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Incidence, Persistence, and Factors Associated With HPV Infection Among Male Adolescents With and Without Perinatally Acquired HIV Infection. J Acquir Immune Defic Syndr 2021; 85:553-560. [PMID: 32925357 DOI: 10.1097/qai.0000000000002499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection with high-risk human papillomavirus (HR-HPV) has been shown to be more prevalent and persistent in female adolescents with HIV. However, data among male adolescents with perinatally acquired HIV (PHIV) are limited. SETTING We investigated the incidence and persistence of HR-HPV in anogenital compartments and associated factors among PHIV in comparison to HIV-uninfected (HU) male adolescents in Thailand. METHODS PHIV and HU males aged 12-24 years were enrolled. At baseline and 3 subsequent annual visits, specimens from the scrotum, penis, and anal area were obtained for HPV and other testing. RESULTS From June 2013 to October 2017, 49 PHIV and 47 HU male adolescents with a median age of 18 (interquartile range 17-20) years were enrolled. PHIV had higher incidence of any HR-HPV infection than HU adolescents {33.05 [95% confidence interval (CI): 20.82 to 52.46] vs. 15.73 [95% CI: 8.18 to 30.22] per 100 person-years, P = 0.04}. The persistence of any HR-HPV genotypes (detected at ≥2 annual visits) was not different by group (PHIV 27% vs. HU 23%, P = 0.75). Having ≥3 sex partners in past 6 months (adjusted prevalence ratio 2.39, 95% CI: 1.14 to 5.05; P = 0.02) and co-infection with other sexually transmitted infections (syphilis, chlamydia, and/or gonorrhea) were associated with persistent HR-HPV infection (adjusted prevalence ratio 6.21, 95% CI: 2.87 to 13.41; P < 0.001). CONCLUSIONS Thai PHIV male adolescents had a higher incidence of HR-HPV infection than those without HIV. Having multiple sex partners and co-infection with sexually transmitted infections was associated with persistent HR-HPV infection. These data demonstrate the need to prioritize PHIV male adolescents in routine and catch-up HPV vaccination programs.
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Patzi-Churqui M, Terrazas-Aranda K, Liljeqvist JÅ, Lindh M, Eriksson K. Prevalence of viral sexually transmitted infections and HPV high-risk genotypes in women in rural communities in the Department of La Paz, Bolivia. BMC Infect Dis 2020; 20:204. [PMID: 32143643 PMCID: PMC7060520 DOI: 10.1186/s12879-020-4931-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bolivia has the highest prevalence of cervical cancer in South America and the prevalence of viral sexually transmitted infections (STIs) among people in urban cities is increasing. Little is known about the prevalence of viral STIs in rural communities, which generally have limited access to health care. In order to study the prevalence of viral STIs in rural Bolivia, we recruited women from villages and towns in the Department of La Paz in Bolivia. Methods Three hundred ninety-four female participants were assessed for IgG-antibodies to herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and hepatitis B virus (HBV, anti-HBc), as well as for the presence of HBV surface antigen (HBsAg) in dried blood spots. The prevalence of 12 high-risk types of human papillomavirus (HPV) was assessed by qPCR in dried cervicovaginal cell spots from 376 of these women. χ2 test was used to compare variables between the populations and binary logistic regression was used to identify risk factors associated with the positivity of the tests. Results The seroprevalence of HSV-2 was 53% and of HBV 10.3%. HBAg was detected in 15.8% of women with anti-HBV antibodies indicating chronic infection. The frequency of high-risk HPV infection was 27%, with the most prevalent high-risk HPV types being HPV 56, 39 and 31 followed by HPV 16 and 18. Finally, none of the 394 women were seropositive for HIV, and about 64% of the studied population was positive for at least one of the viral infections. Conclusions Women in Bolivian rural communities in La Paz show a high prevalence of HBV, HPV and, in particular, HSV-2. In contrast, none of the women were HIV positive, suggesting that the HIV prevalence in this population is low. The pattern of high-risk HPV types differed from many other countries with a predominance of HPV-types not included in the Gardasil vaccine which was officially introduced in Bolivia in April 2017.
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Affiliation(s)
- Marianela Patzi-Churqui
- Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Box 480, S-405 30, Gothenburg, Sweden. .,Unidad de Virología, Inmunidad e Infección, Insituto SELADIS, Facultad de Ciencias Farmacéuticas y Bioquímicas, Universidad Mayor de San Andrés, La Paz, Bolivia.
| | - Katty Terrazas-Aranda
- Unidad de Virología, Inmunidad e Infección, Insituto SELADIS, Facultad de Ciencias Farmacéuticas y Bioquímicas, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Jan-Åke Liljeqvist
- Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kristina Eriksson
- Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Box 480, S-405 30, Gothenburg, Sweden
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Pérez-Stable EJ, Otero-Sabogal R, Sabogal F, Nápoles-Springer A. Pathways to Early Cancer Detection for Latinas: En Acción Contra el Cáncer. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/109019819602301s05] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Latinas have less breast cancer, have more cervical cancer, and obtain fewer screening tests at recommended intervals. This article reviews the epidemiology and use of screening tests for these cancers and cultural factors that affect screening. En Acción Contra el Cáncer was designed to increase use of breast and cervical cancer screening services by distributing free cancer educational materials in Spanish, implementing a media campaign, conducting community outreach, training lay networkers, and assisting clinicians. A survey of 1,601 Latinas, 20 to 74 years old, ascertained screening behavior and knowledge and attitudes about cancer. Comparison of intervention and control cities showed significant differences in proportion insured, married, born in the United States, and less acculturated. There were no significant differences in mammography and Pap smear use, knowledge, and attitudes. Culturally appropriate prevention interventions that target ethnic-specific concerns arc needed.
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Affiliation(s)
| | | | - Fabio Sabogal
- Medical Effectiveness Research Center for Diverse Populations at UCSF
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Mwaka AD, Orach CG, Were EM, Lyratzopoulos G, Wabinga H, Roland M. Awareness of cervical cancer risk factors and symptoms: cross-sectional community survey in post-conflict northern Uganda. Health Expect 2016; 19:854-67. [PMID: 26205470 PMCID: PMC4957614 DOI: 10.1111/hex.12382] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lack of awareness of risk factors and symptoms for cancer may lead to late diagnosis and poor prognosis. OBJECTIVE We assessed community awareness about cervical cancer risk factors and symptoms and perceptions about prevention and cure of cervical cancer in order to contribute data to inform interventions to improve cervical cancer survival. DESIGN Cross-sectional population-based survey. SETTING AND PARTICIPANTS We conducted this study in Gulu, a post-conflict district in Uganda in 2012. The sample included 448 persons aged 18 years and above, selected through a multi-stage stratified cluster sampling process. DATA COLLECTION METHODS AND ANALYSIS We collected data using a pretested structured questionnaire. Logistic regressions were used to determine magnitudes of associations between socio-demographic and outcome variables. RESULTS Most participants (444/448) had heard about cervical cancer. Known risk factors including multiple sexual partners, human papillomavirus infection, and early onset of sexual activity, were recognized by 88%, 82%, and 78% of respondents respectively. 63% of participants believed that prolonged use of family planning pills and injections caused cervical cancer. The majority of participants recognized symptoms of cervical cancer including inter-menstrual bleeding (85%), post-menopausal bleeding (84%), and offensive vaginal discharge (83%). 70% of participants believed that cervical cancer is preventable and 92% believed that it could be cured if diagnosed at an early stage. DISCUSSION AND CONCLUSIONS Recognition of cervical cancer risk factors and symptoms was high among study participants. Targeted interventions including increasing availability of HPV vaccination, population-based cervical screening and diagnostic services can translate high awareness into actual benefits.
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Affiliation(s)
- Amos D Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher G Orach
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Georgios Lyratzopoulos
- Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martin Roland
- Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
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Sabogal F, Perez-Stable EJ, Otero-Sabogal R, Hiatt RA. Gender, Ethnic, and Acculturation Differences in Sexual Behaviors: Hispanic and Non-Hispanic White Adults. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/07399863950172001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hispanics have an increased prevalence of sexually transmitted diseases (STDs). To describe the prevalence of sexual behaviors of Hispanics, we conducted surveys of randomly selected residents in census tract areas and members of a health maintenance organization (n = 2,596). Hispanic men were more likely to start sexual intercourse at an earlier age and reported lower rates of condom use than non-Hispanic White men. Hispanic women reported having a higher number of children, less use of barrier contraception, fewer lifetime sexualpartners, andfewer STDs than non-Hispanic White women. Less-acculturated Hispanic men reported a younger age for theirfirst sexual intercourse and a lower frequency of condom use than did more highly acculturated Hispanic men. Highly acculturated Hispanic women reporteda highernumberof lifetime sexual partners than did less-acculturated women. Gender differences, mediated by marital status, age, and education, were more significantly associated with sexual behavior than ethnicity.
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Epidemiological evidence on environmental tobacco smoke and cancers other than lung or breast. Regul Toxicol Pharmacol 2016; 80:134-63. [PMID: 27321059 DOI: 10.1016/j.yrtph.2016.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 02/07/2023]
Abstract
We reviewed 87 epidemiological studies relating environmental tobacco smoke (ETS) exposure to risk of cancer other than lung or breast in never smoking adults. This updates a 2002 review which also considered breast cancer. Meta-analysis showed no significant relationship with ETS for nasopharynx cancer, head and neck cancer, various digestive cancers (stomach, rectum, colorectal, liver, pancreas), or cancers of endometrium, ovary, bladder and brain. For some cancers (including oesophagus, colon, gall bladder and lymphoma) more limited data did not suggest a relationship. An increased cervix cancer risk (RR 1.58, 95%CI 1.29-1.93, n = 17 independent estimates), reducing to 1.29 (95%CI 1.01-1.65) after restriction to five estimates adjusting for HPV infection or sexual activity suggests a causal relationship, as do associations with nasosinus cancer observed in 2002 (no new studies since), and less so kidney cancer (RR 1.33, 95%CI 1.04-1.70, n = 6). A weaker association with total cancer (RR 1.13, 95%CI 1.03-1.35, n = 19) based on heterogeneous data is inconclusive. Inadequate confounder control, recall bias, publication bias, and occasional reports of implausibly large RRs in individual studies contribute to our conclusion that the epidemiological evidence does not convincingly demonstrate that ETS exposure causes any of the cancers studied.
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Liu ZC, Liu WD, Liu YH, Ye XH, Chen SD. Multiple Sexual Partners as a Potential Independent Risk Factor for Cervical Cancer: a Meta-analysis of Epidemiological Studies. Asian Pac J Cancer Prev 2016; 16:3893-900. [PMID: 25987056 DOI: 10.7314/apjcp.2015.16.9.3893] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
It's known that having multiple sexual partners is one of the risk factors of human papillomavirus (HPV) infection which is a major cause of cervical cancer. However, it is not clear whether the number of sexual partners is an independent risk factor for cervical cancer. We identified relevant studies by searching the databases of MEDLINE, PubMed and ScienceDirect published in English from January 1980 to January 2014. We analyzed those studies by combining the study-specific odds ratios (ORs) using random-effects models. Forty-one studies were included in this meta-analysis. We observed that the number of sexual partners was associated with the occurrence of non-malignant cervical disease (OR=1.82, 95%CI 1.63-2.00) and invasive cervical carcinoma (OR=1.77, 95%CI 1.50-2.05). Subgroup analyses revealed that the association remained significant after controlling for HPV infection (OR=1.52, 95%CI 1.21-1.83 for non-malignant disease; OR=1.53, 95%CI 1.30- 1.76 for invasive cervical carcinoma). We found that there was a non-linear relation of the number of sexual partners with both non-malignant cervical disease and invasive cervical carcinoma. The risk of both malignant and non-malignant disease is relatively stable in women with more than 4-7 sexual partners. Furthermore, the frequency-risk of disease remained significant after controlling for HPV infection.The study suggested that having multiple sexual partners, with or without HPV infection, is a potential risk factor of cervical cancer.
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Affiliation(s)
- Zhi-Chang Liu
- School of Public Health, Guangdong Key Laboratory of Molecular Epidemiology, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China E-mail : ,
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Hanley SJB, Yoshioka E, Ito Y, Konno R, Sasaki Y, Kishi R, Sakuragi N. An exploratory study of Japanese fathers' knowledge of and attitudes towards HPV and HPV vaccination: does marital status matter? Asian Pac J Cancer Prev 2014; 15:1837-43. [PMID: 24641418 DOI: 10.7314/apjcp.2014.15.4.1837] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No studies on male attitudes towards HPV and HPV vaccination have been conducted in Japan, and little is known globally whether attitudes of single fathers differ to those living with a female partner. This exploratory study assessed whether Japanese fathers were likely to have their daughter vaccinated against HPV in a publically funded program and whether any differences existed regarding attitudes and knowledge about HPV according to marital status. MATERIALS AND METHODS Subjects were 27 fathers (16 single; 11 married) who took part in a study on HPV vaccine acceptability aimed at primary caregivers of girls aged 11-14 yrs in three Japanese cities between July and December 2010. RESULTS Knowledge about HPV was extremely poor (mean score out of 13 being 2.74 ± 3.22) with only one (3.7%) participant believing he had been infected with HPV and most (81.4%) believing they had no or low future risk. No difference existed regarding knowledge or awareness of HPV according to marital status. Concerning perceived risk for daughters, single fathers were significantly more likely to believe their daughter was at risk for both HPV (87.5% versus 36.4%; p=0.01) and cervical cancer (75.0% versus 27.3%; p=0.02). Acceptability of free HPV vaccination was high at 92% with no difference according to marital status, however single fathers were significantly more likely (p=0.01) to pay when vaccination came at a cost. Concerns specific to single fathers included explaining the sexual nature of HPV and taking a daughter to a gynecologist to be vaccinated. CONCLUSIONS Knowledge about HPV among Japanese fathers is poor, but HPV vaccine acceptability is high and does not differ by marital status. Providing sexual health education in schools that addresses lack of knowledge about HPV as well as information preferences expressed by single fathers, may not only increase HPV vaccine acceptance, but also actively involve men in cervical cancer prevention strategies. However, further large-scale quantitative studies are needed.
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Schabath MB, Thompson ZJ, Egan KM, Torres BN, Nguyen A, Papenfuss MR, Abrahamsen ME, Giuliano AR. Alcohol consumption and prevalence of human papillomavirus (HPV) infection among US men in the HPV in Men (HIM) study. Sex Transm Infect 2014; 91:61-7. [PMID: 25278617 DOI: 10.1136/sextrans-2013-051422] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Moderate alcohol consumption can impair host defence against viral infections. The objective of this cross-sectional analysis was to assess the association between alcohol intake and prevalent human papillomavirus (HPV) infection among US men enrolled in the HPV in Men (HIM) study using quantitative alcohol intake measured from a Food Frequency Questionnaire. METHODS The HIM study is a prospective, multinational study of the natural history of HPV infection. For this report, we restricted our analyses to men from the US cohort (N = 1313). Samples from the corona of glans penis, penile shaft and scrotum were combined for HPV DNA testing. Self-reported alcohol intake was quantified by grams of alcohol intake per day. Multivariable prevalence ratios (mPRs) were used to assess the association between alcohol intake and HPV infections. RESULTS Prevalent infections were significantly higher among men in the highest quartile of alcohol intake and multivariable models revealed that the highest quartile of alcohol intake was associated with significantly increased risks for any (mPR = 1.13; 95% CI 1.00 to 1.27) HPV types and oncogenic (mPR = 1.35; 95% CI 1.08 to 1.68) HPV types. The fourth quartile of alcohol intake was associated with elevated risks for prevalent HPV infection across all strata of number of sexual partners and among never-smokers and current smokers, but not among former smokers. CONCLUSIONS These results demonstrate that high intake of alcohol is associated with an increased risk for prevalent HPV infections among men. The biological role that alcohol plays in genital HPV infection remains understudied and limited epidemiological data exist, especially among men.
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Affiliation(s)
- Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA Center for Infection Research in Cancer (CIRC), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Zachary J Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kathleen M Egan
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - B Nelson Torres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA Center for Infection Research in Cancer (CIRC), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Anthony Nguyen
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Mary R Papenfuss
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA Center for Infection Research in Cancer (CIRC), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Martha E Abrahamsen
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA Center for Infection Research in Cancer (CIRC), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA Center for Infection Research in Cancer (CIRC), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Liu M, He Z, Zhang C, Liu F, Liu Y, Li J, Xu Z, Wang Q, Hang D, Shen N, Pan Y, Guo C, Cai H, Ke Y. Prevalence, Incidence, Clearance, and Associated Factors of Genital Human Papillomavirus Infection among Men: A Population-Based Cohort Study in Rural China. Cancer Epidemiol Biomarkers Prev 2014; 23:2857-65. [PMID: 25217154 DOI: 10.1158/1055-9965.epi-14-0365] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mengfei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Chanyuan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Fangfang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Ying Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Jingjing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Zhongyao Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Qiyan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Dong Hang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Na Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Yaqi Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China
| | - Hong Cai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China.
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, P.R. China.
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Schabath MB, Villa LL, Lin HY, Fulp WJ, Lazcano-Ponce E, Salmerón J, Abrahamsen ME, Papenfuss MR, Quiterio M, Giuliano AR. A prospective analysis of smoking and human papillomavirus infection among men in the HPV in Men Study. Int J Cancer 2013; 134:2448-57. [PMID: 24222514 DOI: 10.1002/ijc.28567] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/06/2013] [Accepted: 10/16/2013] [Indexed: 11/07/2022]
Abstract
At present it is unknown whether the higher prevalence of human papillomavirus (HPV) infection among smokers in men is attributed to a higher probability of acquiring an infection or because of longer infection persistence. Thus, we investigated the role of smoking on the incidence (acquisition) and clearance (persistence) of genital HPV infections among 4,026 men in the HPV in Men (HIM) Study, a multinational prospective study of the natural history of genital HPV infection in men. Genital HPV infections were grouped by any, oncogenic and nononcogenic HPV infections and smoking status was categorized as current, former and never smokers. The incidence of any, oncogenic and nononcogenic HPV infections was significantly higher among current smokers compared to former and never smokers (p < 0.01). In multivariable analyses adjusting for sexual behavior and potential confounders, when compared to never smokers, current smokers exhibited significantly higher probability of acquiring any [hazard ratio (HR) = 1.23; 95% confidence interval (CI) 1.02-1.50] and nononcogenic (HR = 1.21; 95% CI 1.00-1.45) infections and a borderline significant probability for oncogenic infections (HR = 1.18; 95% CI 0.98-1.41). Although the median duration of HPV infection was generally longer among current smokers, we found no statistically significant associations in the multivariable analyses. Overall, these results demonstrated that current smoking exhibited the highest incidence and highest probability of acquiring genital HPV infections.
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Affiliation(s)
- Matthew B Schabath
- Division of Population Sciences, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Morris DL, Lusero GT, Joyce EV, Hannigan EV, Tucker ER. Cervical Cancer, a Major Killer of Hispanic Women: Implications for Health Education. HEALTH EDUCATION 2013. [DOI: 10.1080/00970050.1989.10622384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Donna LeBlanc Morris
- a University of Texas School of Nursing, J-29, University of Texas Medical Branch , Galveston , TX , 77550 , USA
| | - Gilberto T. Lusero
- b Community Affairs, Center for Cross Cultural Research , University of Texas Medical Branch , Galveston , USA
| | | | - Edward V. Hannigan
- d Division of Gynecologic Oncology, Department of Obstetrics and Gynecology , University of Texas Medical Branch , Galveston , USA
| | - E. Ruth Tucker
- c University of Texas School of Nursing , Galveston , USA
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Akogbe GO, Ajidahun A, Sirak B, Anic GM, Papenfuss MR, Fulp WJ, Lin HY, Abrahamsen M, Villa LL, Lazcano-Ponce E, Quiterio M, Smith D, Schabath MB, Salmeron J, Giuliano AR. Race and prevalence of human papillomavirus infection among men residing in Brazil, Mexico and the United States. Int J Cancer 2012; 131:E282-91. [PMID: 22161806 DOI: 10.1002/ijc.27397] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 11/08/2011] [Indexed: 02/05/2023]
Abstract
Human papillomavirus (HPV) causes anal, penile and oropharyngeal cancers in men. Genital HPV prevalence in men appears to vary by world region with men residing in Asia having among the lowest prevalence. Unfortunately, there is little information on prevalence of HPV infection in men by race. The purpose of this study was to examine HPV prevalence by race across three countries. 3,909 men ages 18-70 years enrolled in an ongoing prospective cohort study of the natural history of HPV in men (The HIM Study) were included in the analysis. Participants completed risk factor questionnaires and samples were taken from the penile epithelium and scrotum for HPV detection. HPV testing of the combined DNA extract was conducted using PCR and genotyping. Asian/Pacific Islanders had the lowest HPV prevalence of 42.2% compared to Blacks (66.2%), and Whites (71.5%). The Asian/Pacific Islander race was strongly protective in univariate analysis (prevalence ratio (PR) = 0.59; 95% confidence interval (CI): 0.48-0.74) and multivariate analysis for any HPV infection (PR = 0.65; 95% CI: 0.52-0.8). Stratified analysis by lifetime number of female partners also showed strong inverse associations with the Asian/Pacific Islander race. We consistently observed the lowest prevalence of HPV infection among Asian/Pacific Islanders with moderate inverse associations even after various adjustments for potential confounding factors. Unmeasured behavioral factors, sexual mixing with low risk women, and/or race-specific differences in the frequency of germline variations among immune regulating genes may underlie these associations. Further studies among Asian populations that incorporate measures of immuno-genetics are needed to understand this phenomenon.
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Affiliation(s)
- Gabriel O Akogbe
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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Dawar DM, Harris MT, McNeil DS. Update on Human Papillomavirus (HPV) Vaccines: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) †. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2012; 38:1-62. [PMID: 31701955 PMCID: PMC6802461 DOI: 10.14745/ccdr.v38i00a01] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schabath MB, Villa LL, Lazcano-Ponce E, Salmerón J, Quiterio M, Giuliano AR. Smoking and human papillomavirus (HPV) infection in the HPV in Men (HIM) study. Cancer Epidemiol Biomarkers Prev 2011; 21:102-10. [PMID: 22016473 DOI: 10.1158/1055-9965.epi-11-0591] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The influence of smoking on the natural history of HPV infection in men is not well understood. Smoking could influence the incidence and persistence of HPV infections by suppressing local immune function, increased cellular proliferation, upregulated proinflammatory factors, or induced host DNA damage resulting in increased susceptibility to infection. The purpose of this analysis is to assess prevalent HPV infections by smoking status in men, and to determine baseline risk of HPV infection associated with smoking. METHODS The HPV in Men (HIM) study is a multinational prospective study of the natural history of HPV infections in men. Samples from the coronal sulcus, glans penis, shaft, and scrotum were combined for HPV DNA testing. Multivariable logistic regression was used to assess the association between smoking and any-, oncogenic-, and nononcogenic HPV infections. RESULTS Our analyses revealed that current smoking was associated with an increased risk of any HPV infection (OR = 1.19; 95% CI: 1.01-1.41) and oncogenic HPV infection (OR = 1.24; 95% CI: 1.05-1.47). However, the association between smoking and any HPV infection (OR = 1.35; 95% CI: 1.05-1.73) and oncogenic HPV infection (OR = 1.46; 95% CI: 1.11-1.92) was only evident among men reporting fewer lifetime sexual partners. DISCUSSION These results suggest that current smokers with the fewest number of sexual partners are associated with an increased risk for oncogenic HPV infection. IMPACT The relationship between smoking and HPV infection remains understudied in men; these data shed new light on the interplay between smoking, sexual activity, and risk of HPV infection.
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Affiliation(s)
- Matthew B Schabath
- H. Lee Moffitt Cancer Center and Research Institute, Cancer Epidemiology Program, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL 33612, USA.
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Giuliano AR, Lee JH, Fulp W, Villa LL, Lazcano E, Papenfuss MR, Abrahamsen M, Salmeron J, Anic GM, Rollison DE, Smith D. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet 2011; 377:932-40. [PMID: 21367446 PMCID: PMC3231998 DOI: 10.1016/s0140-6736(10)62342-2] [Citation(s) in RCA: 323] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Human papillomaviruses (HPVs) cause genital warts and cancers in men. The natural history of HPV infection in men is largely unknown, and that information is needed to inform prevention strategies. The goal in this study was to estimate incidence and clearance of type-specific genital HPV infection in men, and to assess the associated factors. METHODS Men (aged 18-70 years), residing in Brazil, Mexico, and the USA, who were HIV negative and reported no history of cancer were recruited from the general population, universities, and organised health-care systems. They were assessed every 6 months for a median follow-up of 27·5 months (18·0-31·2). Specimens from the coronal sulcus, glans penis, shaft, and scrotum were obtained for the assessment of the status of HPV genotypes. FINDINGS In 1159 men, the incidence of a new genital HPV infection was 38·4 per 1000 person months (95% CI 34·3-43·0). Oncogenic HPV infection was significantly associated with having a high number of lifetime female sexual partners (hazard ratio 2·40, 1·38-4·18, for at least 50 partners vs not more than one partner), and number of male anal-sexual partners (2·57, 1·46-4·49, for at least three male partners vs no recent partners). Median duration of HPV infection was 7·52 months (6·80-8·61) for any HPV and 12·19 months (7·16-18·17) for HPV 16. Clearance of oncogenic HPV infection decreased in men with a high number of lifetime female partners (0·49, 0·31-0·76, for at least 50 female partners vs not more than one partner), and in men in Brazil (0·71, 0·56-0·91) and Mexico (0·73, 0·57-0·94) compared with the USA. Clearance of oncogenic HPV was more rapid with increasing age (1·02, 1·01-1·03). INTERPRETATION The data from this study are useful for the development of realistic cost-effectiveness models for male HPV vaccination internationally. FUNDING National Cancer Institute.
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Affiliation(s)
- Anna R Giuliano
- H Lee Moffitt Cancer Center, Tampa, FL, USA. anna.giuliano@moffi tt.org
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Vardas E, Giuliano AR, Goldstone S, Palefsky JM, Moreira ED, Penny ME, Aranda C, Jessen H, Moi H, Ferris DG, Liaw KL, Marshall JB, Vuocolo S, Barr E, Haupt RM, Garner EIO, Guris D. External genital human papillomavirus prevalence and associated factors among heterosexual men on 5 continents. J Infect Dis 2011; 203:58-65. [PMID: 21148497 PMCID: PMC3086430 DOI: 10.1093/infdis/jiq015] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 08/10/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We examined the baseline prevalence of penile, scrotal, and perineal/perianal human papillomavirus (HPV) in heterosexual men (HM). We also evaluated baseline characteristics of HM to assess factors associated with prevalent HPV detection. METHODS We tested serum samples from 3463 HM aged 16-24 years with 1-5 lifetime female sexual partners for antibodies to HPV 6, 11, 16, and 18. We collected baseline swab specimens for the detection of DNA of HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 from 3 areas: penile, scrotal, and perineal/perianal. Risk factors for prevalent HPV DNA detection were evaluated. RESULTS The prevalence of any tested HPV type was 18.7% at the penis, 13.1% at the scrotum, 7.9% at the perineal/perianal region, and 21.0% at any site. Having >3 lifetime female sexual partners had the greatest impact on HPV prevalence: odds ratio (OR) 3.2 (95% confidence interval (CI) 2.1-4.9) for HPV 6, 11, 16, and 18; and OR 4.5 (95% CI 3.3-6.1) for all HPV types tested. HPV DNA detection was highest in Africa. Neither condom usage nor circumcision was associated with HPV DNA prevalence. CONCLUSION Genital-HPV DNA detection is common in young, sexually active HM. We found HPV to be most prevalent in African men and least prevalent in men from the Asia-Pacific region. Increased numbers of sexual partners was an important risk factor for HPV DNA prevalence.
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Affiliation(s)
- Eftyhia Vardas
- Division of Medical Virology, University of Stellenbosch, South Africa and Lancet Laboratories, Johannesburg, South Africa.
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Parada R, Morales R, Giuliano AR, Cruz A, Castellsagué X, Lazcano-Ponce E. Prevalence, concordance and determinants of human papillomavirus infection among heterosexual partners in a rural region in central Mexico. BMC Infect Dis 2010; 10:223. [PMID: 20667085 PMCID: PMC2941497 DOI: 10.1186/1471-2334-10-223] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 07/28/2010] [Indexed: 11/18/2022] Open
Abstract
Background Although human papillomavirus (HPV) infection in heterosexual couples has been sparsely studied, it is relevant to understand disease burden and transmission mechanisms. The present study determined the prevalence and concordance of type-specific HPV infection as well as the determinants of infection in heterosexual couples in a rural area of Mexico. Methods A cross-sectional study was conducted in 504 clinically healthy heterosexual couples from four municipalities in the State of Mexico, Mexico. HPV testing was performed using biotinylated L1 consensus primers and reverse line blot in cervical samples from women and in genital samples from men. Thirty-seven HPV types were detected, including high-risk oncogenic types and low-risk types. Multivariate logistic regression models were utilized to evaluate factors associated with HPV. Results The prevalence of HPV infection was 20.5% in external male genitals and 13.7% in cervical samples. In 504 sexual couples participating in the study, concordance of HPV status was 79%; 34 partners (6.7%) were concurrently infected, and 21 out of 34 partners where both were HPV positive (61.8%) showed concordance for one or more HPV types. The principal risk factor associated with HPV DNA detection in men as well as women was the presence of HPV DNA in the respective regular sexual partner (OR = 5.15, 95%CI 3.01-8.82). In men, having a history of 10 or more sexual partners over their lifetime (OR 2.5, 95%CI 1.3 - 4.8) and having had sexual relations with prostitutes (OR 1.7, 95%CI 1.01 - 2.8) increased the likelihood of detecting HPV DNA. Conclusions In heterosexual couples in rural regions in Mexico, the prevalence of HPV infection and type-specific concordance is high. High-risk sexual behaviors are strong determinants of HPV infection in men.
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Affiliation(s)
- Rocio Parada
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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20
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Garland SM. Prevention strategies against human papillomavirus in males. Gynecol Oncol 2010; 117:S20-5. [PMID: 20138347 DOI: 10.1016/j.ygyno.2010.01.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 12/22/2022]
Abstract
Sexually transmitted human papillomavirus (HPV) infection is very common in men and women. Oncogenic HPV is strongly associated with cancers and high-grade dysplasias of the anogenital tract, including the anus, penis, and also a proportion of oropharyngeal cancers. In reducing male disease burden, some consider screening and treatment for high-grade anal dysplasia (AIN) to prevent anal cancer in high-risk populations. Such strategies have wide implications for the workforce, and require more evidence for the optimal management of AIN. Male sexual behavior, with consequent HPV infection and disease contribute to considerable disease burden in females. Hence, inclusion of males in prophylactic HPV vaccination programs should prevent HPV-related disease in males as well as substantially reducing disease burden in females. Clinical trial data in males 16-26 years for the quadrivalent vaccine show it is well tolerated, induces a strong type-specific immunological response comparable to that of females, and reduced vaccine HPV-type-related genital infection, as well as disease. Cost-benefit analyses and mathematical modeling show that the most cost-effective strategy involves routine administration of this vaccine to 12-year-old females, with catch-up vaccination of 12- to 24-year-olds, with the most effective strategy in disease reduction including men and/or boys in the program. Such a vaccination strategy including 12-year-old boys is projected by 2050 to reduce HPV 16 infection by 88-94% in females and 68-82% in males, plus the aforementioned male HPV- related cancers by 22-27%. Therefore, inclusion of males in an HPV vaccination program is likely to have significant health and economic benefits over and above those observed from current female-only programs. However, comprehensive cost-benefit analyses are needed to determine the efficacy of these programs in the overall population. Such analyses will be crucial for the design, acceptance, and implementation of these vaccination programs into clinical practice globally.
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Affiliation(s)
- Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
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21
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The Epidemiology behind the HPV Vaccine Discovery. Ann Epidemiol 2009; 19:239-44. [DOI: 10.1016/j.annepidem.2009.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 01/30/2009] [Indexed: 11/22/2022]
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Human papillomavirus infection in men residing in Brazil, Mexico, and the USA. SALUD PUBLICA DE MEXICO 2009; 50:408-18. [PMID: 18852938 DOI: 10.1590/s0036-36342008000500014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/10/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess Human Papillomavirus (HPV) type distribution among men ages 18 years and older recruited from three different countries utilizing a common protocol for sampling HPV detection, and to evaluate whether HPV detection differs by age and country. MATERIAL AD METHODS: The study protocol includes a pre-enrollment run-in visit, a baseline (enrollment) visit, and nine additional visits after enrollment scheduled six months apart. For this analysis, the first 1160 men who completed both the run-in and baseline visit were included. To maximize sampling and prevent fraying of applicators, three different applicators were utilized to sample the external genitalia of participants among different anatomic sites. These samples were later combined to form a single sample for the detection of HPV using polymerase chain reaction (PCR) for amplification of a fragment of the HPV L1 gene. RESULTS Among 1160 men from Brazil, Mexico, and the United States (U.S.), overall HPV prevalence was 65.2%; with 12.0% oncogenic types only, 20.7% non-oncogenic types only, 17.8% both oncogenic and non-oncogenic, and 14.7% unclassified infections. Multiple HPV types were detected in 25.7% of study participants. HPV prevalence was higher in Brazil (72.3%) than in the U.S. (61.3%) and Mexico (61.9%). HPV 16 (6.5%), 51 (6.5%), and 59 (5.3%) were the most commonly detected oncogenic infections, and HPV 84 (7.7%), 62 (7.3%), and 6 (6.6%) were the most commonly detected non-oncogenic infections. Overall HPV prevalence was not associated with age. However, significant associations with age were observed when specific categories of oncogenic, non-oncogenic, and unclassified HPV infections were considered. CONCLUSIONS Studies of HPV type distribution among a broad age range of men from multiple countries is needed to fill the information gap internationally with respect to our knowledge of HPV infection in men.
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Nielson CM, Schiaffino MK, Dunne EF, Salemi JL, Giuliano AR. Associations between male anogenital human papillomavirus infection and circumcision by anatomic site sampled and lifetime number of female sex partners. J Infect Dis 2009; 199:7-13. [PMID: 19086813 DOI: 10.1086/595567] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Male circumcision may lower men's risk of human papillomavirus (HPV) infection and reduce transmission to sex partners. Reported associations between circumcision and HPV infection in men have been inconsistent. METHODS Four hundred sixty-three men in 2 US cities were tested at 6 anogenital sites and in semen for 37 types of HPV. Men were eligible if they reported sex with a woman within the past year, no history of genital warts or penile or anal cancer, and no current diagnosis of a sexually transmitted infection. Participants completed a self-administered questionnaire. Circumcision status was assessed by the study clinician. Logistic regression was used to examine associations between circumcision and HPV detection at each site and in semen, with adjustment for potential confounders. RESULTS Seventy-four men (16.0%) were uncircumcised. Adjusted odds ratios (AORs) for any HPV genotype and circumcision were 0.53 (95% confidence interval [CI], 0.28-0.99) for any anatomic site/specimen, 0.17 (95% CI, 0.05-0.56) for the urethra, 0.44 (95% CI, 0.23-0.82) for the glans/corona, and 0.53 (95% CI, 0.28-0.99) for the penile shaft. AORs were <1.0 but not statistically significant for the scrotum, semen, anal canal, and perianal area. CONCLUSIONS Circumcision may be protective against HPV infection of the urethra, glans/corona, and penile shaft.
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Abstract
BACKGROUND For human papillomavirus (HPV) vaccination to have maximum benefit to public health, both men and women should be vaccinated. Although efficacy trials in men are still ongoing, the HPV vaccine will likely be licensed for men in the near future. Little is known about men's interest in HPV vaccination. This study assessed whether informing men about the benefits of male HPV vaccination for their female sexual partner(s) boosted interest in the HPV vaccine beyond informing them about the benefits to men alone. Predictors of HPV vaccine acceptability were also identified. METHODS Heterosexual male college students (n = 356) were randomly assigned to receive a self-protection versus a self-protection and partner protection message about HPV and the quadrivalent HPV vaccine. Participants provided demographic and sexual history information, HPV-related awareness and knowledge, health beliefs, and HPV vaccination intentions. RESULTS : Men reported moderate interest in the HPV vaccine; vaccine acceptability did not differ by experimental condition. A multivariate regression model identified several independent predictors of HPV vaccine acceptability including sexual activity, perceived susceptibility to HPV, perceived benefits of the vaccine, perceived hassle and cost of vaccination, self-efficacy for vaccination, and perceived norms for vaccination. CONCLUSION Informing men about the benefits of male HPV vaccination for reducing cervical cancer risk in women did not increase men's interest in the vaccine. Correlates of vaccine acceptability among men were generally consistent with those identified for women. Findings have important implications for future HPV vaccination campaigns targeting young adult men.
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Lu B, Wu Y, Nielson C, Flores R, