1
|
Jodry D, Obedin-Maliver J, Flowers L, Jay N, Floyd S, Teoh D, Conageski C, Downs L, Khan MJ. Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus-Related Cancers. J Low Genit Tract Dis 2023; 27:307-321. [PMID: 37729043 PMCID: PMC10545069 DOI: 10.1097/lgt.0000000000000763] [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: 09/22/2023]
Abstract
OBJECTIVES Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)-related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations. MATERIALS AND METHODS An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines. RESULTS Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk. CONCLUSIONS An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.
Collapse
Affiliation(s)
| | | | - Lisa Flowers
- Emory University School of Medicine, Atlanta, GA
| | - Naomi Jay
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Serina Floyd
- Planned Parenthood of Metropolitan Washington, DC, Washington, DC
| | - Deanna Teoh
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | | | - Levi Downs
- Park Nicollet Health Services, Minneapolis, MN
| | | |
Collapse
|
2
|
Mullins MA, Reber L, Washington A, Stasenko M, Rankin A, Friese CR, Cooley ME, Hudson MF, Wallner LP. Barriers, facilitators, and recommendations for sexual orientation and gender identity data collection in community oncology practices. Cancer Med 2023; 12:19203-19214. [PMID: 37732470 PMCID: PMC10557876 DOI: 10.1002/cam4.6517] [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: 05/23/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Sexual orientation and gender identity (SOGI) data collection in community oncology practices is critical to identify and address cancer inequities, but less than 20% of NCI Community Oncology Research Program (NCORP)-affiliated practices regularly collect SOGI data despite widespread recommendations. We evaluated multilevel barriers and facilitators for SOGI data collection at NCORP practices. METHODS We conducted 14 semi-structured interviews at seven purposefully sampled NCORP oncology practices. We interviewed one clinician (oncologist, advanced practice provider) and one clinic staff member per practice. Thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR) was conducted to identify barriers and facilitators. RESULTS Thematic saturation occurred after interviews at six practices and was confirmed with interviews at an additional practice. Participants highlighted multilevel barriers including low levels of understanding, information technology infrastructure, and perceived low relative priority. Not understanding the role of SOGI data in oncology care contributed to cis-heteronormative culture. At the clinic level, this culture coincided with a lack of processes and policies for collecting SOGI from all patients. At the care team level, perceived irrelevance to oncology care was related to discomfort asking SOGI, fear of patient discomfort, and limited awareness of SOGI in electronic health records. Suggested solutions included: normalizing asking SOGI questions, giving patients privacy to complete SOGI, and clarifying clinical relevance. CONCLUSIONS SOGI data collection barriers stemmed from perceptions that SOGI disclosure does not influence care quality. Oncology teams may benefit from training on culturally sensitive SOGI collection, education on SOGI data relevance to oncology practices, and support for implementing SOGI data collection policies.
Collapse
Affiliation(s)
- Megan A. Mullins
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterUT Southwestern Medical CenterDallasTexasUSA
| | - Lisa Reber
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Ariel Washington
- Karmanos Cancer Institute, Department of OncologyWayne State University School of MedicineDetroitMichiganUSA
| | - Marina Stasenko
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyNYU Langone HealthNew YorkNew YorkUSA
| | - Aaron Rankin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Christopher R. Friese
- Center for Improving Patient and Population HealthUniversity of MichiganAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| | - Mary E. Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care ServicesDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Matthew F. Hudson
- Prisma Health Cancer Institute Greenville South CarolinaGreenvilleSouth CarolinaUSA
| | - Lauren P. Wallner
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| |
Collapse
|
3
|
Alli BY, Madathil S, Tran SD, Nicolau B. Protocol: carrageenan for the prevention of oral HPV infection - a feasibility randomised clinical trial. BMJ Open 2023; 13:e074498. [PMID: 37500273 PMCID: PMC10387654 DOI: 10.1136/bmjopen-2023-074498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Head and neck cancers (HNCs) are a significant health burden worldwide. Oral human papillomavirus (HPV) infection is a major risk factor for HNCs. Unfortunately, currently available prophylactic vaccines have limited coverage and potential for HPV type replacement. Carrageenan, a natural product extracted from marine red algae, has demonstrated potency as an HPV inhibitor and could offer a potential alternative to prevent HPV-related diseases, including oral HPV infection. However, there is a lack of clinical studies on the effect of carrageenan on oral HPV infections. As a first step to address this gap, we propose a randomised controlled trial (RCT) to evaluate the feasibility of conducting a larger multicentric RCT to investigate the effect of a carrageenan mouthwash on oral HPV infection. METHODS AND ANALYSIS We will conduct a placebo-controlled triple-blinded feasibility RCT with two parallel arms, each arm consisting of 20 participants. Participants will complete a single in-person visit at baseline and conduct biweekly follow-ups from home by completing a web-based questionnaire and sending saliva self-samples via mail. During the 6-month period trial, participants will gargle with the mouthwash morning and night, and around sexual activities. The study will evaluate several factors including recruitment and retention rates, the feasibility of data collection procedures, compliance with study procedures, acceptability of RCT procedures and intervention and safety data on carrageenan use in the oral cavity. We will estimate the standard deviation of outcome measures, including time to the incidence of oral HPV infection and time to clearance of prevalent oral HPV infection. The trial primary outcome is whether to proceed to a definitive trial based on prespecified progression criteria. ETHICS AND DISSEMINATION The protocol was approved by the McGill University institutional review board. Study results will be presented at scientific conferences and published in academic journals. TRIAL REGISTRATION NUMBER NCT05746988.
Collapse
Affiliation(s)
- Babatunde Y Alli
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Sreenath Madathil
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Belinda Nicolau
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Doucette C, Milano MT, Kamen C. Patient Perceptions of Sexual Orientation and Gender Identity Data Collection in an Outpatient Radiation Oncology Setting. Int J Radiat Oncol Biol Phys 2023; 116:68-78. [PMID: 36549346 DOI: 10.1016/j.ijrobp.2022.12.019] [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: 07/22/2022] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sexual and gender minority patients with cancer experience significant health disparities requiring tailored care. Collecting sexual orientation and gender identity (SOGI) data in the electronic medical record (EMR) could allow care to be tailored and is in line with radiation oncology's mission to better serve diverse patients. This article describes a systematic method for collecting SOGI data for all patients starting radiation treatment in a department of radiation oncology (DRO). METHODS AND MATERIALS During a 3-month experimental period, DRO staff administered a demographic questionnaire and attitude survey to new adult patients. SOGI demographic data, entered into the EMR by nursing staff, were extracted and analyzed for all patients from the experimental period and from the 3 months prior (control period). Descriptive and categorical data completion rates were compared between the experimental and control periods using independent-samples t tests and Pearson χ2 tests. RESULTS A total of 788 patients were included in this analysis: 368 in the control period and 420 in the experimental period. Of the 420 patients enrolled in the experimental period, 267 (63.6%) were offered a survey, of whom 211 (79.0%) completed the survey. There were higher rates of sexual orientation responses entered into the EMR for the experimental group compared with the control group (56.9% vs 27.1%; P <.001), with the highest response rates for patients who completed a survey (82.9%). Ten patients (2.9%) identified as gay or lesbian and 100% identified as cisgender. The majority of patients were not upset by the form, with only 11 patients (5.2%) stating that any specific question caused them distress. CONCLUSIONS Collecting SOGI data via a demographic form is feasible in an outpatient DRO. This approach was well received by the majority of patients and could lead to provision of higher-quality, tailored care.
Collapse
Affiliation(s)
| | | | - Charles Kamen
- Surgery, University of Rochester Medical Center, Rochester, New York.
| |
Collapse
|
5
|
HPV Type Distribution in Benign, High-Grade Squamous Intraepithelial Lesions and Squamous Cell Cancers of the Anus by HIV Status. Cancers (Basel) 2023; 15:cancers15030660. [PMID: 36765617 PMCID: PMC9913553 DOI: 10.3390/cancers15030660] [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: 10/28/2022] [Revised: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 01/25/2023] Open
Abstract
The incidence of anal cancer is increasing, especially in high-risk groups, such as PLWH. HPV 16, a high-risk (HR) HPV genotype, is the most common genotype in anal high-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) in the general population. However, few studies have described the distribution of HR HPV genotypes other than HPV 16 in the anus of PLWH. HPV genotyping was performed by DNA amplification followed by dot-blot hybridization to identify the HR and low-risk (LR) genotypes in benign anal lesions (n = 34), HSIL (n = 30), and SCC (n = 51) of PLWH and HIV-negative individuals. HPV 16 was the most prominent HR HPV identified, but it was less common in HSIL and SCC from PLWH compared with HIV-negative individuals, and other non-HPV 16 HR HPV (non-16 HR HPV) types were more prevalent in samples from PLWH. A higher proportion of clinically normal tissues from PLWH were positive for one or more HPV genotypes. Multiple HPV infection was a hallmark feature for all tissues (benign, HSIL, SCC) of PLWH. These results indicate that the development of anal screening approaches based on HPV DNA testing need to include non-16 HR HPVs along with HPV 16, especially for PLWH. Along with anal cytology, these updated screening approaches may help to identify and prevent anal disease progression in PLWH.
Collapse
|
6
|
Fernández Isart M, Serra Esteban J, Segura Sampedro JJ, Amengual Antich I, Martínez Ortega MA, Forteza Valades A, Riera Jaume M, González Argente FX. Anal intraepithelial neoplasia screening in patients with human immunodeficiency virus infection. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2022; 114:713-718. [PMID: 35285660 DOI: 10.17235/reed.2022.8489/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION the incidence of anal cancer has increased in recent years, making screening and early detection of anal intraepithelial neoplasia (AIN) a necessity in patients at risk. METHODS a descriptive observational study of homosexual patients (MSM) or women with cervical intraepithelial neoplasia (CIN) III, with human immunodeficiency virus (HIV) infection, included in an AIN detection screening program was carried out between March 2016 and September 2019. RESULTS we have performed 695 anal smears, 156 with results of LSIL (low-grade lesion) or HSIL (high-grade lesion) (22.4 %), and 116 high resolution anoscopy (HRA), 75.3 % of patients with altered cytology. We have 403 biopsies, being 84 % pathological, 197 biopsies of AIN I (49 %), 96 of AIN II and III (24 %), 44 condylomas (11 %) and the rest (16 %), normal mucosa. CONCLUSION the high prevalence of premalignant lesions and the improvement in the staging of lesions after treatment recommend this protocol.
