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Ssedyabane F, Niyonzima N, Nambi Najjuma J, Birungi A, Atwine R, Tusubira D, Randall TC, Castro CM, Lee H, Ngonzi J. Prevalence of cervical intraepithelial lesions and associated factors among women attending a cervical cancer clinic in Western Uganda; results based on Pap smear cytology. SAGE Open Med 2024; 12:20503121241252265. [PMID: 38764539 PMCID: PMC11100407 DOI: 10.1177/20503121241252265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
Introduction There are high incidence and mortality rates of cervical cancer among females in East Africa. This is exacerbated by limited up-to-date data on premalignant lesions and associated factors in this setting. In this study, we determined the prevalence of cervical intraepithelial lesions and associated factors among women attending the Mbarara Regional Referral Hospital cervical cancer clinic in Southwestern Uganda. Methods In this cross-sectional study, 364 participants were recruited from among women attending the Mbarara Regional Referral Hospital cervical cancer clinic from 1 April to 30 June 2023. On consent, the study nurse collected demographic data and Pap smears, which were microscopically examined and reported by a laboratory scientist and a pathologist following the Bethesda grading system (2014). Statistical analyses were done in STATA version 17, using proportions, Chi-square, bivariate, and multivariate logistic regression analysis to determine associated factors at ⩽0.05 significance level. Results The mean age of participants was 41.9 years. A third of all study participants (37.6%, 132/351) were contraceptive users, mostly hormonal contraceptives (87.1%, 115/132). Almost 88% (307/351) had an unknown Human Papilloma Virus status. The prevalence of cervical intraepithelial lesions among our study participants was 6.6% (23/351), of which 73.9% (17/23) were low-grade squamous intraepithelial lesions. More than half (9/17, 52.9%) of low-grade squamous intraepithelial lesions were active hormonal contraceptive users. Use of hormonal contraceptives (OR: 3.032, p: 0.0253), use of intrauterine devices (OR: 6.284, p: 0.039), and any family history of cervical cancer (OR: 4.144, p: 0.049) were significantly associated with cervical intraepithelial lesions. Conclusion The prevalence of cervical intraepithelial lesions was 6.6%, lower than global estimates. Use of hormonal and intrauterine device contraceptives, as well as family history of cervical cancer, were significantly associated with cervical intraepithelial lesions among our study population. Prospective studies are recommended to further understand associations between different types of intrauterine devices and hormonal contraceptives, and cervical lesions.
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Affiliation(s)
- Frank Ssedyabane
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science of Science and Technology, Mbarara, Uganda
| | | | - Josephine Nambi Najjuma
- Department of Nursing, Mbarara University of Science of Science and Technology, Mbarara, Uganda
| | - Abraham Birungi
- Department of Pathology, Mbarara University of Science of Science and Technology, Mbarara Uganda
| | - Raymond Atwine
- Department of Pathology, Mbarara University of Science of Science and Technology, Mbarara Uganda
| | - Deusdedit Tusubira
- Department of Biochemistry, Mbarara University of Science of Science and Technology, Mbarara, Uganda
| | - Thomas C Randall
- Department of Global Health and Social Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cesar M Castro
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science of Science and Technology, Mbarara, Uganda
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Urbute A, Frederiksen K, Thomsen LT, Kesmodel US, Kjaer SK. Overweight and obesity as risk factors for cervical cancer and detection of precancers among screened women: A nationwide, population-based cohort study. Gynecol Oncol 2024; 181:20-27. [PMID: 38103421 DOI: 10.1016/j.ygyno.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Obesity is a known risk factor for many types of cancer. However, there is no clear evidence whether overweight and obesity increases the risk of cervical cancer. We investigated the association between body mass index (BMI) and detection of squamous and glandular cervical cancer and precancer. METHODS Based on the Medical Birth Registry, we conducted a nationwide cohort study in Denmark of 384,559 women with BMI ≥18.5 kg/m2 (pre-pregnancy BMI reported at the start of the pregnancy) having a cervical cytology screening at age 23-49 years within 5 years following the date of childbirth. The cohort was followed for 10 years from the first cervical cytology screening after the childbirth. We assessed absolute risks of cervical lesions according to BMI with the Aalen-Johansen estimator. We conducted Cox proportional hazards regression analyses to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Analyses were adjusted for age, calendar year, parity, oral contraception use, HPV vaccination, smoking, country of origin, and education. RESULTS Overweight and obesity were associated with higher rates of cervical cancer (HR = 1.24, 95% CI 1.04-1.49 and HR = 1.14, 95% CI 0.91-1.43, respectively) and lower rates of cervical precancer detection (HR = 0.88, 95% CI 0.84-0.92 and HR = 0.67, 95% CI 0.63-0.71, respectively). CONCLUSIONS Higher than normal BMI was associated with higher incidence rates of cervical cancer and lower rates of precancer detection, emphasizing the importance of further research in possible mechanisms behind this association.
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Affiliation(s)
- Aivara Urbute
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Data analysis, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Reberbansgade 9, Aalborg, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.
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Jain M, Yadav D, Jarouliya U, Chavda V, Yadav AK, Chaurasia B, Song M. Epidemiology, Molecular Pathogenesis, Immuno-Pathogenesis, Immune Escape Mechanisms and Vaccine Evaluation for HPV-Associated Carcinogenesis. Pathogens 2023; 12:1380. [PMID: 38133265 PMCID: PMC10745624 DOI: 10.3390/pathogens12121380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Human papillomavirus (HPV) is implicated in over 90% of cervical cancer cases, with factors like regional variability, HPV genotype, the population studied, HPV vaccination status, and anatomical sample collection location influencing the prevalence and pathology of HPV-induced cancer. HPV-16 and -18 are mainly responsible for the progression of several cancers, including cervix, anus, vagina, penis, vulva, and oropharynx. The oncogenic ability of HPV is not only sufficient for the progression of malignancy, but also for other tumor-generating steps required for the production of invasive cancer, such as coinfection with other viruses, lifestyle factors such as high parity, smoking, tobacco chewing, use of contraceptives for a long time, and immune responses such as stimulation of chronic stromal inflammation and immune deviation in the tumor microenvironment. Viral evasion from immunosurveillance also supports viral persistence, and virus-like particle-based prophylactic vaccines have been licensed, which are effective against high-risk HPV types. In addition, vaccination awareness programs and preventive strategies could help reduce the rate and incidence of HPV infection. In this review, we emphasize HPV infection and its role in cancer progression, molecular and immunopathogenesis, host immune response, immune evasion by HPV, vaccination, and preventive schemes battling HPV infection and HPV-related cancers.
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Affiliation(s)
- Meenu Jain
- Department of Microbiology, Viral Research and Diagnostic Laboratory, Gajra Raja Medical College, Gwalior 474009, Madhya Pradesh, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea;
| | - Urmila Jarouliya
- SOS in Biochemistry, Jiwaji University, Gwalior 474011 Madhya Pradesh, India;
| | - Vishal Chavda
- Department of Pathology, Stanford School of Medicine, Stanford University Medical Center, Palo Alto, CA 94305, USA;
| | - Arun Kumar Yadav
- Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India;
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj 44300, Nepal;
| | - Minseok Song
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea;
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Lu J, Han S, Li Y, Na J, Wang J. A study on the correlation between the prognosis of HPV infection and lesion recurrence after cervical conization. Front Microbiol 2023; 14:1266254. [PMID: 37869677 PMCID: PMC10587556 DOI: 10.3389/fmicb.2023.1266254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Persistent human papillomavirus infection is an important factor in the development of cervical cancer, which is usually a long process evolving from the development of squamous intraepithelial lesions (SIL), also referred to as cervical intraepithelial neoplasia (CIN). Local treatment of advanced squamous intraepithelial lesions, also regarded as High-Grade Squamous Intraepithelial Lesion, may be effective in preventing cancer. Objective To promptly identify high-risk patients with a tendency to recurrence. Methods We retrospectively analyzed the clinical data of 300 patients with high-grade squamous intraepithelial lesions of the cervix admitted to the Second Affiliated Hospital of Dalian Medical University from 2019 to 2020 to investigate the relationship between recurrence of cervical lesions and postoperative regression of HPV infection, as well as other related risk factors. Results We found that the HPV-negative rates were 81.81, 85.71, and 90.91% at 6, 12, and 24 months, respectively, and the average lesion recurrence rate was 8.16%, with a median time to recurrence of 14 months in patients undergoing CKC for HSIL. The risk of cervical squamous intraepithelial lesions was highest in patients with HPV16. Patients over 61 years of age had the lowest postoperative HPV-negative rate. The conversion rate was significantly lower in patients with multiple HPV genotypes than in those with single HPV infection (p < 0.05). The probability of recurrence was higher in patients with the same HPV infection genotype before and after surgery than in patients with different infection genotypes before and after surgery (p < 0.05). Conclusion Combined with the literature review, we believe that patients aged ≥50 years, with ≥3 pregnancies and births, a history of smoking, and consistent genotypes of preoperative and postoperative HPV infection in cervical conization have more HPV re-infection or persistent infection, and that these factors may be high-risk factors for lesion recurrence. For patients with possible potential high-risk factors, we need to carry out individualized follow-up and focused management, take timely and effective management measures, optimize the treatment plan, reduce the recurrence rate, prevent HSIL and cervical cancer, improve the quality of patient's survival, and improve the prognosis.
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Affiliation(s)
| | | | | | - Jing Na
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jun Wang
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Condrat CE, Cretoiu D, Radoi VE, Mihele DM, Tovaru M, Bordea CI, Voinea SC, Suciu N. Unraveling Immunological Dynamics: HPV Infection in Women-Insights from Pregnancy. Viruses 2023; 15:2011. [PMID: 37896788 PMCID: PMC10611104 DOI: 10.3390/v15102011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
During pregnancy, hormonal and immune adaptations are vital for supporting the genetically distinct fetus during elevated infection risks. The global prevalence of HPV necessitates its consideration during pregnancy. Despite a seemingly mild immune response, historical gestational viral infections underscore its significance. Acknowledging the established HPV infection risks during pregnancy, our review explores the unfolding immunological changes in pregnant women with HPV. Our analysis aims to uncover strategies for safely modulating the immune system, mitigating adverse pregnancy consequences, and enhancing maternal and child health. This comprehensive narrative review delves into the existing knowledge and studies on this topic.
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Affiliation(s)
- Carmen Elena Condrat
- Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.E.C.)
| | - Dragos Cretoiu
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (D.C.); (V.E.R.)
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
| | - Viorica Elena Radoi
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (D.C.); (V.E.R.)
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
| | - Dana Mihaela Mihele
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Mihaela Tovaru
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Dermatology Department, Victor Babes Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | - Cristian Ioan Bordea
- Department of Surgical Oncology, Prof. Dr. Alexandru Trestioreanu Oncology Institute, Carol Davila University of Medicine and Pharmacy, 252 Fundeni Rd., 022328 Bucharest, Romania
| | - Silviu Cristian Voinea
- Department of Surgical Oncology, Prof. Dr. Alexandru Trestioreanu Oncology Institute, Carol Davila University of Medicine and Pharmacy, 252 Fundeni Rd., 022328 Bucharest, Romania
| | - Nicolae Suciu
- Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (C.E.C.)
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
- Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
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Olwal CO, Fabius JM, Zuliani-Alvarez L, Eckhardt M, Kyei GB, Quashie PK, Krogan NJ, Bouhaddou M, Bediako Y. Network modeling suggests HIV infection phenocopies PI3K-AKT pathway mutations to enhance HPV-associated cervical cancer. Mol Omics 2023; 19:538-551. [PMID: 37204043 PMCID: PMC10524288 DOI: 10.1039/d3mo00025g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Women coinfected with human immunodeficiency virus type 1 (HIV-1) and human papillomavirus (HPV) are six times as likely to develop invasive cervical carcinoma compared to those without HIV. Unlike other HIV-associated cancers, the risk of cervical cancer development does not change when HPV/HIV coinfected women begin antiretroviral therapy, suggesting HIV-associated immune suppression is not a key driver of cervical cancer development in coinfected women. Here, we investigated whether the persistent secretion of inflammatory factors in HIV-positive patients on antiretroviral therapy could enhance cancer signaling in HPV-infected cervical cells via endocrine mechanisms. We integrated previously reported HIV-induced secreted inflammatory factors (Hi-SIFs), HIV and HPV virus-human protein interactions, and cervical cancer patient genomic data using network propagation to understand the pathways underlying disease development in HPV/HIV coinfection. Our results pinpointed the PI3K-AKT signaling pathway to be enriched at the interface between Hi-SIFs and HPV-host molecular networks, in alignment with PI3K pathway mutations being prominent drivers of HPV-associated, but HIV independent, cervical cancer development. Furthermore, we experimentally stimulated cervical cells with 14 Hi-SIFs to assess their ability to activate PI3K-AKT signaling. Strikingly, we found 8 factors (CD14, CXCL11, CXCL9, CXCL13, CXCL17, AHSG, CCL18, and MMP-1) to significantly upregulate AKT phosphorylation (pAKT-S473) relative to a phosphate buffered saline control. Our findings suggest that Hi-SIFs cooperate with HPV infection in cervical cells to over-activate PI3K-AKT signaling, effectively phenocopying PI3K-AKT pathway mutations, resulting in enhanced cervical cancer development in coinfected women. Our insights could support the design of therapeutic interventions targeting the PI3K-AKT pathway or neutralizing Hi-SIFs in HPV/HIV coinfected cervical cancer patients.
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Affiliation(s)
- Charles Ochieng' Olwal
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Jacqueline M Fabius
- The J. David Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- The Cancer Cell Map Initiative, San Francisco and La Jolla, CA, USA
| | - Lorena Zuliani-Alvarez
- The J. David Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- The Cancer Cell Map Initiative, San Francisco and La Jolla, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA, USA.
| | - Manon Eckhardt
- The J. David Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA, USA.
| | - George Boateng Kyei
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- University of Ghana Medical Centre, University of Ghana, Accra, Ghana
| | - Peter Kojo Quashie
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.
| | - Nevan J Krogan
- The J. David Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- The Cancer Cell Map Initiative, San Francisco and La Jolla, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA, USA.
| | - Mehdi Bouhaddou
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- Institute for Quantitative and Computational Biosciences (QCBio), University of California, Los Angeles, LA, USA
- Department of Microbiology, Immunology, and Molecular Genetics (MIMG), University of California, Los Angeles, LA, USA.
