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Kobayashi O, Kamata S, Okuma Y, Nakajima T, Ikeda Y, Saito K, Kawana K. Carcinogenesis and epidemiology of cervical cancer: The hallmark of human papillomavirus-associated cancer. J Obstet Gynaecol Res 2024. [PMID: 38839079 DOI: 10.1111/jog.15997] [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: 04/11/2024] [Accepted: 05/25/2024] [Indexed: 06/07/2024]
Abstract
Cervical cancer affects women worldwide and is the most common human papillomavirus (HPV)-associated cancer. Carcinogenesis caused by HPV results in specific cancer behavior because of the underlying viral infection. The mechanism and timing of the transformation from viral infection to cancer cells have been elucidated in detail. Treatments for this cancer are based on its characteristics and are being implemented. Moreover, HPV infection is widespread worldwide and is transmitted through sexual activity. Although the HPV vaccination is the most effective strategy of preventing cervical cancer, it is not feasible to vaccinate the entire human population especially in low- and middle-income countries. In order to consider the next step for HPV vaccination, we need to understand the characteristics of HPV carcinogenesis and cervical cancer. Additionally, treatment aimed at preservation of reproductive function in patients with cervical cancer is often required, as the cervix is a reproductive organ and because the disease is more prevalent in the adolescent and young adult generation. Thus, there are still many challenges in the diagnosis, treatment, and prevention of cervical cancer.
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Affiliation(s)
- Osamu Kobayashi
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Saki Kamata
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Yuki Okuma
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Takahiro Nakajima
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Ikeda
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Keisuke Saito
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
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Le VN, Le VNB, Hoang XS, Le VD. Distribution of human papillomavirus among Vietnamese women with cervical cancer and unusual genetic variability of HPV16. Virology 2024; 594:110058. [PMID: 38520797 DOI: 10.1016/j.virol.2024.110058] [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: 08/21/2023] [Revised: 01/21/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
HPV16, with typical mutations that differ in geographical distribution and carcinogenic potency, has implications for cervical cancer screening, clinical diagnosis, and treatment. DNASTAR and MEGA were used to identify HPV16 variants and construct a phylogenetic tree. The most prevalent HPV genotypes were HPV16 (63.9%), HPV18 (26.7%), and other HPV (6.9%). HPV16 alterations were found in all E6, E7, and L1 genes, including 15 missense and 18 synonymous mutations. Missense mutations include R10G, Q14H, D25E, H78Y, L83V (E6); M29V, R35K, L78R, L95P (E7); H73Y, T176 N, N178T, T317P, T386S, L472F/I (L1). HPV16 sublineages include A1 (17.2%), A2 (0.9%), A3 (56.0%), A4 (19.0%), D1 (4.3%), and D3 (2.6%). Although several mutations in the oncoproteins E6, E7, and L1 have been detected, mutations known to be associated with cervical cancer risk, such as D25E and L83V, occur at a relatively low frequency. This suggests that HPV16 mutations are associated with cervical cancer through a complicated mechanism.
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Affiliation(s)
- Van Nam Le
- Departments of Infectious Disease, Military Hospital 103, 261 Phung Hung, Ha Dong, Hanoi, Viet Nam
| | - Van Nguyen Bang Le
- Luong the Vinh High School, 35 Dinh Nup, Trung Hoa, Cau Giay, Hanoi, Viet Nam
| | - Xuan Son Hoang
- Departments of Obstetrics and Gynecology, Cho Moi District General Hospital, Na Mo Village, Dong Tam Town, Cho Moi District, Bac Kan Province, Viet Nam
| | - Van Duyet Le
- Micobiology and Moclecular Biology Department, National Hospital for Tropical Diseases, 78 Giai Phong, Dong Da, Hanoi, Viet Nam.
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3
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Hermansson RS, Lillsunde-Larsson G, Helenius G, Karlsson MG, Kaliff M, Olovsson M, Lindström AK. History of HPV in HPV-positive elderly women. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100297. [PMID: 38496379 PMCID: PMC10944087 DOI: 10.1016/j.eurox.2024.100297] [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: 11/24/2023] [Revised: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Background The aim of this study was to examine the natural course of HPV infection in women of 60 years and older who were HPV positive at inclusion, and any association between HPV positivity in historical samples and dysplasia outcome. Methods Eighty-nine women aged 60-82 years, who tested positive for HPV between 2012 and 2016 were included. Sampling for cytology and/or histology was also performed. HPV genotyping was carried out on archived material back to 1999. Results Of the 89 HPV-positive women 16 had HSIL, 34 had LSIL and 39 were benign at inclusion. Of the women with HSIL, 50.0% had the same HPV type in the archive samples, 12.5% had another type, and 37.5% were HPV negative. Among the 34 women with LSIL, 47.1% had the same HPV type in archive samples, 5.8% had another type, and 47.1% were HPV negative. Of the 39 women without dysplasia at inclusion, 25.6% had the same HPV type in archive samples, 5.1% had another HPV type and 69.2% were HPV negative. Conclusion Surprisingly few of the elderly women thus seem to have a history with the same or any HPV infection the years before being diagnosed with an HPV infection and dysplasia. The significance of an HPV infection for dysplasia development in elderly women is still not fully understood.
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Affiliation(s)
- Ruth S. Hermansson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriella Lillsunde-Larsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Gisela Helenius
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats G. Karlsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Malin Kaliff
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Matts Olovsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Annika K. Lindström
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Nunez AT. College health centers: An update on medical issues. Curr Probl Pediatr Adolesc Health Care 2024; 54:101584. [PMID: 38493024 DOI: 10.1016/j.cppeds.2024.101584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
College health centers are an important source of health care for large numbers of young adults throughout the country. With 16.9 million students enrolled in 2023 in post-secondary institutions in the United States, the potential impact that health centers at these institutions have is significant. Late adolescence and early adulthood is a particularly vulnerable stage of both cognitive and psychosocial development, and college health centers that provide comprehensive medical and mental-health care play an important role in providing comprehensive care for this age group. As we move into a post-pandemic era, colleges and universities across the country continue to navigate all the changes that have been brought about by the COVID-19 pandemic. It is perhaps now more important than ever to review and assess the clinical care college health centers provide, who they provide this care to, and identify opportunities for improvement and where there may be need for change.
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Affiliation(s)
- Ariel Tassy Nunez
- Cohen Children's Medical Center, Division of Adolescent Medicine, Northwell, New Hyde Park, NY, United States.
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5
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Skerlev M, Ljubojević Hadžavdić S, Sirotković-Skerlev M. Not all bad with HPV is the cervical cancer only! J Eur Acad Dermatol Venereol 2024; 38:796-797. [PMID: 38661025 DOI: 10.1111/jdv.19963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 04/26/2024]
Affiliation(s)
- M Skerlev
- Department of Dermatology and Venereology, Zagreb University School of Medicine and Zagreb University Hospital Center, Zagreb, Croatia
| | - S Ljubojević Hadžavdić
- Department of Dermatology and Venereology, Zagreb University School of Medicine and Zagreb University Hospital Center, Zagreb, Croatia
| | - M Sirotković-Skerlev
- Department of Pathophysiology, Zagreb University School of Medicine, Zagreb, Croatia
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Kim M, Kim E. Effective vaccination strategies for human papillomavirus (HPV) infection and cervical cancer based on the mathematical model with a stochastic process. J Med Virol 2024; 96:e29558. [PMID: 38533898 DOI: 10.1002/jmv.29558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
Human papillomavirus (HPV) infection poses a significant risk to women's health by causing cervical cancer. In addition to HPV, cervical cancer incidence rates can be influenced by various factors, including human immunodeficiency virus and herpes, as well as screening policy. In this study, a mathematical model with stochastic processes was developed to analyze HPV transmission between genders and its subsequent impact on cervical cancer incidence. The model simulations suggest that both-gender vaccination is far more effective than female-only vaccination in preventing an increase in cervical cancer incidence. With increasing stochasticity, the difference between the number of patients in the vaccinated group and the number in the nonvaccinated group diminishes. To distinguish the patient population distribution of the vaccinated from the nonvaccinated, we calculated effect size (Cohen's distance) in addition to Student's t-test. The model analysis suggests a threshold vaccination rate for both genders for a clear reduction of cancer incidence when significant stochastic factors are present.
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Affiliation(s)
- Minsoo Kim
- Natural Product Informatics Research Center, Korea Institute of Science and Technology, Gangneung, Republic of Korea
| | - Eunjung Kim
- Natural Product Informatics Research Center, Korea Institute of Science and Technology, Gangneung, Republic of Korea
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7
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Song Y, Choi W, Shim E. Cost-Effectiveness of Human Papillomavirus Vaccination in the UK: Two Versus Single-Dose of Nonavalent HPV Vaccination. Am J Prev Med 2024:S0749-3797(24)00102-8. [PMID: 38508425 DOI: 10.1016/j.amepre.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION The UK implemented a single-dose HPV vaccination policy in September 2023, aiming for sustained protection, better vaccine coverage, and reduced healthcare costs. This research assesses the cost-effectiveness of both one-dose and two-dose schedules from a healthcare perspective. METHODS Using an age-structured dynamic model, the study analyzed long-term health and economic outcomes of these two different vaccination approaches. It focused on the effects of vaccinating 12- to 13-year-olds with the 9-valent HPV vaccine in either single-dose or two-dose regimens from 2023 to 2093. The analysis, conducted in 2023-2024, explored different immunity durations (10, 30 years, or lifetime) and efficacy levels for the single-dose strategy. RESULTS The study indicated that in the UK, vaccinating 12- to 13-year-olds with a two-dose regimen is not considered cost-effective compared to the single-dose option, assumed to be 90% as effective for 10 years. The incremental cost-effectiveness ratios for two doses ranged from £230,903 to £1,082,916 per quality-adjusted life year (QALY), significantly exceeding the UK's £20,000/QALY willingness-to-pay threshold. Over 70 years, a switch from a two-dose to a single-dose vaccination schedule could potentially lead to savings of over £1,073 million in the healthcare system. Furthermore, the single-dose regimen was cost-effective compared to no vaccination, with an incremental cost-effectiveness ratio below £2,040/QALY. CONCLUSIONS The study affirms the cost-effectiveness of the UK's single-dose HPV vaccine, in sync with its September 2023 policy shift. The shift not only provides financial benefits but also simplifies vaccine administration, strategically reducing HPV's epidemiological and economic impacts.
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Affiliation(s)
- Youngji Song
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
| | - Wongyeong Choi
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
| | - Eunha Shim
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea.
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Arthur AW, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Detection and Clearance of Type-Specific and Phylogenetically Related Genital Human Papillomavirus Infections in Young Women in New Heterosexual Relationships. J Infect Dis 2024; 229:691-706. [PMID: 37824429 PMCID: PMC10938200 DOI: 10.1093/infdis/jiad450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Understanding the natural history of human papillomavirus (HPV) infections is essential to cervical cancer prevention planning. We estimated HPV type-specific infection detection and clearance in young women. METHODS The HPV Infection and Transmission among Couples through Heterosexual activity (HITCH) study is a prospective cohort of 502 college-age women who recently initiated a heterosexual relationship. We tested vaginal samples collected at 6 clinical visits over 24 months for 36 HPV types. Using rates and Kaplan-Meier analysis, we estimated time-to-event statistics with 95% confidence intervals (CIs) for detection of incident infections and clearance of incident and present-at-baseline infections (separately). We conducted analyses at the woman- and HPV-levels, with HPV types grouped by phylogenetic relatedness. RESULTS By 24 months, we detected incident infections in 40.4% (CI, 33.4%-48.4%) of women. Incident subgenus 1 (43.4; CI, 33.6-56.4), 2 (47.1; CI, 39.9-55.5), and 3 (46.6; CI, 37.7-57.7) infections cleared at similar rates per 1000 infection-months. We observed similar homogeny in HPV-level clearance rates among present-at-baseline infections. CONCLUSIONS Our analyses provide type-specific infection natural history estimates for cervical cancer prevention planning. HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections persist longer than their low oncogenic risk subgenera 1 and 3 counterparts.
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Affiliation(s)
- Andrew W Arthur
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St.Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - François Coutlée
- Département Clinique de Médecine de Laboratoire, Service de Diagnostique Moléculaire, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
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Liu Y, Li Z. Vaginal pH value can affect the susceptibility to human papillomavirus infection. BMC Infect Dis 2024; 24:176. [PMID: 38331746 PMCID: PMC10854022 DOI: 10.1186/s12879-024-09074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women, with persistent high-risk human papillomavirus (HPV) infection being responsible for its progression. In healthy, pre-menopausal women, the vaginal pH value is maintained at 3.8-4.5, but various factors can affect it. Previous studies have suggested the relationship between vaginal pH value and HPV infection. In this study, we aimed to explore the relationship between vaginal pH and susceptibility of HPV infection. METHODS In our study, we retrospectively collected medical information from women who underwent leukorrhea examination at our hospital. We excluded women with infectious diseases or cancer, those who were pregnant or within 6 months post-delivery, and those without HPV test results within 6 months. The association between percentage of HPV infection and vaginal pH value was analyzed. Furthermore, we prepared HPV pseudovirus (PsVs) by co-transfecting structure plasmids and report plasmids in 293FT cells. In vitro, we changed the pH value of cell culture medium to investigate its influence on HPV PsVs infection. In vivo, we changed mouse's vaginal pH value to investigate its influence on HPV PsVs infection. RESULTS Our retrospective study included 3115 women aged 20-78, including 2531 women with HPV negative and 584 women with HPV positive. The percentages of both HPV infection and high-risk HPV infection were higher in women with a vaginal pH value ≥5.0 compared to those with a pH value < 5.0. In vitro, HPV PsVs infection rate was higher in cell culture medium of higher pH value, dominantly due to the influence of pH value on the stage of HPV PsVs adhering to cell surface. Neither of the cell surface HPV receptors Syndecan-1 nor integrin α6 was found to be changed obviously in different pH values. In vivo, more HPV PsVs were adhered to the mouse's vaginal epithelial cells with the increase of the vaginal pH value. CONCLUSIONS Our study suggests a possible association between vaginal pH value and HPV infection. The pH value can influence the susceptibility of HPV PsVs infection by affecting the adhering of HPV PsVs to cells in vivo and in vitro. Additionally, the cell surface HPV receptors Syndecan-1 and Integrin α6 do not seem to be affected by pH value, and the specific mechanism needs to be further explored.