Collapse
|
7
|
The role of infections in the causation of cancer in Kenya. Cancer Causes Control 2022; 33:1391-1400. [PMID: 36087193 DOI: 10.1007/s10552-022-01625-3] [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: 03/01/2022] [Accepted: 08/31/2022] [Indexed: 12/09/2022]
Abstract
Cancer constitutes a major health care burden in the world today with the situation worsening in resource poor settings as seen in most Sub-Saharan African (SSA) countries. Infections constitute by far the most common risk factors for cancer in SSA and being a typical country in this region, Kenya has experienced an upsurge in the incidence of various types of cancers in the last few decades. Although there is limited population-based data in Kenya of infections-associated cancers, this review provides an up-to-date literature-based discussion on infections-associated cancers, their pathogenesis, and preventive approaches in the country. The primary infectious agents identified are largely viral (human immunodeficiency virus, human papillomavirus (HPV), Kaposi's sarcoma-associated herpes virus, Epstein-Barr virus, hepatitis B virus (HBV), hepatitis C virus), and also bacterial: Helicobacter pylori and parasitic: Schistosomiasis haematobium. Cancers associated with infections in Kenya are varied but the predominant ones are Non-Hodgkin lymphoma, Kaposi's sarcoma, Hodgkin lymphoma, Burkitt's lymphoma, cervical, liver, and gastric cancers. The mechanisms of infections-induced carcinogenesis are varied but they mainly seem to stem from disruption of signaling, chronic inflammation, and immunosuppression. Based on our findings, actionable cancer-preventive measures that are economically feasible and aligned with existing infrastructure in Kenya include screening and treatment of infections, implementation of cancer awareness and screening, and vaccination against infections primarily HBV and HPV. The development of vaccines against other infectious agents associated with causation of cancer remains also as an important goal in cancer prevention.
Collapse
|
8
|
Patient-reported bowel and urinary function in long-term survivors of squamous cell carcinoma of the anus treated with definitive intensity-modulated radiotherapy and concurrent chemotherapy. Int J Radiat Oncol Biol Phys 2022; 114:78-88. [DOI: 10.1016/j.ijrobp.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/30/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022]
|
9
|
Yang N, Xu L, Wang Q, Chen F, Zhou Y. Construction and validation of a prognostic nomogram for anal squamous cell carcinoma. Cancer Med 2021; 11:392-405. [PMID: 34850581 PMCID: PMC8729044 DOI: 10.1002/cam4.4458] [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: 07/30/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background Anal squamous cell carcinoma (ASCC) is the main subtype of anal cancer and has great heterogeneity in prognosis. We aimed to construct a nomogram for predicting their 1‐, 3‐, and 5‐year overall survival (OS) rates. Methods Patients with ASCC, enrolled between January 1, 2010 and December 31, 2017, were identified from the SEER database. They were divided into a training group and a validation group in a ratio of 7:3. Univariate and multivariate Cox analyses were used to identify the prognostic factors for OS. Then a prognostic nomogram was established and validated by Harrell consistency index (C‐index), area under the curve (AUC) of the receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results We identified 761 patients in training group and 326 patients in validation group. Four prognostic factors including age, sex, AJCC stage, and radiotherapy were identified and integrated to construct a prognostic nomogram. The C‐index and AUC values proved the model's effectiveness and calibration plots manifested its excellent discrimination. Furthermore, in comparison to the AJCC stage, the C‐index, AUC, and DCA proved the nomogram to be of good predictive value. Finally, we constructed a risk stratification model for dividing patients into low‐risk, medium‐risk, and high‐risk groups, and there were obvious differences in OS. Conclusions A prognostic nomogram was firstly established for predicting the survival probability of ASCC patients and helping clinicians improve their risk management.
Collapse
Affiliation(s)
- Ningning Yang
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lu Xu
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qingqing Wang
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fengxia Chen
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yunfeng Zhou
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
10
|
Ejaz M, Mubarak M, Ali TS, Andersson S, Ekström AM. Human papillomavirus-associated anal squamous intraepithelial lesions in men who have sex with men and transgender women living with and without HIV in Karachi Pakistan: implications for screening and prevention. BMC Infect Dis 2021; 21:1163. [PMID: 34789177 PMCID: PMC8597180 DOI: 10.1186/s12879-021-06850-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Anal squamous intraepithelial lesions (ASIL), strongly related to human papilloma virus (HPV) infection, is more prevalent among men who have sex with men (MSM). However, no such data are available for Pakistan yet, and neither HPV vaccination nor anal-cytology screening is implemented in Pakistan. The purpose of this first ever study was to assess the prevalence of HPV-related anal cytological abnormalities among MSM and transgender women living with and without HIV infection in Pakistan. METHODS We conducted a cross-sectional study from March 2016 to November 2017 at sexual health centers run by the Perwaaz Trust and the National AIDS Control Program in Karachi. The study enrolled MSM and transgender women aged greater-than-and-equal-to-18-years who reported anal sex in the preceding 6 months. We collected two anal samples for liquid-based cytology and HPV type testing by PCR, and socio-demographic and behavioral data were collected through face-to face interviews. ASIL and its associations with biological and behavioral risk factors were analyzed through Cox regression for prevalence ratios (PR) and corresponding 95% confidence intervals (CIs). RESULTS Out of 271 qualifying participants, 79% were MSM and 21% transgender women. The mean age was 28.8 (± 8) years. Almost 35% (93/271) of the study population had ASIL detected, ASIL was significantly more common among participants living with HIV than in HIV negative ((50/118) 42.4%; vs. (43/153) 28.1%) (p ≤ 0.001). Among ASIL, 66% (61/93) had low-grade squamous intraepithelial lesions (LSIL), and 3.6% (3/93) had high-grade squamous intraepithelial lesions (HSIL). The overall, HPV16 positivity was 35.5% (33/93) among all abnormal anal lesions and all 3 HSIL were HPV16 positive, however, HPV16 positivity could show its association with ASIL detection in univariate model only (PRcrude: 2.11(1.39-3.18)). Moreover, any HR-HPV type (PR 3.04; 95% CI 1.75-5.26), concurrent sexually transmitted infection (STI) (2.13; (1.28-3.55)) and HIV + /HPV + coinfection (1.75; (1.07-2.88)) remained independently associated with ASIL in the multivariate model. CONCLUSIONS Abnormal anal cytology among MSM and transgender is prevalent enough to consider optimal screening regimens. Further studies are required to see if periodic anal cytology can be made part of HIV care and treatment programs among MSM in Pakistan.
Collapse
Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. .,Department of Community Health Sciences, Aga Khan University (AKU), Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Muhammad Mubarak
- Department of Cytology and Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | | | - Sören Andersson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| |
Collapse
|
11
|
Sexual and Gender Minorities and Risk Behaviours among University Students in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111724. [PMID: 34770238 PMCID: PMC8583234 DOI: 10.3390/ijerph182111724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
Abstract
Sexual and gender minorities (SGM) may experience stigma, discrimination and show higher prevalence of behavioural risk factors than heterosexual counterparts. In Italy, the information on SGM is scarce and outdated. The present cross-sectional study aims to provide a more up-to-date estimate of the SGM proportion in young adults and to assess differences in the adoption of risk behaviours compared to their heterosexual counterparts. The study involved university students aged 18-25. Information on socio-demographic and behavioural characteristics were collected. The effect of sexual orientation on risk behaviours was assessed with a multinomial single-step logistic regression analysis. A total of 9988 participants were included. Overall, 518 students (5.2%) self-identified as SGM. While lesbians showed significantly higher odds of only non-regular use of protective barriers (AOR: 11.16), bisexuals showed higher odds for frequent drinking (AOR: 2.67), smoking (AOR: 1.85), multiple sexual partnerships (AOR: 1.78) and non-regular use of protective barriers (AOR: 1.90) compared with heterosexual women. Gay men showed higher odds of multiple sexual partnerships compared with heterosexual males (AOR: 5.52). SGM accounted for 5.2% of the sample, slightly more than the proportion found in the general population, but substantially in line with similarly aged populations abroad. Our findings confirm that unhealthy risk behaviours are more frequent among LGBTQ+, in particular among bisexual women. Rather than targeting specific subpopulations, our study aims to show the need for health promotion interventions that aim at the empowerment of all students regardless of sexual orientation, being aware that SGMs can benefit to a relatively greater extent.
Collapse
|
12
|
Lu H, He H, Qin J, Chen M, Liu Q, Li M, Huang Y, Wei A, Liu S, Xu M, Zhang Z. Populations at high risk of cervical cancer in Guangxi Province: Findings from two screening projects in a minority area of South China. J Med Screen 2021; 29:44-52. [PMID: 34693798 PMCID: PMC8892057 DOI: 10.1177/09691413211039254] [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: 11/16/2022]
Abstract
Objective To analyse the positive rates of low-grade (LSIL) and high-grade (HSIL) squamous intraepithelial lesions, and cervical cancer (CC), and identify groups at high risk for CC in Guangxi. Setting CC screening options in Guangxi, which is the only minority autonomous area in South China, include the National Cervical Cancer Screening Project (NCCSP) and physical examination (PE). Methods This study was based on PE and NCCSP sample data obtained from 2012 to 2019. We calculated the positive rates of LSIL, HSIL, and CC; analysed the adjusted odds ratio (aOR) and 95% confidence intervals (CI) of the variables in multivariate logistic regression; and subsequently identified groups at high risk for CC. Results The positive rates of LSIL, HSIL, and CC for the total of 873,880 samples were 1.89%, 0.60%, and 0.03%, respectively. Females over 64 years of age (vs. 50–64; aOR = 2.05; 95% CI, 1.71–2.46; P < 0.001) and those from urban (vs. rural; aOR = 1.66; 95% CI, 1.57–1.76; P < 0.001), minority (vs. non-minority; aOR = 1.24; 95% CI, 1.13–1.35; P < 0.001), and coastal (vs. inland; aOR = 1.15; 95% CI, 1.06–1.25; P = 0.001) areas were associated with a high risk of HSIL. Females over 64 (vs. 50–64; aOR = 4.37; 95% CI, 2.88–6.63; P < 0.001) and those from urban (vs. rural; aOR = 3.05; 95% CI, 2.36–3.95; P < 0.001) areas were significantly associated with a high risk of CC. Conclusion Females from urban areas in Guangxi are at high risk for CC. Public health strategies should focus on high-risk populations.