- Molecular Biology Institute, University of California, Los Angeles, LA, USA
| | - Yaw Bediako
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.
- Yemaachi Biotech, Accra, Ghana
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Wang W, Spurgeon ME, Pope A, McGregor S, Ward-Shaw E, Gronski E, Lambert PF. Stress keratin 17 and estrogen support viral persistence and modulate the immune environment during cervicovaginal murine papillomavirus infection. Proc Natl Acad Sci U S A 2023; 120:e2214225120. [PMID: 36917668 PMCID: PMC10041145 DOI: 10.1073/pnas.2214225120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023] Open
Abstract
A murine papillomavirus, MmuPV1, infects both cutaneous and mucosal epithelia of laboratory mice and can be used to model high-risk human papillomavirus (HPV) infection and HPV-associated disease. We have shown that estrogen exacerbates papillomavirus-induced cervical disease in HPV-transgenic mice. We have also previously identified stress keratin 17 (K17) as a host factor that supports MmuPV1-induced cutaneous disease. Here, we sought to test the role of estrogen and K17 in MmuPV1 infection and associated disease in the female reproductive tract. We experimentally infected wild-type and K17 knockout (K17KO) mice with MmuPV1 in the female reproductive tract in the presence or absence of exogenous estrogen for 6 mon. We observed that a significantly higher percentage of K17KO mice cleared the virus as opposed to wild-type mice. In estrogen-treated wild-type mice, the MmuPV1 viral copy number was significantly higher compared to untreated mice by as early as 2 wk postinfection, suggesting that estrogen may help facilitate MmuPV1 infection and/or establishment. Consistent with this, viral clearance was not observed in either wild-type or K17KO mice when treated with estrogen. Furthermore, neoplastic disease progression and cervical carcinogenesis were supported by the presence of K17 and exacerbated by estrogen treatment. Subsequent analyses indicated that estrogen treatment induces a systemic immunosuppressive state in MmuPV1-infected animals and that both estrogen and K17 modulate the local intratumoral immune microenvironment within MmuPV1-induced neoplastic lesions. Collectively, these findings suggest that estrogen and K17 act at multiple stages of papillomavirus-induced disease at least in part via immunomodulatory mechanisms.
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Affiliation(s)
- Wei Wang
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, Madison, WI53705
| | - Megan E. Spurgeon
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, Madison, WI53705
| | - Ali Pope
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, Madison, WI53705
| | - Stephanie McGregor
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI53705
| | - Ella Ward-Shaw
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, Madison, WI53705
| | - Ellery Gronski
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, Madison, WI53705
| | - Paul F. Lambert
- McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, Madison, WI53705
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Mangieri LFL, Cezar-dos-Santos F, Trugilo KP, Watanabe MAE, de Jaime Curti RR, Castilha EP, Moretto SL, Fernandes CYM, de Oliveira JN, de Oliveira KB. Cross-Sectional Analysis of Human Papillomavirus Infection and Cytological Abnormalities in Brazilian Women. Pathogens 2023; 12:pathogens12010148. [PMID: 36678496 PMCID: PMC9863329 DOI: 10.3390/pathogens12010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
The aim of this study was to determine the incidence of infections and cytological abnormalities and to investigate possible predisposing factors such as sociodemographic characteristics, sexual behavioral habits, and gynecological and obstetric backgrounds. Between 2013 and December 2016, a cross-sectional study was conducted among 429 consenting women, from whom cervical samples were tested for the presence of Human papillomavirus (HPV) by polymerase chain reaction (PCR). Susceptibility to HPV infection was assessed by binary logistic regression in light of possible predisposing factors, which were collected using a questionnaire. In our sample population, the prevalence of HPV infection was 49%; high-risk types had a higher prevalence of 89.1%. A larger proportion of HPV-infected women were under 25 years of age, were single, and had monthly incomes up to minimum wage. Multivariate binary logistic regression analysis showed that age younger than 25 years increased the odds of infection fivefold, while a monthly income of one to three minimum wages provided protection against HPV infection, even if the women were married or had a cohabiting partner. In the HPV-positive group, squamous intraepithelial lesions (SIL) occurred more frequently in women who earned up to one minimum wage monthly, but a monthly income of one to three minimum wages protected against the development of SIL. The results suggest that age, marital status, and monthly income are important cofactors for HPV infection and the development of SIL.
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Affiliation(s)
- Luis Fernando Lasaro Mangieri
- Department of Gynecology and Obstetrics, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Fernando Cezar-dos-Santos
- Department of Pathological Sciences, Biological Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Kleber Paiva Trugilo
- Department of Pathological Sciences, Biological Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Maria Angelica Ehara Watanabe
- Department of Pathological Sciences, Biological Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Rafaela Roberta de Jaime Curti
- Department of Pathological Sciences, Biological Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Eliza Pizarro Castilha
- Department of Pathological Sciences, Biological Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Sarah Lott Moretto
- Department of Pathological Sciences, Biological Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | | | - Janaina Nicolau de Oliveira
- Department of Pathological Sciences, Biological Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Karen Brajão de Oliveira
- Department of Pathological Sciences, Biological Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
- Correspondence: ; Tel.: +55-43-3371-5629
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Zhou Z, Hou Y, Qing W, Shi Y, Zhang Y, Chen R, Ou J, Zhou H, Chen M. The association of HPV infection and vaginal microbiota of reproductive women in China: A multicenter cohort study protocol. MEDICINE IN MICROECOLOGY 2022. [DOI: 10.1016/j.medmic.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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10
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Identification of women with high grade histopathology results after conisation by artificial neural networks. Radiol Oncol 2022; 56:355-364. [PMID: 35776841 PMCID: PMC9400436 DOI: 10.2478/raon-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate if artificial neural networks can predict high-grade histopathology results after conisation from risk factors and their combinations in patients undergoing conisation because of pathological changes on uterine cervix. PATIENTS AND METHODS We analysed 1475 patients who had conisation surgery at the University Clinic for Gynaecology and Obstetrics of University Clinical Centre Maribor from 1993-2005. The database in different datasets was arranged to deal with unbalance data and enhance classification performance. Weka open-source software was used for analysis with artificial neural networks. Last Papanicolaou smear (PAP) and risk factors for development of cervical dysplasia and carcinoma were used as input and high-grade dysplasia Yes/No as output result. 10-fold cross validation was used for defining training and holdout set for analysis. RESULTS Bas eline classification and multiple runs of artificial neural network on various risk factors settings were performed. We achieved 84.19% correct classifications, area under the curve 0.87, kappa 0.64, F-measure 0.884 and Matthews correlation coefficient (MCC) 0.640 in model, where baseline prediction was 69.79%. CONCLUSIONS With artificial neural networks we were able to identify more patients who developed high-grade squamous intraepithelial lesion on final histopathology result of conisation as with baseline prediction. But, characteristics of 1475 patients who had conisation in years 1993-2005 at the University Clinical Centre Maribor did not allow reliable prediction with artificial neural networks for every-day clinical practice.
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11
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Wabo B, Nsagha DS, Nana TN, Assob CJN. Prevalence and risk factors associated with precancerous cervical lesions among women in two cities in Cameroon. Pan Afr Med J 2022; 41:276. [PMID: 35784594 PMCID: PMC9206178 DOI: 10.11604/pamj.2022.41.276.21972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/17/2021] [Indexed: 01/27/2023] Open
Abstract
Introduction cervical cancer is the fourth commonest cancer of women world-wide with increasing incidence in developing countries. This study determined the prevalence and assessed risk factors associated with precancerous cervical lesions among women in Cameroon. Methods this cross-sectional study enrolled 925 women participants of a screening campaign for precancerous cervical lesions from June to November 2018 in the selected hospitals. A convenience sampling technique was used and socio-demographic, sexual and reproductive data collected from consented participants by means of self-administered questionnaire. During the gynaecologic examination, a cervical smear was collected, stained by the Papanicolaou staining technique and the results classified according to the Bethesda 2014 guidelines. Frequency, percentage, Chi square and regression analysis were conducted using SPSS version 20 and p-value considered at 0.05. Results of the 925 participants aged 25-65 years (mean 40.2±10.2 SD), 113 (12.2%) had the lesions among whom 9 (7.9%) had atypical squamous cells of undetermined significance, 75 (66.4 %) had Low-grade squamous intraepithelial lesion and 29 (25.7%) had high-grade squamous intraepithelial lesion. Factors associated with the lesions were: age 1.85 [1.42-2.41; p= 0.001] and parity [OR= 1.46; 95% CI: 1.30-1.89; P= 0.004]. Conclusion the prevalence of precancerous lesions was 12.2%. Age, parity were significant risk factors. Regular screening targeting the population at risk in this study becomes a priority.
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Affiliation(s)
- Bernard Wabo
- Department of Medical Laboratory Science, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Dickson Shey Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Théophile Njamen Nana
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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12
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Läsche M, Gallwas J, Gründker C. Like Brothers in Arms: How Hormonal Stimuli and Changes in the Metabolism Signaling Cooperate, Leading HPV Infection to Drive the Onset of Cervical Cancer. Int J Mol Sci 2022; 23:ijms23095050. [PMID: 35563441 PMCID: PMC9103757 DOI: 10.3390/ijms23095050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
Despite all precautionary actions and the possibility of using vaccinations to counteract infections caused by human papillomaviruses (HPVs), HPV-related cancers still account for approximately 5% of all carcinomas. Worldwide, many women are still excluded from adequate health care due to their social position and origin. Therefore, immense efforts in research and therapy are still required to counteract the challenges that this disease entails. The special thing about an HPV infection is that it is not only able to trick the immune system in a sophisticated way, but also, through genetic integration into the host genome, to use all the resources available to the host cells to complete the replication cycle of the virus without activating the alarm mechanisms of immune recognition and elimination. The mechanisms utilized by the virus are the metabolic, immune, and hormonal signaling pathways that it manipulates. Since the virus is dependent on replication enzymes of the host cells, it also intervenes in the cell cycle of the differentiating keratinocytes and shifts their terminal differentiation to the uppermost layers of the squamocolumnar transformation zone (TZ) of the cervix. The individual signaling pathways are closely related and equally important not only for the successful replication of the virus but also for the onset of cervical cancer. We will therefore analyze the effects of HPV infection on metabolic signaling, as well as changes in hormonal and immune signaling in the tumor and its microenvironment to understand how each level of signaling interacts to promote tumorigenesis of cervical cancer.
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13
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Gupta SM, Warke H, Chaudhari H, Mavani P, Katke RD, Kerkar SC, Mania-Pramanik J. Human Papillomavirus E6/E7 oncogene transcripts as biomarkers for the early detection of cervical cancer. J Med Virol 2022; 94:3368-3375. [PMID: 35257379 DOI: 10.1002/jmv.27700] [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: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 11/10/2022]
Abstract
Cancer of the cervix uteri is the fourth most common cancer worldwide with a high mortality rate. Due to the limitations of existing methods, alternative methods for triage are needed for early detection of cervical cancer precursors before progression to high grade disease.The aim of this study was to evaluate HPV E6/E7 oncogene expression as markers for early identification of cervical cancer risk in women with minor cytological abnormalities and in those with negative cytology. The detection of HPV was done using PCR and confirmed by southern hybridization. The high risk (HR) and low risk (LR) HPV types were identified by HPV typing. HPV DNA positive patients were further tested for markers of oncogene expression by real time PCR. Out of the women screened, 54/512 (10.54%) women tested positive for HPV infection. HR HPV DNA was found in 32/485 (6.60%) in women with normal cytology (Pap negative) and 22/27 (81.5%) ASCUS/LSIL cases. High-risk HPV E6/E7 oncogene transcripts were detected in 36/512 (7.03%) of these patients. The positivity rate of E6/E7 mRNA was 2.48% (12/485) in the normal cervical cytology group and 88.9% (24/27) in abnormal cervical cytology group. The HPV E6/E7mRNA test sensitivity was found to be 88.89% and specificity was 97.53%. In comparison the sensitivity of HPV DNA test was found to be 81.48% and specificity was 93.40%. In conclusion, E6 and E7 transcripts could provide a sensitive, early predictor of cervical cancer risk in women with normal cytology and minor cytological alterations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sadhana M Gupta
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Himangi Warke
- Department of Obstetrics and Gynecology, Seth G.S Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Hemangi Chaudhari
- Department of Obstetrics and Gynecology, Seth G.S Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Padmaja Mavani
- Department of Obstetrics and Gynecology, Seth G.S Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Rajshree D Katke
- Department of Obstetrics and Gynecology, Cama and Albless Hospital, Mumbai, India
| | - Shilpa C Kerkar
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Jayanti Mania-Pramanik
- Department of Infectious Diseases Biology, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
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14
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Muntinga CLP, de Vos van Steenwijk PJ, Bekkers RLM, van Esch EMG. Importance of the Immune Microenvironment in the Spontaneous Regression of Cervical Squamous Intraepithelial Lesions (cSIL) and Implications for Immunotherapy. J Clin Med 2022; 11:jcm11051432. [PMID: 35268523 PMCID: PMC8910829 DOI: 10.3390/jcm11051432] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/10/2022] Open
Abstract
Cervical high-grade squamous intraepithelial lesions (cHSILs) develop as a result of a persistent high-risk human papilloma virus (hrHPV) infection. The natural course of cHSIL is hard to predict, depending on a multitude of viral, clinical, and immunological factors. Local immunity is pivotal in the pathogenesis, spontaneous regression, and progression of cervical dysplasia; however, the underlying mechanisms are unknown. The aim of this review is to outline the changes in the immune microenvironment in spontaneous regression, persistence, and responses to (immuno)therapy. In lesion persistence and progression, the immune microenvironment of cHSIL is characterized by a lack of intraepithelial CD3+, CD4+, and CD8+ T cell infiltrates and Langerhans cells compared to the normal epithelium and by an increased number of CD25+FoxP3+ regulatory T cells (Tregs) and CD163+ M2 macrophages. Spontaneous regression is characterized by low numbers of Tregs, more intraepithelial CD8+ T cells, and a high CD4+/CD25+ T cell ratio. A ‘hot’ immune microenvironment appears to be essential for spontaneous regression of cHSIL. Moreover, immunotherapy, such as imiquimod and therapeutic HPV vaccination, may enhance a preexisting pro-inflammatory immune environment contributing to lesion regression. The preexisting immune composition may reflect the potential for lesion regression, leading to a possible immune biomarker for immunotherapy in cHSILs.
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Affiliation(s)
- Caroline L. P. Muntinga
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands; (C.L.P.M.); (R.L.M.B.)
- GROW—School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Peggy J. de Vos van Steenwijk
- GROW—School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
- Department of Gynecology and Obstetrics, Maastricht Universitair Medisch Centrum, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ruud L. M. Bekkers
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands; (C.L.P.M.); (R.L.M.B.)
- GROW—School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Edith M. G. van Esch
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands; (C.L.P.M.); (R.L.M.B.)
- Correspondence: ; Tel.: +31-402-399-111
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15
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Anastasiou E, McCarthy KJ, Gollub EL, Ralph L, van de Wijgert JH, Jones HE. The relationship between hormonal contraception and cervical dysplasia/cancer controlling for human papillomavirus infection: A systematic review. Contraception 2022; 107:1-9. [PMID: 34752778 PMCID: PMC8837691 DOI: 10.1016/j.contraception.2021.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Studies on the effect of long-term use of combined oral contraceptives (COCs) on cervical dysplasia and/or cancer risk have been inconsistent. Less is known about the effects of other forms of hormonal contraception (HC). We examine whether HC use increases the risk of incident cervical intraepithelial neoplasia (CIN) 2, 3 and/or cancer after accounting for preexisting human papillomavirus (HPV) infection. STUDY DESIGN Systematic review of prospective studies on HC use as risk factor for cervical dysplasia with HPV infection documented prior to outcome assessment including PubMed and EMBASE records between January 2000 and February 2020 (Prospero #CRD42019130725). RESULTS Among nine eligible studies, seven described recency and type of HC use and therefore comprise the primary analysis; two studies limit comparisons to ever versus never use and are summarized separately. All seven studies explored the relationship between oral contraceptive (OC) use and cervical dysplasia/cancer incidence: two found increased risk (adjusted odds ratio, aOR = 1.5-2.7), one found no association but decreased risk when restricted to women with persistent HPV (adjusted hazard ratio = 0.5), and four found no association. None of the seven studies differentiated between COC and progestin-only pills (POPs) by use recency or duration. The only study that included injectable progestin-only contraception (DMPA) found increased CIN3 incidence among current versus never users (aOR = 1.6). The one study that included Norplant found no association. Two studies included intrauterine device (IUD) use, but did not differentiate between hormonal and copper IUDs, and found no association. CONCLUSION We found no consistent evidence that OC use is associated with increased risk for cervical dysplasia/cancer after controlling for HPV infection. There were too few studies of progestin-only injectables, implants or IUDs to assess their effect on cervical dysplasia/cancer risk. IMPLICATIONS Use of single self-reported HC measures and insufficient distinction by hormonal constituent cloud our understanding of whether some HCs increase risk for cervical cancer. Methodologically rigorous studies with distinct HCs measured as time-varying exposures are needed to inform cervical cancer prevention efforts and improve our understanding of cervical cancer etiology.
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Affiliation(s)
- Elle Anastasiou
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA
| | - Katharine J. McCarthy
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA
| | - Erica L. Gollub
- College of Health Professions, Health Science Program, Pace University, 861 Bedford Rd, Pleasantville, NY 10570, USA
| | - Lauren Ralph
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1330 Broadway Suite 1100 Oakland CA 94612 USA
| | - Janneke H.H.M. van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Stratenum room 7.127, 3584 Utrecht, Netherlands
| | - Heidi E. Jones
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA,CUNY Institute for Implementation Science in Public Health, 55 W. 125th St., New York, NY 10027, USA
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16
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Singini MG, Sitas F, Bradshaw D, Chen WC, Motlhale M, Kamiza AB, de Villiers CB, Lewis CM, Mathew CG, Waterboer T, Newton R, Muchengeti M, Singh E. Ranking lifestyle risk factors for cervical cancer among Black women: A case-control study from Johannesburg, South Africa. PLoS One 2021; 16:e0260319. [PMID: 34879064 PMCID: PMC8654217 DOI: 10.1371/journal.pone.0260319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. METHODS We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. RESULTS Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53-3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2-1 children (ORadj = 1.25, 95% CI = 1.07-1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24-1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15-1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41-1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 4.4%). CONCLUNSION This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.
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Affiliation(s)
- Mwiza Gideon Singini
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales Sydney, Australia
- Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Melitah Motlhale
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Abram Bunya Kamiza
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College, London, United Kingdom
| | - Christopher G. Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King’s College, London, United Kingdom
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York, United Kingdom
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- * E-mail:
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17
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Sallam M, Al-Mahzoum K, Eid H, Assaf AM, Abdaljaleel M, Al-Abbadi M, Mahafzah A. Attitude towards HPV Vaccination and the Intention to Get Vaccinated among Female University Students in Health Schools in Jordan. Vaccines (Basel) 2021; 9:vaccines9121432. [PMID: 34960177 PMCID: PMC8707789 DOI: 10.3390/vaccines9121432] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
Cervical cancer is a leading cause of morbidity and mortality in women worldwide. The availability of prophylactic vaccines for high-risk types of human papillomavirus (HPV) infection represents an important advancement in the prevention of cervical cancer. In Jordan, the availability of the HPV vaccination is restricted to individuals who are willing to pay. The aim of the current study was to evaluate the willingness and attitude of female university students in health schools/faculties in Jordan to get HPV vaccination and their knowledge about the virus. A self-administered online questionnaire was distributed in October 2021, which comprised 27 items to evaluate HPV knowledge, history of HPV vaccination, intentions to get the HPV vaccine, and the reason(s) behind vaccine refusal for those who rejected vaccination. The study sample comprised 836 participants: medical students (39.7%), pharmacy students (26.0%), dental students (21.2%), and nursing students (13.2%). Only 524 participants had heard of HPV prior to the study (62.7%), of which 48.7% knew about the availability of HPV vaccines. The lowest level of HPV knowledge was observed among nursing students. Only 19/524 students reported a history of HPV vaccination (3.6%). The overall willingness to receive HPV vaccination if provided freely was 75.0%, while only 16.0% were willing to pay for the vaccine. The most common reason for HPV vaccine rejection was the perceived low risk to get HPV infection. Significantly higher intentions to get HPV vaccination were found among older participants and medical students. The embrace of vaccine conspiracy beliefs was associated with a significantly less willingness to get the HPV vaccination (p < 0.001). Dependence on the internet/social media as the source of HPV knowledge was associated with a significantly lower intention to get HPV vaccination (p = 0.002). The coverage of the HPV vaccination among female university students in health schools in Jordan appeared extremely low; however, three-fourths of the students who had heard of HPV were willing to receive the HPV vaccination if provided freely. Complacency appeared as a major factor for HPV vaccine rejection. Increasing the levels of knowledge and awareness of HPV infection and its association with cervical cancer through reliable sources is recommended. This can be helpful for the individual benefit of the students besides the potentially positive role they can play in community education. Countering vaccine conspiracy beliefs with proper education and awareness programs can be helpful to appraise the role of HPV vaccines in cancer prevention.
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Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (M.A.-A.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
- Correspondence: ; Tel.: +962-791845186
| | | | - Huda Eid
- School of Dentistry, The University of Jordan, Amman 11942, Jordan;
| | - Areej M. Assaf
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan;
| | - Maram Abdaljaleel
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (M.A.-A.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Mousa Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (M.A.-A.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (M.A.-A.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
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18
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Orr J, Kenny RA, McGarrigle CA. Higher Parity Is Associated With Lower Mortality in a European Population of Women With High Fertility: Results From Ireland. J Gerontol A Biol Sci Med Sci 2021; 76:1571-1578. [PMID: 33367528 DOI: 10.1093/gerona/glaa323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Indexed: 11/13/2022] Open
Abstract
Research has often found a U- or J-shaped association between parity and mortality. Many researchers have suggested repeated pregnancy, childbirth, and lactation taxes the body beyond a certain parity level. Available research has concentrated on populations with controlled fertility or historic populations. Ireland presents an opportunity to explore these associations in a modern sample with high fertility. We use data from the Irish Longitudinal Study on Ageing (TILDA) to test whether parity is associated with mortality in women aged 50 years or over (n = 4177). We use Cox proportional hazards models to model survival and adjust for demographics and early life circumstances. We test whether a number of health characteristics mediate these effects. Models were also stratified by birth cohort to test possible cohort effects. Higher parity was associated with lower risk of mortality, even after adjustment for early life and socioeconomic circumstances. This effect was not mediated by current health characteristics. The effects were largely driven by those born between 1931 and 1950. Increasing parity is associated with decreasing mortality risk in this sample. The effects of parity could not be explained through any of the observed health characteristics. These findings are in contrast to much of the literature on this question in similar populations. Lack of fertility control in Ireland may have "selected" healthier women into high parity. Social explanations for these associations should be further explored.
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Affiliation(s)
- Joanna Orr
- The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Christine A McGarrigle
- The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College Dublin, Ireland
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19
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Abila DB, Wasukira SB, Ainembabazi P, Wabinga H. Burden of Risk Factors for Cervical Cancer Among Women Living in East Africa: An Analysis of the Latest Demographic Health Surveys Conducted Between 2014 and 2017. JCO Glob Oncol 2021; 7:1116-1128. [PMID: 34264750 PMCID: PMC8457811 DOI: 10.1200/go.21.00123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In East Africa, cervical cancer is a leading cause of morbidity and mortality among women diagnosed with cancer. In this study, we describe the burden of risk factors for cervical cancer among women of reproductive age in five East African countries.
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Affiliation(s)
- Derrick Bary Abila
- Makerere University, College of Health Sciences, Kampala, Uganda.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | | | - Provia Ainembabazi
- Makerere University, College of Health Sciences, Kampala, Uganda.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Henry Wabinga
- Makerere University, College of Health Sciences, Kampala, Uganda
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20
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Sierra MS, Tsang SH, Hu S, Porras C, Herrero R, Kreimer AR, Schussler J, Boland J, Wagner S, Cortes B, Rodríguez AC, Quint W, van Doorn LJ, Schiffman M, Sampson JN, Hildesheim A. Risk Factors for Non-Human Papillomavirus (HPV) Type 16/18 Cervical Infections and Associated Lesions Among HPV DNA-Negative Women Vaccinated Against HPV-16/18 in the Costa Rica Vaccine Trial. J Infect Dis 2021; 224:503-516. [PMID: 33326576 PMCID: PMC8496490 DOI: 10.1093/infdis/jiaa768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Factors that lead human papillomavirus (HPV) infections to persist and progress to cancer are not fully understood. We evaluated co-factors for acquisition, persistence, and progression of non-HPV-16/18 infections among HPV-vaccinated women. METHODS We analyzed 2153 women aged 18-25 years randomized to the HPV-vaccine arm of the Costa Rica HPV Vaccine Trial. Women were HPV DNA negative for all types at baseline and followed for approximately 11 years. Generalized estimating equation methods were used to account for correlated observations. Time-dependent factors evaluated were age, sexual behavior, marital status, hormonally related factors, number of full-term pregnancies (FTPs), smoking behavior, and baseline body mass index. RESULTS A total of 1777 incident oncogenic non-HPV-16/18 infections were detected in 12 292 visits (average, 0.14 infections/visit). Age and sexual behavior-related variables were associated with oncogenic non-HPV-16/18 acquisition. Twenty-six percent of incident infections persisted for ≥1 year. None of the factors evaluated were statistically associated with persistence of oncogenic non-HPV-16/18 infections. Risk of progression to Cervical Intraepithelial Neoplasia grade 2 or worst (CIN2+) increased with increasing age (P for trend = .001), injectable contraceptive use (relative risk, 2.61 [95% confidence interval, 1.19-5.73] ever vs never), and increasing FTPs (P for trend = .034). CONCLUSIONS In a cohort of HPV-16/18-vaccinated women, age and sexual behavior variables are associated with acquisition of oncogenic non-HPV-16/18 infections; no notable factors are associated with persistence of acquired infections; and age, parity, and hormonally related exposures are associated with progression to CIN2+.
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Affiliation(s)
- Mónica S Sierra
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Sabrina H Tsang
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Shangying Hu
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
- Prevention and Implementation Group, International Agency
for Research on Cancer, Lyon, France
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - John Schussler
- Information Management Services, Silver
Spring, Maryland, USA
| | - Joseph Boland
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National
Laboratory for Cancer Research, Leidos Biomedical Research Inc,
Frederick, Maryland, USA
| | - Sarah Wagner
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National
Laboratory for Cancer Research, Leidos Biomedical Research Inc,
Frederick, Maryland, USA
| | - Bernal Cortes
- Agencia Costarricense de Investigaciones Biomédicas,
formerly Proyecto Epidemiológico Guanacaste, Fundación
INCIENSA, San José, Costa
Rica
| | | | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk,
The Netherlands
| | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Bethesda, Maryland, USA
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21
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Tanaka LF, Schriefer D, Radde K, Schauberger G, Klug SJ. Impact of opportunistic screening on squamous cell and adenocarcinoma of the cervix in Germany: A population-based case-control study. PLoS One 2021; 16:e0253801. [PMID: 34260601 PMCID: PMC8279357 DOI: 10.1371/journal.pone.0253801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background We investigated the uptake of opportunistic cervical cancer screening (CCS) and other risk factors and their association with cervical cancer in Germany in a case-control study. Methods and findings We recruited incident cases of cervical cancer (ICD-10 C53) diagnosed between 2012 and 2016 and matched with three population-based controls, based on age and region of residence. Cases and controls reported their CCS participation during the past ten years (frequent: every three years; no or infrequent: less than every three years) and other relevant variables. We fitted conditional logistic regression models, reporting odds ratios (OR) and 95% confidence intervals (95% CI). We report overall and stratified analyses by histologic group (squamous cell–SCC, and adenocarcinoma–AC), T category (T1 and T2+), and age (<50 and ≥50 years). We analysed 217 cases and 652 matched controls. 53.0% of cases and 85.7% of controls attended CCS frequently. In the overall adjusted model, no or infrequent participation in CCS (OR 5.63; 95% CI 3.51 to 9.04), having had more than one sexual partner (OR 2.86; 95%CI 1.50 to 5.45) and obesity (OR 1.69; 95% CI 1.01 to 2.83) were associated with cervical cancer. Twelve years of schooling (OR 0.37; 95% CI 0.23 to 0.60) and a net monthly income of €3000 or more (OR 0.50; 95% CI 0.30 to 0.82) were protective factors. In the stratified analyses, no or infrequent participation was associated with T1 (OR 4.37; 95% CI 2.48 to 7.71), T2+ (OR 10.67; 95% CI 3.83 to 29.74), SCC (OR 6.88; 95% CI 4.08 to 11.59) and AC (OR 3.95; 95% CI 1.47 to 10.63). Conclusion Although women who frequently attended CCS were less likely to develop cervical cancer, especially larger tumours, the high proportion of cases who had been frequently screened prior to diagnosis underscores the need to investigate the quality of cytology and treatment of precancerous lesions in Germany.