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Affiliation(s)
- Yinxia Liu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, No. 20 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, No. 20 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People's Republic of China.
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.
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Kirjavainen L, Suominen H, Syrjänen K, Waterboer T, Grenman S, Syrjänen S, Louvanto K. Impact of Different Cofactors on Naturally Acquired Human Papillomavirus Antibody Levels Among Unvaccinated Pregnant Women. Viral Immunol 2024; 37:36-43. [PMID: 38315747 DOI: 10.1089/vim.2023.0108] [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] [Indexed: 02/07/2024] Open
Abstract
Human papillomavirus (HPV) infections are common, transmitted by sexual and nonsexual routes. The present case-control setting was designed to examine potential cofactors associated with either persistently low or high HPV-antibody levels. The study subjects were from the Finnish HPV Family cohort of 329 baseline pregnant, non-HPV-vaccinated women, who were sampled for genital and oral HPV-DNA and HPV serology at baseline, and at 12, 24, and 36 months. Antibodies to the L1 major capsid protein of HPV 6, 11, 16, 18, and 45 were analyzed by multiplex HPV serology and HPV genotyping was performed. This study included 59 women, 23 women with persistently low (<200 median fluorescence intensity [MFI]) and 36 women with persistently high and always positive (>200 MFI) levels of these antibodies for all five HPV genotypes. Potential HPV-associated covariates were derived from detailed questionnaires. Only cofactors other than detected HPV genotype significantly impact on the levels of natural HPV antibodies. A higher number of past sexual partners or a history of diagnosed genital warts were significant covariates of high HPV antibody levels (p = 0.023 and p = 0.043, respectively). Of interest, women with a history of allergies presented with low levels of HPV antibodies (p = 0.03), potentially exposing these women to an increased risk of future HPV-related diseases that merit closer surveillance.
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Affiliation(s)
- Laura Kirjavainen
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Helmi Suominen
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Seija Grenman
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Stina Syrjänen
- Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland
| | - Karolina Louvanto
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
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Aggarwal S, Agarwal P, Singh AK. Human papilloma virus vaccines: A comprehensive narrative review. Cancer Treat Res Commun 2023; 37:100780. [PMID: 38006748 DOI: 10.1016/j.ctarc.2023.100780] [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: 10/14/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
Cervical cancer is one of the most common cancers in women aged 15-44 years in the world, with more than three-quarters of cases diagnosed at a locally advanced clinical stage with minor prospects of survival. Although only a small percentage of women with Human Papilloma Virus (HPV) develop cervical cancer and most of the HPV infections are cleared subsequently at primary stage itself, but seroconversion not always guarantees that the individual is immune to HPV. The advent of the cervical carcinoma vaccine has raised the expectations that eradication of cervical carcinoma might be possible in the near future as it exhibited remarkably high efficacy against the vaccine-specific types in naive women with no serious vaccine-related adverse events. Few prophylactic HPV vaccines are currently licensed in over 100 countries. It has also been suggested that vaccinating both men and women is more beneficial than vaccinating only females. Vaccination is a cost-effective strategy to reduce the incidence of cervical cancer and mortality compared to no vaccination based on the cost of cancer treatment. Well-coordinated vaccination strategy with focus on adolescent girls and if possible, boys can lead to dramatic impact on disease reduction around the world.
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Affiliation(s)
- Sumit Aggarwal
- Division of ECD, Indian Council of Medical Research, Ansari Nagar, New-Delhi, 110029, India.
| | - Pragati Agarwal
- Division of ECD, Indian Council of Medical Research, Ansari Nagar, New-Delhi, 110029, India
| | - Amit Kumar Singh
- National JALMA Institute of Leprosy And Other Mycobacterial Diseases, Agra, India
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Yokoji K, Giguère K, Malagón T, Rönn MM, Mayaud P, Kelly H, Delany-Moretlwe S, Drolet M, Brisson M, Boily MC, Maheu-Giroux M. Association of naturally acquired type-specific HPV antibodies and subsequent HPV re-detection: systematic review and meta-analysis. Infect Agent Cancer 2023; 18:70. [PMID: 37941016 PMCID: PMC10631102 DOI: 10.1186/s13027-023-00546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/13/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Understanding the role of naturally acquired (i.e., infection-induced) human papillomavirus (HPV) antibodies against reinfection is important given the high incidence of this sexually transmitted infection. However, the protective effect of naturally acquired antibodies in terms of the level of protection, duration, and differential effect by sex remains incompletely understood. We conducted a systematic review and a meta-analysis to (1) strengthen the evidence on the association between HPV antibodies acquired through past infection and subsequent type-specific HPV detection, (2) investigate the potential influence of type-specific HPV antibody levels, and (3) assess differential effects by HIV status. METHODS We searched Embase and Medline databases to identify studies which prospectively assessed the risk of type-specific HPV detection by baseline homologous HPV serostatus among unvaccinated individuals. Random-effect models were used to pool the measures of association of naturally acquired HPV antibodies against subsequent incident detection and persistent HPV positivity. Sources of heterogeneity for each type were assessed through subgroup analyses stratified by sex, anatomical site of infection, male sexual orientation, age group, and length of follow-up period. Evidence of a dose-response relationship of the association between levels of baseline HPV antibodies and type-specific HPV detection was assessed. Finally, we pooled estimates from publications reporting associations between HPV serostatus and type-specific HPV detection by baseline HIV status. RESULTS We identified 26 publications (16 independent studies, with 62,363 participants) reporting associations between baseline HPV serostatus and incident HPV detection, mainly for HPV-16 and HPV-18, the most detected HPV type. We found evidence of protective effects of baseline HPV seropositivity and subsequent detection of HPV DNA (0.70, 95% CI 0.61-0.80, NE = 11) and persistent HPV positivity (0.65, 95% CI 0.42-1.01, NE = 5) mainly for HPV-16 among females, but not among males, nor for HPV-18. Estimates from 8 studies suggested a negative dose-response relationship between HPV antibody level and subsequent detection among females. Finally, we did not observe any differential effect by baseline HIV status due to the limited number of studies available. CONCLUSION We did not find evidence that naturally acquired HPV antibodies protect against subsequent HPV positivity in males and provide only modest protection among females for HPV-16. One potential limitation to the interpretation of these findings is potential misclassification biases due to different causes.
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Affiliation(s)
- Kana Yokoji
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, 2001 Avenue McGill College, Suite 1200, Montreal, QC, H3A 1G1, Canada
| | - Katia Giguère
- Institut national de santé publique du Québec, Quebec City, Canada
| | - Talía Malagón
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - Minttu M Rönn
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Kelly
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mélanie Drolet
- Centre de recherche du CHU de Québec - Université Laval, Quebec City, Canada
| | - Marc Brisson
- Centre de recherche du CHU de Québec - Université Laval, Quebec City, Canada
| | - Marie-Claude Boily
- MRC Center for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, 2001 Avenue McGill College, Suite 1200, Montreal, QC, H3A 1G1, Canada.
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Maehama T, Shimada S, Sakamoto J, Shibata T, Fujita S, Takakura M, Takagi H, Sasagawa T. Chemical Peeling Therapy Using Phenol for the Cervico-Vaginal Intraepithelial Neoplasia. Viruses 2023; 15:2219. [PMID: 38005896 PMCID: PMC10675195 DOI: 10.3390/v15112219] [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: 08/23/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Objective: This study aimed to validate the use of liquid phenol-based chemical peeling therapy for cervical and vaginal intraepithelial neoplasia (CIN and VaIN, respectively), with the goal of circumventing obstetric complications associated with surgical treatment and to determine the factors associated with treatment resistance. Methods: A total of 483 eligible women diagnosed with CIN, VaIN, or both, participated in this study. Participants underwent phenol-based chemical peeling therapy every 4 weeks until disease clearance. Disease clearance was determined by negative Pap tests for four consecutive weeks or by colposcopy. HPV genotyping was conducted at the onset of the study and after disease clearance in select cases. Our preliminary analysis compared the recurrence and persistence rates between 294 individuals who received phenol-based chemical peeling therapy and 189 untreated patients. Results: At 2 years following diagnosis, persistent disease was observed in 18%, 60%, and 88% of untreated patients with CIN1-3, respectively, and <2% of patients with CIN who received phenol-based chemical peeling therapy. Among 483 participants, 10 immune-suppressed patients required multiple treatments to achieve disease clearance, and 7 were diagnosed with cervical cancer. Of the 466 participants, except those with cancer or immune suppression, the number of treatment sessions until CIN/VaIN clearance ranged from 2 to 42 (average: 9.2 sessions). In total, 43 participants (9.2%) underwent surgical treatment. Six patients (1.3%) experienced recurrence of CIN2 or worse, suggesting that treatment failed in 46 patients (9.9%). No obstetrical complications were noted among the 98 pregnancies following this therapy. Factors associated with resistance to this therapy include immune suppression, ages 35-39 years, higher-grade lesions, and multiple HPV-type infections. Conclusions: Phenol-based therapy is safe and effective for CINs and VaINs. Women aged < 35 years and with persistent CIN1 or CIN2 with a single HPV-type infection are suitable candidates for phenol-based chemical peeling therapy. However, this therapy requires multiple lengthy sessions.
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Affiliation(s)
- Toshiyuki Maehama
- Department of Obstetrics and Gynecology, Yuai-Medical Center, Tomishiro 901-0224, Okinawa, Japan;
| | - Sumire Shimada
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Jinichi Sakamoto
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Takeo Shibata
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Satoko Fujita
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Masahiro Takakura
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Hiroaki Takagi
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
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14
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McCarthy AM, Tiro JA, Hu E, Ehsan S, Chubak J, Kamineni A, Feldman S, Atlas SJ, Silver MI, Kobrin S, Haas JS. Factors associated with shorter-interval cervical cancer screening for young women in three United States healthcare systems. Prev Med Rep 2023; 35:102279. [PMID: 37361923 PMCID: PMC10285268 DOI: 10.1016/j.pmedr.2023.102279] [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: 02/21/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Frequently changing cervical cancer screening guidelines over the past two decades have been inconsistently adopted in the United States. Current guidelines set the recommended screening interval to three years for average-risk women aged 21-29 years. Few studies have evaluated how patient and provider factors are associated with implementation of cervical cancer screening intervals among younger women. This study evaluated multilevel factors associated with screening interval length among 69,939 women aged 21-29 years with an initial negative Pap screen between 2010 and 2015 across three large health systems in the U.S. Shorter-interval screening was defined as a second screening Pap within 2.5 years of an initial negative Pap. Mixed-effects logistic regression was performed for each site to identify provider and patient characteristics associated with shorter-interval screening. The odds of shorter-interval screening decreased over the study period across all sites, though the proportion of patients screened within 2.5 years remained between 7.5% and 20.7% across sites in 2014-2015. Patient factors including insurance, race/ethnicity, and pregnancy were associated with shorter-interval screening, though the patterns differed across sites. At one site, the variation in shorter-interval screening explained by the provider was 10.6%, whereas at the other two sites, the provider accounted for < 2% of the variation in shorter-interval screening. Our results highlight the heterogeneity in factors driving cervical cancer screening interval across health systems and point to the need for tailored approaches targeted to both providers and patients to improve guideline-concordant screening.
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Affiliation(s)
- Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jasmin A. Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ellen Hu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah Ehsan
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven J. Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle I. Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Sarah Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, USA
| | - Jennifer S. Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Studstill CJ, Moody CA. For Better or Worse: Modulation of the Host DNA Damage Response by Human Papillomavirus. Annu Rev Virol 2023; 10:325-345. [PMID: 37040798 PMCID: PMC10956471 DOI: 10.1146/annurev-virology-111821-103452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
High-risk human papillomaviruses (HPVs) are associated with several human cancers. HPVs are small, DNA viruses that rely on host cell machinery for viral replication. The HPV life cycle takes place in the stratified epithelium, which is composed of different cell states, including terminally differentiating cells that are no longer active in the cell cycle. HPVs have evolved mechanisms to persist and replicate in the stratified epithelium by hijacking and modulating cellular pathways, including the DNA damage response (DDR). HPVs activate and exploit DDR pathways to promote viral replication, which in turn increases the susceptibility of the host cell to genomic instability and carcinogenesis. Here, we review recent advances in our understanding of the regulation of the host cell DDR by high-risk HPVs during the viral life cycle and discuss the potential cellular consequences of modulating DDR pathways.
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Affiliation(s)
- Caleb J Studstill
- Department of Microbiology and Immunology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
| | - Cary A Moody
- Department of Microbiology and Immunology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
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16
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Mukherjee A, Ye Y, Wiener HW, Kuniholm MH, Minkoff H, Michel K, Palefsky J, D'Souza G, Rahangdale L, Butler KR, Kempf MC, Sudenga SL, Aouizerat BE, Ojesina AI, Shrestha S. Variations in Genes Encoding Human Papillomavirus Binding Receptors and Susceptibility to Cervical Precancer. Cancer Epidemiol Biomarkers Prev 2023; 32:1190-1197. [PMID: 37410084 PMCID: PMC10472094 DOI: 10.1158/1055-9965.epi-23-0300] [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] [Received: 03/27/2023] [Revised: 06/04/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Cervical cancer oncogenesis starts with human papillomavirus (HPV) cell entry after binding to host cell surface receptors; however, the mechanism is not fully known. We examined polymorphisms in receptor genes hypothesized to be necessary for HPV cell entry and assessed their associations with clinical progression to precancer. METHODS African American women (N = 1,728) from the MACS/WIHS Combined Cohort Study were included. Two case-control study designs were used-cases with histology-based precancer (CIN3+) and controls without; and cases with cytology-based precancer [high-grade squamous intraepithelial lesions (HSIL)] and controls without. SNPs in candidate genes (SDC1, SDC2, SDC3, SDC4, GPC1, GPC2, GPC3, GPC4, GPC5, GPC6, and ITGA6) were genotyped using an Illumina Omni2.5-quad beadchip. Logistic regression was used to assess the associations in all participants and by HPV genotypes, after adjusting for age, human immunodeficiency virus serostatus, CD4 T cells, and three principal components for ancestry. RESULTS Minor alleles in SNPs rs77122854 (SDC3), rs73971695, rs79336862 (ITGA6), rs57528020, rs201337456, rs11987725 (SDC2), rs115880588, rs115738853, and rs9301825 (GPC5) were associated with increased odds of both CIN3+ and HSIL, whereas, rs35927186 (GPC5) was found to decrease the odds for both outcomes (P value ≤ 0.01). Among those infected with Alpha-9 HPV types, rs722377 (SDC3), rs16860468, rs2356798 (ITGA6), rs11987725 (SDC2), and rs3848051 (GPC5) were associated with increased odds of both precancer outcomes. CONCLUSIONS Polymorphisms in genes that encode binding receptors for HPV cell entry may play a role in cervical precancer progression. IMPACT Our findings are hypothesis generating and support further exploration of mechanisms of HPV entry genes that may help prevent progression to cervical precancer.
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Affiliation(s)
- Amrita Mukherjee
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yuanfan Ye
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark H. Kuniholm
- Department of Epidemiology & Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Howard Minkoff
- Department of Obstetrics & Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Kate Michel
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Joel Palefsky
- Department of Medicine, University of California, San Francisco, California
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Lisa Rahangdale
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kenneth R. Butler
- Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mirjam-Colette Kempf
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
- Schools of Nursing and Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Staci L. Sudenga
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bradley E. Aouizerat
- Translational Research Center, College of Dentistry, New York University, New York, New York
| | - Akinyemi I. Ojesina
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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17
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Zhu P, Xiong J, Yuan D, Li X, Luo L, Huang J, Wang B, Nie Q, Wang S, Dang L, Chen Y, Li S, An Y, Yang L, Liu R, He Y, Li X, Chen P, Zhou H, Li Q. ZNF671 methylation test in cervical scrapings for cervical intraepithelial neoplasia grade 3 and cervical cancer detection. Cell Rep Med 2023; 4:101143. [PMID: 37557178 PMCID: PMC10439250 DOI: 10.1016/j.xcrm.2023.101143] [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: 11/07/2022] [Revised: 05/23/2023] [Accepted: 07/14/2023] [Indexed: 08/11/2023]
Abstract
Effective triage of high-risk human papillomavirus (hrHPV)+ women is warranted to avoid unnecessary referral and overtreatment. Molecular triage tests have recently begun to impact cervical intraepithelial neoplasia grade 3 (CIN3) or cervical cancer (CC), termed CIN3+, detection. We find that zinc finger protein 671 methylation (ZNF671m) test has superior performance for CIN3+ detection in all single molecular triage tests, including HPV16/18 genotyping, paired box gene 1 methylation (PAX1m), and ZNF671m, in the training set. Using ZNF671m test instead of Thinprep cytologic test (TCT) as a single triage strategy or as a combined triage strategy with HPV16/18 genotyping has achieved comparable sensitivity but higher specificity for CIN3+ detection among 391 hrHPV+ women in the validation set. Little attention has been paid to the women with hrHPV- status but detected CIN3+. We find that the CIN3+ risk after a negative result could be reduced further by triage using ZNF671m in hrHPV- patients.
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Affiliation(s)
- Peng Zhu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, P.R. China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha 410078, P.R. China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, P.R. China
| | - Jing Xiong
- Department of Gynaecology and Obstetrics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha 410011, P.R. China
| | - Ding Yuan
- Health Management Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, P.R. China
| | - Xiang Li
- Department of Gynaecology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha 410013, P.R. China
| | - Lili Luo
- Department of Gynaecology, The First Affiliated Hospital of Shantou University Medical College, Shantou, P.R. China
| | - Ju Huang
- Department of Gynaecology, The First Affiliated Hospital of Shantou University Medical College, Shantou, P.R. China
| | - Binbin Wang
- Department of Obstetrics and Gynecology, Loudi Central Hospital, 51 Chang Qing Road, Loudi 417000, P.R. China
| | - Quanfang Nie
- Department of Obstetrics and Gynecology, Loudi Central Hospital, 51 Chang Qing Road, Loudi 417000, P.R. China
| | - Shuli Wang
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, P.R. China
| | - Liying Dang
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, P.R. China
| | - Yan Chen
- Xiangya Medical Laboratory, Central South University, 110 Xiangya Road, Changsha 410078, P.R. China
| | - Shu Li
- Xiangya Medical Laboratory, Central South University, 110 Xiangya Road, Changsha 410078, P.R. China
| | - Yuhang An
- Xiangya Medical Laboratory, Central South University, 110 Xiangya Road, Changsha 410078, P.R. China
| | - Li Yang
- Xiangya Medical Laboratory, Central South University, 110 Xiangya Road, Changsha 410078, P.R. China
| | - Rong Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, P.R. China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha 410078, P.R. China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, P.R. China
| | - Yanping He
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital, Guangdong Pharmaceutical University, 19 Nonglinxia Road, Yuexiu District, Guangzhou, Guangdong, P.R. China
| | - Xiong Li
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital, Guangdong Pharmaceutical University, 19 Nonglinxia Road, Yuexiu District, Guangzhou, Guangdong, P.R. China
| | - Puxiang Chen
- Department of Gynaecology and Obstetrics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha 410011, P.R. China
| | - Honghao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, P.R. China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha 410078, P.R. China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, P.R. China
| | - Qing Li
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, P.R. China; Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha 410078, P.R. China; Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, P.R. China.
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18
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Kusakabe M, Taguchi A, Sone K, Mori M, Osuga Y. Carcinogenesis and management of human papillomavirus-associated cervical cancer. Int J Clin Oncol 2023:10.1007/s10147-023-02337-7. [PMID: 37294390 PMCID: PMC10390372 DOI: 10.1007/s10147-023-02337-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/01/2023] [Indexed: 06/10/2023]
Abstract
Approximately 95% of cervical cancer are caused by human papillomavirus (HPV) infection. Although it is estimated that HPV-associated cervical cancer will decrease with the widespread use of HPV vaccine, it may take time for HPV-associated cervical cancer to be eliminated. For the appropriate management of HPV-associated cervical cancer, it is important to understand the detailed mechanisms of cervical cancer development. First, the cellular origin of most cervical cancers is thought to be cells in the squamocolumnar junction (SCJ) of the uterine cervix. Therefore, it is important to understand the characteristics of SCJ for cervical cancer screening and treatment. Second, cervical cancer is caused by high risk HPV (HR-HPV) infection, however, the manner of progression to cervical cancer differs depending on the type of HR-HPV: HPV16 is characterized by a stepwise carcinogenesis, HPV18 is difficult to detect in precancerous lesions, and HPV52, 58 tends to remain in the state of cervical intraepithelial neoplasia (CIN). Third, in addition to the type of HPV, the involvement of the human immune response is also important in the progression and regression of cervical cancer. In this review, we demonstrate the carcinogenesis mechanism of HPV-associated cervical cancer, management of CIN, and the current treatment of CIN and cervical cancer.
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Affiliation(s)
- Misako Kusakabe
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
- Laboratory of Human Single Cell Immunology, World Premier International Immunology Frontier Research Center (WPI-IFReC), Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
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19
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Alberton DL, Salcedo MP, Zen RP, Ferreira CF, Schmeler K, Pessini SA. Conservative Treatment of Stage IA1 Cervical Carcinoma Without Lymphovascular Space Invasion: A 20-year Retrospective Study in Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:201-206. [PMID: 37224842 PMCID: PMC10208732 DOI: 10.1055/s-0043-1769000] [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: 08/06/2022] [Accepted: 11/22/2022] [Indexed: 05/26/2023] Open
Abstract
PURPOSE To evaluate recurrence rates and risk factors among women with stage IA1 cervical cancer without lymph vascular space invasion managed conservatively. METHODS retrospective review of women with stage IA1 squamous cervical cancer who underwent cold knife cone or loop electrosurgical excision procedure, between 1994 and 2015, at a gynecologic oncology center in Southern Brazil. Age at diagnosis, pre-conization findings, conization method, margin status, residual disease, recurrence and survival rates were collected and analyzed. RESULTS 26 women diagnosed with stage IA1 squamous cervical cancer without lymphovascular space invasion underwent conservative management and had at least 12 months follow-up. The mean follow-up was 44.6 months. The mean age at diagnosis was 40.9 years. Median first intercourse occurred at age 16 years, 11.5% were nulliparous and 30.8% were current or past tobacco smokers. There was one Human immunodeficiency virus positive patient diagnosed with cervical intraepithelial neoplasia grade 2 at 30 months after surgery. However, there were no patients diagnosed with recurrent invasive cervical cancer and there were no deaths due to cervical cancer or other causes in the cohort. CONCLUSION Excellent outcomes were noted in women with stage IA1 cervical cancer without lymphovascular space invasion and with negative margins who were managed conservatively, even in a developing country.
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Affiliation(s)
- Daniele Lima Alberton
- Obstetrics and Gynecology Department, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Obstetrics and Gynecology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mila Pontremoli Salcedo
- Obstetrics and Gynecology Department, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Raquel Potrich Zen
- Internal Medicine, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Kathleen Schmeler
- Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Suzana Arenhart Pessini
- Obstetrics and Gynecology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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20
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Han M, Wang N, Han W, Ban M, Sun T, Xu J. Vaginal and tumor microbiomes in gynecological cancer (Review). Oncol Lett 2023; 25:153. [PMID: 36936020 PMCID: PMC10018329 DOI: 10.3892/ol.2023.13739] [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: 09/27/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Cervical, ovarian and endometrial cancer are the three most common types of gynecologic cancer. As a hub, the vagina connects the site of gynecological cancer with the external environment. Lactobacilli participate in the formation of a healthy vaginal microenvironment as the first line of defense against pathogen invasion; a dysbiotic vaginal microenvironment loses its original protective function and is associated with the onset, metastasis, poor efficacy and poor prognosis of gynecological cancer. The early diagnosis of cancer is the key to improve the survival time of patients with cancer. The screening of Porphyromonas, Sneathia and Atopobium vaginae, and other microbial markers, can assist the diagnosis of gynecological cancer, and screen out the high-risk population as early as possible. With the in-depth study of the microbes in tumor tissues, reasearchers have analyzed the immunological associations of microorganisms in tumor tissues. Due to the structural-functional interconnection between the organ of gynecological tumorigenesis and the vagina, the present study aims to review the relationship between vaginal and tumor microorganisms and gynecological cancer in terms of occurrence, screening, treatment and prognosis.
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Affiliation(s)
- Mengzhen Han
- Department of Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
| | - Na Wang
- Department of Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
| | - Wenjie Han
- Department of Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
| | - Meng Ban
- Liaoning Microhealth Biotechnology Co., Ltd., Shenyang, Liaoning 110000, P.R. China
| | - Tao Sun
- Department of Breast Medicine, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
| | - Junnan Xu
- Department of Breast Medicine, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
- Correspondence to: Professor Junnan Xu, Department of Breast Medicine, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital, 44 Xiaoheyan Road, Dadong, Shenyang, Liaoning 110000, P.R. China, E-mail:
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21
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Arthur AW, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Detection and clearance of type-specific and phylogenetically related genital human papillomavirus infections in young women in new heterosexual relationships. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.24.23286387. [PMID: 36865299 PMCID: PMC9980228 DOI: 10.1101/2023.02.24.23286387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Understanding the natural history of human papillomavirus (HPV) infections is essential to effective cervical cancer prevention planning. We examined these outcomes in-depth among young women. Methods The HPV Infection and Transmission among Couples through Heterosexual Activity (HITCH) study is a prospective cohort of 501 college-age women who recently initiated a heterosexual relationship. We tested vaginal samples collected at six clinical visits over 24 months for 36 HPV types. Using rates and Kaplan-Meier analysis, we estimated time-to-event statistics with 95% confidence intervals (CIs) for detection of incident infections and liberal clearance of incident and present-at-baseline infections (separately). We conducted analyses at the woman- and HPV-levels, with HPV types grouped by phylogenetic relatedness. Results By 24 months, we detected incident infections in 40.4%, CI:33.4-48.4 of women. Incident subgenus 1 (43.4, CI:33.6-56.4), 2 (47.1, CI:39.9-55.5) and 3 (46.6, CI:37.7-57.7) infections cleared at similar rates per 1000 infection-months. We observed similar homogeny in HPV-level clearance rates among present-at-baseline infections. Conclusions Our woman-level analyses of infection detection and clearance agreed with similar studies. However, our HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections take longer to clear than their low oncogenic risk and commensal subgenera 1 and 3 counterparts.
