be applied in the future screening and managing programs of this major disease and also in vaccination against the prevalent types of the virus. Meanwhile, it seems that more studies should be performed to determine the role of different risk factors involved in development of the disease, especially those related with social behaviors and traditions with respect to different areas.
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Affiliation(s)
- Pezhman Mahmoodi
- Department of Pathobiology, Faculty of Para Veterinary Science, Bu-Ali Sina University, Hamadan, IR Iran
| | - Hossein Motamedi
- Department of Biology, Faculty of Science, Shahid Chamran University, Ahvaz, IR Iran
| | | | | | - Mohammad Kargar
- Department of Microbiology, Jahrom Branch, Islamic Azad University, Jahrom, IR Iran
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Luu HN, Amirian ES, Beasley RP, Piller L, Chan W, Scheurer ME. Association between smoking and size of anal warts in HIV-infected women. Int J STD AIDS 2012; 23:792-8. [PMID: 23155099 PMCID: PMC4629988 DOI: 10.1258/ijsa.2012.011420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While the association between smoking and human papillomavirus infection, cervical cancer, and anal cancer has been well studied, evidence on the association between cigarette smoking and anal warts is limited. The purpose of this study was to investigate if cigarette smoking status influences the size of anal warts over time in HIV-infected women in a sample of 976 HIV-infected women from the Women's Interagency HIV Study (WIHS). A linear mixed model was used to determine the effect of smoking on anal wart size. Even though women who were currently smokers had larger anal warts at baseline and slower growth rate of anal wart size after each visit than women who were not current smokers, there was no association between size of anal wart and current smoking status over time. Further studies on the role of smoking and interaction between smoking and other risk factors, however, should be explored.
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Affiliation(s)
- H N Luu
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
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Modinou O, Liaropoulos L, Kaitelidou D, Kioulafas K, Theodoraki EM. Management of Precancerous Lesions of the Uterine Cervix according to Demographic Data. ISRN OBSTETRICS AND GYNECOLOGY 2010; 2011:301680. [PMID: 21637358 PMCID: PMC3102582 DOI: 10.5402/2011/301680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 10/21/2010] [Indexed: 12/03/2022]
Abstract
Aims. Worldwide, cervical cancer is the fifth most deadly cancer in women, but screening prevents cancer by detecting precancerous lesions. The purpose of this study is to present the treatment profile for precancerous lesions of the uterine cervix, according to demographic data.
Methods. An annual retrospective study was conducted in two public primary health care centres in Greece. The total number of Pap smears and colposcopies performed as well as the management of women with cervical intraepithelial neoplasia was collected and analysed.
Results. Demographic characteristics and correlations with levels of Cervical Intraepithelial Neoplasia (CIN) and treatment path are presented. For each case, we noted the patients' age, the marital and educational status, and the professional and insurance type. From a total of 238 diagnostic procedures, 118 (49.5%) showed precancerous lesions, 83.3% of these were high grade while 16.7% were low grade.
Conclusions. This study provides an estimate of the extensiveness of precancerous lesions of the uterine cervix. Management of CIN should be accounted for when balancing the benefits and unfavourable effects of this screening.
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Affiliation(s)
- Olga Modinou
- Department of Nursing, Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Dilou 1A, Goudi, 115 27 Athens, Greece
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Veena MS, Lee G, Keppler D, Mendonca MS, Redpath JL, Stanbridge EJ, Wilczynski SP, Srivatsan ES. Inactivation of the cystatin E/M tumor suppressor gene in cervical cancer. Genes Chromosomes Cancer 2008; 47:740-54. [PMID: 18506750 DOI: 10.1002/gcc.20576] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We have previously localized a cervical cancer tumor suppressor gene to a 300 kb interval of 11q13. Analysis of candidate genes revealed loss of expression of cystatin E/M, a lysosomal cysteine protease inhibitor, in 6 cervical cancer cell lines and 9 of 11 primary cervical tumors. Examination of the three exons in four cervical cancer cell lines, 19 primary tumors, and 21 normal controls revealed homozygous deletion of exon 1 sequences in one tumor. Point mutations were observed in six other tumors. Two tumors contained mutations at the consensus binding sites for cathepsin L, a lysosomal protease overexpressed in cervical cancer. Introduction of these two point mutations using site directed mutagenesis resulted in reduced binding of mutated cystatin E/M to cathepsin L. Although mutations were not observed in any cell lines, four cell lines and 12 of 18 tumors contained promoter hypermethylation. Reexpression of cystatin E/M was observed after 5'aza 2-deoxycytidiene and/or Trichostatin A treatment of cervical cancer cell lines, HeLa and SiHa, confirming promoter hypermethylation. Ectopic expression of cystatin E/M in these two cell lines resulted in growth suppression. There was also suppression of soft agar colony formation by HeLa cells expressing the cystatin E/M gene. Reexpression of cystatin E/M resulted in decreased intracellular and extracellular expression of cathepsin L. Overexpression of cathepsin L resulted in increased cell growth which was inhibited by the reintroduction of cystatin E/M. We conclude, therefore, that cystatin E/M is a cervical cancer suppressor gene and that the gene is inactivated by somatic mutations and promoter hypermethylation.
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Affiliation(s)
- Mysore S Veena
- Department of Surgery, VAGLAHS/David Geffen School of Medicine at UCLA, Los Angeles 90073, CA
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Abd El All HS, Refaat A, Dandash K. Prevalence of cervical neoplastic lesions and Human Papilloma Virus infection in Egypt: National Cervical Cancer Screening Project. Infect Agent Cancer 2007; 2:12. [PMID: 17610742 PMCID: PMC1945019 DOI: 10.1186/1750-9378-2-12] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2007] [Accepted: 07/04/2007] [Indexed: 11/10/2022] Open
Abstract
Background Data from Egyptian studies provide widely varying estimates on the prevalence of pre-malignant and malignant cervical abnormalities and human papilloma virus (HPVs) infection. To define the prevalence and risk factors of pre-invasive and invasive cervical cancer (cacx), a community based full-scale cross sectional, household survey including 5453 women aged between 35 and 60 years was conducted. Methods The study period was between February 2000 and December 2002. Initially, conventional Papanicolaou (Pap) smears were evaluated using the Bethesda system (TBS), followed by colposcopic guided biopsy (CGB) for all epithelial abnormalities (EA). In a third step, HPV was tested on all EA by in-situ hybridization (ISH) using first the broad spectrum HPV probe recognizing HPVs 6, 11, 16, 18, 30, 31, 35, 45, 51 and 52 followed by subtyping with probes 6/11, 16/18 and 31/33. Lastly, unequivocal cases were immunostained for herpes simplex type-2 (HSV-2), cytomegalovirus (CMV), and human immunodeficiency virus (HIV). Results EA representing 7.8% (424/5453), were categorized into atypical squamous cell of undetermined significance (ASCUS) (34.4%), atypical glandular cell of undetermined significance (AGCUS) (15.3%), combined ASCUS and AGCUS (3.1%), low grade squamous intraepithelial lesions (SIL) (41.0%), high grade SIL (5.2%) and invasive lesions (1%). CGB of EA (n = 281) showed non neoplastic lesions (12.8%), atypical squamous metaplasia (ASM) (19.2%), cervical intraepithelial neoplasia I (CIN) (44.4%), CIN II (4.4%), CINIII (2.8%), endocervical lesions (5.2%), combined squamous and endocervical lesions (10.0%), invasive squamous cell carcinoma (SCC) (0.02%) and extranodal marginal zone B cell lymphoma (MZBCL) (0.02%). The overall predictive value of cytology was 87% while the predictive value for high grade lesions was 80%. On histological basis, HPVs were present in 94.3% of squamous lesions while it was difficult to be identified in endocervical ones. ISH revealed positivity for pan HPV in 65.9% of the studied biopsies (n = 217), with incorporation of the viral genome HPV 6/11, 16/18 and 31/33 in 11.1%, 33.3% and 17.1% respectively. Multiple HPVs infections were identified in 0.02%. Conclusion Pre-invasive high grade lesions and invasive cervical carcinoma represent 0.5% and 0.04% respectively in Egyptian women. HPV mostly 16/18 as a risk factor (p < 0.001), was frequently associated with mixed infections (p < 0.001) and bilharzial infestation (p < 0.001).
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Affiliation(s)
- Howayda S Abd El All
- Howayda S Abd El All, Principal Investigator for Pathology, Department of Pathology, Faculty of Medicine Suez Canal University, Ismailia, Egypt
| | - Amany Refaat
- Department of Community Medicine, Principal Investigator for Data Management, Faculty of Medicine Suez Canal University, Ismailia, Egypt
| | - Khadiga Dandash
- Department of Community Medicine, Principal Investigator for Field Work, Faculty of Medicine Suez Canal University, Ismailia, Egypt
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D'Souza G, Fakhry C, Sugar EA, Seaberg EC, Weber K, Minkoff HL, Anastos K, Palefsky JM, Gillison ML. Six-month natural history of oral versus cervical human papillomavirus infection. Int J Cancer 2007; 121:143-50. [PMID: 17354235 DOI: 10.1002/ijc.22667] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Human papillomavirus (HPV) infection is etiologically associated with a subset of oral cancers, and yet, the natural history of oral HPV infection remains unexplored. The feasibility of studying oral HPV natural history was evaluated by collecting oral rinse samples on 2 occasions at a 6-month interval from 136 HIV-positive and 63 HIV-negative participants. Cervical vaginal lavage samples were concurrently collected for comparison. HPV genomic DNA was detected in oral and cervical samples by consensus primer PCR and type-specified for 37 HPV types. The six-month cumulative prevalence of oral HPV infection was significantly less than for cervical infection (p < 0.0001). HIV-positive women were more likely than HIV-negative women to have an oral (33 vs. 15%, p = 0.016) or cervical (78 vs. 51%, p < 0.001) infection detected. Oral HPV infections detected at baseline were as likely as cervical infections to persist to 6 months among HIV-negative (60% vs. 51%, p = 0.70) and HIV-positive (55% vs. 63%, p = 0.27) women. Factors that independently elevated odds for oral HPV persistence differed from cervical infection and included current smoking (OR = 8, 95% CI = 1.3-53), age above 44 years (OR = 20, 95% CI = 4.1-83), CD4 < 500 (OR = 6, 95% CI = 1.1-26), use of HAART therapy (OR = 12, 95% CI = 1.0-156), and time on HAART therapy (trend p = 0.04). The rate of oral HPV infections newly detected at follow-up was significantly lower than cervical infection among HIV-positive (p < 0.001) and HIV-negative women (p < 0.001). Our study not only demonstrates that it is feasible to study the natural history of oral HPV infection with oral rinse sampling, but also indicates that oral and cervical HPV natural history may differ.
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Affiliation(s)
- Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
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Oliveira LHS, Rosa MLG, Pereira CRN, Vasconcelos GALBM, Silva RA, Barrese TZ, Carvalho MOO, Abi GMA, Rodrigues EM, Cavalcanti SMB. Human papillomavirus status and cervical abnormalities in women from public and private health care in Rio de Janeiro State, Brazil. Rev Inst Med Trop Sao Paulo 2007; 48:279-85. [PMID: 17086317 DOI: 10.1590/s0036-46652006000500008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 06/14/2006] [Indexed: 11/21/2022] Open
Abstract
This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4% presented HPV and nearly 90% of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3%. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3%), and invasive cervical carcinoma (16.3%). HPV infection was found in 93.1% and 94.4% of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p<0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions. These data provides baseline support for the role of social inequalities linked to high risk HPV infection leading to cervical cancer. Broadly screening programs and the development of safe and effective vaccines against HPV would diminish the toll of this disease that affect mainly poor women.
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Affiliation(s)
- Ledy H S Oliveira
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, UFF, Niterói, RJ, Brazil.
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Wensveen C, Kagie M, Veldhuizen R, De Groot C, Denny L, Zwinderman K, Trimbos B. Detection of cervical intraepithelial neoplasia in women with atypical squamous or glandular cells of undetermined significance cytology: a prospective study. Acta Obstet Gynecol Scand 2003; 82:883-9. [PMID: 12911453 DOI: 10.1034/j.1600-0412.2003.00231.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND (1) To assess the prevalence of histologically confirmed cervical intraepithelial neoplasia in patients with cervical smears diagnosed as atypical squamous or glandular cells of undetermined significance. (2) To evaluate the role of colposcopy and the presence of human papillomavirus in detecting underlying cervical intraepithelial neoplasia. MATERIALS AND METHODS In this prospective cohort, 148 women with atypical squamous or glandular cells of undetermined significance were evaluated by colposcopy, histological sampling, and human papillomavirus deoxyribonucleic acid testing. RESULTS Histological diagnosis of >/= cervical intraepithelial neoplasia II was found in 10/148 women. Women with a histological >/= cervical intraepithelial neoplasia II had a higher prevalence of >/= two abnormal quadrants (90% vs. 38%</= cervical intraepithelial neoplasia I, p = 0.002) and of high/intermediate-risk human papillomavirus (90% vs. 42% </= cervical intraepithelial neoplasia I, p = 0.005). CONCLUSION Our study shows that premalignant lesions of the cervix were present in 7% of the patients with a cytological diagnosis of atypical squamous or glandular cells of undetermined significance. Colposcopy and human papillomavirus deoxyribonucleic acid testing are both important parameters in detecting >/= cervical intraepithelial neoplasia II.
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Affiliation(s)
- Celesta Wensveen
- Department of Obstetrics and Gynecology, the Medical Center Haaglanden, Westeinde Hospital, the Hague, The Netherlands.
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12
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Haverkos HW, Soon G, Steckley SL, Pickworth W. Cigarette smoking and cervical cancer: Part I: a meta-analysis. Biomed Pharmacother 2003; 57:67-77. [PMID: 12854514 DOI: 10.1016/s0753-3322(03)00196-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cancer of the cervix is the third most common cancer among women worldwide and its etiology is not clearly understood. Human papillomavirus can be found in approximately 95% of cervical cancers, but it does not appear to be necessary or sufficient to induce malignancy. In 1977, Winkelstein suggested that cigarette smoking was a causative factor in the development of cervical cancer. We report a meta-analysis of cigarette smoking and cervical disease and conclude that the data support a role for cigarette smoking as a risk factor for cervical cancer. We propose a multifactorial hypothesis involving a virus-tar interaction as the etiology of cervical cancer.
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Affiliation(s)
- Harry W Haverkos
- The Infectious Disease Service, Department of Medicine, Walter ReedMedical Center, Washington, DC, USA.
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Coker AL, Bond SM, Williams A, Gerasimova T, Pirisi L. Active and passive smoking, high-risk human papillomaviruses and cervical neoplasia. CANCER DETECTION AND PREVENTION 2002; 26:121-8. [PMID: 12102146 DOI: 10.1016/s0361-090x(02)00039-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Few studies have evaluated the role of passive smoke exposure and cervical neoplasia risk. We assessed the role of active and passive cigarette smoke exposure and risk of cervical squamous intraepithelial lesion (SIL) in a case-control study based in a South Carolina Health Department; 59 high-grade SIL (HSIL) cases, 313 low-grade SIL (LSIL) cases and 427 controls were recruited and interviewed. Passive cigarette smoke exposure was significantly (P < 0.05) associated with high grade SIL (adjusted odds ratio (aOR) = 2.2) and low-grade SIL (aOR = 1.4). Active smoking was associated with SIL only among White women (aOR = 1.8). High-risk human papillomaviruses (HR-HPVs) appear to interact with active cigarette smoking to increase HSIL risk. HSIL cases compared with LSIL cases were significantly more likely to be HR-HPV positive current smokers (aOR = 3.0; 95% CI: (1.2, 7.7)). These data suggest that active and perhaps passive smoke exposure may be important co-factors in HSIL development among HR-HPV positive women.
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Affiliation(s)
- Ann L Coker
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA.
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14
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Hildesheim A, Herrero R, Castle PE, Wacholder S, Bratti MC, Sherman ME, Lorincz AT, Burk RD, Morales J, Rodriguez AC, Helgesen K, Alfaro M, Hutchinson M, Balmaceda I, Greenberg M, Schiffman M. HPV co-factors related to the development of cervical cancer: results from a population-based study in Costa Rica. Br J Cancer 2001; 84:1219-26. [PMID: 11336474 PMCID: PMC2363883 DOI: 10.1054/bjoc.2001.1779] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We examined factors associated with high-grade squamous intraepithelial lesions (HSIL) and cervical cancer among human papillomavirus (HPV)-infected women in a prevalent case-control study conducted within a population-based cohort of 10 077 women in Costa Rica. We compared 146 women with HPV-positive HSIL or cancer (HSIL/CA) against 843 HPV-positive women without evidence of HSIL/CA. Subjects completed a risk factor questionnaire. We evaluated the associations between exposures and HSIL/CA among women positive for any HPV and restricted to those positive for high-risk HPV types. Risk of HSIL/CA increased with increasing number of live births (P(trend)= 0.04). Women who smoked 6+ cigarettes/day had a RR for HSIL/CA of 2.7 (95% CI = 1.1-6.7) compared to non-smokers. Current use of barrier contraceptives was associated with a reduction in risk of HSIL/CA (RR = 0.39; 95% CI = 0.16-0.96). Sexual behaviour and a self-reported history of sexually transmitted diseases (STDs) other than HPV were not associated with HSIL/CA. Oral contraceptive use was associated with HSIL/CA among women with <3 pregnancies. Effects were similar in analysis restricted to women positive for high-risk HPV types. Among women positive for high-risk HPV types, 44% of HSIL/CA could be attributed to multiparity (>/=3 pregnancies) and/or smoking. Among HPV-positive women, multiparity and smoking are risk factors for HSIL/CA. Oral contraceptive use may be associated with HSIL/CA in subgroups of women.