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Affiliation(s)
- Luana F Tanaka
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Dirk Schriefer
- Center of Clinical Neuroscience, University Clinic Carl Gustav Carus Dresden, Dresden, Germany
| | - Kathrin Radde
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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22
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Huber J, Mueller A, Sailer M, Regidor PA. Human papillomavirus persistence or clearance after infection in reproductive age. What is the status? Review of the literature and new data of a vaginal gel containing silicate dioxide, citric acid, and selenite. ACTA ACUST UNITED AC 2021; 17:17455065211020702. [PMID: 34096424 PMCID: PMC8785287 DOI: 10.1177/17455065211020702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical cancer, the third most common cancer in women, is caused in nearly all cases by a persistent infection with high-risk types of the human papillomavirus. Although human papillomavirus infections are 80%-90% transient and disappear spontaneously within 24 months, human papillomavirus infections that remain are at risk of developing cervical lesions. Different therapeutical approaches have been tested to promote the regression of low-grade lesions or prevent progression. They include the application of 5-fluorouracil, curcumin, imiquimod, interferons, Vitamin D, and others. Also, the effect of probiotics and vaginal therapy with carboxy-methyl-beta glucan was assessed. Review of the literature and presentation of the last study data are presented. Clearance of high-risk human papillomavirus seemed to be promoted by treatment with a new vaginal gel containing a highly disperse SiO2 and an anti-oxidative combination of citric acid and sodium. This gel showed, after 6 months, an improvement of cytological Pap findings (ASC-US, LSIL, ASC-H, or HSIL) in 80.9% of the participants. Similarly, there was a clearing of hr-human papillomavirus in 53% of cases after 3 months of gel administration. The percentage increased slightly in the non-treated control group from 78.3% at baseline to 83% after 3 months. The percentage of patients who were tested positive for p16/Ki67 reduced from 75% at baseline to 5.3% in the treatment group after 6 months, while the percentage decreased only slightly in the non-treated group (baseline: 91.5%; 6 months: 75.2%). The examined vaginal gel may support the healing of conspicuous cytological findings (ASC-US, LSIL, ASC-H, or HSIL) and clearance of hr-human papillomavirus positive results.
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23
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R S J. The Immune Microenvironment in Human Papilloma Virus-Induced Cervical Lesions-Evidence for Estrogen as an Immunomodulator. Front Cell Infect Microbiol 2021; 11:649815. [PMID: 33996630 PMCID: PMC8120286 DOI: 10.3389/fcimb.2021.649815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/29/2021] [Indexed: 12/24/2022] Open
Abstract
Globally, human papilloma virus (HPV) infection is a common sexually transmitted disease. However, most of the HPV infections eventually resolve aided by the body’s efficient cell-mediated immune responses. In the vast majority of the small group of patients who develop overt disease too, it is the immune response that culminates in regression of lesions. It is therefore a rarity that persistent infection by high-risk genotypes of HPV compounded by other risk factors progresses through precancer (various grades of cervical intraepithelial neoplasia—CIN) to cervical cancer (CxCa). Hence, although CxCa is a rare culmination of HPV infection, the latter is nevertheless causally linked to >90% of cancer. The three ‘Es’ of cancer immunoediting viz. elimination, equilibrium, and escape come into vogue during the gradual evolution of CIN 1 to CxCa. Both cell-intrinsic and extrinsic mechanisms operate to eliminate virally infected cells: cell-extrinsic players are anti-tumor/antiviral effectors like Th1 subset of CD4+ T cells, CD8+ cytotoxic T cells, Natural Killer cells, etc. and pro-tumorigenic/immunosuppressive cells like regulatory T cells (Tregs), Myeloid-Derived Suppressor Cells (MDSCs), type 2 macrophages, etc. And accordingly, when immunosuppressive cells overpower the effectors e.g., in high-grade lesions like CIN 2 or 3, the scale is tilted towards immune escape and the disease progresses to cancer. Estradiol has long been considered as a co-factor in cervical carcinogenesis. In addition to the gonads, the Peyer’s patches in the gut synthesize estradiol. Over and above local production of the hormone in the tissues, estradiol metabolism by the gut microbiome: estrobolome versus tryptophan non-metabolizing microbiome, regulates free estradiol levels in the intestine and extraintestinal mucosal sites. Elevated tissue levels of the hormone serve more than one purpose: besides a direct growth-promoting action on cervical epithelial cells, estradiol acting genomically via Estrogen Receptor-α also boosts the function of the stromal and infiltrating immunosuppressive cells viz. Tregs, MDSCs, and carcinoma-associated fibroblasts. Hence as a corollary, therapeutic repurposing of Selective Estrogen Receptor Disruptors or aromatase inhibitors could be useful for modulating immune function in cervical precancer/cancer. The immunomodulatory role of estradiol in HPV-mediated cervical lesions is reviewed.
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Affiliation(s)
- Jayshree R S
- Department of Microbiology, Kidwai Memorial Institute of Oncology, Bangalore, India
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24
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Molina-Pineda A, López-Cardona MG, Limón-Toledo LP, Cantón-Romero JC, Martínez-Silva MG, Ramos-Sánchez HV, Flores-Miramontes MG, de la Mata-González P, Jave-Suárez LF, Aguilar-Lemarroy A. High frequency of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. BMC Infect Dis 2020; 20:889. [PMID: 33238902 PMCID: PMC7690193 DOI: 10.1186/s12879-020-05627-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Human papillomavirus infection is an important factor associated with cervical cancer (CC) development. The prevalence and genotype distribution vary greatly worldwide. Examining local epidemiological data constitutes an important step towards the development of vaccines to prevent CC. In this work, we studied the prevalence of HPV genotypes in women from Western Mexico with the COBAS 4800 and/or Linear Array Genotyping Test (LA). METHODS The samples analysed in this study represent a population from Western Mexico, which includes six different states. Our approach was first to test for HPV in cervical samples from women who attended their health clinic for routine gynaecological studies (open-population, n = 3000) by utilizing COBAS 4800. Afterwards, 300 of the HPV-positive samples were randomly selected to be genotyped with LA; finally, we genotyped samples from women with cervical intraepithelial neoplasia grade 1 (CIN 1, n = 71) and CC (n = 96) with LA. Sociodemographic data of the diverse groups were also compared. RESULTS The overall HPV prevalence among the open-population of women as determined by COBAS 4800 was 12.1% (n = 364/3000). Among the HPV-positive samples, single infections (SI) with HPV16 were detected in 12.4% (n = 45/364), SI with HPV18 were detected in 1.4%, and infection with at least one of the genotypes included in the high-risk HPV pool was detected in 74.5% of the cases. LA analysis of the samples showed that in addition to HPV genotypes 16 and 18, there was a high prevalence of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. With respect to the sociodemographic data, we found statistically significant differences in the number of pregnancies, the use of hormonal contraceptives and tobacco intake. CONCLUSIONS Our data indicate that there is a high prevalence of HPV genotypes which are not covered by the vaccines currently available in Mexico; therefore, it is necessary to include HPVs 59, 66, 51, 39 and 56 in the design of future vaccines to reduce the risk of CC development. It is also essential to emphasize that the use of hormonal contraceptives and tobacco smoking are risk factors for CC development in addition to the presence of HPV.
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Affiliation(s)
- Andrea Molina-Pineda
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - María Guadalupe López-Cardona
- Unidad de Medicina Genómica y Genética, Hospital Regional Dr. Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, Mexico.,Departamento de Fisiología, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Laura Patricia Limón-Toledo
- Clínica de Displasias, Unidad Médica de Alta Especialidad (UMAE), Hospital de Ginecología y Obstetricia, Centro Médico Nacional de Occidente-IMSS, Guadalajara, Jalisco, Mexico
| | - Juan Carlos Cantón-Romero
- Servicio de Ginecología Oncológica, UMAE Hospital de Ginecología y Obstetricia, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, Mexico
| | | | - Holanda Vanesa Ramos-Sánchez
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - María Guadalupe Flores-Miramontes
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Pedro de la Mata-González
- Unidad de Medicina Genómica y Genética, Hospital Regional Dr. Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, Mexico.,Departamento de Fisiología, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Luis F Jave-Suárez
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico. .,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
| | - Adriana Aguilar-Lemarroy
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico. .,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
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25
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Chen M, Wang H, Liang Y, Hu M, Li L. Establishment of multifactor predictive models for the occurrence and progression of cervical intraepithelial neoplasia. BMC Cancer 2020; 20:926. [PMID: 32993576 PMCID: PMC7523359 DOI: 10.1186/s12885-020-07265-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/05/2020] [Indexed: 01/05/2023] Open
Abstract
Background To study the risk factors involved in the occurrence and progression of cervical intraepithelial neoplasia (CIN) and to establish predictive models. Methods Genemania was used to build a gene network. Then, the core gene-related pathways associated with the occurrence and progression of CIN were screened in the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) experiments were performed to verify the differential expression of the identified genes in different tissues. R language was used for predictive model establishment. Results A total of 10 genes were investigated in this study. A total of 30 cases of cervical squamous cell cancer (SCC), 52 cases of CIN and 38 cases of normal cervix were enrolled. Compared to CIN cases, the age of patients in the SCC group was older, the number of parities was greater, and the percentage of patients diagnosed with CINII+ by TCT was higher. The expression of TGFBR2, CSKN1A1, PRKCI and CTBP2 was significantly higher in the SCC groups. Compared to patients with normal cervix tissue, the percentage of patients who were HPV positive and were diagnosed with CINII+ by TCT was significantly higher. FOXO1 expression was significantly higher in CIN tissue, but TGFBR2 and CTBP2 expression was significantly lower in CIN tissue. The significantly different genes and clinical factors were included in the models. Conclusions Combination of clinical and significant genes to establish the random forest models can provide references to predict the occurrence and progression of CIN.
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Affiliation(s)
- Mengjie Chen
- Guangxi Medical University affiliated Cancer Hospital, NO.71 Hedi Road Qingxiu Square, Nanning City, Guangxi Province, China
| | - He Wang
- Guangxi Medical University affiliated Cancer Hospital, NO.71 Hedi Road Qingxiu Square, Nanning City, Guangxi Province, China
| | - Yuejuan Liang
- Guangxi Medical University affiliated Cancer Hospital, NO.71 Hedi Road Qingxiu Square, Nanning City, Guangxi Province, China
| | - Mingmiao Hu
- Guangxi Medical University affiliated Cancer Hospital, NO.71 Hedi Road Qingxiu Square, Nanning City, Guangxi Province, China
| | - Li Li
- Guangxi Medical University affiliated Cancer Hospital, NO.71 Hedi Road Qingxiu Square, Nanning City, Guangxi Province, China.
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Venkatas J, Singh M. Cervical cancer: a meta-analysis, therapy and future of nanomedicine. Ecancermedicalscience 2020; 14:1111. [PMID: 33144879 PMCID: PMC7581334 DOI: 10.3332/ecancer.2020.1111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 12/18/2022] Open
Abstract
Cervical cancer is one of the leading causes of female death, with an annual mortality rate exceeding 200,000 in developing communities. Despite the past decade bearing witness to a reduction in cervical cancer cases throughout developed countries, the prevalence in developing countries continues to rapidly rise. The increase in cervical cancer cases is attributed to the lack of financial resources and the unavoidable risk factors of the disease. Traditional means of anticancer therapy are compromised by reduced drug potency, non-specificity, negative side effects and the development of multiple drug resistance (MDR), which leads to a decrease in the long-term anticancer therapeutic efficacy. Recent advances in nanomedicine have elucidated the potential of nanoparticles to reduce the side effects and improve the survival rate of patients, by enhancing selective delivery and uptake of photosensitive, therapeutic and genetic material to cervical cancer cells, thereby enhancing antitumour efficiency. This review paper analyses the risk factors and epidemiology of cervical cancer globally, especially in developing communities, whilst demonstrating the enhanced anticancer treatment using selected nanoparticles.