Collapse
Affiliation(s)
- Huaxiang Lu
- School of Public Health, 74626Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,573426Department of Guangxi Science and Technology Major Project, Guangxi Center for Diseases Prevention and Control, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Haoyu He
- School of Public Health, 74626Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,School of Stomatology, 74626Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Jian Qin
- School of Public Health, 74626Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Mingjian Chen
- Department of Cytopathology Diagnosis, 573426Guangxi Kingmed Diagnostics Group Co., Ltd, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Qiumei Liu
- School of Public Health, 74626Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Min Li
- Department of Cytopathology Diagnosis, 573426Guangxi Kingmed Diagnostics Group Co., Ltd, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yongsheng Huang
- Department of Cytopathology Diagnosis, 573426Guangxi Kingmed Diagnostics Group Co., Ltd, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Anxiang Wei
- Department of Cytopathology Diagnosis, 573426Guangxi Kingmed Diagnostics Group Co., Ltd, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Shuzhen Liu
- School of Public Health, 74626Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Min Xu
- School of Public Health, 74626Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Zhiyong Zhang
- School of Public Health, 74626Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,School of Public Health, 74716Guilin Medical University, Guangxi Zhuang Autonomous Region, China
| |
Collapse
|
13
|
Hao Z, Guo Y, Bowling J, Ledenyi M. Facilitators and Barriers of HPV Vaccine Acceptance, Initiation, and Completion among LGBTQ Community in the U.S.: A Systematic Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 34:291-307. [PMID: 38596525 PMCID: PMC10903696 DOI: 10.1080/19317611.2021.1989535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/22/2021] [Accepted: 09/25/2021] [Indexed: 04/11/2024]
Abstract
Objective: This study aims to identify facilitators and barriers of Human Papillomavirus (HPV) vaccine acceptance, initiation, and completion among LGBTQ (lesbian, gay, bisexual, trans, and queer) individuals. Method: A systematic review of qualitative and quantitative studies on HPV vaccine acceptance, initiation, and completion from 2006 to June 15, 2020 was performed in each database. Results: Twenty-six studies focusing on HPV vaccination among LGBTQ individuals were reviewed. Conclusions: Knowledge of HPV vaccine and healthcare providers' recommendations were identified as facilitators to receive HPV vaccinate, while high co-pay cost and concerns of the effectiveness and safety were identified as barriers.
Collapse
Affiliation(s)
- Zhichao Hao
- College of State Governance, Southwest University, Chongqing, China
| | - Yuqi Guo
- School of Social Work, University of North Carolina at Charlotte, Charlotte, NC, USA
- School of Data Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Madeleine Ledenyi
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| |
Collapse
|
14
|
Morgan E, Meites E, Markowitz LE, Xavier Hall CD, Querec TD, Unger ER, Crosby RA, Newcomb ME, Mustanski B. Sexual Positioning Practices and Anal Human Papillomavirus Infection Among Young Men Who Have Sex with Men and Transgender Women-Chicago, Illinois, 2016-2018. Sex Transm Dis 2021; 48:709-713. [PMID: 34110734 PMCID: PMC8459672 DOI: 10.1097/olq.0000000000001433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; men who have sex with men (MSM) have higher prevalence of infection and related disease compared with other men. We assessed whether differences in HPV acquisition exist among MSM according to their sexual positioning practices, as well as self-reported receipt of HPV vaccination. METHODS We enrolled young MSM and transgender women aged 18 to 26 years in Chicago, IL (N = 666). Participants self-reported their history of HPV vaccination and submitted self-collected anal swab specimens for type-specific HPV detection using an L1-consensus PCR assay. Multivariable logistic regression analyses were used to assess relationships between sexual positioning practices and detection of any HPV or quadrivalent HPV vaccine (4vHPV) types by vaccination status, defined as self-reported receipt of ≥1 HPV vaccine dose versus none. RESULTS Among 666 participants, 400 (60.1%) had any anal HPV, and 146 (21.9%) had a 4vHPV type. Among vaccinated participants, 18, 36, and 177 reported exclusively insertive, exclusively receptive, or both sexual positioning practices, respectively. Compared with participants reporting exclusively insertive anal sex, odds of any HPV were significantly higher among participants engaging exclusively in receptive anal sex (adjusted odds ratio [aOR], 5.90; 95% confidence interval [CI], 2.52-13.78), as well as those engaging in both (aOR, 3.32; 95% CI, 1.71-6.44). Vaccinated participants, compared with unvaccinated participants, had lower odds of 4vHPV-type HPV regardless of sexual positioning practices (aOR, 0.56; 95% CI, 0.34-0.92). CONCLUSIONS Adult men and transgender women who practice anal receptive sex have high prevalence of infection with any HPV. Routine vaccination of all adolescents is expected to reduce HPV-related disease incidence among adult MSM and transgender women as vaccinated cohorts age.
Collapse
Affiliation(s)
- Ethan Morgan
- Infectious Disease Institute and College of Nursing, The Ohio State University, Columbus, OH
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lauri E. Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Casey D. Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Troy D. Querec
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth R. Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Michael E. Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| |
Collapse
|
15
|
Bushara O, Krogh K, Weinberg SE, Finkelman BS, Sun L, Liao J, Yang GY. Human Immunodeficiency Virus Infection Promotes Human Papillomavirus-Mediated Anal Squamous Carcinogenesis: An Immunologic and Pathobiologic Review. Pathobiology 2021; 89:1-12. [PMID: 34535611 DOI: 10.1159/000518758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Anal squamous cell carcinoma (SCC) is a rare gastrointestinal malignancy with rising incidence, both in the United States and internationally. The primary risk factor for anal SCC is human papillomavirus (HPV) infection. However, there is a growing burden of disease in patients with human immunodeficiency virus (HIV) and HPV coinfection, with the incidence of anal SCC significantly increasing in this population. This is particularly true in HIV-infected men. The epidemiologic correlation between HIV-HPV coinfection and anal SCC is established; however, the immunologic mechanisms underlying this relationship are not well understood. SUMMARY HIV-related immunosuppression due to low circulating CD4+ T cells is one component of increased risk, but other mechanisms, such as the effect of HIV on CD8+ T lymphocyte tumor infiltration and the PD-1/PD-L1 axis in antitumor and antiviral response, is emerging as significant contributors. The goal of this article is to review existing research on HIV-HPV coinfected anal SCC and precancerous lesions, propose explanations for the detrimental synergy of HIV and HPV on the pathogenesis and immunologic response to HPV-associated cancers, and discuss implications for future treatments and immunotherapies in HIV-positive patients with HPV-mediated anal SCC. Key Messages: The incidence of anal squamous cell carcinoma is increased in human immunodeficiency virus (HIV)-infected patients, even in patients on highly active antiretroviral therapy. Locoregional HIV infection may enhance human papillomavirus oncogenicity. Chronic inflammation due to HIV infection may contribute to CD8+ T lymphocyte exhaustion by upregulating PD-1 expression, thereby blunting cytotoxic antitumor response.
Collapse
Affiliation(s)
- Omar Bushara
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katrina Krogh
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samuel Edward Weinberg
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Steven Finkelman
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leyu Sun
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jie Liao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
16
|
Drysdale K, Cama E, Botfield J, Bear B, Cerio R, Newman CE. Targeting cancer prevention and screening interventions to LGBTQ communities: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1233-1248. [PMID: 33316150 DOI: 10.1111/hsc.13257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Although some people within LGBTQ communities are at risk of developing some cancers at higher rates than non-LGBTQ people, there is limited evidence of the outcomes of targeted cancer prevention and screening interventions for these communities. This scoping review examined key findings regarding the feasibility, acceptability and efficacy of evaluated intervention studies conducted in high income settings and published in peer reviewed literature (2014-2020) by combining evidence of both cancer risk-reducing behavioural interventions and screening and preventative practice interventions. While there is limited evidence of stronger outcomes from targeted interventions with cohorts of gender and sexuality diverse communities, compared with the use of mainstream or untailored interventions, there is stronger evidence that targeted interventions are more acceptable to these communities and may be more feasible in some contexts. Thus, there is benefit in understanding what targeting entails in these interventions, and to understand what influences acceptability, to inform the design and delivery of such interventions.
Collapse
Affiliation(s)
- Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jessica Botfield
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| |
Collapse
|
17
|
Banerjee SC, Staley JM, Alexander K, Walters CB, Parker PA. Encouraging patients to disclose their lesbian, gay, bisexual, or transgender (LGBT) status: oncology health care providers' perspectives. Transl Behav Med 2021; 10:918-927. [PMID: 30476333 DOI: 10.1093/tbm/iby105] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A compelling touted strategy for reducing discrimination towards lesbian, gay, bisexual, and transgender (LGBT) patients is improving communicative competence of health care providers (HCPs); however, evidence base for describing communication practices between HCPs and LGBT patients is scarce. The purpose of this study was to qualitatively examine HCP experiences and perspectives as they relate to patient sexual orientation and gender identity (SOGI) disclosure, perceived communication and structural/administrative challenges in interactions with LGBT patients, and suggestions for improving care of LGBT patients. The sample consisted of 1,253 HCPs, who provided open-ended responses to an online cross-sectional survey conducted at a Comprehensive Cancer Center in the Northeastern United States. The open-ended responses were inductively and deductively coded for key themes and sub-themes. The results demonstrated an array of useful communication strategies employed by oncology HCPs to encourage LGBT patients' SOGI disclosure (direct questions regarding sexual orientation, use of the term "partner," and using correct pronouns), communication and structural/administrative challenges faced by HCPs in providing care (HCP own fears and biases, transgender patient care, insurance issues, and procedural challenges for LGBT patients), and suggested recommendations from oncology HCPs to improve their care delivery for LGBT patients (more provider-based training, improving awareness of LGBT-friendly resources, establishing trusting relationships, and not assuming sexuality or gender identity). These findings have implications for developing and evaluating training programs to improve LGBT sensitivity and communication among HCPs, and encourage SOGI disclosure in an open and judgment-free health care environment.
Collapse
Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica M Staley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Koshy Alexander
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chasity B Walters
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
18
|
Banerjee SC, Staley JM, Alexander K, Parker PA, Haviland KS, Moreno A, Walters CB. Sexual and Gender Minority Communication Skills (SGM Comskil) Training for Oncology Clinicians: Development, Implementation, and Preliminary Efficacy. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2021; 2:35-52. [PMID: 37475763 PMCID: PMC10358276 DOI: 10.1891/lgbtq-2020-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Enhancing communicative competence of healthcare providers (HCPs) is a critical initiative for improving the healthcare experience of sexual and gender minority (SGM) cancer patients. This study presents the development, implementation, and preliminary efficacy of a new training curriculum for improving oncology HCPs' skills in providing a safe and welcoming environment for SGM cancer patients (SGM Comskil training). Thirty-three (N = 33) oncology HCPs including nurses, nurse leaders, and nurse practitioners participated in a 4.25-hour SGM Comskil Training between July and August 2019. Overall, participants reported highly favorable evaluations of the training, with more than 80% of the participants reacting positively to 12 of the 15 evaluation items assessing engagement and reflectiveness for experiential role-plays with lesbian, gay, bisexual (LGB) and transgender standardized patients (SPs), respectively. Participants also demonstrated significant improvements in SGM healthcare knowledge, self-efficacy, beliefs toward LGB and transgender persons, and SGM-sensitive language use skills following the training. Encouraged by the feasibility of conducting this experiential training with busy cancer care HCPs and the initial favorable participant evaluation of the SGM Comskil training, results clearly indicate that this training can be rolled out into clinical settings to ensure its translational potential. The next steps should assess observable changes in communication skills and SGM-sensitive language skills with SGM patients and improvements in SGM patients' healthcare experience.
Collapse
Affiliation(s)
| | | | | | | | | | - Aimee Moreno
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
19
|
Nowak RG, Ndembi N, Dauda W, Jibrin P, Bentzen SM, Nnaji CH, Olaomi O, Darragh TM, Madukwe J, Crowell TA, Baral SD, Blattner WA, Charurat ME, Palefsky JM, Cullen KJ. Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men. J Glob Oncol 2020; 5:1-11. [PMID: 31322994 PMCID: PMC6690628 DOI: 10.1200/jgo.19.00102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Anal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria. METHODS From August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL. RESULTS Median age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL. CONCLUSION Proficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening.
Collapse
Affiliation(s)
| | | | - Wuese Dauda
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | | | | | | | | | - Trevor A Crowell
- Walter Reed Army Institute of Research, Silver Spring, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | - Kevin J Cullen
- University of Maryland School of Medicine, Baltimore, MD
| | | |
Collapse
|
20
|
Laurie C, El-Zein M, Tota J, Tellier PP, Coutlée F, Franco EL, de Pokomandy A. Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV): design and methods for a randomised controlled trial. BMJ Open 2020; 10:e035113. [PMID: 32205376 PMCID: PMC7103806 DOI: 10.1136/bmjopen-2019-035113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Gay, bisexual and other men who have sex with men (gbMSM) have an increased risk of human papillomavirus (HPV) infection and HPV-associated diseases, such as anal cancer and anogenital warts. A carrageenan-based lubricant could prevent HPV infection, thereby reducing the disease burden in this population. This paper describes the protocol for the Lubricant Investigation in Men to Inhibit Transmission of HPV Infection (LIMIT-HPV) study, an ongoing randomised controlled trial (RCT), evaluating efficacy of a carrageenan-based personal lubricant in reducing type-specific anal HPV incidence and prevalence among sexually active gbMSM, efficacy by HIV status, safety and tolerability of the gel and participant adherence to the intervention. METHODS AND ANALYSIS The study is a double-blinded, placebo-controlled RCT. Volunteer gbMSM 18 years and older are randomly assigned 1:1 to receive the treatment (a self-applied anal microbicide gel with carrageenan) or placebo (a self-applied placebo gel). At each visit, computerised questionnaires are used to collect data on sociodemographic and clinical variables, lifestyle, sexual behaviour and the gels' safety and tolerability. At baseline and each follow-up visit (months 1, 2, 3, 6, 9 and 12), nurses collect anal specimens tested for 36 HPV types (linear array assay). HIV status is determined at baseline and 12 months. The primary outcome is incidence of type-specific anal HPV infection(s) undetected at baseline. Secondary outcomes are prevalence of type-specific anal HPV infection, safety, tolerability and adherence. We aim to recruit 380 participants to attain the study's objectives. Data will be analysed using intention-to-treat and per-protocol approaches with subgroup analyses by HIV status. ETHICS AND DISSEMINATION Ethics approval was obtained by the Research Ethics Boards of McGill University, the McGill University Health Centre, Concordia University and Centre Hospitalier de l'Université de Montréal. Trial results will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT02354144.
Collapse
Affiliation(s)
- Cassandra Laurie
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Joseph Tota
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | | | - Francois Coutlée
- Service de Microbiologie Médicale et Service d'Infectiologie, Départements de Médecine et de médecine de laboratoire, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
21
|
Abstract
OBJECTIVES Approximately 8,300 new cases of anal carcinoma will be diagnosed in the United States in 2019. Anal squamous cell carcinoma (SCC) accounts for about 70% of all anal cancers. As cancer prevention and treatments have evolved over time, medical management of human immunodeficiency virus has improved, and sexual behaviors have changed, anal carcinoma incidence rates (IRs) may have also changed. METHODS The 9 oldest Surveillance, Epidemiology, and End Results registries were used to identify and determine IR of carcinoma in situ (CIS) and invasive SCC for 9757 patients below 65 years diagnosed with anal SCC/CIS from 1973 to 2014. Joinpoint regression models identified time points at which incidence trends changed. RESULTS The incidence of CIS decreased since 2010 (age-adjusted IR annual percent change [APC]: -5.65, 95% CI: -10.0 to -1.1), especially for men (APC: -8.30, 95% CI: -12.6 to -3.8). In contrast, the incidence of SCC increased since 2007 (APC: 2.59, 95% CI: 0.1-5.2). During 2010-2014, men were more likely to present with CIS (incidence rate ratio [IRR]: 3.234, 95% CI: 3.000-3.489) but less likely to present with localized (IRR: 0.827, 95% CI: 0.754-0.906), regional (IRR: 0.603, 95% CI: 0.537-0.676), and distant SCC (IRR: 0.751, 95% CI: 0.615-0.915) compared with women. CONCLUSIONS The previously observed rise in anal SCC/CIS incidence slowed in 2010, largely due to a decline in CIS rates. Patients were more likely to present with CIS than SCC at any stage. Future studies are necessary to determine if this decline in CIS precedes a decline in invasive SCC.
Collapse
|
22
|
Templeton DJ, Williamson C, Jin F, Hillman RJ, Roberts JM, Law C, Fairley CK, Garland SM, Grulich AE, Poynten IM. Prevalence and associations of larger burden of intra-anal high-grade squamous intraepithelial lesions at baseline in an Australian cohort of gay and bisexual men: The Study of the Prevention of Anal Cancer. Cancer Epidemiol 2020; 64:101661. [PMID: 31918181 DOI: 10.1016/j.canep.2019.101661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate factors associated with larger burden of intra-anal high-grade squamous intraepithelial lesions (HSIL) in a natural history study of HSIL. METHODS 617 gay and bisexual men (GBM) attended a baseline visit. High-resolution anoscopy-directed biopsy was performed of suspected HSIL. GBM with biopsy-confirmed HSIL (bHSIL) affecting a single-octant were compared with those who had bHSIL affecting a larger area. RESULTS Of 196 men with bHSIL at baseline, 73 (37.2 %) had larger bHSIL burden. Larger burden was independently associated with anal HPV16 detection (aOR 2.06, 95 % CI 1.09-3.89, p = 0.026) and infection with a greater number of high-risk HPV types (aOR per type increase 1.25, 95 % CI 1.05-1.49, p-trend = 0.010). CONCLUSION The observation that men with a larger burden of HSIL also had more risk factors for anal cancer suggests this group may warrant closer observation to ensure earlier detection, and thus improved prognosis, of individuals whose HSIL may progress to anal cancer.
Collapse
Affiliation(s)
- D J Templeton
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Randwick, New South Wales 2031, Australia; Department of Sexual Health Medicine, Sydney Local Heath District, 16 Marsden Street, Camperdown, Sydney, New South Wales 2050, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - C Williamson
- Department of Sexual Health Medicine, Sydney Local Heath District, 16 Marsden Street, Camperdown, Sydney, New South Wales 2050, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia; The University of Aberdeen, School of Medicine and Dentristy, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - F Jin
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Randwick, New South Wales 2031, Australia.
| | - R J Hillman
- St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - J M Roberts
- Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, Sydney, New South Wales 2113, Australia.
| | - C Law
- St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - C K Fairley
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Victoria 3053, Australia.
| | - S M Garland
- Department of Microbiology and Infectious Diseases, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Department of Microbiology, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia; Infection Immunity, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Grattan Street, Parkville, New South Wales 3052, Australia.
| | - A E Grulich
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Randwick, New South Wales 2031, Australia.
| | - I M Poynten
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Randwick, New South Wales 2031, Australia.
| | | |
Collapse
|
23
|
Piyathilake CJ, Badiga S, Kumar R, Crowley MR, Burkholder GA, Raper JL. A rigorous exploration of anal HPV genotypes using a next-generation sequencing (NGS) approach in HIV-infected men who have sex with men at risk for developing anal cancer. Cancer Med 2019; 9:807-815. [PMID: 31769225 PMCID: PMC6970045 DOI: 10.1002/cam4.2720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background There are no HPV‐based measures for managing anal cancer (AC) in HIV‐infected (HIV+) men who have sex with men (MSM) because of the high positivity of high‐risk (HR)‐HPVs. As next‐generation sequencing (NGS) is able to describe the composition of HPVs as percent (%) reads rather than positive vs negative results, we used NGS approach to detect HPVs in anal samples of HIV+ MSM to test its ability to differentiate those who are diagnosed with atypical squamous cells of unknown significance or greater (ASCUS+) from those who are free of such lesions and to understand the burden of HPV infections in relation to HPV vaccines. Methods Study included 81 HIV+ MSM characterized for demographics, patient‐reported outcome measures, HIV related laboratory measures and anal cytology. We summarized NGS HPV data using % read cut points (>0%‐>30%) and tested the relationship between % reads of HR‐HPVs and risk of ASCUS+ using logistic regression. Results Forty‐six HPVs were detected at the >0% read cut point. The prevalence of any HR‐HPVs varied from 100% to 40% with >0% to >30% reads while ≥99% were infected with HR‐HPVs included or not included in the 9 valent HPV vaccine at the >0% read cut point. MSM with >30% HR‐HPV reads were 4.5 times more likely to be diagnosed with ASCUS+ compared to ≤30% reads (P = .033). Conclusion NGS‐based approach is more accurate than PCR‐based HPV testing for identifying HIV+ MSM at risk for developing AC. We raise the concern regarding the efficacy of current HPV vaccines for preventing AC in this high‐risk population.
Collapse
Affiliation(s)
- Chandrika J Piyathilake
- Department of Nutrition Sciences, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Suguna Badiga
- Department of Nutrition Sciences, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Ranjit Kumar
- UAB Center for Clinical & Translational Science, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Michael R Crowley
- Department of Genetics, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Greer A Burkholder
- Division of Infectious Diseases, Department of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - James L Raper
- Division of Infectious Diseases, Department of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| |
Collapse
|
24
|
Almaazmi H, Taylor JP, Stem M, Yu D, Lo BD, Safar B, Efron JE. Anal Squamous Cell Carcinoma: Radiation Therapy Alone Must Be Avoided. J Surg Res 2019; 247:530-540. [PMID: 31648811 DOI: 10.1016/j.jss.2019.09.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/07/2019] [Accepted: 09/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anal squamous cell carcinoma (ASCC) is the most common histological subtype of anal cancer. Rates have been observed to increase in recent years. Combined chemoradiotherapy (CCRT) is currently the gold standard of treatment. The aim of this study is to assess ASCC prevalence, treatment trends, and overall survival (OS) in the United States. METHODS Patients diagnosed with stage I-IV ASCC were identified from the National Cancer Database from 2004 to 2015. The primary outcome was 5-year OS, which was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. RESULTS 34,613 cases were included (stage I: 21.45%; II: 41.00%; III: 31.62%; IV: 5.94%), with an increasing trend in prevalence. CCRT was the most used treatment. Multimodal treatment, combining surgery with CCRT, offered the best OS rates for stage I, II, and IV cancers (I: 84.87%; II: 75.12%; IV: 33.08%), comparable with survival of stage III patients treated with CCRT (III: 61.14%). Radiation alone had the worse OS rates, and on adjusted analysis, radiation treatment alone had the greatest risk of mortality (I: hazard ratio, 2.01; 95% confidence interval, 1.14-3.54; P = 0.016; II: 2.05, 1.44-2.93, P < 0.001; IV: 1.99, 0.99-4.02, P = 0.054). CONCLUSIONS ASCC has increased in prevalence, notably in stage III and IV disease. Although CCRT is the most commonly used treatment type for all stages of ASCC, multimodal treatment offers better OS in stages I, II, and IV. Treatment with radiation alone offers the worst OS no matter the stage and should no longer be used as a solitary treatment modality.