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Affiliation(s)
- Andrew W Arthur
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Pierre-Paul Tellier
- Department of Family Medicine, McGill University, Montréal, Québec, H3S 1Z1, Canada
| | - Francois Coutlée
- Départements de Clinique de Médecine de Laboratoire et de Médecine, Services de Biologie Moléculaire et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, H2X 0C1, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Québec, H4A 3T2, Canada
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22
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Rad A, Sørbye SW, Brenn T, Tiwari S, Løchen ML, Skjeldestad FE. 13-Type HPV DNA Test versus 5-Type HPV mRNA Test in Triage of Women Aged 25-33 Years with Minor Cytological Abnormalities-6 Years of Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4119. [PMID: 36901129 PMCID: PMC10002392 DOI: 10.3390/ijerph20054119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A specific, cost-effective triage test for minor cytological abnormalities is essential for cervical cancer screening among younger women to reduce overmanagement and unnecessary healthcare utilization. We compared the triage performance of one 13-type human papillomavirus (HPV) DNA test and one 5-type HPV mRNA test. METHODS We included 4115 women aged 25-33 years with a screening result of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) recorded in the Norwegian Cancer Registry during 2005-2010. According to Norwegian guidelines, these women went to triage (HPV testing and repeat cytology: 2556 were tested with the Hybrid Capture 2 HPV DNA test, which detects the HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68; and 1559 were tested with the PreTect HPV-Proofer HPV mRNA test, which detects HPV types 16, 18, 31, 33, and 45). Women were followed through December 2013. RESULTS HPV positivity rates at triage were 52.8% and 23.3% among DNA- and mRNA-tested women (p < 0.001), respectively. Referral rates for colposcopy and biopsy and repeat testing (HPV + cytology) after triage were significantly higher among DNA-tested (24.9% and 27.9%) compared to mRNA-tested women (18.3% and 5.1%), as were cervical intraepithelial neoplasia grade 3 or worse (CIN3+) detection rates (13.1% vs. 8.3%; p < 0.001). Ten cancer cases were diagnosed during follow-up; eight were in DNA-tested women. CONCLUSION We observed significantly higher referral rates and CIN3+ detection rates in young women with ASC-US/LSIL when the HPV DNA test was used at triage. The mRNA test was as functional in cancer prevention, with considerably less healthcare utilization.
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Affiliation(s)
- Amir Rad
- Department of Community Medicine & Department of Clinical Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | | | - Tormod Brenn
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Sweta Tiwari
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine & Department of Clinical Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Finn Egil Skjeldestad
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
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Seyoum A, Seyoum B, Gure T, Alemu A, Belachew A, Abeje D, Aseffa A, Howe R, Mulu A, Mihret A. Genotype heterogeneity of high-risk human papillomavirus infection in Ethiopia. Front Microbiol 2023; 14:1116685. [PMID: 36846744 PMCID: PMC9951590 DOI: 10.3389/fmicb.2023.1116685] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Cervical cancer is a vaccine-preventable sexually transmitted disease. In the year 2020, there were an estimated 604,000 new cases and 342,000 deaths worldwide. Although its incidence is global, it is much higher in sub-Saharan African countries. In Ethiopia, there is a scarcity of data about the prevalence of high-risk HPV infection and its association with cytological profiles. Therefore, this study was conducted to fill this information gap. A hospital-based cross-sectional study was conducted from April 26 to August 28, 2021, and enrolled 901 sexually active women. Socio-demographic and other relevant bio-behavioral and clinical data were collected using a standardized questionnaire. Visual inspection with acetic acid [VIA] was done as an initial screening method for cervical cancer. The cervical swab was then collected using L-Shaped FLOQSwabs in eNAT nucleic acid preservation and transportation medium. A Pap test was done to determine the cytological profile. Nucleic acid was extracted using STARMag 96 ProPrep Kit on SEEPREP32. A Real-time multiplex assay was performed to amplify and detect the HPV L1 gene used for genotyping. The data were entered into Epi data version 3.1 software and exported to STATA version 14 for analysis. A total of 901 (age range from 30 to 60 years, mean age = 34.8 years, and SD± 5.8) women were screened for cervical cancer using VIA and 832 women had a valid co-testing (Pap test and HPV DNA testing) results for further process. The overall prevalence of hr HPV infection was 13.1%. Out of 832 women, 88% of them had normal and 12% had abnormal Pap test results. The proportion of high risk HPV was significantly higher among women with abnormal cytology (X 2 = 688.446, p < 0.001) and younger age (X 2 = 15.3408, p = 0.018). Among 110 women with hr HPV, 14 genotypes (HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68) were identified while HPV-16, -31, -52, -58, and -35 genotypes were highly prevalent. The high risk HPV infection continues to be a significant public health problem among women 30-35 years old. The presence of high-risk HPV irrespective of genotypes is highly correlated with cervical cell abnormalities. Genotype heterogeneity is observed suggesting the importance of periodic geospatial genotyping surveillance for vaccine effectiveness.
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Affiliation(s)
- Ayichew Seyoum
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Armauer Hansen Research Institute, Addis Ababa, Ethiopia,*Correspondence: Ayichew Seyoum, ✉
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tadesse Gure
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Anteneh Belachew
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Abraham Aseffa
- TDR, the Special Program for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Uusküla A, Oja M, Tamm S, Tisler A, Laanpere M, Padrik L, Nygard M, Reisberg S, Vilo J, Kolde R. Prevaccination Prevalence of Type-Specific Human Papillomavirus Infection by Grade of Cervical Cytology in Estonia. JAMA Netw Open 2023; 6:e2254075. [PMID: 36745455 DOI: 10.1001/jamanetworkopen.2022.54075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
IMPORTANCE Large-scale data on type-specific human papillomavirus (HPV) prevalence and disease burden worldwide are needed to guide cervical cancer prevention efforts. Promoting the research and application of health care big data has become a key factor in modern medical research. OBJECTIVE To examine the prevaccination prevalence of high-risk HPV (hrHPV) and type distribution by cervical cytology grade in Estonia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used text mining and the linking of data from electronic health records and health care claims to examine type-specific hrHPV positivity in Estonia from 2012 to 2019. Participants were women aged at least 18 years. Statistical analysis was performed from September 2021 to August 2022. MAIN OUTCOMES AND MEASURES Type-specific hrHPV positivity rate by cervical cytological grade. RESULTS A total of 11 017 cases of cervical cytology complemented with data on hrHPV testing results between 2012 and 2019 from 66 451 women aged at least 18 years (mean [SD] age, 48.1 [21.0] years) were included. The most common hrHPV types were HPV16, 18, 31, 33, 51 and 52, which accounted for 73.8% of all hrHPV types detected. There was a marked decline in the positivity rate of hrHPV infection with increasing age, but the proportion did not vary significantly based on HPV type. Implementation of nonavalent prophylactic vaccination was estimated to reduce the number of women with high-grade cytology by 50.5% (95% CI, 47.4%-53.6%) and the number with low-grade cytology by 27.8% (95% CI, 26.3%-29.3%), giving an overall estimated reduction of 33.1% (95% CI, 31.7%-34.5%) in the number of women with precancerous cervical cytology findings. CONCLUSIONS AND RELEVANCE In this cross-sectional study, text mining and natural language processing techniques allowed the detection of precursors to cervical cancer based on data stored by the nationwide health system. These findings contribute to the literature on type-specific HPV distribution by cervical cytology grade and document that α-9 phylogenetic group HPV types 16, 31, 33, 52 and α-7 phylogenetic group HPV 18 are the most frequently detected in normal-to-high-grade precancerous lesions in Estonia.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Marek Oja
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- STACC, Tartu, Estonia
| | - Sirli Tamm
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- STACC, Tartu, Estonia
| | - Anna Tisler
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Made Laanpere
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu; Tartu University Hospital Women's Clinic, Tartu, Estonia
| | - Lee Padrik
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu; Tartu University Hospital Women's Clinic, Tartu, Estonia
| | - Mari Nygard
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Sulev Reisberg
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- STACC, Tartu, Estonia
- Quretec, Tartu, Estonia
| | - Jaak Vilo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
- STACC, Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu, Estonia
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Rajendra S, Sharma P. Causal Link of Human Papillomavirus in Barrett Esophagus and Adenocarcinoma: Are We There Yet? Cancers (Basel) 2023; 15:cancers15030873. [PMID: 36765833 PMCID: PMC9913573 DOI: 10.3390/cancers15030873] [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: 11/27/2022] [Revised: 01/07/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Esophageal cancer is a relatively common malignancy worldwide with a high mortality (5-year survival of <15%). Despite screening, surveillance, improved imaging and treatment, the exponential rise in OAC continues. The strongest risk factors for OAC are chronic heartburn and metaplastic transformation of the lower third of the esophagus (Barrett's esophagus). The risk profile includes Caucasian race, male gender older age, obesity and smoking. Although the tumor risk in BO has been progressively revised downwards, the exponential rise in OAC remains unchecked. This paradox points to an unidentified missing link. Relatively recently, we provided the world's initial data for a strong association of biologically relevant hr-HPV with BD and OAC. Since then, systematic reviews and meta-analysis have documented HPV DNA prevalence rates in OAC of between 13 to 35%. In this review, we provide some evidence for a probable causal relationship between hr-HPV and OAC. This is challenging given the multifactorial etiology and long latency. Increasingly, high-risk HPV (hr-HPV) is regarded as a risk factor for OAC. This discovery will aid identification of a sub-group of high-risk progressors to esophageal cancer by surveillance and the development of effective preventive strategies including vaccination.
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Affiliation(s)
- Shanmugarajah Rajendra
- Gastro-Intestinal Viral Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, NSW 2052, Australia
- Department of Gastroenterology & Hepatology, Bankstown-Lidcombe Hospital, South-Western Sydney Local Health Network, Bankstown, Sydney, NSW 2200, Australia
- Correspondence: ; Tel.: +61-(0)-2-9722-8814; Fax: +61-(0)-9722-8570
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MO 64128, USA
- School of Medicine, University of Kansas, Kansas City, MO 66160, USA
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Low-Grade Cervical Intraepithelial Neoplasia (CIN1) Evolution: Analysis of Opportunistic Preventive Vaccination Role. Vaccines (Basel) 2023; 11:vaccines11020284. [PMID: 36851162 PMCID: PMC9961273 DOI: 10.3390/vaccines11020284] [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: 01/04/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Low-grade cervical lesions have a high percentage of clearance in young women, even if 71-82% of low-grade intraepithelial lesion/atypical squamous cells of undetermined significance (LSIL/ASCUS) reported a High-Risk Human Papillomavirus (HR-HPV) infection, which correlates with an increased risk of Cervical Intraepithelial Neoplasia (CIN)2+. The immunogenic effect of the anti-HPV vaccine appears to be significant. The aim of the study is to evaluate the effect, two years after the diagnosis, of the anti-HPV preventive vaccination on patients with low-grade cervical lesions. METHODS We collected clinical, colposcopic, histological, and virological data from patients aged 21-45 years who attended the colposcopy service of the department of Obsetrics and Gynecology of IRCCS Foundation Policlinico San Matteo, Pavia, Italy. In the 2005-2019 period and had a low-grade pap-smear. RESULTS We enrolled 422 women consecutively, divided into two groups (vaccinated and not vaccinated) for the retrospective analysis. The rate of persistence and progression of CIN were higher in the not-vaccinated group (p = 0.019). The relative risk (RR) to develop CIN2+ during follow-up vs. the the CIN1 persistence was 1.005 (95% Confidence Interval-CI 0.961-1.051) vs. 0.994 (95% CI 0.994-1.018) for age, 3.472 (95% CI 1.066-11.320) vs. 1.266 (95% CI 0.774-2.068) for non-vaccinated, 0.299 (95% CI 0.088-1.018) vs. 0.518 (95% CI 0.242-1.109) for HIV status negative, respectively. Analyzing the time to negativity, the odds ratio (OR) was 1.012 (95% CI 1-1.024) for age and 1.591 (95% CI 1.223-2.069) for vaccination; on the other hand, considering the relationship between the time to negative and the HPV genotypes contained in the 9-valent HPV vaccines, the OR was 1.299 (95% CI 1.026-1.646) for at least one of these at recruitment and 0.631 (95% CI 0.471-0.846) at follow-up. Furthermore, the presence of at least one of the HPV genotypes targeted by the HPV nonavalent vaccine is a key indicator of the risk of progression to CIN2+: OR was 3.443 (95% CI 1.065-11.189) for the presence of at least one HPV genotype at enrollment and 5.011 (95% CI 1.899-13.224) for the presence of at least one HPV genotype at follow-up, respectively. CONCLUSIONS We reported in a retrospective study the benefit of anti-HPV vaccination in promoting negativity and increasing low-grade cervical lesions regression.
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Cobas HPV Genotyping of FNA Sample Supernatant and Frozen Section Scrapings of Suspected Head and Neck Cancer. Appl Immunohistochem Mol Morphol 2023; 31:51-56. [PMID: 36121288 DOI: 10.1097/pai.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/21/2022] [Indexed: 12/13/2022]
Abstract
The human papillomavirus (HPV) status of squamous cell carcinomas (SCCs) of the head and neck is relevant for therapy planning, staging, and follow-up. Immunohistochemistry (IHC) for p16 is a surrogate marker of HPV status in oropharyngeal SCC, but not at other head and neck sites. We tested if the cobas HPV test was feasible and superior to p16-IHC on fine-needle aspiration (FNA) supernatants and frozen section (FS) scrapings of suspected SCC. A 500 μL aliquots of postcentrifugation supernatant CytoRich Red media of FNA cellblock specimens and scrapings of FS suspended in SurePath media vials were tested with the cobas HPV test and compared with p16-IHC and/or HPV in situ hybridization (ISH) performed on cellblock and/or resections. Twenty-nine (n=29) FNAs were tested for a cobas HPV test, p16, and/or HPV-ISH. The mean collection to testing time was 6.3 days (range: 0 to 24 d). Cobas yielded valid results in all cases; p16-IHC could not be interpreted in 4 (13%) cellblocks; correlation was performed on subsequent resections. Cohen κ correlation for cobas versus p16-IHC/HPV-ISH on FNA samples was 0.9, perfect agreement, sensitivity 100%, specificity 92.3%, positive predictive value 94.1%, negative predictive value 100%. Thirty-four (n=34) scrapings from FS were tested for cobas, p16, and/or HPV-ISH. The mean collection to testing time was 10.4 days (range: 1 to 28 d). Cohen κ correlation for cobas versus p16-IHC/HPV-ISH on FS scrapings was 1, perfect agreement. Sensitivity, specificity, positive predictive value, and negative predictive value was 100%. Cobas genotype was HPV-16 in 87%, HPV-18 in 3%, and HPV-other in 10%. Cobas HPV test in FNA supernatant and FS scrapings outperformed or was equivalent to p16-IHC and provided genotyping information.