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Affiliation(s)
- Jeaneen Venkatas
- Nano-Gene and Drug Delivery Group, Discipline of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa
- https://orcid.org/0000-0001-5061-0788
| | - Moganavelli Singh
- Nano-Gene and Drug Delivery Group, Discipline of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa
- https://orcid.org/0000-0002-9985-6567
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Tekalegn Y, Aman R, Woldeyohannes D, Sahiledengle B, Degno S. Determinants of VIA Positivity Among Women Screened for Cervical Precancerous Lesion in Public Hospitals of Oromia Region, Ethiopia: Unmatched Case-Control Study. Int J Womens Health 2020; 12:587-596. [PMID: 32801936 PMCID: PMC7398741 DOI: 10.2147/ijwh.s256821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Globally, cervical cancer is the fourth most frequent cancer among women. An estimated 570,000 cases of cervical cancer representing 6.6% of all female cancers were reported in the year 2018. Approximately, 90% of deaths from cervical cancer occurred in low- and middle-income countries. Screening cervical cancer at an early stage and providing access to effective treatment can significantly improve the likelihood of survival. Hence, this study aimed to assess the determinants of visual inspection of cervix with acetic acid (VIA) positivity among women screened in public hospitals of Oromia region, Ethiopia. Methods A hospital-based un-matched case-control study was conducted in Oromia region, Ethiopia. Cases were women who have a positive result for the VIA test, and controls were women with a negative result. An interviewer-administered questionnaire was used to collect the data. Multiple binary logistic regressions were conducted to assess the determinants of VIA positivity. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported to describe the strength of associations. Statistical significance was declared at a p-value <0.05. Results A total of 74 cases and 148 controls were included in this study. The mean age of cases and controls was 40.5 ± 13.3 years and 37.1 ± 11.9 years, respectively. Women with parity of four or more children had two times higher odds being positive for VIA test compared to their counterparts (AOR: 2.1, 95% CI: 1.3–4.0). Women with a history of post-coital bleeding had three times higher odds of VIA positivity compared to their counterparts (AOR: 3.3, 95% CI: 1.2–8.0). History of sexually transmitted infection (AOR: 1.9, 95% CI: 1.1–3.5), having multiple sexual partners (AOR: 3.2, 95% CI: 1.2–8.0), and history of smoking (AOR: 8.9, 95% CI: 1.6–48.0) were also found to be determinants of VIA positivity. Conclusion This study found that women with parity greater than four children, post-coital bleeding, history of sexually transmitted infections, having multiple sexual partners, and history of smoking were significantly associated with VIA positivity. Women with the mentioned characteristics should be encouraged to have a close follow-up for the screening. Additionally, awareness creation activities on the identified risk factors are strongly recommended for all women.
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Affiliation(s)
- Yohannes Tekalegn
- School of Health Science, Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
| | - Rameto Aman
- School of Health Science, Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
| | - Demelash Woldeyohannes
- School of Health Science, Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
| | - Biniyam Sahiledengle
- School of Health Science, Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
| | - Sisay Degno
- School of Medicine, Department of Anatomy, Madda Walabu University, Goba Referral Hospital, Goba, Ethiopia
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Nessa A, Ara R, Fatema P, Nasrin B, Chowdhury A, Khan KH, Barua AR, Rashid MHU. Influence of Demographic and Reproductive Factors on Cervical Pre-Cancer and Cancer in Bangladesh. Asian Pac J Cancer Prev 2020; 21:1883-1889. [PMID: 32711411 PMCID: PMC7573429 DOI: 10.31557/apjcp.2020.21.7.1883] [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: 10/14/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In Bangladesh, cervical cancer (CC) is the 2nd most common cancer with estimated 8068 new cases and 5,214 deaths every year. It is also revealed that different socio-demographic factors have association with CC. This study was performed to evaluate the colposcopy outcomes and the association of different demographic and reproductive risk factors with cervical pre-cancer and cancer. METHODS This retrospective cross-sectional study was carried out at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) between January 2010 and December 2016. RESULTS A total 16147 women attended the colposcopy clinic of BSMMU with VIA positive reports. Among them, 65.73% women were referred from different VIA centers of Dhaka district. Mean age of marriage of the subjects was 16. 93 (± 1) and mean age of 1st delivery was 18.45 years (± 4.10). Almost three-fourth of them were married before 18 years and had their 1st delivery by 20 years. Colposcopy examination of the VIA positive women revealed that 36.7% had CINI, 10.6% had CINII/ III and 7.1% had carcinoma of cervix. Considering CIN as disease the Sensitivity, Specificity, PPV and NPV of colposcopy were found 99.7%, 75.3%, 70.3% and 99.8% respectively. On other hand considering CIN2+ as disease the Sensitivity, Specificity, PPV and NPV of colposcopy were found 73.8%, 92.7%, 64.4% and 95.2% respectively. Statistical analysis revealed that higher age (p=0.000), lower level of education (p=0.007), lower socioeconomic status (p=0.014), higher parity (p=0.001) had individual influence on cervical pre-cancer and cancer. CONCLUSIONS This study indicated higher age, low level of education, lower socio-economic condition and higher parity as most important socio-demographic factors for developing cervical pre-cancer and cancer in Bangladesh.
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Affiliation(s)
- Ashrafun Nessa
- Department of Gynaeclogical Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka-1000, Bangladesh
| | - Rowson Ara
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Parveen Fatema
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Begum Nasrin
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Afroza Chowdhury
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Kamrul Hasan Khan
- Department of Histopathology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | | | - Mohammad Harun Ur Rashid
- Institute of Epidemiology, Diseese Control and Research (IEDCR), Directorate General of Health Services, Mohakhali, Dhaka-1212, Bangladesh
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Aykut Tuncer H, Tuncer SF. The effect of age On cervical cancer screening in women aged 20-29. Acta Clin Croat 2020; 59:277-284. [PMID: 33456115 PMCID: PMC7808238 DOI: 10.20471/acc.2020.59.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
No definite consensus exists currently regarding the appropriate age at which to start cervical cancer screening. We analyzed the effectiveness of age in abnormal histology outcomes in women aged 20-29. Data on women aged 20-29 having undergone opportunistic cervical cancer screening with cytology during the 2014-2019 period were retrospectively reviewed. Based on cytology outcomes, human papillomavirus test results (if present), age and clinical decision, patients underwent either colposcopy or observation. The effects of age and other epidemiologic factors on histologic diagnoses of cervical intraepithelial neoplasia (CIN) or cancer [CIN (+)] were analyzed in univariate and binomial logistic regression analyses. Among 1649 women, CIN (+) lesions were observed in 61 (3.7%) women. The occurrence of CIN (+) lesions increased 1.149 times each year; thus, women aged 25-29 were more likely to have CIN (+) than those aged 20-24 (4.4% vs. 2.1%; p=0.019). A significant determinant of CIN (+) was the increase in age, i.e. women aged 20-29. Accordingly, considering age is crucial for the diagnosis of CIN (+) in cancer screening.
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Affiliation(s)
| | - Serap Fırtına Tuncer
- 1Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Akdeniz University School of Medicine Hospital, Antalya, Turkey; 2Department of Obstetrics and Gynecology, Antalya Education & Research Hospital, Antalya, Turkey
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Li W, Liu LL, Luo ZZ, Han CY, Wu QH, Zhang L, Tian LS, Yuan J, Zhang T, Chen ZW, Yang TB, Feng TJ, Zhang M, Chen XS. Associations of sexually transmitted infections and bacterial vaginosis with abnormal cervical cytology: A cross-sectional survey with 9090 community women in China. PLoS One 2020; 15:e0230712. [PMID: 32214342 PMCID: PMC7098628 DOI: 10.1371/journal.pone.0230712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/06/2020] [Indexed: 01/04/2023] Open
Abstract
Background Although it is well acknowledged that persistent infection with high-risk human papillomavirus types in genital sites plays a crucial role in the development of squamous cell cervical carcinoma, there is no unanimous consensus on the association between non-HPV sexually transmitted infections and abnormal cervical cytology. Methods In the present study, we evaluated cervical cytology status, sexually transmitted infections and bacterial vaginosis status, and collected social-demographic information among recruited participants to explore the association of STIs and bacterial vaginosis with abnormal cervical cytology. Results 9,090 women’s specimens were successfully tested, with a total of 8,733 (96.1%) women had normal cytology and 357 (3.9%) women exhibited abnormal cytology. The prevalence of HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis was significantly higher in the ≥ASC-US group than the NILM group (P<0.05). Women with Neisseria gonorrhoeae infection (AOR = 5.30, 95% CIs = 1.30–21.51, P = 0.020) or bacterial vaginosis (AOR = 1.94, 95% CIs = 1.08–3.47, P = 0.026) exhibited an increased risk of abnormal cervical cytology after adjusted for carcinogenic HPV-positive status. Conclusions Our results demonstrated that Neisseria gonorrhoeae infection in genital sites and/or bacterial vaginosis may independently increase the risk for cervical cytology abnormalities after adjusted for carcinogenic HPV-positive status. Besides, these results improved our understanding of the etiology of abnormal cervical cytology and may be useful for the management of women with ASC-US cytology.
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Affiliation(s)
- Wu Li
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Lan-lan Liu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Zhen-zhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
- * E-mail:
| | - Chun-yan Han
- Shenzhen Nanshan Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Qiu-hong Wu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li-shan Tian
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Jun Yuan
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Tao Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Zhong-wei Chen
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Tu-bao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Tie-jian Feng
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Min Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
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Chen J, Gopala K, Akarsh PK, Struyf F, Rosillon D. Prevalence and Incidence of Human Papillomavirus (HPV) Infection Before and After Pregnancy: Pooled Analysis of the Control Arms of Efficacy Trials of HPV-16/18 AS04-Adjuvanted Vaccine. Open Forum Infect Dis 2019; 6:ofz486. [PMID: 31824976 PMCID: PMC6892569 DOI: 10.1093/ofid/ofz486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/27/2019] [Indexed: 12/18/2022] Open
Abstract
Objective Data on human papillomavirus (HPV) prevalence around pregnancy were inconsistent. We assessed HPV prevalence before and after pregnancy, HPV incidence after pregnancy, and risk factors for HPV infection. Method Data from 15 754 women in control arms of 5 AS04-HPV-16/18 vaccine efficacy trials were analyzed, including 3001 women with at least 1 pregnancy. Results of HPV deoxyribonucleic acid testing on cervical samples were available. We analyzed risk factors, including age, region, pregnancy and its outcomes, duration from pregnancy resolution to collection of first postresolution cervical sample, previous HPV infection, cigarette smoking, and number of sexual partners with Cox regression. Results Prevalence of high-risk oncogenic (hr)-HPV types was similar before and after pregnancy (20.8% vs 19.8%). Incidence of hr-HPV was 40.1 per 1000 person-years (95% confidence interval [CI], 23.4–64.2) at 0–3 months, 266.7 (95% CI, 217.4–323.7) at 3–6 months, and 95.7 (95% CI, 83.9–108.7) at >6 months after pregnancy. Risk factors associated with HPV infection after pregnancy are previous HPV infection, elective abortion, and younger age at pregnancy resolution. Conclusions Pregnancy could not be confirmed as a risk factor for HPV infection in this population despite an increased incidence detected 3–6 months after pregnancy resolution. Most women remained HPV negative after pregnancy. Clinical Trial Registration NCT001226810 (HPV-008 trial), NCT00294047 (HPV-015 trial), NCT00316693 and NCT00929526 (HPV-032/063 trials), and NCT00779766 (HPV-039 trial).
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Loopik DL, IntHout J, Melchers WJG, Massuger LFAG, Bekkers RLM, Siebers AG. Oral contraceptive and intrauterine device use and the risk of cervical intraepithelial neoplasia grade III or worse: a population-based study. Eur J Cancer 2019; 124:102-109. [PMID: 31760309 DOI: 10.1016/j.ejca.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/10/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hormonal contraceptive use has been associated with the development of cervical cancer, although inconsistent results are reported on the association with intrauterine device (IUD) use. The aim of this study was to evaluate the association between the type of contraceptive use and the development of cervical intraepithelial neoplasia grade III or worse (CIN3+). METHODS A retrospective population-based cohort study including women aged 29-44 years attending the cervical cancer screening program with normal cytology between 2005 and 2009 identified from the Dutch Pathology Registry. Subgroups with at least 5 years registered use of an oral contraceptive (OC) or IUD were compared with non-users. Risk ratios of CIN3+ were estimated per contraceptive type. RESULTS 702,037 women were included with a median follow-up of 9.7 years, of which 6705 (0.96%) and 559 (0.08%) women developed CIN3 and cervical cancer, respectively. IUD use was associated with an increased risk of developing CIN3+ (risk ratio (RR) 1.51, 95% confidence interval (CI) 1.32-1.74), and OC use was associated with an increased risk of developing CIN3+ (RR 2.77, 95%CI 2.65-3.00) and cervical cancer (RR 2.06, 95%CI 1.52-2.79). The risk of developing CIN3+ and cervical cancer was higher for OC users compared with IUD users (RR 1.83, 95%CI 1.60-2.09 and RR 1.70, 95%CI 1.00-2.90, respectively). CONCLUSIONS Both OC use and IUD use were associated with an increased risk of developing CIN3+. However, for women with a contraceptive wish, an IUD seems safer than an OC as the risk of developing CIN3+ and cervical cancer was higher for OC users.
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Affiliation(s)
- Diede L Loopik
- Department of Obstetrics and Gynaecology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands.
| | - Joanna IntHout
- Department of Biostatistics, Radboud Institute for Health Sciences, Radboud university medical center, PO Box 9101, 6585KM, Nijmegen, the Netherlands.
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands.
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands.
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, PO Box 1350, 5602ZA, Eindhoven, the Netherlands.
| | - Albert G Siebers
- Department of Pathology, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands; PALGA, Randhoeve 225a, 3995 GA, Houten, the Netherlands.
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Cesarean delivery may be protective against neoplasms of the uterine cervix in women of childbearing age. Eur J Cancer Prev 2019; 29:501-503. [DOI: 10.1097/cej.0000000000000555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saleem A, Bekele A, Fitzpatrick MB, Mahmoud EA, Lin AW, Velasco HE, Rashed MM. Knowledge and awareness of cervical cancer in Southwestern Ethiopia is lacking: A descriptive analysis. PLoS One 2019; 14:e0215117. [PMID: 31714915 PMCID: PMC6850540 DOI: 10.1371/journal.pone.0215117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/23/2019] [Indexed: 01/06/2023] Open
Abstract
Purpose Cervical cancer remains the second most common cancer and cancer-related death among women in Ethiopia. This is the first study, to our knowledge, describing the demographic, and clinicopathologic characteristics of cervical cancer cases in a mainly rural, Southwestern Ethiopian population with a low literacy rate to provide data on the cervical cancer burden and help guide future prevention and intervention efforts. Methods A descriptive analysis of 154 cervical cancer cases at the Jimma University Teaching Hospital in Southwestern Ethiopia from January 2008 –December 2010 was performed. Demographic and clinical characteristics were obtained from patient questionnaires and cervical punch biopsies were histologically examined. Results Of the 154 participants with a histopathologic diagnosis of cervical cancer, 95.36% had not heard of cervical cancer and 89.6% were locally advanced at the time of diagnosis. Moreover, 86.4% of participants were illiterate, and 62% lived in a rural area. Conclusion A majority of the 154 women with cervical cancer studied at the Jimma University Teaching Hospital in Southwestern Ethiopia were illiterate, had not heard of cervical cancer and had advanced disease at the time of diagnosis. Given the low rates of literacy and knowledge regarding cervical cancer in this population which has been shown to correlate with a decreased odds of undergoing screening, future interventions to address the cervical cancer burden here must include an effective educational component.