Collapse
Affiliation(s)
- Hamda Almaazmi
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James P Taylor
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Miloslawa Stem
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Yu
- Department of Surgery, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Brian D Lo
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan E Efron
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
25
|
Patel P, Bush T, Kojic EM, Conley L, Unger ER, Darragh TM, Henry K, Hammer J, Escota G, Palefsky JM, Brooks JT. Prevalence, Incidence, and Clearance of Anal High-Risk Human Papillomavirus Infection Among HIV-Infected Men in the SUN Study. J Infect Dis 2019; 217:953-963. [PMID: 29211874 DOI: 10.1093/infdis/jix607] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/22/2017] [Indexed: 01/10/2023] Open
Abstract
Background The natural history of anal human papilloma virus (HPV) infection among human immunodeficiency virus (HIV)-infected men is unknown. Methods Annually, from 2004 to 2012, we examined baseline prevalence, incidence, and clearance of anal HPV infection at 48 months, and associated factors among HIV-infected men. Results We examined 403 men who have sex with men (MSM) and 96 men who have sex with women (MSW) (median age 42 years for both, 78% versus 81% prescribed cART, median CD4+ T-lymphocyte cell count 454 versus 379 cells/mm3, and 74% versus 75% had undetectable viral load, respectively). Type 16 prevalence among MSM and MSW was 38% versus 14% (P < .001), and incidence 24% versus 7% (P = .001). Type 18 prevalence was 24% versus 8% (P < .001), and incidence 13% versus 4% (P = .027). Among MSM and MSW, clearance of prevalent HPV 16 and HPV 18 was 31% and 60% (P = .392), and 47% and 25% (P = .297), respectively. Among MSM, receptive anal sex (with or without a condom) was associated with persistent HPV 16 (OR 2.24, P < .001). Conclusions MSM had higher prevalence and incidence of HPV than MSW, but similar clearance. Receptive anal sex may predict cancer risk among HIV-infected MSM.
Collapse
Affiliation(s)
- Pragna Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tim Bush
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lois Conley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Keith Henry
- Hennepin County Medical Center, Minneapolis, Minnesota
| | - John Hammer
- Denver Infectious Disease Consultants, Colorado
| | - Gerome Escota
- Washington University School of Medicine, St. Louis, Missouri
| | | | - John T Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
26
|
Pepper N, Zúñiga ML, Reed MB. Prevalence and correlates of "popper" (amyl nitrite inhalant) use among HIV-positive Latinos living in the U.S.-Mexico border region. J Ethn Subst Abuse 2019; 19:435-452. [PMID: 30614780 DOI: 10.1080/15332640.2018.1540955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Poppers (nitrite inhalants) are legal, commonly used by men who have sex with men, and associated with HIV acquisition, yet research is lacking on popper use and associated adverse outcomes. People living with HIV (PLWH) in the U.S.-Mexico border region lead binational lives, including accessing care and having sex and drug use partners on both sides of the border, with broad personal and public health implications. Understanding popper use provides crucial information to guide policy and develop targeted interventions for binational PLWH. We examine prevalence and correlates of popper use among HIV-positive Latinos in the border region, an underserved population at risk for poor health outcomes. This cross-sectional study recruited a convenience sample from agencies in San Diego and Tijuana to complete quantitative surveys. Participants (N = 121) were primarily male (82.6%) and gay/bisexual (62%). Lifetime substance use (excluding cannabis) was reported by 72% of participants, and 25.6% reported lifetime popper use. Individuals recruited in the U.S. were significantly more likely to report use of poppers than were participants recruited in Mexico. Our regression model found that identifying as gay/bisexual and having bought, sold, or traded sex for money, drugs, or other goods were independently associated with popper use. Findings shed light on the profile of individuals who use poppers and lay the foundation for further research to understand the context of popper use as it relates to high-risk behavior among PLWH in this region of high transborder mobility. Binational collaborative approaches are needed to improve regional HIV care outcomes and reduce transmission risk.
Collapse
Affiliation(s)
- Nicole Pepper
- School of Social Work, San Diego State University, San Diego, California
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California
| | - Mark B Reed
- School of Social Work, San Diego State University, San Diego, California
| |
Collapse
|
27
|
Gautam A, Chakravarty J, Singh VK, Ghosh A, Chauhan SB, Rai M, Sundar S. Human papillomavirus infection & anal cytological abnormalities in HIV-positive men in eastern India. BMC Infect Dis 2018; 18:692. [PMID: 30587145 PMCID: PMC6307225 DOI: 10.1186/s12879-018-3618-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 12/13/2018] [Indexed: 02/02/2023] Open
Abstract
Background Oncogenic Human papillomavirus (HPV) infections are closely associated with anal cancer which is high among human immunodeficiency virus (HIV) infected males. There are no data regarding anal HPV infection and cytological abnormalities in HIV positive males receiving free therapy in the national program. Thus, this cross-sectional study was performed to assess the prevalence and risk factors of anal HPV infection and cytological abnormalities in HIV positive males. Methods We screened 126 HIV-positive male patients attending the antiretroviral treatment center (ART) between 2014 and 2015 with anal papanicolaou smear cytology and HPV-DNA testing. HPV-DNA was detected by using polymerase chain reaction (PCR) method with two consensus primer sets E6 and MY09/11 and further analyzed for the presence of various HPV genotype by Sanger sequencing. Risk factors associated with anal cytological abnormalities and HPV infection was analyzed by using univariate and multivariate logistic regression models. Results Out of 126, 52 were on antiretroviral therapy. 91% were married to female partners but during the study 48 (38%) gave positive history of anal intercourse with other men. Anal cytology was done in 95 patients, out of which 60 (63.15%) had cytological abnormalities. LSIL (low-grade squamous intraepithelial lesions) was present in 27 (45%), ASCUS (atypical squamous cells of undetermined significance) in 31 (52%) and ASC-H (atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion) in 2 (3.33%). In multivariate analysis, the risk factors for cytological abnormality were presence of history of anal intercourse (OR, 6.1; 95% CI, 2.0–18.7) and WHO stage III & IV (OR, 2.7; 95% CI, 1.1–7.5). HPV-DNA was detected in 33/119 (27.73%) patients. The most prevalent HPV type in the study was HPV-16 (10.08%), other HPV types detected were 18,31,35,17,66,72,52,68 and 107 (17.65%). Conclusions High prevalence of anal cytological abnormalities in our study suggests that regular anal Pap smear screening should be done in HIV positive males in the ART center.
Collapse
Affiliation(s)
- Abhilasha Gautam
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
| | - Vijay Kumar Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Amrita Ghosh
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Shashi Bhushan Chauhan
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Madhukar Rai
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| |
Collapse
|
28
|
Papillomavirus vaccine for women, and for men? Med Clin (Barc) 2018; 152:264-265. [PMID: 30591274 DOI: 10.1016/j.medcli.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/16/2018] [Indexed: 11/20/2022]
|
29
|
Abstract
OBJECTIVES The aim of this study was to determine whether biomarker P16 predicts progression risk for anal low-grade squamous intraepithelial lesions (LSILs). DESIGN A retrospective study. METHODS One hundred and nine HIV-infected and 18 HIV-uninfected patients with biopsy-proven anal LSIL at initial screening underwent surveillance high-resolution anoscopy and biopsy within 2 years of diagnosis. P16 immunohistochemistry was performed on index lesions and evaluated using a semi-quantitative scoring system. The association of predictors and lesional outcomes (progression, persistence or regression) was analysed using ordinal logistic regression models. A subset of p16-positive LSILs was tested for high-risk human papillomavirus (HR-HPV) DNA using real-time PCR. RESULTS Upon follow-up, 46 (36%) LSILs progressed to high-grade squamous intraepithelial lesion (HSIL), 50 (40%) persisted as LSIL and 31 (24%) regressed to benign mucosa (median 16 months, range 5-24 months). Age, sex, race, history of condylomata, CD4 T-cell count and HIV plasma viral load were similar regardless of clinical outcome. P16 immunoreactivity of index lesion was classified as block-positive (n = 36), focal-positive (n = 49) or negative (n = 42). Sixty-four percent of block-positive lesions progressed, as opposed to 35% of focal-positive and 14% of negative lesions (P < 0.001). HR-HPV DNA was detected in 90% of p16 block-positive lesions vs. 55% of focal-positive lesions. In unadjusted analyses, positive p16, HIV and former smoker status were significantly associated with lesional persistence and progression. P16 remained the only significant predictor in an adjusted model. CONCLUSION Biomarker p16 is the strongest predictor for anal LSIL-to-HSIL progression, outperforming other risk factors. To enhance the overall effectiveness of surveillance, we propose using p16 immunohistochemistry to help stratify patients at high vs. low risk of progression.
Collapse
|
30
|
Ruben MA, Fullerton M. Proportion of patients who disclose their sexual orientation to healthcare providers and its relationship to patient outcomes: A meta-analysis and review. PATIENT EDUCATION AND COUNSELING 2018; 101:1549-1560. [PMID: 29778500 DOI: 10.1016/j.pec.2018.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/20/2018] [Accepted: 05/01/2018] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Patient-centered care emphasizes the need to form a therapeutic and trusting relationship between patients and providers in which patients feel comfortable disclosing health-relevant and personal information. It is still unknown how many patients disclose their sexual orientation to providers, under what circumstances and what it is related to in terms of outcomes. METHOD The present meta-analysis and review sought to identify the overall proportion of sexual orientation disclosure to healthcare providers, facilitators and barriers of disclosure, patient populations less likely to disclose, and the relationship between disclosure and outcomes. Thirty-five studies met the inclusion criteria yielding 38 independent proportions. Characteristics of patients, providers, location, and disclosure were extracted. RESULTS Sexual orientation disclosure proportions to healthcare providers ranged from .29 to .98. The random-effects pooled estimate was .63 (95% CI: .58, .68). Disclosure compared to nondisclosure was related to more positive direct and indirect health outcomes including higher satisfaction, more healthcare seeking and screenings and better self-reported health and psychological wellbeing. CONCLUSION The overall proportion of disclosure to healthcare providers varied by patient, provider, location, and disclosure characteristics. PRACTICE IMPLICATIONS These findings emphasize the need for future interventions directed at facilitating disclosure among populations identified as less likely to disclose.