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Affiliation(s)
- A Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Summersgill KF, Smith EM, Levy BT, Allen JM, Haugen TH, Turek LP. Human papillomavirus in the oral cavities of children and adolescents. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:62-9. [PMID: 11174573 DOI: 10.1067/moe.2001.108797] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this pilot study was to determine the frequency of human papillomavirus (HPV) in the oral cavities of children and adolescents and to identify potential risk factors for HPV infection. STUDY DESIGN Sociodemographic information was obtained on 268 healthy infants, children, and adolescents who were < or = 20 years old. Oral squamous cells were collected from swabs with young children and from oral saline solution rinses with older children and adolescents. Extracted DNA was evaluated for HPV by polymerase chain reaction, dot blot hybridization, and DNA sequencing. Factors associated with the presence of HPV were tested by using chi(2), Fisher's exact test, and logistic regression tests. RESULTS HPV was detected in 6.0% of the participants. HPV frequency among young children (<7 years old) was 8.7% (11/127), and among adolescents (13-20 years old) it was 5.2% (5/97). HPV was not detected in children aged 7 to 12 years old (0/44). Fifty-four percent (6/11) of HPV-positive children were 1 year of age or less; 3 of the HPV-positive children (<7 years old) were delivered by cesarean section. No statistically significant association was found between the detection of HPV in the oral cavity and method of delivery or gender; parent's race, education, HPV-related conditions, smoking history, or number of sex partners; or adolescent's smoking history or history of sexual activity. CONCLUSIONS This study suggests that HPV is present in the oral cavity primarily in children 2 years old and younger and in adolescents 13 years and older. Cesarean delivery was not protective against oral HPV infection; in fact, half of the HPV-positive infants were born by cesarean delivery.
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Affiliation(s)
- K F Summersgill
- Veterans Affairs Medical Center, and Department of Oral Pathology, Radiology, and Medicine, University of Iowa College of Dentistry, Iowa City, USA.
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Lapin GA, Derchain SF, Tambascia J. [Comparison between reference oncologic colpocytology and severity of intraepithelial cervical lesions]. Rev Saude Publica 2000; 34:120-5. [PMID: 10881146 DOI: 10.1590/s0034-89102000000200004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The study was designed to compare the Pap smear results, performed on the public health service, with: the results of Pap smear collected on the reference service; the colposcopy and punch biopsy results. METHODS The total of 213 women assisted at the women's hospital from January 1989 to April 1991, and followed until July 1998 were selected. Ninety were referred because a Pap smears suggestive of Human Papillomavirus (HPV) induced lesion or cervical intraepithelial neoplasia (CIN) grade 1, and 123, CIN 2 or 3. RESULTS Among the 90 women referred because of HPV/CIN 1.49% presented CIN 2 or 3 in the Pap smears performed at this service. At the colposcopy, 16/90 women did not present suspicious lesions, and in 10 women, the squamous columnar junction was not observed. At biopsy, 42 (46%) presented CIN 2 or 3. Out of the 123 women referred with Pap smear of CIN 2 or 3.54% presented CIN 2 or 3 at this service. At the colposcopy, 24 women did not present suspicious lesions and the squamous columnar junction was not observed in 12. About biopsy, 61 (49%) presented CIN 2 or 3. CONCLUSIONS The expectant conduct in cases of Pap smear with HPV/CIN 1, should follow a criterion, involving qualified professionals to collect the Pap smear, and should provide people awareness as to control follow-up.
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Affiliation(s)
- G A Lapin
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brasil.
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