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Affiliation(s)
- Atif Saleem
- Department of Pathology, Stanford University Medical Center, Stanford, California, United States of America
- * E-mail:
| | | | - Megan B. Fitzpatrick
- Department of Pathology, Stanford University Medical Center, Stanford, California, United States of America
| | - Eiman A. Mahmoud
- Department of Basic Sciences, College of Osteopathic Medicine, Touro University, Vallejo, California, United States of America
| | - Athena W. Lin
- Department of Basic Sciences, College of Osteopathic Medicine, Touro University, Vallejo, California, United States of America
| | - H. Eduardo Velasco
- Department of Basic Sciences, College of Osteopathic Medicine, Touro University, Vallejo, California, United States of America
| | - Mona M. Rashed
- Department of Pathology, Affiliated to General Organization of Teaching Hospitals and Institutes, Cairo, Egypt
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Baskran K, Kumar PK, Santha K, Sivakamasundari II. Cofactors and Their Association with Cancer of the Uterine Cervix in Women Infected with High-Risk Human Papillomavirus in South India. Asian Pac J Cancer Prev 2019; 20:3415-3419. [PMID: 31759367 PMCID: PMC7063002 DOI: 10.31557/apjcp.2019.20.11.3415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Human papilloma viruses (HPVs) are recognized as the major etiological agents of most pre invasive and invasive cancer of the uterine cervix. Many cofactors in association with high-risk HPV (HR-HPV) trigger infection which leads to cervical carcinogenesis. The aim was to study various cofactors and their association with cervical cancer in women infected with HR-HPV. Methods: The present study screened a total of 156 subjects for the presence of HPV infection. Association of various cofactors with cervical cancer was estimated using binary logistic regression analysis. Results: The HR-HPV infection showed a very significant risk factor for cervical cancer. Among the cofactors, the education level, early sexual exposure and age at pregnancy had no significant association while low socioeconomic status (SES) and high parity showed significant association as risk factors for cervical cancer. Tobacco chewing with betel quid was not significantly associated with cervical cancer. Conclusions: The present study indicates that low SES is a major risk factor associated with cervical cancer. Bringing awareness about HPV infection and intensifying routine screening programs for cervical cancer will help reduce the risk of cervical cancer among women with low SES in this region.
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Affiliation(s)
- Krishnan Baskran
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
| | - P Kranthi Kumar
- Department of Genetics, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India
| | - K Santha
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
| | - Inmozhi I Sivakamasundari
- Department of Biochemistry, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalainagar, Tamil Nadu, India
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Meng JW, Song JH. Association between interleukin-2, interleukin-10, secretory immunoglobulin A and immunoglobulin G expression in vaginal fluid and human papilloma virus outcome in patients with cervical lesions. Oncol Lett 2019; 18:5543-5548. [PMID: 31612062 DOI: 10.3892/ol.2019.10897] [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] [Received: 10/20/2016] [Accepted: 11/21/2017] [Indexed: 11/06/2022] Open
Abstract
The present study was designed to investigate the association between a change in vaginal local immunity and human papilloma virus (HPV) infection outcome in patients with cervical lesions, through the study of the expression of vaginal local immune factors, interleukin (IL)-2, IL-10, secretory immunoglobulin A (sIgA) and IgG, in patients with different grades of cervical lesions and different degrees of cervical lesions caused by HPV infection prior to and following treatment. The experimental group comprised 136 patients with low-grade squamous intraepithelial lesions, 236 patients with high-grade squamous intraepithelial lesions and 133 patients with cervical squamous cell carcinoma, while the control group comprised 100 time- and location-matched healthy women. The concentrations of sIgA, IgG, IL-2 and IL-10 in the vaginal lavage fluid, were detected using ELISA prior to treatment and at 3, 6 and 12 months after treatment. Prior to treatment, differences in HPV infection rate and changes in vaginal immune factors between patients with all grades of lesions and controls were statistically significant (P<0.05). Furthermore, IL-2 and IL-10 expression levels and the IL-2/IL-10 ratio in patients with different grades of lesions, with or without seroconversion, were significantly different to those in controls (P<0.05). However, the differences between changes in IgG and sIgA expression between patients with HPV seroconversion and patients with persistent HPV infection were not statistically significant (P>0.05). The results of the present study suggest that the restoration of humoral immune function promotes HPV seroconversion, and that IL-2 and IL-10 levels and their ratio may reflect the severity of cervical lesions and treatment effects to a certain extent.
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Affiliation(s)
- Jing-Wei Meng
- Department of Graduate School, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Jing-Hui Song
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
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Koeneman MM, Hendriks N, Kooreman LFS, Winkens B, Kruitwagen RFPM, Kruse AJ. Prognostic factors for spontaneous regression of high-risk human papillomavirus-positive cervical intra-epithelial neoplasia grade 2. Int J Gynecol Cancer 2019; 29:1003-1009. [DOI: 10.1136/ijgc-2019-000343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022] Open
Abstract
IntroductionSince the implementation of human papillomavirus (HPV)-based screening for cervical cancer, the majority of cervical intra-epithelial neoplasia grade 2 (CIN2) lesions are high-risk (hr)HPV positive. Evidence on prognostic factors in hrHPV-positive CIN2 is lacking, hampering the individual counseling of women undergoing observation as routine management. The aim of this study is to identify prognostic factors for the spontaneous regression of hrHPV-positive CIN2.MethodsA retrospective cohort study was conducted at the Maastricht University Medical Center, the Netherlands. Women with hrHPV-positive CIN2 who underwent observation between January 1, 2000 and April 30, 2013 were included. Regression was defined as Pap 1/2 cytology (normal or atypical squamous cells of undetermined significance (ASCUS) cytology) or ≤CIN1 histology at the 24 month follow-up and no diagnosis of ≥CIN2 before the 24 month follow-up visit. Potential prognostic factors (HPV-16/18, p16 staining, KI67 staining, age, smoking status, last Pap smear result, multiple CIN2 lesions, oral contraception use, and parity) were assessed using logistic regression analysis.ResultsA total of 56 women were included in the study, of which 34 (61%) showed spontaneous regression of their lesion. Of all studied potential prognostic factors, only not smoking and nulliparity were significantly associated with disease regression (OR 3.84, 95% CI 1.04 to 14.21, and OR 5.00, 95% CI 1.32 to 19.00, respectively, in the univariate analysis). Both effects remained significant after correction for age and HPV-16/18 in a multivariable regression analysis. In women who smoked, disease regression occurred in 10 of 22 women (46%), compared with 16 of 21 women (76%) who did not smoke. In parous women, regression occurred in 12 of 27 women (44%), compared with 16 of 20 nulliparous women (80%).DiscussionSmoking status and parity may influence the likelihood of disease regression in hrHPV-positive CIN2. These factors could be considered in individual patient counseling regarding the choice between immediate treatment or conservative management.
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Muitta E, Were T, Kebira AN. Reproductive and Lifestyle Characteristics of Kenyan Women Presenting With Precancerous Cervical Lesions: A Hospital-Based Case-Control Study. East Afr Health Res J 2019; 3:115-124. [PMID: 34308204 PMCID: PMC8279231 DOI: 10.24248/eahrj-d-19-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/21/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Cervical cancer is a leading cause of cancer in women, accounting for 68% of cancer-related deaths among women in developing countries. Several reproductive, lifestyle and demographic risk factors are associated with increased risk for cervical cancer. This study examined the association of risk factors with precancerous cervical lesion grade in women attending Nakuru County Referral Hospital. Methods: This hospital-based, case-control study was conducted among women aged 20 to 70 years from January to December, 2017. A total of 142 women were recruited into the study and stratified based on precancerous cervical lesion grades based on the Bethesda System as: atypical glandular cells or adenocarcinoma in situ (AGC/AIS, n=8), high-grade squamous intraepithelial lesions (HSIL, n=59), low-grade squamous intraepithelial lesions (LSIL, n=35), and controls (n=40). Structured questionnaires were used to collect information on demographic, reproductive health, and lifestyle characteristics; anthropo-metric assessments were conducted. Endocervical swabs and scrapings were obtained from the study participants and used for human papillomavirus (HPV)-16/18, and Pap smear screening. Results: Age differed significantly among the study groups, with age rising with higher grade of precancerous lesion. Higher rates of HPV 16/18 infection was associated with presenting with AGC/AIS (n=8, 100.0%), HSIL (n=47, 79.7%), and (n= 29, 82.9%), compared to controls (n=4, 10.0%; P<.001). History of concomitant lower abdominal pain, vaginal bleeding and discharge was associated with higher risk of precancerous lesion in the HSIL group (odds ratio [OR] 8.9; 95% confidence interval [CI], 2.6 to 30.6) and the LSIL group (OR 5.8; 95% CI, 1.8 to 18.8). Bust circumference <99 cm was associated with higher risk of having AGC/AIS (OR 17.4; 95% CI, 1.1 to 276.0), HSIL (OR 5.9; 95% CI, 2.0 to 17.1), and LSIL (OR 2.7; 95% CI, 0.9 to 7.8). Waist circumference <86 cm was associated with higher risk of HSIL (OR, 5.4; 95% CI, 1.9 to 15.4) and LSIL (OR 2.9; 95% CI, 0.9 to 8.2). Having a healthy diet was associated with higher odds of LSIL (OR, 4.2; 95% CI, 1.4 to 12.9), but was not associated with HSIL or AGC/AIS. Conclusion: This study suggests that high-risk HPV 16/18 infection, chronic lower abdominal pain with vaginal bleeding, and decreased upper and lower trunk body mass, are associated with higher risk of precancerous cervical lesions. Integrating targeted cervical cancer screening in routine reproductive health-care services may reduce the risk of developing cervical cancer.
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Affiliation(s)
- Esther Muitta
- Department of Medical Laboratory Sciences, School of Medicine, Mount Kenya University, Thika, Kenya
| | - Tom Were
- Department of Medical Laboratory Sciences, School of Public Health, Biomedical Science and Technology, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Anthony N Kebira
- Department of Microbiology, School of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
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Harder E, Juul KE, Jensen SM, Thomsen LT, Frederiksen K, Kjaer SK. Factors associated with non-participation in cervical cancer screening - A nationwide study of nearly half a million women in Denmark. Prev Med 2018; 111:94-100. [PMID: 29501474 DOI: 10.1016/j.ypmed.2018.02.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/26/2022]
Abstract
Cervical cancer occurs most often in under-screened women. In this nationwide register study, we described differences in sociodemographic characteristics between passive and active non-participants and examined socio-demographic characteristics, reproductive history, and mental and physical health as potential determinants for passive non-participation compared with participation in the Danish cervical cancer screening program. Screening history in women aged 23-49 years invited for cervical cancer screening in 2008-2009 was retrieved from the Danish Pathology Databank with information about dates of invitation and unsubscription. We identified participants (n = 402,984), active non-participants (n = 10,251) and passive non-participants (n = 63,435) within four years following baseline invitation and retrieved data about the study population from high-quality registries. We examined differences in socio-demographic characteristics of passive and active non-participants, and used multiple logistic regression analyses to identify potential determinants of passive non-participation. We found that active and passive non-participants differed in relation to socio-demography. When compared with screening participants, the odds of passive non-participation was increased in women who originated from less developed countries; were unmarried; had basic education or low income; had four or more children; smoked during pregnancy; had multiple induced abortions; or had a history of obesity, intoxicant abuse or schizophrenia or other psychoses. In conclusion, in this nationwide, prospective, population-based study, differences in socio-demographic characteristics between passive and active non-participants were found. Furthermore, sociodemography, reproductive history, and mental and physical health were determinants for passive non-participation. Addressing inequalities in screening attendance may help to further decrease the incidence of and mortality from cervical cancer.
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Affiliation(s)
- Elise Harder
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Kirsten E Juul
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Signe M Jensen
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 8, 2100 Copenhagen, Denmark.
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Averbach S, Silverberg MJ, Leyden W, Smith-McCune K, Raine-Bennett T, Sawaya GF. Recent intrauterine device use and the risk of precancerous cervical lesions and cervical cancer. Contraception 2018; 98:S0010-7824(18)30144-6. [PMID: 29673740 PMCID: PMC6192861 DOI: 10.1016/j.contraception.2018.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Understanding the effect of contraceptives on the development of precancerous lesions of the cervix and cervical cancer may provide information that is valuable to women in contraceptive decision-making. The purpose of this study was to evaluate the association between recent intrauterine device (IUD) use (by type) and cervical intraepithelial neoplasia 2, 3, adenocarcinoma in situ or cancer (CIN2+ or CIN3+). STUDY DESIGN Case-control study of 17,559 women age 18-49 with incident CIN2+ cases and 5:1 age-matched, incidence-density selected controls (N=87,378) who were members of Kaiser Permanente Northern California Healthcare System from 1996 to 2014. Recent IUD use, within 18 months prior to index, was the exposure of interest. RESULTS We identified 1,657 IUD users among the cases and 7,925 IUD users among controls. After adjusting for sexually transmitted infection testing, smoking, HPV vaccination, hormonal contraceptive use, parity, race and number of outpatient healthcare system visits, IUD use was associated with an increased rate of CIN2+ [rate ratio (RR) 1.12, 95% confidence interval (1.05-1.18), p<0.001] but not CIN3+ [RR 1.02 (0.93-1.11), p=0.71]. Levonorgestrel-IUD use was associated with an increased rate of CIN2+ [RR 1.18 (1.08-1.30), p<0.001] but not CIN3+ [RR 1.05 (0.91-1.21), p=0.48]. Copper-IUD use was not associated with CIN2+ [RR 0.88 (0.75-1.04), p=0.13] or CIN3+ [RR 0.81 (0.64-1.02), p=0.07]. CONCLUSION Recent IUD use had variable weak associations with CIN2+ but was not associated with increased risk of CIN3+. IMPLICATIONS Recent levonorgestrel-IUD use may be associated with CIN2, a lesion with a high rate of regression, but not CIN3, which is considered a true pre-cancerous lesion. The observed association between levonorgestrel-IUDs and CIN2+ was modest but warrants further investigation. It may have clinical importance for contraceptive counseling if this finding is shown to be consistent across other studies and other populations.