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Ma K, Li S, Wu S, Zhu J, Yang Y. Impact of smoking exposure on human papillomavirus clearance among Chinese women: A follow-up propensity score matching study. Tob Induc Dis 2023; 21:42. [PMID: 36949733 PMCID: PMC10026377 DOI: 10.18332/tid/161026] [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: 10/07/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Smoking has been proven to increase the risk of cervical cancer, but it is still controversial whether smoking reduces women's ability to clear human papillomavirus (HPV) infection. This study investigated the association between smoking behaviors during follow-up and clearance of HPV infection in women with HPV-positive and pathologically normal uterine cervix in China, using a propensity score matching (PSM) analysis. METHODS The present prospective study included data from women examined in the Gynecology Department of Shanghai General Hospital from January 2018 to June 2020. Twenty patients who smoked throughout follow-up were selected and matched with 60 patients using the 1:3 PSM method on age, marital status, and whether infected with high-risk HPV (HR-HPV). At each visit, smoking and sexual behaviors were collected. The Kaplan-Meier method and a Cox proportional hazard regression model were used to evaluate the probability of clearing HPV infection within a 2-year follow-up. RESULTS A total of 80 patients were included in the study, all of whom were infected with at least one HR-HPV type at baseline. Current smokers had a lower likelihood of clearing the HPV infection than current non-smokers, after adjusting for a history of sexually transmitted diseases (STD), HPV infection status, and sexual behaviors during follow-up (AHR=0.478; 95% CI: 0.239-0.958, p=0.037). Additionally, longer duration, higher frequency and larger doses of smoking correlated with the lower clearance possibility of HPV infection (p for trend=0.029, 0.022 and 0.026, respectively). CONCLUSIONS This study showed that the use of tobacco throughout follow-up could increase the risk of a persistent HPV infection, this risk being higher for smokers with heavier tobacco consumption. Our results should alert HPV-positive women to reiterate the advice to cut-back on or stop smoking.
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Affiliation(s)
- Kangli Ma
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shu Li
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Sufang Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jingfen Zhu
- School of Public Health, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yongbin Yang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Hewavisenti RV, Arena J, Ahlenstiel CL, Sasson SC. Human papillomavirus in the setting of immunodeficiency: Pathogenesis and the emergence of next-generation therapies to reduce the high associated cancer risk. Front Immunol 2023; 14:1112513. [PMID: 36960048 PMCID: PMC10027931 DOI: 10.3389/fimmu.2023.1112513] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Human papillomavirus (HPV), a common sexually transmitted virus infecting mucosal or cutaneous stratified epithelia, is implicated in the rising of associated cancers worldwide. While HPV infection can be cleared by an adequate immune response, immunocompromised individuals can develop persistent, treatment-refractory, and progressive disease. Primary immunodeficiencies (PIDs) associated with HPV-related disease include inborn errors of GATA, EVER1/2, and CXCR4 mutations, resulting in defective cellular function. People living with secondary immunodeficiency (e.g. solid-organ transplants recipients of immunosuppression) and acquired immunodeficiency (e.g. concurrent human immunodeficiency virus (HIV) infection) are also at significant risk of HPV-related disease. Immunocompromised people are highly susceptible to the development of cutaneous and mucosal warts, and cervical, anogenital and oropharyngeal carcinomas. The specific mechanisms underlying high-risk HPV-driven cancer development in immunocompromised hosts are not well understood. Current treatments for HPV-related cancers include surgery with adjuvant chemotherapy and/or radiotherapy, with clinical trials underway to investigate the use of anti-PD-1 therapy. In the setting of HIV co-infection, persistent high-grade anal intraepithelial neoplasia can occur despite suppressive antiretroviral therapy, resulting in an ongoing risk for transformation to overt malignancy. Although therapeutic vaccines against HPV are under development, the efficacy of these in the setting of PID, secondary- or acquired- immunodeficiencies remains unclear. RNA-based therapeutic targeting of the HPV genome or mRNA transcript has become a promising next-generation therapeutic avenue. In this review, we summarise the current understanding of HPV pathogenesis, immune evasion, and malignant transformation, with a focus on key PIDs, secondary immunodeficiencies, and HIV infection. Current management and vaccine regimes are outlined in relation to HPV-driven cancer, and specifically, the need for more effective therapeutic strategies for immunocompromised hosts. The recent advances in RNA-based gene targeting including CRISPR and short interfering RNA (siRNA), and the potential application to HPV infection are of great interest. An increased understanding of both the dysregulated immune responses in immunocompromised hosts and of viral persistence is essential for the design of next-generation therapies to eliminate HPV persistence and cancer development in the most at-risk populations.
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Affiliation(s)
- Rehana V. Hewavisenti
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Joshua Arena
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- UNSW RNA Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Chantelle L. Ahlenstiel
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- UNSW RNA Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah C. Sasson
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Sarah C. Sasson,
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Feldstein O, Gali‐Zamir H, Schejter E, Feinberg T, Yehuda‐Shnaidman E, Bornstein J, Levy T. High-risk HPV testing vs liquid-based cytology for cervical cancer screening among 25- to 30-year-old women: A historical cohort study. Acta Obstet Gynecol Scand 2022; 102:226-233. [PMID: 36478537 PMCID: PMC9889323 DOI: 10.1111/aogs.14482] [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: 04/19/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION High-risk human papilloma virus (hrHPV) DNA testing is more sensitive than cytology screening, achieving greater protection against cervical cancer. Controversy exists regarding the preferred screening method for women 25-30 years of age. At this age, infection with HPV is common and usually transient. Consequently, hrHPV screening in this age group is fraught with high false-positive screening results, leading to more colposcopies and unnecessary treatments with the potential for harm. In the present study, we aimed to compare the results of two screening methods in relation to high-grade cervical intraepithelial lesion detection rate in the young age group of 25-30 years. MATERIAL AND METHODS Retrospective information on cervical cytology, hrHPV testing, colposcopy referrals and histologic results, from one screening round, were retrieved from the Maccabi HealthCare Health Maintenance Organization centralized database during the study period from March 1, 2017 to April 1, 2019 for 25- to 30-year-old women. Screening with hrHPV testing for types 16, 18 and 12 other hrHPV types was compared with the conventional PAP liquid-based cytology (LBC) test. Odds ratio (OR) of detection with 95% confidence interval (CI) was calculated for cervical intraepithelial neoplasia (CIN) grade 3 or higher (CIN 3+). RESULTS During the study period, 42 244 women 25-30 years old underwent cervical cancer screening; of them, 20 997 were screened with LBC between March 1, 2017 and March 1, 2018 and compared with 21 247 who were screened with hrHPV between April 1, 2018 and April 1, 2019. Testing for hrHPV resulted in a higher colposcopy referral rate compared with primary LBC screening: 9.8% vs 7.8%, respectively; (OR 1.28; 95% CI 1.2-1.37; p < 0.001). Screening with hrHPV led to significantly higher detection of CIN 3+ lesions (OR 1.4; 95% CI 1.2-1.6; p < 0.001) compared with LBC. HPV infections with non-16/18 hrHPV (other hrHPV) were the most prevalent (84.8%). CONCLUSIONS In women 25-30 years old, primary hrHPV screening was associated with a higher detection rate of CIN 3+ compared with cytology screening and should be considered for primary screening in this age group.
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Affiliation(s)
- Ohad Feldstein
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWolfson Medical Center and Sackler Faculty of MedicineTel Aviv UniversityHolonIsrael
| | - Hadar Gali‐Zamir
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWolfson Medical Center and Sackler Faculty of MedicineTel Aviv UniversityHolonIsrael
| | | | | | | | - Jacob Bornstein
- Department of Obstetrics and GynecologyGalilee Medical Center and Azrieli Faculty of MedicineBar Ilan UniversityIsrael
| | - Tally Levy
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWolfson Medical Center and Sackler Faculty of MedicineTel Aviv UniversityHolonIsrael
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Chandra S, Goswami A, Mandal P. Molecular Heterogeneity of Cervical Cancer Among Different Ethnic/Racial Populations. J Racial Ethn Health Disparities 2022; 9:2441-2450. [PMID: 34741276 DOI: 10.1007/s40615-021-01180-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022]
Abstract
The study aimed to find differential gene mutation profile and gene expression status among different ethnic/racial human populations relevant for cervical cancer pathogenesis. The study was based on freely available datasets of The Cancer Genome Atlas (TCGA) of cervical cancer samples in Genomic Data Commons (GDC) data portal. We identified that choline metabolism in cancer and Ras signaling pathways were significantly associated with the Hispanic and Latino group of cervical cancer patients. In these pathways, mutations in the PIK3CA gene, especially E545K, were significantly associated with the Hispanic and LATINO group. We found that AFF3 gene mutation was associated with downregulation of its expression only among the White racial category of cervical cancer cases. Additionally, hypomethylation of the CpG position in the S shore region of the PM20D1 gene was associated with overexpression among the Asian category of cervical cancer cases. Heterogeneity of the molecular profile of AFF3 and PM20D1 gene among racial groups reflects the potential of differential targeted therapy of cervical cancer.
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Affiliation(s)
- Sanchita Chandra
- Biomedical Genetics Laboratory, Department of Zoology, The University of Burdwan, Burdwan, 713104, West Bengal, India
| | - Anindita Goswami
- Biomedical Genetics Laboratory, Department of Zoology, The University of Burdwan, Burdwan, 713104, West Bengal, India
| | - Paramita Mandal
- Biomedical Genetics Laboratory, Department of Zoology, The University of Burdwan, Burdwan, 713104, West Bengal, India.
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Denninghoff V, von Petery F, Fresno C, Galarza M, Torres F, Avagnina A, Fishkel V, Krupitzki H, Fiorillo A, Monge F. Clinical implementation of a cervical cancer screening program via co-testing at a university hospital. PLoS One 2022; 17:e0278476. [PMID: 36454784 PMCID: PMC9714701 DOI: 10.1371/journal.pone.0278476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
The Human Papillomavirus (HPV) test is a crucial technology for cervical cancer prevention because it enables programs to identify women with high-risk HPV infection who are at risk of developing cervical cancer. Current U.S. Preventive Services Task Force recommendations include cervical cancer screening every three years with cervical cytology alone or every five years with either high-risk HPV testing alone or high-risk HPV testing combined with cytology (co-testing). In Argentina, 7,548 new cervical cancer cases are diagnosed each year with 3,932 deaths attributed to this cause. Our study aims to show the clinical implementation of a cervical cancer screening program by concurrent HPV testing and cervical cytology (co-testing); and to evaluate the possible cervical cancer screening scenarios for Latin America, focusing on their performance and average cost. A cervical cancer screening five year program via co-testing algorithm (Hybrid-2-Capture/cytology) was performed on women aged 30-65 years old at a university hospital. Statistical analysis included a multinomial logistic regression, and two cancer screening classification alternatives were tested (cytology-reflex and HPV-reflex). A total of 2,273 women were included, 91.11% of the participants were double-negative, 2.55% double-positive, 5.90% positive-Hybrid-2-Capture-/negative-cytology, and 0.44% negative-Hybrid-2-Capture/positive-cytology. A thorough follow-up was performed in the positive-Hybrid-2-Capture group. Despite our efforts, 21 (10.93%) were lost, mainly because of changes on their health insurance coverage which excluded them from our screening algorithm. Of the 171 women with positive-Hybrid-2-Capture results and follow-up, 68 (39.77%) cleared the virus infection, 64 (37.43%) showed viral persistence, and 39 (22.81%) were adequately treated after detection via colposcopy/biopsy of histological HSIL (High-Grade Squamous Intraepithelial Lesion). The prevalence of high-risk HPV in this population was 192 women (8.45%), with HSIL histology detection rates of 17 per 1,000 screened women. A multinomial logistic regression analysis was performed over the women with positive-Hybrid-2-Capture considering the follow up (clearance, persistence and HSIL) as dependent variable, and the cytology test results (positive- or negative-cytology and Atypical Squamous Cells of Undetermined Significance, ASC-US) as independent variable. The model supported a direct association between cytology test results and follow up: negative-cytology/clearance, ASC-US/persistence, and positive-cytology/HSIL with the following probabilities of occurrence for these pairs 0.5, 0.647 and 0.647, respectively. Cytology could be considered a prognostic-factor in women with a positive-Hybrid-2-Capture. These findings suggest that the introduction of co-testing could diminish the burden of cervical cancer in low-and middle-income-countries, acting as a tool against inequity in healthcare.
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Affiliation(s)
- Valeria Denninghoff
- Molecular-Clinical Laboratory, University of Buenos Aires—National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
- * E-mail: (VD); (CF)
| | - Felicitas von Petery
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Cristóbal Fresno
- Health and Sciences Research Center (CICSA), Health and Sciences Faculty, Anahuac University, Huixquilucan, Estado de México, México
- * E-mail: (VD); (CF)
| | - Mercedes Galarza
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Florencia Torres
- General Acute’s Hospital Dr. I. Pirovano, Buenos Aires, Argentina
| | - Alejandra Avagnina
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Vanina Fishkel
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Hugo Krupitzki
- CEMIC-CONICET Interacting Units, Buenos Aires, Argentina
| | - Angel Fiorillo
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
| | - Fernando Monge
- Center for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina
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Tawe L, Ramatlho P, Ketlametswe R, Koobotse M, Robertson ES, Grover S, Ramogola-Masire D, Paganotti GM. Cervical human papillomavirus genotypes in a high HIV setting: A scoping review of a decade of human papillomavirus epidemiological research in Botswana. Front Med (Lausanne) 2022; 9:1020760. [PMID: 36507502 PMCID: PMC9729273 DOI: 10.3389/fmed.2022.1020760] [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: 08/16/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
Cervical cancer burden is still high in low- and middle-income countries, including Botswana. Persistent human papillomavirus (HPV) infection is the leading cause of cervical cancer. Accurate knowledge of HPV diversity associated to cervical cancer in sub-Saharan Africa may provide accurate understanding of the natural history of HPV infection in these contexts. The goal of this review was to consolidate existing evidence on cervical HPV infection and to conduct a pooled analysis of data from all eligible Botswana studies. After a successful review of twelve studies on cervical HPV genotypes that met the inclusion criteria, HPV-16 genotype was the most frequently discovered in women with pre-cancerous and cancer lesions, followed by HPV-18. HPV-16 in HIV-positive women with precancerous lesions to cancer is between 45% and 47.7%, and between 4.5% and 26.1% for HPV-18. With reference to other HPV genotypes, the proportion of HPV-35 and HPV-58 (13-16%) seems relatively consistent among the studies, however HPV-58 appears to be more common in HIV-positive subjects compared to HIV-negative women. Indeed, HPV-45 seems to be frequently detected in women with cervical cancer compared to women with precancerous lesions. Regarding the low-risk HPV genotypes, an appropriate breakdown has been provided. In conclusion, the current prophylactic vaccines against HPV-16 and HPV-18, which have demonstrated good immunogenicity in HIV-infected populations, may still prevent infection and ultimately cancer.
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Affiliation(s)
- Leabaneng Tawe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Pleasure Ramatlho
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | | | - Moses Koobotse
- School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Erle S. Robertson
- Department of Otorhinolaryngology - Head and Neck Surgery, The Tumor Virology Program, Abramson Comprehensive Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Doreen Ramogola-Masire
- Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Giacomo M. Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana,*Correspondence: Giacomo M. Paganotti,
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34
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Classification and diagnosis of cervical lesions based on colposcopy images using deep fully convolutional networks: a man-machine comparison cohort study. FUNDAMENTAL RESEARCH 2022. [DOI: 10.1016/j.fmre.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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35
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Lalonde CS, Teng Y, Burtness BA, Ferris RL, Ahmed R, Saba NF. The Quest to Eradicate HPV-Related Oropharyngeal Carcinoma: An Opportunity Not to Miss. J Natl Cancer Inst 2022; 114:1333-1337. [PMID: 35567531 PMCID: PMC9552310 DOI: 10.1093/jnci/djac098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/29/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) accounts for more than half of all head and neck cancers. Since the 1970s, OPSCC has shifted from an environmentally triggered to virally mediated disease due to a sharp rise in human papillomavirus (HPV)-related squamous cell carcinoma. Although a highly effective prophylactic vaccine is available, its current implementation is far below national targets, and OPSCC incidence is predicted to further increase by 2045. However, we believe that with prompt action now, we can not only defy these predictions but also effectively eradicate HPV-related OPSCC in these next 20 years. We herein provide an overview of the necessary elements to eliminate this disease: improved primary vaccine uptake, a 1-time universal vaccination effort, and implementation of novel therapeutics that have potential to cure existing disease.
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Affiliation(s)
- Chloe S Lalonde
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Barbara A Burtness
- Department of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rafi Ahmed
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nabil F Saba
- Correspondence to: Nabil F. Saba, MD, Department of Hematology/Oncology, Winship Cancer Institute, 1365 Clifton Road, Building C, Atlanta, GA 30322, USA (e-mail: )
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36
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Zheng C, Zheng Z, Chen W. Association between serum vitamin C and HPV infection in American women: a cross-sectional study. BMC Womens Health 2022; 22:404. [PMID: 36199060 PMCID: PMC9533549 DOI: 10.1186/s12905-022-01993-7] [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: 05/10/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Background Evidence regarding the relationship between serum vitamin C levels and human papillomavirus (HPV) infection is limited. Therefore, this study aimed to investigate whether serum vitamin C levels are independently associated with HPV infection. Methods Data for this cross-sectional study were obtained from the National Health and Nutrition Examination Survey 2003–2006. A total of 2174 women, 18–59 years of age, were enrolled in this study. The associations between serum vitamin C levels (continuous and categorical forms) and cervicovaginal HPV infection were estimated using weighted logistic regression. Results The adjusted binary logistic regression showed that serum vitamin C was not associated with the risk of HPV infection after adjusting for age, race, poverty income ratio, alcohol consumption, smoking, body mass index, education, and health condition (odds ratio [OR] 0.998, 95% confidence interval [CI] 0.994–1.001). Serum vitamin C levels were converted from a continuous variable to a categorical variable for the analysis. Compared with the vitamin C deficiency and hypovitaminosis groups, there was a negative correlation between vitamin C and HPV infection when vitamin C was adequate (OR 0.7, 95% CI: 0.52–0.94); however, when the serum vitamin C level was inadequate and saturated, this negative correlation was weaker or nonexistent (OR 0.76, 95% CI 0.56–1.03 and OR 0.76, 95% CI 0.55–1.04, respectively). A nonlinear relationship was detected between vitamin C level and HPV infection. Furthermore, we performed subgroup analysis of different models and found that serum vitamin C concentration was negatively associated with HPV infection in women ≥ 25 years of age; however, in women < 25 years of age, serum vitamin C levels were not associated with HPV infection. Conclusion The results from this United States nationally representative sample supported the hypothesis that there was a U-shaped relationship between serum vitamin C levels and HPV infection. Future studies are warranted to assess the association between vitamin C and HPV persistence and clarify the underlying mechanisms of these associations.
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Affiliation(s)
- Chunqin Zheng
- grid.452734.3Department of Obstetrics and Gynecology, Shantou Central Hospital, Shantou, 515000 China
| | - Zhixiang Zheng
- grid.452734.3Department of Obstetrics and Gynecology, Shantou Central Hospital, Shantou, 515000 China
| | - Weiqiang Chen
- grid.452734.3Department of Anesthesiology, Shantou Central Hospital, Shantou, 515000 China
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37
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Desai KT, Adepiti CA, Schiffman M, Egemen D, Gage JC, Wentzensen N, de Sanjose S, Burk RD, Ajenifuja KO. Redesign of a rapid, low-cost HPV typing assay to support risk-based cervical screening and management. Int J Cancer 2022; 151:1142-1149. [PMID: 35666530 PMCID: PMC9378567 DOI: 10.1002/ijc.34151] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
Abstract
Accelerated cervical cancer control will require widespread human papillomavirus (HPV) vaccination and screening. For screening, sensitive HPV testing with an option of self-collection is increasingly desirable. HPV typing predicts risk of precancer/cancer, which could be useful in management, but most current typing assays are expensive and/or complicated. An existing 15-type isothermal amplification assay (AmpFire, Atila Biosystems, USA) was redesigned as a 13-type assay (ScreenFire) for public health use. The redesigned assay groups HPV types into four channels with differential cervical cancer risk: (a) HPV16, (b) HPV18/45, (c) HPV31/33/35/52/58 and (d) HPV39/51/56/59/68. Since the assay will be most useful in resource-limited settings, we chose a stratified random sample of 453 provider-collected samples from a population-based screening study in rural Nigeria that had been initially tested with MY09-MY11-based PCR with oligonucleotide hybridization genotyping. Frozen residual specimens were masked and retested at Atila Biosystems. Agreement on positivity between ScreenFire and prior PCR testing was very high for each of the channels. When we simulated intended use, that is, a hierarchical result in order of clinical importance of the type groups (HPV16 > 18/45 > 31/33/35/52/58 > 39/51/56/59/68), the weighted kappa for ScreenFire vs PCR was 0.90 (95% CI: 0.86-0.93). The ScreenFire assay is mobile, relatively simple, rapid (results within 20-60 minutes) and agrees well with reference testing particularly for the HPV types of greatest carcinogenic risk. If confirmed, ScreenFire or similar isothermal amplification assays could be useful as part of risk-based screening and management.
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Affiliation(s)
- Kanan T. Desai
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Clement A. Adepiti
- Department of Obstetrics, Gynecology, and PerinatologyThe Obafemi Awolowo UniversityIle‐IfeOsun StateNigeria
| | - Mark Schiffman
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Didem Egemen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Julia C. Gage
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Nicolas Wentzensen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Silvia de Sanjose
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
- ISGlobalBarcelonaSpain
| | - Robert D. Burk
- Albert Einstein Cancer CenterAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | - Kayode O. Ajenifuja
- Department of Obstetrics, Gynecology, and PerinatologyThe Obafemi Awolowo UniversityIle‐IfeOsun StateNigeria
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Hillyar CR, Kanabar SS, Pufal KR, Lawson AW, Saw Hee JL, Rallis KS, Nibber A, Sideris M. A systematic review and meta-analysis of the diagnostic effectiveness of human papillomavirus methylation biomarkers for detection of cervical cancer. Epigenomics 2022; 14:1055-1072. [PMID: 36169190 DOI: 10.2217/epi-2022-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The aim of this systematic review and meta-analysis was to assess the evidence for the diagnostic effectiveness of human papillomavirus (HPV) methylation biomarkers for detection of cervical cancer. Methods: PubMed, Embase and Web of Science were searched. Nine articles focusing on HPV methylation for detection of precancerous and cancerous cervical lesions were included. The QUADAS-2 tool was used for quality assessment. The receiver operating characteristic (ROC) was the main diagnostic performance parameter extracted. Results: Of the nine articles included in this study, seven were of moderate quality and two were of high quality. A meta-analysis of the ROC for 27 HPV methylation biomarkers revealed an overall pooled ROC of 0.770 (95% CI: 0.720-0.819; I2: 98.4%; Q: 1537.4; p < 0.01). Four methylation biomarkers had strong diagnostic ability (ROC > 0.900), 17 were moderate (ROC: 0.7000-0.8999) and six were poor (ROC < 0.700). Conclusion: HPV methylation biomarkers hold significant promise as independent screening tests for the detection of cervical precancerous and cancerous lesions.
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Affiliation(s)
- Christopher Rt Hillyar
- Green Templeton College, University of Oxford, Oxford, OX2 6HG, UK.,Surgery, Women's & Oncology Division, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Shivani S Kanabar
- University of Birmingham Medical School, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kamil R Pufal
- University of Birmingham Medical School, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Alexander W Lawson
- University of Birmingham Medical School, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Joshua Li Saw Hee
- University of Birmingham Medical School, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kathrine S Rallis
- Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, E1 2AD, UK.,Cancer Research UK City of London Centre, Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, EC1M 6BQZ, UK
| | - Anjan Nibber
- Green Templeton College, University of Oxford, Oxford, OX2 6HG, UK.,Surgery, Women's & Oncology Division, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Michail Sideris
- Cancer Research UK Barts Centre, Queen Mary University of London, London, EC1M 5PZ, UK.,Department of Gynaecological Oncology, Barts Health NHS Trust, London, E1 1BB, UK
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39
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Michalczyk K, Misiek M, Chudecka-Głaz A. Can Adjuvant HPV Vaccination Be Helpful in the Prevention of Persistent/Recurrent Cervical Dysplasia after Surgical Treatment?—A Literature Review. Cancers (Basel) 2022; 14:cancers14184352. [PMID: 36139514 PMCID: PMC9496656 DOI: 10.3390/cancers14184352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Primary prophylactic, early detection and the treatment of precancerous lesions are the main goals of cervical cancer screening. Despite effective surgical treatment methods, using loop electrosurgical excision procedures and conization, the overall risk of the recurrence of HSIL lesions remains at approximately 6.6%. There is increasing evidence of the potential role of HPV vaccines in the adjuvant setting and their impact on the reduction of disease recurrence. This review aims to analyze the up-to-date research concerning the use and efficacy of secondary human papilloma virus (HPV) vaccination as an adjuvant method to surgical treatment in patients diagnosed with cervical HSILs. Abstract Cervical cancer formation is preceded by precursor lesions, including low-grade squamous intraepithelial lesions (LSILs) and high-grade squamous intraepithelial lesions (HSILs), which are usually diagnosed in women of reproductive age. Despite the recent advanced diagnostic and treatment methods, including colposcopy, the loop electrosurgical excision procedure (LEEP), and surgical conization, the recurrence or residual disease affects as many as 6.6% of patients. The lesions are often associated with human papilloma virus (HPV) infection. As HPV persistence is the leading and only modifiable factor affecting the risk of progression of CIN lesions into high-grade cervical dysplasia and cancer, it has been proposed to conduct adjuvant vaccination in patients treated for high-grade cervical dysplasia. To date, no vaccine has been approved for therapeutic use in patients diagnosed with HSILs; however, attempts have been made to determine the use of HPV prophylactic vaccination to reduce recurrent HSILs and prevent cervical cancer. The aim of this review was to analyze the up-to-date literature concerning the possible use of secondary human papilloma virus (HPV) vaccination as an adjuvant method to surgical treatment in patients diagnosed with cervical HSILs. Adjuvant HPV vaccination after surgical treatment may reduce the risk of recurrent cervical dysplasia.