Collapse
Affiliation(s)
- Mollie A Ruben
- School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA.
| | - Madeline Fullerton
- School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| |
Collapse
|
31
|
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Anal Squamous Cell Cancers (Revised 2018). Dis Colon Rectum 2018; 61:755-774. [PMID: 29878949 DOI: 10.1097/dcr.0000000000001114] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
32
|
St Laurent J, Luckett R, Feldman S. HPV vaccination and the effects on rates of HPV-related cancers. Curr Probl Cancer 2018; 42:493-506. [PMID: 30041818 DOI: 10.1016/j.currproblcancer.2018.06.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023]
Abstract
Globally, human papillomavirus (HPV) infection is one of the most common sexually transmitted infection. HPV is linked to at least five malignancies including vulvar, vaginal, anal penile, oropharyngeal, and cervical cancer. Three HPV vaccines are currently available: bivalent (HPV 16,18), quadrivalent (HPV 6,11,16,18), and nonavalent (6,11,16,18,31,33,45,52,58) targeting between 2 and 7 oncogenic HPV serotypes. This review highlights the currently epidemiologic burden of HPV-related cancers, efficacy of current HPV vaccines, and speculates about the benefits of widespread HPV vaccination. At present, all three vaccines are effective in reducing cervical disease and anogenital dysplasia in industry sponsored clinical trials and in limited study of clinical effectiveness. Models predict elimination of HPV infection with global vaccination rates of 80% and benefits in reducing malignancy at 20% global coverage. Large population-based clinical efficacy studies of these vaccines will be necessary to assess the true impact of vaccination. HPV vaccines provide a promising primary approach to preventing malignancy and barriers to vaccine access must be addressed to meet vaccination goals.
Collapse
Affiliation(s)
- Jessica St Laurent
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Rebecca Luckett
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
33
|
Stanley C, Secter M, Chauvin S, Selk A. HPV vaccination in male physicians: A survey of gynecologists and otolaryngology surgeons' attitudes towards vaccination in themselves and their patients. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2018; 5:89-95. [PMID: 29524677 PMCID: PMC5887017 DOI: 10.1016/j.pvr.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Attitudes and barriers towards HPV vaccination were explored in a population of male surgeons in Gynecology and Otolaryngology in Ontario, Canada. MATERIALS/METHODS An internet-based survey was distributed to male residents and physicians affiliated with the departments of Obstetrics and Gynecology, and Otolaryngology at six Ontario universities. The survey consisted of 16 questions (3 demographic, 3 workplace exposure, 6 regarding personal vaccination, and 3 regarding patient vaccination). Subgroup analyses examined differences between residents versus staff physicians and gynecologists versus otolaryngologists. RESULTS Most respondents (51/63, 81.0%) had not been vaccinated against HPV, yet would consider vaccination in the future (41/51, 80.4%). Significantly more residents would consider vaccination compared to staff physicians (p = .03). Personal protection from benign HPV disease was the most common motivating factor (25/59, 42.4%) among participants. A notable barrier to vaccination was "age over recommendations" (9/44, 20.4%). Most participants would recommend the HPV vaccine to both male patients (49/62, 79.0%) and male partners of female patients (47/62, 75.8%). CONCLUSIONS This study demonstrates male gynecologists and otolaryngologists had largely favorable attitudes towards HPV vaccination though few had received vaccination. These findings may be used to increase HPV vaccine uptake among male health care professionals and their patients.
Collapse
Affiliation(s)
- Claire Stanley
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5S 1A8
| | - Michael Secter
- Department of Obstetrics and Gynecology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada M4N 3M5
| | - Sarah Chauvin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5S 1A8
| | - Amanda Selk
- Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, Ontario, Canada M5S 1B2; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada M5G 1E2.
| |
Collapse
|
34
|
Wang CCJ, Sparano J, Palefsky JM. Human Immunodeficiency Virus/AIDS, Human Papillomavirus, and Anal Cancer. Surg Oncol Clin N Am 2018; 26:17-31. [PMID: 27889034 DOI: 10.1016/j.soc.2016.07.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Anal cancer is an increasingly common non-AIDS-defining cancer among individuals infected with the human immunodeficiency virus (HIV). It is associated with human papillomavirus (HPV). HPV16 is the most common genotype detected in anal cancers. The HPV types detected in anal cancer are included in the 9-valent vaccine. HPV vaccines have demonstrated efficacy in reducing anal precancerous lesions in HIV-infected individuals. Standard treatment has been fluorouracil and mitomycin (or cisplatin) plus radiation. Continued studies are needed to test new treatment strategies in HIV-infected patients with anal cancer to determine which treatment protocols provide the best therapeutic index.
Collapse
Affiliation(s)
- Chia-Ching J Wang
- Division of Hematology/Oncology, Department of Medicine, Zuckerberg San Francisco General Hospital, 995 Potrero Avenue, Building 80, 4th Floor, San Francisco, CA 94110, USA
| | - Joseph Sparano
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Road, Bronx, NY 10461, USA
| | - Joel M Palefsky
- Division of Infectious Diseases, Department of Medicine, University of California at San Francisco, 513 Parnassus Avenue, Medical Science Room 420E, Box 0654, San Francisco, CA 94143, USA.
| |
Collapse
|
35
|
Lafaurie GI, Perdomo SJ, Buenahora MR, Amaya S, Díaz-Báez D. Human papilloma virus: An etiological and prognostic factor for oral cancer? ACTA ACUST UNITED AC 2018; 9:e12313. [DOI: 10.1111/jicd.12313] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Gloria I. Lafaurie
- Unit of Basic Oral Investigation, School of Dentistry, El Bosque University; Bogotá Colombia
| | - Sandra J. Perdomo
- Unit of Basic Oral Investigation, School of Dentistry, El Bosque University; Bogotá Colombia
| | - María R. Buenahora
- Unit of Oral Clinical Epidemiology; School of Dentistry, El Bosque University; Bogotá Colombia
| | - Sandra Amaya
- School of Dentistry, University of Valle; Cali Colombia
| | - David Díaz-Báez
- Unit of Basic Oral Investigation, School of Dentistry, El Bosque University; Bogotá Colombia
| |
Collapse
|
36
|
A Pilot Study of the Prevalence of Anal Human Papillomavirus and Dysplasia in a Cohort of Patients With IBD. Dis Colon Rectum 2017; 60:1307-1313. [PMID: 29112567 DOI: 10.1097/dcr.0000000000000878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Defective cell-mediated immunity increases the risk of human papillomavirus-associated anal dysplasia and cancer. There is limited information on anal canal disease in patients with IBD. OBJECTIVE The purpose of this study was to assess anal/vaginal human papillomavirus and anal dysplasia prevalence in patients with IBD. DESIGN Patients had an anal examination before routine colonoscopy. SETTINGS The study was conducted at a tertiary IBD referral center. PATIENTS We studied a convenience sample of sexually active male and female patients with IBD who were not on biological therapy. INTERVENTION Anal examination, anal and vaginal human papillomavirus testing, anal cytology, and high-resolution anoscopy/biopsy were carried out. MAIN OUTCOME MEASURES Anal and vaginal human papillomavirus types, anal cytology, and biopsy grade were measured. RESULTS Twenty-five male and 21 female evaluable participants, 31 with Crohn's disease, 14 with ulcerative colitis, and 1 with indeterminate colitis, were predominantly white (91.3%), treatment experienced (76.1%), an average age of 38.1 years (range, 22.0-66.0 y), and had an average length of IBD diagnosis of 9.3 years (range, 1.0-33.0 y). Eighteen (39.1%) had an abnormal perianal examination and 3 (6.5%) had an abnormal digital examination. Forty-one (89.1%) had anal human papillomavirus, 16 with a single type and 25 with multiple types (range, 2-5 types). Human papillomavirus type 16 was most common (65.2%), followed by human papillomavirus types 11 and 45 (37.0% each). Nineteen of 21 (90.5%) women had vaginal human papillomavirus. Overall, 21 (45.7%) had abnormal anal cytology. Thirty three (71.7%) had ≥1 anal biopsy (9 had multiple), with dysplasia diagnosed in 28 (60.9%) and high-grade and low-grade squamous intraepithelial lesions diagnosed in 4 (8.7%) and 24 (43.5%). LIMITATIONS No control group was included, and no detailed sexual history was taken. CONCLUSIONS A high prevalence of anal and vaginal human papillomavirus and anal dysplasia was demonstrated in the study population outcomes. See Video Abstract at http://links.lww.com/DCR/A379.
Collapse
|
37
|
McCloskey JC, Kast WM, Flexman JP, McCallum D, French MA, Phillips M. Syndemic synergy of HPV and other sexually transmitted pathogens in the development of high-grade anal squamous intraepithelial lesions. PAPILLOMAVIRUS RESEARCH 2017; 4:90-98. [PMID: 29179876 PMCID: PMC5883243 DOI: 10.1016/j.pvr.2017.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 01/21/2023]
Abstract
Background Anal intraepithelial neoplasia is associated with high-risk human papillomavirus (hrHPV) as a precursor to anal cancer. However, factors other than hrHPV are likely to be involved and further study of cofactors is required because of the possibility of syndemic interactions. Methods Three hundred and fourteen patients underwent 457 operations. Histopathology and hrHPV testing using the Digene Hybrid Capture 2 (HC 2) method were performed. Demographic factors and sexually transmissible infections (STIs) were recorded. Results Results showed that hrHPV alone was associated with HSIL (OR = 4.65, p < 0.001). None of the other STIs were alone associated with HSIL but amplification of risk was found when hrHPV infection occurred with HIV (OR = 11.1); syphilis (OR = 5.58); HSV 2 (OR = 7.85); gonorrhoea (OR = 6.45) and some other infections. Conclusions These results suggest that hrHPV is a sufficient cause of anal HSIL. Seropositivity for HIV, HSV 2, T. pallidum, HBV and HCV and a history of gonorrhoea or chlamydia exert a powerful amplifying factor increasing the risk of HSIL above the risk with hrHPV alone. Other co-factors which are associated with an increased risk of HSIL are increased age, male gender, MSM behaviour and self-reported history of more than 50 sexual partners. This pattern of disease in patients with warts is characteristic of a syndemic with potential serious increased risk of anal carcinoma. High-risk HPV is a necessary and sufficient cause of progression from LSIL to HSIL. HIV, HSV 2, HBV and HCV are associated with an amplified risk of hrHPV induced HSIL. Gonorrhoea, chlamydia, and syphilis are associated with increased odds HSIL. HSIL shows syndemic interaction patterns with STIs and behavioural/social factors.
Collapse
Affiliation(s)
- Jenny C McCloskey
- Sexual Health Services, Royal Perth Hospital; School of Medicine and Pharmacology, University of Western Australia, Perth, WA 6000, Australia.
| | - W Martin Kast
- Departments of Molecular Microbiology & Immunology and Obstetrics & Gynaecology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA.
| | - James P Flexman
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital; PathWest Laboratory Medicine, WA, Australia; Departments of Microbiology and Immunology and Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia 6009, Australia.
| | - Dugald McCallum
- Department of Anatomical Pathology, PathWest Laboratory Medicine (WA), Barry Marshall Drive, Murdoch, WA 6150, Australia.
| | - Martyn A French
- Medical School and School of Biomedical Sciences, University of Western Australia, Perth, Australia; Department of Clinical Immunology, Royal Perth Hospital and PathWest Laboratory Medicine, Perth, Australia.
| | - Michael Phillips
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia; Centre for Medical Research, The University of Western Australia, Crawley, Western Australia 6009, Australia.
| |
Collapse
|
38
|
Wan Z, Huang Z, Vikash V, Rai K, Vikash S, Chen L, Li J. Survival rate variation with different histological subtypes of poor prognostic male anal squamous cell carcinoma: a population-based study. Oncotarget 2017; 8:84349-84359. [PMID: 29137429 PMCID: PMC5663601 DOI: 10.18632/oncotarget.20969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/17/2017] [Indexed: 12/23/2022] Open
Abstract
Background and objective The prognosis of male anal squamous cell carcinoma (MASCC) and female anal squamous cell carcinoma (FASCC) is variable. The influence of tumor subtype on the survival rate and gender is poorly known. Our study is the largest population-based study and aims to outline the difference in survival between MASCC and FASCC patients. Methods A retrospective population-based study was performed to compare the disease-specific mortalities (DSMs) between genders related to the tumor subtypes. The Surveillance, Epidemiology, and End Results (SEER) program database was employed to obtain the data from January 1988 to December 2014. Results A total of 4,516, (3,249 males and 1,267 females), patients with anal squamous cell carcinomas (ASCC) were investigated. The 5-year DSMs were 24.18% and 18.08% for men and women, respectively. The univariate analysis of the male basaloid squamous cell carcinoma (BSCC) and cloacogenic carcinoma (CC) patients demonstrated higher DSMs (P <0.001). Moreover, in the multivariate analysis, BSCC and CC were associated with soaring DSMs in male patients (P < 0.05). Conclusions In the cohort of BSCC and CC patients, male patients demonstrated a considerable decrease in survival rate compared to females. A more precise classification of ASCC and individualized management for MASCC are warranted.
Collapse
Affiliation(s)
- Zihao Wan
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhihao Huang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Vikash Vikash
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Kelash Rai
- Department of Medicine, Ziauddin Hospital, Karachi, Sindh, Pakistan
| | - Sindhu Vikash
- Department of Medicine, Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Sindh, Pakistan
| | - Liaobin Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jingfeng Li
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| |
Collapse
|
39
|
Gibson AW, Radix AE, Maingi S, Patel S. Cancer care in lesbian, gay, bisexual, transgender and queer populations. Future Oncol 2017; 13:1333-1344. [DOI: 10.2217/fon-2017-0482] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Lesbian, gay, bisexual, transgender and queer (LGBTQ) populations experience health and healthcare disparities that may place them at higher risk for developing cancer. In addition, LGBTQ communities have psychosocial factors, such as fear of discrimination, that have substantial impacts on their medical care. As a result, these populations have specific needs with regard to cancer screening, treatment and support that must be addressed by cancer care providers. Although much has been done to address cancer care in the general population, more improvement is needed in the care of LGBTQ patients. We aim to present an overview of the current state of LGBTQ cancer care, opportunities for improvement and how cancer centers and providers can create a better future for the care of LGBTQ cancer patients.
Collapse
Affiliation(s)
- Alec W Gibson
- Medical Scientist Training Program & Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, NY, USA
| | - Shail Maingi
- Department of Medical Oncology, St Peter's Health Partners Cancer Care, Troy, NY, USA
| | - Shilpen Patel
- Department of Radiation Oncology & Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
40
|
Wentzensen N, Arbyn M, Berkhof J, Bower M, Canfell K, Einstein M, Farley C, Monsonego J, Franceschi S. Eurogin 2016 Roadmap: how HPV knowledge is changing screening practice. Int J Cancer 2017; 140:2192-2200. [PMID: 28006858 DOI: 10.1002/ijc.30579] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 01/01/2023]
Abstract
Human papillomaviruses (HPVs) are the necessary cause of most cervical cancers, a large proportion of other anogenital cancers, and a subset of oropharyngeal cancers. The knowledge about HPV has led to development of novel HPV-based prevention strategies with important impact on clinical and public health practice. Two complementary reviews have been prepared following the 2015 Eurogin Conference to evaluate how knowledge about HPV is changing practice in HPV infection and disease control through vaccination and screening. This review focuses on screening for cervical and anal cancers in increasingly vaccinated populations. The introduction of HPV vaccines a decade ago has led to reductions in HPV infections and early cancer precursors in countries with wide vaccination coverage. Despite the high efficacy of HPV vaccines, cervical cancer screening will remain important for many decades. Many healthcare systems are considering switching to primary HPV screening, which has higher sensitivity for cervical precancers and allows extending screening intervals. We describe different approaches to implementing HPV-based screening efforts in different healthcare systems with a focus in high-income countries. While the population prevalence for other anogenital cancers is too low for population-based screening, anal cancer incidence is very high in HIV-infected men who have sex with men, warranting consideration of early detection approaches. We summarize the current evidence on HPV-based prevention of anal cancers and highlight important evidence gaps.
Collapse
Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology & Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Johannes Berkhof
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Bower
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Einstein
- Department of OB/GYN & Women's Health, Rutgers New Jersey Medical School, Newark, USA
| | - Christopher Farley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | |
Collapse
|
41
|
Abstract
OBJECTIVES Nitrite inhalants (poppers) are commonly used recreational drugs among MSM and were previously associated with elevated rates of high-risk sexual behavior, HIV and human herpesvirus type 8 (HHV-8) seroconversion, and transient immunosuppressive effects in experimental models. Whether long-term popper use is associated with cancer risk among MSM in the HAART era is unclear. DESIGN Prospective cohort study of cancer risk in 3223 HIV-infected and uninfected MSM in the Multicenter AIDS Cohort Study from 1996-2010. METHODS Poisson regression models were used to examine the association between heavy popper use (defined as daily or weekly use for at least 1 year) and risk of individual cancers or composite category of virus-associated cancers. RESULTS Among all participants, heavy popper use was not associated with increased risk of any individual cancers. Among HIV-uninfected men aged 50-70, heavy popper use was associated with increased risk of virus-associated cancer with causes linked to human papillomavirus, HHV-8, and Epstein-Barr virus in models adjusted for demographics, number of sexual partners, immunological parameters (CD4 cell counts or CD4/CD8 ratios), and hepatitis B and C viruses [incidence rate ratio (IRR), 95% confidence interval (CI) 3.24, 1.05-9.96], or sexually transmitted infections (IRR 3.03, 95% CI, 1.01-9.09), as was cumulative use over a 5-year period (IRR 1.012, 95% CI 1.003-1.021; P = 0.007). There was no significant association between heavy popper use and virus-associated cancer in HIV-infected men. CONCLUSIONS Long-term heavy popper use is associated with elevated risk of some virus-associated cancers with causes related to human papillomavirus, HHV-8, and Epstein-Barr virus infections in older HIV-uninfected MSM independent of sexual behavior and immunological parameters.
Collapse
|
42
|
Megill C, Wilkin T. Topical therapies for the treatment of anal high-grade squamous intraepithelial lesions. SEMINARS IN COLON AND RECTAL SURGERY 2017; 28:86-90. [PMID: 29910593 DOI: 10.1053/j.scrs.2017.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Anal cancer may be prevented by treating anal high-grade squamous intraepithelial lesions (HSIL). Ablative therapies are the most commonly used treatments, but they may not be appropriate for all patients including those with extensive HSIL or bleeding diastheses. Researchers have studied topical therapies for human papillomavirus related lesions including anal HSIL. These therapies include patient-applied 5-fluorouracil, imiquimod and cidofovir, and provider-applied trichloroacetic acid. This review will discuss literature supporting efficacy of these products, which is based mainly on case series with few controlled trials having been conducted. Side effects are common with patient-applied topical therapy often requiring dose reduction and medication to treat pain. However, treatment discontinuations are infrequent. This review will also discuss some approaches to the use of these products in clinical practice.
Collapse
Affiliation(s)
- Christina Megill
- Division of Infectious Diseases, Weill Cornell Medicine 53 W. 23 St. 6 Floor, New York, NY 10010, 212-746-7204 (phone), 212-746-7203 (fax)
| | - Timothy Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine 53 W. 23 St. 6 Floor, New York, NY 10010, 212-746-7204 (phone), 212-746-7203 (fax)
| |
Collapse
|
43
|
Hafeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus 2017. [PMID: 28638747 PMCID: PMC5478215 DOI: 10.7759/cureus.1184] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
About 3.5% Americans identify themselves as lesbian, gay, or bisexual while 0.3% identify themselves as transgender. The LGBT (lesbian, gay, bisexual, and transgender) community belongs to almost every race, ethnicity, religion, age, and socioeconomic group. The LGBT youth are at a higher risk for substance use, sexually transmitted diseases (STDs), cancers, cardiovascular diseases, obesity, bullying, isolation, rejection, anxiety, depression, and suicide as compared to the general population. LGBT youth receive poor quality of care due to stigma, lack of healthcare providers' awareness, and insensitivity to the unique needs of this community. The main objective of this literature review is to highlight the challenges faced by the LGBT youth and to enhance the awareness among physicians about the existing disparities in order to provide a more comprehensive, evidence-based, and humane medical care to this community.
Collapse
Affiliation(s)
| | - Muhammad Zeshan
- Department of Psychiatry, Bronx Lebanon Hospital Icahn School of Medicine at Mount Sinai, Bronx, NY
| | | | | | | |
Collapse
|
44
|
Hulbert-Williams NJ, Plumpton CO, Flowers P, McHugh R, Neal RD, Semlyen J, Storey L. The cancer care experiences of gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28239936 DOI: 10.1111/ecc.12670] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/22/2023]
Abstract
Understanding the effects of population diversity on cancer-related experiences is a priority in oncology care. Previous research demonstrates inequalities arising from variation in age, gender and ethnicity. Inequalities and sexual orientation remain underexplored. Here, we report, for the first time in the UK, a quantitative secondary analysis of the 2013 UK National Cancer Patient Experience Survey which contains 70 questions on specific aspects of care, and six on overall care experiences. 68,737 individuals responded, of whom 0.8% identified as lesbian, gay or bisexual. Controlling for age, gender and concurrent mental health comorbidity, logistic regression models applying post-estimate probability Wald tests explored response differences between heterosexual, bisexual and lesbian/gay respondents. Significant differences were found for 16 questions relating to: (1) a lack of patient-centred care and involvement in decision-making, (2) a need for health professional training and revision of information resources to negate the effects of heteronormativity and (3) evidence of substantial social isolation through cancer. These findings suggest a pattern of inequality, with less positive cancer experiences reported by lesbian, gay and (especially) bisexual respondents. Poor patient-professional communication and heteronormativity in the healthcare setting potentially explain many of the differences found. Social isolation is problematic for this group and warrants further exploration.
Collapse
Affiliation(s)
- N J Hulbert-Williams
- Chester Research Unit for the Psychology of Health (CRUPH), Department of Psychology, University of Chester, Chester, UK
| | | | - P Flowers
- Glasgow Caledonian University, Glasgow, UK
| | - R McHugh
- Chester Research Unit for the Psychology of Health (CRUPH), Department of Psychology, University of Chester, Chester, UK
| | | | - J Semlyen
- University of East Anglia, Norwich, UK
| | - L Storey
- School of Psychology, Queen's University, Belfast, UK
| |
Collapse
|
45
|
Roberts JR, Siekas LL, Kaz AM. Anal intraepithelial neoplasia: A review of diagnosis and management. World J Gastrointest Oncol 2017; 9:50-61. [PMID: 28255426 PMCID: PMC5314201 DOI: 10.4251/wjgo.v9.i2.50] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/28/2016] [Accepted: 11/29/2016] [Indexed: 02/05/2023] Open
Abstract
Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus (HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPV-mediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations.
Collapse
|
46
|
Torres-Román JS, Montenegro-Idrogo JJ. Inmunización contra el virus de papiloma humano en Perú. Más allá del cáncer de cérvix. SALUD PUBLICA DE MEXICO 2017; 59:1-2. [DOI: 10.21149/7863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
La introducción de la vacuna contra el virus del papiloma humano (VPH) en el Esquema Nacional de Vacunación en la población de niñas entre 9 y 13 años ocurre ante la necesidad de reducir el riesgo de cáncer de cérvix en población femenina (RM Nº 255-2015/MINSA). No obstante, no es la única población en la que la vacuna puede reducir el riesgo de cáncer asociado con este virus...
Collapse
|
47
|
Coleman TA, Bauer GR, Pugh D, Aykroyd G, Powell L, Newman R. Sexual Orientation Disclosure in Primary Care Settings by Gay, Bisexual, and Other Men Who Have Sex with Men in a Canadian City. LGBT Health 2016; 4:42-54. [PMID: 27996376 DOI: 10.1089/lgbt.2016.0004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Sexual orientation affects individuals' health histories and is fundamental to providers' understanding of patients as a whole. Gay, bisexual, and other men who have sex with men (GB-MSM) are vulnerable to certain health conditions, including HIV. The aim of this exploratory analysis was to examine factors associated with sexual orientation disclosure and communication with providers about GB-MSM health issues and to discuss implications. METHODS We conducted a cross-sectional internet survey of GB-MSM (n = 202) in London-Middlesex, Ontario, Canada; analyses were limited to those with a regular primary care provider (n = 173). Blockwise regression models explored demographic, psychosocial, and healthcare-related factors associated with sexual orientation disclosure and physician-patient communication about GB-MSM-related health. RESULTS Just over seventy-one percent (71.1%) of participants reported that their primary care provider (PCP) knew their sexual orientation, and 44.5% had talked to them about GB-MSM health. Overt negative comments or being refused care based on sexual orientation occurred infrequently, although 26.6% reported their provider had assumed they were heterosexual. Being married to or living common-law with another man, more frequent experiences of homosexual prejudice, and higher quality assessment of provider's communication skills were associated with the PCP knowing respondents' sexual orientation. Greater internalized homonegativity was associated with not talking to a PCP about GB-MSM-related health issues. More frequent experiences of homosexual prejudice, higher assessment of provider communication, and having prior negative experiences with a PCP were significantly associated with talking to a PCP about GB-MSM health. CONCLUSION The majority of our sample disclosed their sexual orientation; however, not all patients voluntarily disclose. Medical training and education in Canada, where specific rights protections exist for sexual orientation minority populations, should emphasize awareness of essential patient health information. Training should include information about GB-MSM health and building a foundation on how to speak with GB-MSM patients nonjudgmentally.
Collapse
Affiliation(s)
- Todd A Coleman
- 1 Department of Psychology, Ryerson University , Toronto, Canada .,2 Department of Epidemiology and Biostatistics, University of Western Ontario , London, Canada
| | - Greta R Bauer
- 2 Department of Epidemiology and Biostatistics, University of Western Ontario , London, Canada
| | - Daniel Pugh
- 3 Gay Men's Sexual Health Alliance , Toronto, Canada
| | - Gloria Aykroyd
- 4 St. Joseph's Infectious Diseases Care Program , London, Canada
| | | | - Rob Newman
- 6 Regional HIV/AIDS Connection , London, Canada
| |
Collapse
|
48
|
Anal Cancer Screening in Men Who Have Sex With Men in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr 2016; 71:570-6. [PMID: 26656784 DOI: 10.1097/qai.0000000000000910] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the prevalence of anal cytology (ACyt) abnormalities among HIV-infected and HIV-uninfected men who have sex with men (MSM). DESIGN Multicenter cohort study of 723 HIV-infected and 788 HIV-uninfected MSM with ACyt, with a second ACyt collected 2 years later. A referral for high-resolution anoscopy was suggested for abnormal ACyt. METHODS ACyt samples were collected using a polyester swab and liquid cytology media and read in a central laboratory. RESULTS Prevalence of any abnormal ACyt was 25% in HIV-uninfected MSM and increased to 38%, 41%, and 47% among HIV-infected MSM with current CD4 T-cell counts ≥500, 350-499, and <350 cells/mm (P < 0.001), respectively. Anal HPV16 DNA was also more common in HIV-infected than HIV-uninfected MSM (25% versus 16%, P < 0.001). Abnormal baseline ACyt together with prevalent HPV16 DNA detection was present in only 7% of HIV-uninfected MSM compared to 18% of HIV-infected MSM with current CD4 < 350, P < 0.001. Among HIV-infected men, 56% of the men with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions ASCs-US/LSILs and 81% of men with atypical squamous cells cannot exclude high-grade (ASC-H/)/high-grade squamous intraepithelial lesions (HSIL) had lower grade ACyt findings 18-30 months later ("regressed"). However, 19% of untreated HIV-infected men with ASC-H/HSIL cytology maintained that same grade of cytology in their second test approximately 2 years later, and 15% with ASC-US/LSIL "progressed" to ASC-H/HSIL. Abnormal ACyt had high sensitivity (96%) but low specificity (17%) for biopsy-proven HSIL. CONCLUSIONS Prevalence of abnormal ACyt remains elevated in HIV-infected men during the current antiretroviral therapy era.
Collapse
|
49
|
Alam NN, White DA, Narang SK, Daniels IR, Smart NJ. Systematic review of guidelines for the assessment and management of high-grade anal intraepithelial neoplasia (AIN II/III). Colorectal Dis 2016; 18:135-46. [PMID: 26559167 DOI: 10.1111/codi.13215] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/02/2015] [Indexed: 12/28/2022]
Abstract
AIM There is ambiguity with regard to the optimal management of anal intraepithelial neoplasia (AIN) III. The aim of this review was to assess and compare international/national society guidelines currently available in the literature on the management, treatment and surveillance of AIN III. We also aimed to assess the quality of the studies used to compile the guidelines and to clarify the terminology used in histological assessment. METHOD An electronic search of PubMed and Embase was performed using the search terms 'anal intraepithelial neoplasia', 'AIN', 'anal cancer', 'guidelines', 'surveillance' and 'management'. Literature reviews and guidelines or practice guidelines in peer reviewed journals from 1 January 2000 to 31 December 2014 assessing the treatment, surveillance or management of patients with AIN related to human papilloma virus were included. The guidelines identified by the search were assessed for the quality of evidence behind them using the Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence. RESULTS The database search identified 5159 articles and two further guidelines were sourced from official body guidelines. After inclusion criteria were applied, 28 full-text papers were reviewed. Twenty-five of these were excluded, leaving three guidelines for inclusion in the systematic review: those published by the Association of Coloproctology of Great Britain and Ireland, the American Society of Colon and Rectal Surgeons and the Italian Society of Colorectal Surgery. No guidelines were identified on the management of AIN III from human papilloma virus associations and societies. All three guidelines agree that a high index of clinical suspicion is essential for diagnosing AIN with a disease-specific history, physical examination, digital rectal examination and anal cytology. There is interchange of terminology from high-grade AIN (HGAIN) (which incorporates AIN II/III) and AIN III in the literature leading to confusion in therapy use. Treatment varies from immunomodulation and photodynamic therapy to targeted destruction of areas of HGAIN/AIN II/III using infrared coagulation, electrocautery, cryotherapy or surgical excision but with little consensus between the guidelines. Recommendations on surveillance strategies are similarly discordant, ranging from 6-monthly physical examination to annual anoscopy ± biopsy. Over 50% of the recommendations are based on Level 3 or Level 4 evidence and many were compiled using studies that were more than 10 years old. CONCLUSION Despite concordance regarding diagnosis, there is significant variation in the guidelines over recommendations on the treatment and surveillance of patients with HGAIN/AIN II/III. All three sets of guidelines are based on low level, outdated evidence originating from the 1980s and 1990s.
Collapse
Affiliation(s)
- N N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK
| | - D A White
- Warwick Medical School, University of Warwick, Coventry, UK
| | - S K Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK
| |
Collapse
|
50
|
Fenkl EA, Jones SG, Schochet E, Johnson P. HPV and Anal Cancer Knowledge Among HIV-Infected and Non-Infected Men Who Have Sex with Men. LGBT Health 2016; 3:42-48. [DOI: 10.1089/lgbt.2015.0086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric A. Fenkl
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida
| | - Sandra Gracia Jones
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida
| | - Elie Schochet
- Colorectal Surgery, Holy Cross Medical Group, Fort Lauderdale, Florida
| | - Paulette Johnson
- School of Integrated Science and Humanity, Florida International University, Miami, Florida
| |
Collapse
|