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Affiliation(s)
- Sarah Averbach
- University of California, San Diego, Department of Obstetrics, Gynecology and Reproductive Sciences, San Diego, CA; University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA.
| | | | - Wendy Leyden
- Kaiser Permanente Northern California (KPNC), Division of Research, Oakland, CA
| | - Karen Smith-McCune
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA
| | - Tina Raine-Bennett
- Kaiser Permanente Northern California (KPNC), Division of Research, Oakland, CA
| | - George F Sawaya
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA
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Bhattacharya A, Sen S, Mandal P, Sharma Saha S, Sarkar S, Pathak OP, Biswas L, Roy J, Banerjee R, Roy Chowdhury R, Pal M, Mukherjee A, Sengupta S. Prevalence and age-wise distribution of Human Papillomavirus type 16/18 infections among hospital screened women of a peri-urban area in West Bengal: Impact of socio-demographic factors. Cancer Epidemiol 2018; 54:31-37. [PMID: 29571035 DOI: 10.1016/j.canep.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/08/2018] [Accepted: 03/11/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND We undertook the current study on cervical Human Papillomavirus (HPV) prevalence along with cytology in women visiting the Gynecology Out-patient Department of a hospital for common gynecological ailments, subsequent to our earlier population-based study on HPV prevalence from India. METHODS We analyzed data on cervical-cytology (Pap smears) and PCR-based molecular detection of HPV infection along with socio-demographic variables (N = 696). RESULTS We identified 36.84% HPV-positive women amongst whom, HPV16 and 18 together predominated (79.37%) over other HPV types (20.63%). Contrarily, only 6.4% women revealed abnormal cytological lesions, of which, 46.51% were HPV-positive and 95% of such women harbored HPV16/18, while 5% harbored other HPV types. Individuals with normal cytology portrayed 36.09% HPV infections, of which, 77.97% were HPV16/18-positive and 22.03% harbored other HPV types. Overall HPV prevalence decreased significantly (ptrend = 0.047) with increase in age, but HPV16/18 infections were significantly over-represented compared to the other HPV types across all age-groups. Specifically, HPV16 prevalence increased (p trend < 0.01) with increase in severity of cervical lesions. HPV16 prevalence did not differ between the Hindus and Muslims but HPV18 was significantly higher among the cytologically normal Muslim women (24.14%, p = 0.02), compared to the Hindus (11.91%), specifically among those ≥ 30 years of age. There was a significant (p < 0.05) overrepresentation of HPV16 prevalence among women who were users of oral contraceptive-pills, irrespective of cytology. CONCLUSIONS Our study highlights the need for HPV16/18-based screening of cervical cancers in India considering the immense socio-cultural and genetic diversity at the population level.
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Affiliation(s)
- Amrapali Bhattacharya
- National Institute of Biomedical Genomics, P.O.: N.S.S., Kalyani 741251, West Bengal, India.
| | - Shrinka Sen
- National Institute of Biomedical Genomics, P.O.: N.S.S., Kalyani 741251, West Bengal, India.
| | - Paramita Mandal
- National Institute of Biomedical Genomics, P.O.: N.S.S., Kalyani 741251, West Bengal, India.
| | - Sweta Sharma Saha
- National Institute of Biomedical Genomics, P.O.: N.S.S., Kalyani 741251, West Bengal, India.
| | - Somosree Sarkar
- National Institute of Biomedical Genomics, P.O.: N.S.S., Kalyani 741251, West Bengal, India.
| | - Om Prakash Pathak
- Department of Obstetrics & Gynecology, College of Medicine & J.N.M. Hospital, WBUHS, P.O. Kalyani, Nadia 741235, West Bengal, India.
| | - Lena Biswas
- Department of Obstetrics & Gynecology, College of Medicine & J.N.M. Hospital, WBUHS, P.O. Kalyani, Nadia 741235, West Bengal, India.
| | - Jayeeta Roy
- Department of Obstetrics & Gynecology, College of Medicine & J.N.M. Hospital, WBUHS, P.O. Kalyani, Nadia 741235, West Bengal, India.
| | - Rimpa Banerjee
- Department of Obstetrics & Gynecology, College of Medicine & J.N.M. Hospital, WBUHS, P.O. Kalyani, Nadia 741235, West Bengal, India.
| | - Ranita Roy Chowdhury
- Department of Obstetrics & Gynecology, College of Medicine & J.N.M. Hospital, WBUHS, P.O. Kalyani, Nadia 741235, West Bengal, India.
| | - Manidip Pal
- Department of Obstetrics & Gynecology, College of Medicine & J.N.M. Hospital, WBUHS, P.O. Kalyani, Nadia 741235, West Bengal, India.
| | - Ankur Mukherjee
- National Institute of Biomedical Genomics, P.O.: N.S.S., Kalyani 741251, West Bengal, India.
| | - Sharmila Sengupta
- National Institute of Biomedical Genomics, P.O.: N.S.S., Kalyani 741251, West Bengal, India.
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Tran PL, Kenfack B, Tincho Foguem E, Viviano M, Temogne L, Tebeu PM, Catarino R, Benski AC, Vassilakos P, Petignat P. Efficacy of thermoablation in treating cervical precancerous lesions in a low-resource setting. Int J Womens Health 2017; 9:879-886. [PMID: 29238232 PMCID: PMC5716313 DOI: 10.2147/ijwh.s142911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Treating cervical intraepithelial neoplasia (CIN) grades 2 and 3 is the recommended strategy for preventing invasive carcinoma in low- and middle-income countries (LMICs). Our objective was to assess the efficacy of thermoablation in the treatment of CIN2 and CIN3 in a screen-and-treat approach. Methods Women aged 30-49 years in Dschang, Cameroon, were invited to undergo vaginal sampling for human papillomavirus (HPV), samples being assessed by an Xpert HPV Assay. HPV-positive women underwent visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI), cervical biopsy, and endocervical curettage. Women positive for HPV-16/18/45 or other HPV types with abnormal VIA/VILI were treated by thermoablation on the same day. The primary outcome was persistence of high-grade disease on cytologic examination at 12 months. Results Of a total of 1,012 recruited women, 188 were HPV-positive, 121 patients required thermoablation, and 99 had a CIN of grade <2, making the overtreatment rate 9.9%. The cure rate for CIN2 and CIN3 at 12 months was 70.6%. Failure (higher risk of persistent disease) was associated with the presence of occult endocervical lesions at baseline diagnosis (adjusted odds ratio [aOR] =128.97 [95% confidence interval [CI], 8.80-1,890.95]; p<0.0001). First sexual intercourse before the age of 15 was also a risk factor (aOR =0.003 [95% CI, 0.001-0.61]; p=0.023). Conclusion In LMICs, use of thermoablation in a screen-and-treat approach is a valuable treatment option for CIN2 and CIN3. Studies comparing thermoablation with cryotherapy are needed to determine the most appropriate treatment for cervical precancer in such countries.
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Affiliation(s)
- Phuong Lien Tran
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Bruno Kenfack
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | - Eveline Tincho Foguem
- Department of Gynecology and Obstetrics, District Hospital of Biyem-Assi, Yaoundé, Cameroon
| | - Manuela Viviano
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Liliane Temogne
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | - Pierre-Marie Tebeu
- Department of Gynecology and Obstetrics, University Centre Hospital, Yaoundé, Cameroon
| | - Rosa Catarino
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Anne-Caroline Benski
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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Bedoya-Pilozo CH, Medina Magües LG, Espinosa-García M, Sánchez M, Parrales Valdiviezo JV, Molina D, Ibarra MA, Quimis-Ponce M, España K, Párraga Macias KE, Cajas Flores NV, Orlando SA, Robalino Penaherrera JA, Chedraui P, Escobar S, Loja Chango RD, Ramirez-Morán C, Espinoza-Caicedo J, Sánchez-Giler S, Limia CM, Alemán Y, Soto Y, Kouri V, Culasso ACA, Badano I. Molecular epidemiology and phylogenetic analysis of human papillomavirus infection in women with cervical lesions and cancer from the coastal region of Ecuador. Rev Argent Microbiol 2017; 50:136-146. [PMID: 29157596 DOI: 10.1016/j.ram.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/28/2017] [Accepted: 06/25/2017] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to gather information regarding the molecular epidemiology of Human papillomavirus (HPV) and related risk factors in a group of women with low- and high-grade cervical lesions and cancer from the coastal region of Ecuador. In addition, we studied the evolution of HPV variants from the most prevalent types and provided a temporal framework for their emergence, which may help to trace the source of dissemination within the region. We analyzed 166 samples, including 57 CIN1, 95 CIN2/3 and 14 cancer cases. HPV detection and typing was done by PCR-sequencing (MY09/MY11). HPV variants and estimation of the time to most recent common ancestor (tMRCA) was assessed through phylogeny and coalescence analysis. HPV DNA was found in 54.4% of CIN1, 74.7% of CIN2/3 and 78.6% of cancer samples. HPV16 (38.9%) and HPV58 (19.5%) were the most prevalent types. Risk factors for the development of cervical lesions/cancer were the following: three or more pregnancies (OR=4.3), HPV infection (OR=3.7 for high-risk types; OR=3.5 for HPV16), among others. With regard to HPV evolution, HPV16 isolates belonged to lineages A (69%) and D (31%) whereas HPV58 isolates belonged only to lineage A. The period of emergence of HPV16 was in association with human populations (tMRCA=91052 years for HPV16A and 27000 years for HPV16D), whereas HPV58A preceded Homo sapiens evolution (322257 years). This study provides novel data on HPV epidemiology and evolution in Ecuador, which will be fundamental in the vaccine era.
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Affiliation(s)
- Cesar H Bedoya-Pilozo
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador; Escuela Superior Politécnica del Litoral, ESPOL, Laboratorio de Biomedicina - Facultad de Ciencias de la Vida (FCV), Campus Gustavo Galindo, Km 30.5 Vía Perimetral, Guayaquil, Ecuador.
| | - Lex G Medina Magües
- Escuela Superior Politécnica del Litoral, ESPOL, Laboratorio de Biomedicina - Facultad de Ciencias de la Vida (FCV), Campus Gustavo Galindo, Km 30.5 Vía Perimetral, Guayaquil, Ecuador
| | - Maylen Espinosa-García
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Martha Sánchez
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Johanna V Parrales Valdiviezo
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Denisse Molina
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - María A Ibarra
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - María Quimis-Ponce
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Karool España
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Karla E Párraga Macias
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Nancy V Cajas Flores
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Solon A Orlando
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador; Universidad Agraria del Ecuador, Av. 25 de Julio y Pio Jaramillo, P.O. BOX 09-04-100, Guayaquil, Ecuador
| | - Jorge A Robalino Penaherrera
- Dirección de Investigación, Desarrollo e Innovación, Instituto Nacional de Investigaciones en Salud Pública (INSPI), Av. Julian Coronel 905 y Esmeraldas, 090510 Guayaquil, Ecuador
| | - Peter Chedraui
- Hospital Gineco-Obstétrico Enrique C. Sotomayor, Guayaquil, Ecuador
| | - Saul Escobar
- Institute of Biomedicine, Facultad Ciencias Médicas, Universidad Católica de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Rita D Loja Chango
- Institute of Biomedicine, Facultad Ciencias Médicas, Universidad Católica de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Cecibel Ramirez-Morán
- Institute of Biomedicine, Facultad Ciencias Médicas, Universidad Católica de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Jasson Espinoza-Caicedo
- Institute of Biomedicine, Facultad Ciencias Médicas, Universidad Católica de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Sunny Sánchez-Giler
- Facultad de Ciencias Médicas, Universidad Especialidades Espíritu Santo, Km 2,5 vía Samborondón, Ecuador
| | - Celia M Limia
- Sexually Transmitted Diseases Laboratory, Department of Virology, Institute of Tropical Medicine "Pedro Kouri", Autopista Novia del Mediodia, Km 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Yoan Alemán
- Sexually Transmitted Diseases Laboratory, Department of Virology, Institute of Tropical Medicine "Pedro Kouri", Autopista Novia del Mediodia, Km 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Yudira Soto
- Sexually Transmitted Diseases Laboratory, Department of Virology, Institute of Tropical Medicine "Pedro Kouri", Autopista Novia del Mediodia, Km 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Vivian Kouri
- Sexually Transmitted Diseases Laboratory, Department of Virology, Institute of Tropical Medicine "Pedro Kouri", Autopista Novia del Mediodia, Km 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Andrés C A Culasso
- Investigador Asistente CONICET, Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, (C1033AAJ) Caba, Argentina; Cátedra de Virología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junin 954, 4to piso, Capital Federal, (C1113AAD) Buenos Aires, Argentina
| | - Inés Badano
- Investigador Asistente CONICET, Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, (C1033AAJ) Caba, Argentina; Laboratorio de Biología Molecular Aplicada, FCEQyN, Universidad Nacional de Misiones, Av. Mariano Moreno 1375, 3300 Posadas, Misiones, Argentina; Yachay EP, Secretaría de Educación Superior, Ciencia, Tecnología e Innovación, 9 de Octubre N22-64 y Ramírez Dávalos, Casa Patrimonial, Ecuador
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Papoutsis D, Underwood M, Parry-Smith W, Panikkar J. Comparison of cure rates in women treated with cold-coagulation versus LLETZ cervical treatment for CIN2-3 on pretreatment cervical punch biopsies: a retrospective cohort study. Arch Gynecol Obstet 2017; 295:979-986. [PMID: 28229232 DOI: 10.1007/s00404-017-4306-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 01/25/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the cure rates between women who were treated with cold-coagulation versus large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia grade 2 (CIN2) or 3 (CIN3) on pretreatment cervical punch biopsies. METHODS This was a retrospective cohort study of women having had a single cervical treatment for CIN2 or CIN3 on pretreatment cervical punch biopsies between 2010 and 2011. The cure rates were defined as the absence of any dyskaryosis (mild/moderate/severe) on cytology tests during follow-up and were determined at 6 and 12 months after treatment. RESULTS We identified 411 women having had cervical treatment with 178 cases of cold-coagulation and 233 cases of LLETZ. The cure rates at 6 months following cold-coagulation and LLETZ treatment were 91.6 versus 97.1% (p = 0.02), whereas at 12 months, they were 96.5 versus 97.3% (p = 0.76). Multivariable analysis showed that after adjusting for confounding factors, there was a fourfold higher cure rate with LLETZ in comparison with cold-coagulation at 6 months after treatment (adjusted OR 4.50, 95% CI 1.20-16.83; p = 0.026), with this difference disappearing at 12 months. The lower cure rates with cold-coagulation were due to its higher rates of mild dyskaryosis cytology tests at 6 months. The rates of moderate/severe dyskaryosis cytology tests were similar between the two treatment methods at 6 and 12 months. CONCLUSION We found that women with CIN2 or CIN3 on pretreatment cervical punch biopsies, after adjusting for multiple confounding factors, had higher cure rates when treated with LLETZ versus cold-coagulation at 6 months, with this difference disappearing at 12 months.
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Affiliation(s)
- Dimitrios Papoutsis
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Princess Royal Hospital, Apley Castle, Grainger Drive, Telford, TF16TF, UK.
| | - Martyn Underwood
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Princess Royal Hospital, Apley Castle, Grainger Drive, Telford, TF16TF, UK
| | - William Parry-Smith
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Princess Royal Hospital, Apley Castle, Grainger Drive, Telford, TF16TF, UK
| | - Jane Panikkar
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Princess Royal Hospital, Apley Castle, Grainger Drive, Telford, TF16TF, UK
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Does the vaginal microbiota play a role in the development of cervical cancer? Transl Res 2017; 179:168-182. [PMID: 27477083 PMCID: PMC5164950 DOI: 10.1016/j.trsl.2016.07.004] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/19/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023]
Abstract
Persistent infection with oncogenic human papillomavirus (HPV) is necessary but not sufficient for the development of cervical cancer. The factors promoting persistence as well those triggering carcinogenetic pathways are incompletely understood. Rapidly evolving evidence indicates that the vaginal microbiome (VM) may play a functional role (both protective and harmful) in the acquisition and persistence of HPV, and subsequent development of cervical cancer. The first studies examining the VM and the presence of an HPV infection using next-generation sequencing techniques identified higher microbial diversity in HPV-positive as opposed to HPV-negative women. Furthermore, there appears to be a temporal relationship between the VM and HPV infection in that specific community state types may be correlated with a higher chance of progression or regression of the infection. Studies describing the VM in women with preinvasive disease (squamous intraepithelial neoplasia [SIL]) consistently demonstrate a dysbiosis in women with the more severe disease. Although it is plausible that the composition of the VM may influence the host's innate immune response, susceptibility to infection, and the development of cervical disease, the studies to date do not prove causality. Future studies should explore the causal link between the VM and the clinical outcome in longitudinal samples from existing biobanks.
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Genetic and Environmental Factors in Invasive Cervical Cancer: Design and Methods of a Classical Twin Study. Twin Res Hum Genet 2016; 20:10-18. [PMID: 27917752 DOI: 10.1017/thg.2016.93] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Persistent high-risk human papillomavirus (HPV) infection is a necessary prerequisite for development of cervical cancer and its precursor lesion, high-grade squamous intraepithelial lesion (HSIL). However, HPV infection is not sufficient to drive this process, and genetic and environmental factors may also play a role. METHODS/DESIGN The Cervical Cancer, Genetics and Environment Twin Study was established to investigate the environmental and genetic influences on variation in susceptibility to cervical pre-cancer in 25- to 69-year-old monozygotic (MZ) and dizygotic (DZ) twins recruited through the Australian Twin Registry. Reviews of Papanicolaou (Pap) screening histories were undertaken to identify individual women with a history of an abnormal Pap test. This was followed by detection of HPV in archival Pap smears of selected twin pairs to determine HPV persistence. Selected twin pairs also completed a detailed questionnaire on socio-demographic characteristics, sexual behavior, and HPV knowledge. In future analyses, under the assumptions of the classical twin design, case-wise concordance for persistent HPV infection and HSIL will be calculated for MZ and DZ twin pairs, and twin pairs (both MZ and DZ) who are discordant for the above outcomes will be used to assess the contributions of measured environmental risk factors. DISCUSSION The study examines factors related to HPV persistence and development of HSIL among female MZ and DZ twins. The results will contribute to our understanding of the natural history of cervical HPV infection and the relative contributions of genetic and environmental factors in disease progression.
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Muwonge R, Ngo Mbus L, Ngoma T, Gombe Mbalawa C, Dolo A, da Ganda Manuel M, Nouhou H, Nacoulma M, Mwaiselage J, Koulibaly M, Bayo S, Nsonde Malanda J, De Vuyst H, Herrero R, Sankaranarayanan R, Keita N. Socio-demographic and reproductive determinants of cervical neoplasia in seven sub-Sahara African countries. Cancer Causes Control 2016; 27:1437-1446. [PMID: 27822586 DOI: 10.1007/s10552-016-0823-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since most human papilloma virus (HPV) infections regress without any intervention, HPV is a necessary but may not be a solely sufficient cause of cervical intraepithelial neoplasia (CIN) and cervical cancer. Hence, the influence of cofactors on progression from cervical HPV infection to high-grade CIN and invasive cervical cancer has been a subject of intensive research. OBJECTIVE We assessed the effect of socio-demographic and sexual reproductive factors on the prevalence of invasive cervical cancer and CIN diagnosed in cross-sectional cervical cancer screening projects carried out in seven sites of different sub-Saharan countries. METHODS Between January 2000 and August 2007, healthy women aged 25-59 who participated in the screening projects were interviewed for socio-demographic, reproductive, and behavioral characteristics, investigated for disease confirmation with colposcopy, and had biopsies directed from colposcopically abnormal areas by trained local physicians. Odds ratios (ORs) and their 95% confidence intervals (CIs) from logistic regression analyses were used to assess the effect of women characteristics on CIN 1, CIN 2-3, CIN 3, and invasive cancer outcome measures. RESULTS Among 47,361 women screened and investigated for disease confirmation, CIN 1 was diagnosed in 1,069 (2.3%), CIN 2 in 517 (1.1%), CIN 3 in 175 (0.5%), and invasive cancer in 485 (1.0%). The site-specific prevalence of CIN 2-3 lesions ranged from 0.3 to 5.1% and from 0.2 to 1.9% for invasive cancers. Risk factors for CIN 2-3 were being widowed or separated versus currently married (OR 1.3, 95% CI 1.0-1.7 a); and having had at least four pregnancies versus zero or one pregnancy (OR at least 1.4-fold, 95% CI 1.1-1.8). Risk factors for invasive cancer were being widowed or separated versus currently married (OR 2.0, 95% CI 1.3-3.1); and having had at least three pregnancies versus zero or one pregnancy (OR at least 3.0-fold, 95% CI 2.1-4.2). Additionally, cervical cancer risk increased with increasing age, age at menarche, and age at marriage, while the risk decreased with increasing level of education and in those with some form of employment compared to housewives. CONCLUSION The exposure of the exocervix and/or the increased levels of estrogen and progesterone for more prolonged periods during pregnancy in multiparous women and the vulnerability of widowed/separated women in society might result in increased risk of cervical neoplasia more so among women exposed to HPV infection. High parity probably explains the persistently high rates of cervical cancer in sub-Saharan Africa.
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Affiliation(s)
- Richard Muwonge
- Screening Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
| | - Louise Ngo Mbus
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Twalib Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Amadou Dolo
- Département de Gynécologie-Obstétrique, Hôpital Gabriel Touré, Bamako, Mali
| | | | - Hassan Nouhou
- Faculté des Sciences de la Santé, Université de Niamey, Niamey, Niger
| | - Marius Nacoulma
- Département de Gynécologie-Obstétrique, Centre Hospitalier National Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Julius Mwaiselage
- Ocean Road Cancer Institute, Dar es Salaam, United Republic of Tanzania
| | - Moussa Koulibaly
- Centre National d'Anatomie Pathologique, CHU Donka, Conakry, Guinea
| | | | | | - Hugo De Vuyst
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Namory Keita
- Service de Gynécologie/Obstétrique, CHU Donka, Conakry, Guinea
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Conisation as a marker of persistent human papilloma virus infection and risk of breast cancer. Br J Cancer 2016; 115:588-91. [PMID: 27253173 PMCID: PMC4997534 DOI: 10.1038/bjc.2016.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/18/2016] [Accepted: 04/30/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection may increase breast cancer (BC) risk. METHODS To examine this, we used nationwide medical registries to identify all Danish women who underwent conisation to remove HPV-associated cervical precancerous lesions (n=87 782) from 1978 to 2013. We computed the absolute risk of BC and standardised incidence ratios (SIRs) and 95% confidence intervals (95% CIs) for breast cancer, based on national breast cancer incidence rates. RESULTS Conisation was associated with slightly increased BC incidence (SIR=1.1, 95% CI=1.0-1.1), and an absolute BC risk of 7.7% (95% CI=7.3-8.1%) in 35.9 years of follow-up. BC risk was elevated throughout follow-up, especially in the first 5 years (<1 year: SIR=1.2, 95% CI=0.92-1.5; 1-5 years: SIR=1.2, 95% CI=1.1-1.3; ⩾5 years: SIR=1.1, 95% CI=1.0-1.1). Women who underwent conisation and had autoimmune disease had elevated BC risk after 5 years of follow-up (SIR=1.4, 95% CI=1.0-1.8). CONCLUSIONS BC risk is slightly elevated in women with persistent HPV infection, possibly due to detection bias.
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Whop LJ, Baade P, Garvey G, Cunningham J, Brotherton JML, Lokuge K, Valery PC, O’Connell DL, Canfell K, Diaz A, Roder D, Gertig DM, Moore SP, Condon JR. Cervical Abnormalities Are More Common among Indigenous than Other Australian Women: A Retrospective Record-Linkage Study, 2000-2011. PLoS One 2016; 11:e0150473. [PMID: 27064273 PMCID: PMC4827842 DOI: 10.1371/journal.pone.0150473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
Indigenous Australian women have much higher incidence of cervical cancer compared to non-Indigenous women. Despite an organised cervical screening program introduced 25 years ago, a paucity of Indigenous-identified data in Pap Smear Registers remains. Prevalence of cervical abnormalities detected among the screened Indigenous population has not previously been reported. We conducted a retrospective cohort study of population-based linked health records for 1,334,795 female Queensland residents aged 20–69 years who had one or more Pap smears during 2000–2011; from linked hospital records 23,483 were identified as Indigenous. Prevalence was calculated separately for Indigenous and non-Indigenous women, for cytology-detected low-grade (cLGA) and high-grade abnormalities (cHGA), and histologically confirmed high-grade abnormalities (hHGA). Odds ratios (OR) were estimated from logistic regression analysis. In 2010–2011 the prevalence of hHGA among Indigenous women (16.6 per 1000 women screened, 95% confidence interval [CI] 14.6–18.9) was twice that of non-Indigenous women (7.5 per 1000 women screened, CI 7.3–7.7). Adjusted for age, area-level disadvantage and place of residence, Indigenous women had higher prevalence of cLGA (OR 1.4, CI 1.3–1.4), cHGA (OR 2.2, CI 2.1–2.3) and hHGA (OR 2.0, CI 1.9–2.1). Our findings show that Indigenous women recorded on the Pap Smear Register have much higher prevalence for cLGA, cHGA and hHGA compared to non-Indigenous women. The renewed cervical screening program, to be implemented in 2017, offers opportunities to reduce the burden of abnormalities and invasive cancer among Indigenous women and address long-standing data deficiencies.
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Affiliation(s)
- Lisa J. Whop
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
- * E-mail:
| | - Peter Baade
- Cancer Council Queensland, Brisbane, Australia
| | - Gail Garvey
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - Joan Cunningham
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - Julia M. L. Brotherton
- Victorian Cytology Service Inc, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kamalini Lokuge
- National Centre of Epidemiology and Public Health, Australian National University, Canberra, Australia
| | - Patricia C. Valery
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Abbey Diaz
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - David Roder
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Dorota M. Gertig
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Suzanne P. Moore
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - John R. Condon
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
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Kennedy NT, Ikechukwu D, Goddy B. Risk factors and distribution of oncogenic strains of human papilloma virus in women presenting for cervical cancer screening in Port Harcourt, Nigeria. Pan Afr Med J 2016; 23:85. [PMID: 27222684 PMCID: PMC4867190 DOI: 10.11604/pamj.2016.23.85.8510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/06/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Human papilloma virus(HPV) accounts for most cases of cervical cancer with high risk HPV(hrHPV) genotypes largely responsible. The objective is to ascertain the distribution of oncogenic strains of human papilloma virus genotypes and predisposing risk factors in women presenting for cervical cancer screening in Nigeria. METHODS A cross-sectional study of 80 women who presented for cervical cancer screening. The biodata of the participants, the presence of risk factors to HPV were recorded and hrHPV were identified using PCR technique. The information obtained was processed using the SPSS version 20 software. Results were presented in tables, test of significance and association done using student's t-test and Odds ratio, with P value < 0.05 as significant. RESULTS The age range of patients was 19-62 years with prevalence of hrHPV of 10%. HrHPV are more in patients with more than one life time sexual partner (OR 1.26,95%CI 0.13-29.99), multiple sexual partners (OR 1.55, 95% CI 0.28-8.70), early coitarche (OR 1.57, 95% CI 0.14-15.00) and previous STI (OR 150, 95%CI 9.53-1979. 62). Four hrHPV genotypes: 16, 18, 31 and 35 were detected. CONCLUSION HPV genotype 18 was predominant in Port Harcourt, Nigeria. High risk sexual behaviours are associated with acquisition of hrHPV.
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Affiliation(s)
- Nyengidiki Tamunomie Kennedy
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Durugbo Ikechukwu
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Bassey Goddy
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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