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Affiliation(s)
- Kaja Michalczyk
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-204 Szczecin, Poland
- Correspondence:
| | - Marcin Misiek
- Holy Cross Cancer Center, Clinical Gynecology, 25-743 Kielce, Poland
| | - Anita Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-204 Szczecin, Poland
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40
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Markowitz LE, Drolet M, Lewis RM, Lemieux-Mellouki P, Pérez N, Jit M, Brotherton JM, Ogilvie G, Kreimer AR, Brisson M. Human papillomavirus vaccine effectiveness by number of doses: Updated systematic review of data from national immunization programs. Vaccine 2022; 40:5413-5432. [PMID: 35965239 PMCID: PMC9768820 DOI: 10.1016/j.vaccine.2022.06.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines were first licensed as a three-dose series. Two doses are now widely recommended in some age groups; there are data suggesting high efficacy with one dose. We updated a systematic literature review of HPV vaccine effectiveness by number of doses in observational studies. METHODS We searched Medline and Embase databases from January 1, 2007, through September 29, 2021. Data were extracted and summarized in a narrative synthesis. We also conducted quality assessments for bias due to selection, information, and confounding. RESULTS Overall, 35 studies were included; all except one were conducted within the context of a recommended three-dose schedule. Evaluations were in countries that used bivalent HPV vaccine (seven), quadrivalent HPV vaccine (27) or both (one). Nine evaluated effectiveness against HPV infection, ten anogenital warts, and 16 cervical abnormalities. All studies were judged to have moderate or serious risk of bias. The biases rated as serious would likely result in lower effectiveness with fewer doses. Investigators attempted to control for or stratify by potentially important variables, such as age at vaccination. Eight studies evaluated impact of buffer periods (lag time) for case counting and 10 evaluated different intervals between doses for two-dose vaccine recipients. Studies that stratified by vaccination age found higher effectiveness with younger age at vaccination, although differences were not all formally tested. Most studies found highest estimates of effectiveness with three doses; significant effectiveness was found among 28/29 studies that evaluated three doses, 19/29 that evaluated two doses, and 18/30 that evaluated one dose. Some studies that adjusted or stratified analyses by age at vaccination found similar effectiveness with three, two and one doses. CONCLUSION Observational studies of HPV vaccine effectiveness have many biases. Studies examining persons vaccinated prior to sexual activity and using methods to reduce sources of bias are needed for valid effectiveness estimates.
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Affiliation(s)
- Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Rayleen M Lewis
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Synergy America, Inc, Duluth, GA, USA
| | - Philippe Lemieux-Mellouki
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Norma Pérez
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada
| | - Mark Jit
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julia M Brotherton
- Population Health, VCS Foundation, East Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Gina Ogilvie
- University of British Columbia, British Columbia, Canada
| | - Aimée R Kreimer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marc Brisson
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom
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Assessing the Cervicovaginal Microbiota in the Context of hrHPV Infections: Temporal Dynamics and Therapeutic Strategies. mBio 2022; 13:e0161922. [PMID: 35980030 PMCID: PMC9600249 DOI: 10.1128/mbio.01619-22] [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: 11/20/2022] Open
Abstract
Cervical cancer is the third leading cause of female cancers globally, resulting in more than 300,000 deaths every year. The majority of all cervical cancers are caused by persistent infections with high-risk human papillomaviruses (hrHPV) that can progress to cancer via a series of premalignant lesions. Most women, however, clear this infection within a year, concomitant with disease regression. Both hrHPV clearance and disease regression have been associated with the composition of the cervicovaginal microenvironment, which is defined by the host immune system and the cervicovaginal microbiome (CVM). A healthy microbiome is generally characterized by a high abundance of Lactobacillus species, and a change in the composition may cause bacterial vaginosis (BV), which is associated with an increased susceptibility to persistent hrHPV infections and disease. In this review, the composition of the CVM is discussed, with emphasis on the possible causes that drive changes in the cervicovaginal microbiota in relation to hrHPV infections, disease progression, and disease regression. The literature search focused on the composition of the CVM and its correlation with hrHPV infections and neoplastic lesions as well as the current efforts to adjust the microbiome against adverse viral outcomes.
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Reuschenbach M, Mihm S, Wölle R, Schneider KM, Jacob C, Greiner W, Hampl M, Goodman E. Healthcare resource utilization and costs in 23-25-year-old women with human papillomavirus (HPV) associated anogenital diseases in Germany - a retrospective analysis of statutory health insurance claims data. BMC Health Serv Res 2022; 22:1002. [PMID: 35932066 PMCID: PMC9356499 DOI: 10.1186/s12913-022-08397-1] [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: 11/24/2021] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Human papilloma virus (HPV) causes multiple anogenital diseases including cervical cancer and is the most common sexually transmitted infection. Healthcare resource utilization (HRU) associated with HPV-related anogenital diseases includes diagnostic and disease specific treatment regimens. A recent study showed disease burden of young women aged 23–25 years, who were the first populations eligible to receive HPV vaccination after its introduction in Germany. Cost for the German statutory health insurance (SHI) due to HPV‑related anogenital diseases in this population are unknown. This study aimed at assessing HRU and costs related to HPV-associated anogenital diseases for the Germany SHI. Methods We used a retrospective, matched cohort design to leverage the prior identified cohort of 23–25-year-old women born between 1989–1992 diagnosed with HPV-related anogenital disease from the Institute for Applied Health Research Berlin (InGef) Research Database. German SHI claims data from 2012–2017 were analyzed. The prior identified cases were matched (direct, without replacement) to women without anogenital diseases (1:10 ratio). HRU and costs for inpatient care, outpatient care, and pharmaceutical during a 3-year observation period were determined for both cases and controls and increments between the groups were assessed. Results 2,972 women diagnosed with anogenital diseases (cases) who were matched to 29,720 women without anogenital diseases (controls). Cases had more outpatient visits (52.4 visits vs. 39.2 visits) and more cases (45.2% vs. 31.7%) were hospitalized at least once in the 3‑year observation period. Most common outpatient procedures performed in cases were conization of the cervix uteri (4.4% cases; n < 5 controls), followed by other excision and destruction of diseased tissue of the cervix uteri (3.1% in cases; 0.0% in controls). Median difference in total healthcare costs of €684 (mean difference: €1,089, 95%CI: €752–1,426) suggest that HPV-related anogenital diseases were responsible for approximately €3.2 Million more healthcare costs for the identified cases in the four birth cohorts within the 3‑year observation period in the InGef Research Database. Costs were mainly driven by outpatient care (41.6% of total costs). Conclusion In Germany, HPV-related anogenital diseases among young women are associated with considerable HRU and financial expenditures, mostly driven by outpatient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08397-1.
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Affiliation(s)
- Miriam Reuschenbach
- Global Medical and Scientific Affairs, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Sarah Mihm
- Department of Market Access, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Regine Wölle
- Department of Market Access, MSD Sharp and Dohme GmbH, Munich, Germany
| | | | | | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Monika Hampl
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Elizabeth Goodman
- Center for Observational and Real-World Evidence (CORE), Merck and Co., Inc, Rahway, NJ, USA.
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Yao X, Chu K, Zhao J, Hu Y, Lin Z, Lin B, Chen Q, Li Y, Zhang Q, Fang M, Huang S, Wang Y, Su Y, Wu T, Zhang J, Xia N. Comparison of HPV neutralizing and IgG antibodies in unvaccinated female adolescents. Future Microbiol 2022; 17:1207-1215. [PMID: 35905119 DOI: 10.2217/fmb-2021-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To analyze the consistency between HPV neutralizing antibodies and specific total IgG antibodies in unvaccinated females. Materials & methods: Serum samples from 978 unvaccinated Chinese females aged 9-26 years were measured for antibodies against HPV-16 and HPV-18 using simultaneous pseudovirus-based neutralization assay and ELISA. Results: There was a moderate level of consistency between HPV neutralizing antibodies and specific IgG in females aged 18-26 years (Cohen's κ coefficient for HPV-16 and HPV-18: 0.52 and 0.38) and poor consistency in those aged 9-17 years (Cohen's κ coefficient <0.05). However, Cohen's κ coefficient remained almost unchanged in sensitivity analysis when the IgG antibody cut-off value was raised. Conclusion: HPV neutralizing antibodies are a more specific indicator for the evaluation of HPV natural humoral immunity.
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Affiliation(s)
- Xingmei Yao
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Kai Chu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, Jiangsu, China
| | - Jun Zhao
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yuemei Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, Jiangsu, China
| | - Zhijie Lin
- Xiamen Innovax Biotech Co., Ltd., Xiamen, 361022, Fujian, China
| | - Bizhen Lin
- Xiamen Innovax Biotech Co., Ltd., Xiamen, 361022, Fujian, China
| | - Qi Chen
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yafei Li
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Qiufen Zhang
- Xiamen Innovax Biotech Co., Ltd., Xiamen, 361022, Fujian, China
| | - Mujin Fang
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Shoujie Huang
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yingbin Wang
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yingying Su
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology & Molecular Diagnostics, National Institute of Diagnostics & Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China.,Research Unit of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen, 361102, Fujian, China
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Smith JA, Gaikwad AA, Mathew L, Rech B, Faro JP, Lucci JA, Bai Y, Olsen RJ, Byrd TT. AHCC® Supplementation to Support Immune Function to Clear Persistent Human Papillomavirus Infections. Front Oncol 2022; 12:881902. [PMID: 35814366 PMCID: PMC9256908 DOI: 10.3389/fonc.2022.881902] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the efficacy, safety, and durability of the use of AHCC supplementation for 6 months to support the host immune system to clear high-risk human papillomavirus (HPV) infections. The AHCC supplement is a proprietary, standardized extract of cultured lentinula edodes mycelia (AHCC®, Amino Up, Ltd., Sapporo, Japan) that has been shown to have unique immune modulatory benefits. Study Design This was a randomized, double-blind, placebo-controlled study (CTN: NCT02405533) in 50 women over 30 years of age with confirmed persistent high-risk HPV infections for greater than 2 years. Patients were randomized to placebo once daily for 12 months (N = 25) or AHCC 3-g supplementation by mouth once daily on empty stomach for 6 months followed by 6 months of placebo (N = 25). Every 3 months, patients were evaluated with HPV DNA and HPV RNA testing as well as a blood sample collected to evaluate a panel of immune markers including interferon-alpha, interferon-beta (IFN-β), interferon-gamma (IFN-γ), IgG1, T lymphocytes, and natural killer (NK) cell levels. At the completion of the 12-month study period, patients on the placebo arm were given the option to continue on the study to receive AHCC supplementation unblinded for 6 months with the same follow-up appointments and testing as the intervention arm. Results Fifty women with high-risk HPV were enrolled, and 41 completed the study. Fourteen (63.6%) of the 22 patients in the AHCC supplementation arm were HPV RNA/HPV DNA negative after 6 months, with 64.3% (9/14) achieving a durable response defined as being HPV RNA/HPV DNA negative 6 months off supplementation. On the placebo arm, two (10.5%) of 19 patients were HPV negative at 12 months. In the twelve placebo arm patients who elected to continue on the unblinded study, 50% (n = 6) were HPV RNA/HPV DNA negative after 6 months of AHCC supplementation. At the time of completion of the study, there were a total of 34 patients (22 blinded and 12 unblinded) who had received AHCC supplementation with an overall response rate of 58.8% that cleared HPV persistent infections. At the time of enrollment, the mean IFN-β level was 60.5 ± 37.6 pg/ml in women with confirmed persistent HPV infections. Suppression of IFN-β to less than 20 pg/ml correlated with an increase in T lymphocytes and IFN-γ and durable clearance of HPV infections in women who received AHCC supplementation. Conclusion Results from this phase II study demonstrated that AHCC 3 g once daily was effective to support the host immune system to eliminate persistent HPV infections and was well tolerated with no significant adverse side effects reported. The duration of AHCC supplementation required beyond the first negative result needs more evaluation to optimize success for durable outcomes. The suppression of the IFN-β level to less than 20 pg/ml correlated with clearance of HPV infections and merits further evaluation as a clinical tool for monitoring patients with HPV infections. Clinical Trial Registration clinicaltrials.gov/ct2/, identifier NCT02405533
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Affiliation(s)
- Judith A. Smith
- Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health McGovern Medical School, Houston, TX, United States
- Department of Pharmacy, UT Heath-Memorial Hermann Cancer Center, Houston, TX, United States
- *Correspondence: Judith A. Smith,
| | - Anjali A. Gaikwad
- Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health McGovern Medical School, Houston, TX, United States
| | - Lata Mathew
- Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health McGovern Medical School, Houston, TX, United States
| | - Barbara Rech
- UT Physicians Women’s Center, Houston, TX, United States
| | - Jonathan P. Faro
- Specialists in Obstetrics & Gynecology, Houston, TX, United States
| | - Joseph A. Lucci
- Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health McGovern Medical School, Houston, TX, United States
- Department of Pharmacy, UT Heath-Memorial Hermann Cancer Center, Houston, TX, United States
| | - Yu Bai
- Department of Pathology, UT Health McGovern Medical School, Houston, TX, United States
| | - Randall J. Olsen
- Department of Molecular Pathology, Houston Methodist Research Institute, Houston, TX, United States
| | - Teresa T. Byrd
- Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health McGovern Medical School, Houston, TX, United States
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Cambrea SC, Aschie M, Resul G, Mitroi AF, Chisoi A, Nicolau AA, Baltatescu GI, Cretu AM, Lupasteanu G, Serbanescu L, Manea M, Topliceanu ST, Petcu LC, Pazara L, Cozaru GC. HPV and HIV Coinfection in Women from a Southeast Region of Romania—PICOPIV Study. Medicina (B Aires) 2022; 58:medicina58060760. [PMID: 35744023 PMCID: PMC9231193 DOI: 10.3390/medicina58060760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives: Romania faces one of the highest cervical cancer burdens in Europe though it is a preventable cancer through population screening by cytology and human papillomavirus (HPV) detection. Also, it has one of the highest incidences of human immunodeficiency virus (HIV) infection. HPV and HIV coinfection are frequently encountered. The aim of study was to establish the prevalence of HPV infection among HIV-positive women in Southeast Region of Romania, to genotype high risk HPV types -and to correlate the results with clinical data and cytological cervical lesions. Materials and Methods: 40 HIV-positive women were screened for HPV types and for cytological cervical lesions. The findings were evaluated in correlation with CD4 cell counts, HIV viral load, age at first sexual intercourse, number of sexual partners, vaginal candidiasis, and Gardnerella using statistical methods. Results: 19/40 (47.5%) women were positive for HPV types, 63.15% infected with single HPV type and 36.85% with multiple HPV types. The most frequent types were type: 31 (42.1%), 56 (31.57%), 53 (15.78%). On cytology, 34 (85%) women were found with NILM of which 38.23% were HPV-positive. Fifteen percent of women had abnormal cytology (three ASC-US, three LSIL), and all of them were HPV-positive. Through analyzing the value of CD4 count, women with CD4 count ≤ 200 cells/μL were found to be significantly more likely to be infected with HPV; meanwhile there was no correlation between the detection of HPV types and HIV viral load. Candida or Gardnerella were more often associated with HIV-positive women with HPV, than in women without HPV. Conclusions: Infection with HPV types is common among HIV-positive women in the Southeast Region of Romania and it is associated with age at the beginning of sexual life, number of sexual partners, CD4 value, vaginal candidiasis, and Gardnerella infection.
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Affiliation(s)
- Simona Claudia Cambrea
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania; (S.C.C.); (M.A.); (L.S.); (L.P.)
- Clinical Hospital of Infectious Diseases, 100 Ferdinand Blvd., 900178 Constanta, Romania
| | - Mariana Aschie
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania; (S.C.C.); (M.A.); (L.S.); (L.P.)
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Institute of Doctoral Studies, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
| | - Ghiulendan Resul
- Clinical Hospital of Infectious Diseases, 100 Ferdinand Blvd., 900178 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Institute of Doctoral Studies, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
- Correspondence: ; Tel.: +40-74-5904-219
| | - Anca Florentina Mitroi
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Anca Chisoi
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Antonela Anca Nicolau
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Gabriela Izabela Baltatescu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Ana Maria Cretu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Gabriela Lupasteanu
- Clinical Hospital of Infectious Disease Sf. Cuvioasa Parascheva, 393 Traian Street, 800179 Galati, Romania;
| | - Lucian Serbanescu
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania; (S.C.C.); (M.A.); (L.S.); (L.P.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Mihaela Manea
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
| | - Sebastian Theodor Topliceanu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Institute of Doctoral Studies, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
| | - Lucian Cristian Petcu
- Faculty of Dentistry, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania;
| | - Loredana Pazara
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania; (S.C.C.); (M.A.); (L.S.); (L.P.)
| | - Georgeta Camelia Cozaru
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
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Pavlov V, Fyodorov S, Zavjalov S, Pervunina T, Govorov I, Komlichenko E, Deynega V, Artemenko V. Simplified Convolutional Neural Network Application for Cervix Type Classification via Colposcopic Images. Bioengineering (Basel) 2022; 9:bioengineering9060240. [PMID: 35735482 PMCID: PMC9219648 DOI: 10.3390/bioengineering9060240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/14/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
The inner parts of the human body are usually inspected endoscopically using special equipment. For instance, each part of the female reproductive system can be examined endoscopically (laparoscopy, hysteroscopy, and colposcopy). The primary purpose of colposcopy is the early detection of malignant lesions of the cervix. Cervical cancer (CC) is one of the most common cancers in women worldwide, especially in middle- and low-income countries. Therefore, there is a growing demand for approaches that aim to detect precancerous lesions, ideally without quality loss. Despite its high efficiency, this method has some disadvantages, including subjectivity and pronounced dependence on the operator’s experience. The objective of the current work is to propose an alternative to overcoming these limitations by utilizing the neural network approach. The classifier is trained to recognize and classify lesions. The classifier has a high recognition accuracy and a low computational complexity. The classification accuracies for the classes normal, LSIL, HSIL, and suspicious for invasion were 95.46%, 79.78%, 94.16%, and 97.09%, respectively. We argue that the proposed architecture is simpler than those discussed in other articles due to the use of the global averaging level of the pool. Therefore, the classifier can be implemented on low-power computing platforms at a reasonable cost.
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Affiliation(s)
- Vitalii Pavlov
- Higher School of Applied Physics and Space Technologies, Peter the Great St. Petersburg Polytechnic University, 195251 St. Petersburg, Russia; (S.F.); (S.Z.)
- Personalised Medicine Centre, 197341 St. Petersburg, Russia; (T.P.); (I.G.); (E.K.); (V.D.); (V.A.)
- Correspondence:
| | - Stanislav Fyodorov
- Higher School of Applied Physics and Space Technologies, Peter the Great St. Petersburg Polytechnic University, 195251 St. Petersburg, Russia; (S.F.); (S.Z.)
| | - Sergey Zavjalov
- Higher School of Applied Physics and Space Technologies, Peter the Great St. Petersburg Polytechnic University, 195251 St. Petersburg, Russia; (S.F.); (S.Z.)
| | - Tatiana Pervunina
- Personalised Medicine Centre, 197341 St. Petersburg, Russia; (T.P.); (I.G.); (E.K.); (V.D.); (V.A.)
| | - Igor Govorov
- Personalised Medicine Centre, 197341 St. Petersburg, Russia; (T.P.); (I.G.); (E.K.); (V.D.); (V.A.)
| | - Eduard Komlichenko
- Personalised Medicine Centre, 197341 St. Petersburg, Russia; (T.P.); (I.G.); (E.K.); (V.D.); (V.A.)
| | - Viktor Deynega
- Personalised Medicine Centre, 197341 St. Petersburg, Russia; (T.P.); (I.G.); (E.K.); (V.D.); (V.A.)
| | - Veronika Artemenko
- Personalised Medicine Centre, 197341 St. Petersburg, Russia; (T.P.); (I.G.); (E.K.); (V.D.); (V.A.)
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Ojha PS, Maste MM, Tubachi S, Patil VS. Human papillomavirus and cervical cancer: an insight highlighting pathogenesis and targeting strategies. Virusdisease 2022; 33:132-154. [DOI: 10.1007/s13337-022-00768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/07/2022] [Indexed: 11/29/2022] Open
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Brown DR, Castellsagué X, Ferris D, Garland SM, Huh W, Steben M, Wheeler CM, Saah A, Luxembourg A, Li S, Velicer C. Human papillomavirus seroprevalence and seroconversion following baseline detection of nine human papillomavirus types in young women. Tumour Virus Res 2022; 13:200236. [PMID: 35525430 PMCID: PMC9172167 DOI: 10.1016/j.tvr.2022.200236] [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: 12/08/2021] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Estimates of the humoral immune response to incident human papillomavirus (HPV) infections are limited. Methods In this post hoc analysis of 3875 women aged 16–23 years from a 4-valent HPV vaccine trial (NCT00092482), HPV seroprevalence on day 1 was measured with a 9-valent HPV (HPV 6/11/16/18/31/33/45/52/58) competitive Luminex immunoassay and compared with cervical/external genital HPV detection by polymerase chain reaction. In the control group, among women who were HPV DNA‒negative on day 1, seroconversion following initial HPV detection was estimated using Kaplan-Meier methods. Results Type-specific HPV seropositivity among women with no day 1 cervical/external genital HPV detection was 0.6%–3.6%. Women with any 9-valent HPV (9vHPV) cervical/external genital detection (796/3875; 20.5%) had concordant seropositivity ranging from 13.4% (HPV 45) to 38.5% (HPV 6). Among women in the control group who were negative for all HPV types on day 1, seroconversion by month 30 after initial detection ranged from 29% (HPV 45) to 75% (HPV 16). Conclusions Humoral immune response to HPV is variable and dynamic, depending on type-specific exposure. This longitudinal analysis provides insight into the relationship between incident infection and seropositivity. ClinicalTrials.gov; NCT00092482 https://clinicaltrials.gov/ct2/show/NCT00092482. Research on humoral immune responses to HPV infection are limited. HPV-related serologic responses were analyzed in women aged 16–23 years. Type-specific HPV seropositivity was low in women without initial HPV DNA detection. Concordant seropositivity in women with any 9vHPV DNA detection ranged from 13% to 40%. Seroconversion to the same genotype within 30 months of an infection was common.
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Affiliation(s)
- Darron R Brown
- Department of Medicine, Indiana University School of Medicine, Van Nuys Med Science Building, Suite 224, 635 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Xavier Castellsagué
- Institut Catala D'Oncologia, IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Granvia de L'Hospitalet 199-203, Barcelona, Catalonia, 08908, Spain
| | - Daron Ferris
- Clinica CerviCusco, Calle Los Saucos B-8-2, Larapa, Curco, Peru
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Infection and Immunity, Murdoch Children's Research Institute, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, The Royal Women's Hospital, Locked Bag 300
- Corner Grattan Street and Flemington Road, Parkville, VIC, 3052, Australia
| | - Warner Huh
- Division of Gynecologic Oncology, University of Alabama, 1700 6th Avenue South, Birmingham, AL, 35233, USA
| | - Marc Steben
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, 1851 East Sherbrooke Street, Montréal, Quebec, H2K 4L5, Canada
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Comprehensive Cancer Center, 1201 Camino de Salud NE, Albuquerque, NM, 87102, USA
| | - Alfred Saah
- Merck & Co., Inc., 126 E Lincoln Ave, Rahway, NJ, 07065, USA
| | | | - Se Li
- Merck & Co., Inc., 126 E Lincoln Ave, Rahway, NJ, 07065, USA
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49
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Kattoor J, Kamal MM. The gray zone squamous lesions: ASC-US / ASC-H. Cytojournal 2022; 19:30. [PMID: 35673698 PMCID: PMC9168398 DOI: 10.25259/cmas_03_10_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
The unequivocal and easily recognizable entities of LSIL and HSIL pose no diagnostic problems for a trained eye. However, when the defining morphologic features are either qualitatively or quantitatively insufficient, it is then that the borderline category of “Atypical Squamous cells” (ASC) may have to be used. Scant and suboptimal preparations (mainly in conventional smears) are the common causes that hinder confident decision-making. The binary classification of the ASC category has been retained in The Bethesda System 2014. It includes ASC of undetermined significance (ASC-US) when the atypia is seen in mature cells and ASC-cannot rule out high-grade lesion (ASC-H) when borderline changes are seen in less mature, smaller metaplastic cells or smaller basaloid cells. There are many criticisms of the ASC category. The major one is its subjective and inconsistent applications and the low interobserver and intraobserver reproducibility. However, studies have shown that if we eliminate ASC-US, the LSIL rate will increase. If ASC-H is eliminated, the chances of detecting true lesions are reduced. Hence, there are strong reasons to retain the ASC category. The usual problems leading to the categorization of such cells as atypical are hyperchromasia beyond that acceptable as reactive change; abnormal chromatin pattern that is not overt dyskaryosis; minor variations in nuclear shape; and membrane outlines. Qualifying the atypical cells precisely in one of the categories has bearing on the clinical management and follow-up of the patient. Surveillance of women under the ASC-US category is either by repeat smear at 6 months and 1 year or by reflex human papillomaviruses DNA testing. Women with a Pap smear interpretation of ASC-H are directed to undergo immediate colposcopy. This article describes in detail the morphologic features of the ASC category, doubts about the correct interpretation of the chromatin pattern of the cells in question, and the differential diagnosis between normal, reactive, or inflammatory conditions, and LSIL/HSIL.
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Affiliation(s)
- Jayasree Kattoor
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India,
| | - Meherbano M. Kamal
- Department of Pathology, Government Medical College, Nagpur, Maharashtra, India,
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50
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Zhang L, Tan W, Yang H, Zhang S, Dai Y. Detection of Host Cell Gene/HPV DNA Methylation Markers: A Promising Triage Approach for Cervical Cancer. Front Oncol 2022; 12:831949. [PMID: 35402283 PMCID: PMC8990922 DOI: 10.3389/fonc.2022.831949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer is the most prevalent gynecologic malignancy, especially in women of low- and middle-income countries (LMICs). With a better understanding of the etiology and pathogenesis of cervical cancer, it has been well accepted that this type of cancer can be prevented and treated via early screening. Due to its higher sensitivity than cytology to identify precursor lesions of cervical cancer, detection of high-risk human papillomavirus (HR-HPV) DNA has been implemented as the primary screening approach. However, a high referral rate for colposcopy after HR-HPV DNA detection due to its low specificity in HR-HPV screening often leads to overtreatment and thus increases the healthcare burden. Emerging evidence has demonstrated that detection of host cell gene and/or HPV DNA methylation represents a promising approach for the early triage of cervical cancer in HR-HPV-positive women owing to its convenience and comparable performance to cytology, particularly in LMICs with limited healthcare resources. While numerous potential markers involving DNA methylation of host cell genes and the HPV genome have been identified thus far, it is crucial to define which genes or panels involving host and/or HPV are feasible and appropriate for large-scale screening and triage. An ideal approach for screening and triage of CIN/ICC requires high sensitivity and adequate specificity and is suitable for self-sampling and inexpensive to allow population-based screening, particularly in LMICs. In this review, we summarize the markers of host cell gene/HR-HPV DNA methylation and discuss their triage performance and feasibility for high-grade precancerous cervical intraepithelial neoplasia or worse (CIN2+ and CIN3+) in HR-HPV-positive women.
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Affiliation(s)
- Lingyi Zhang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China.,Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Wenxi Tan
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Hongmei Yang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China.,Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Songling Zhang
- Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Changchun, China
| | - Yun Dai
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
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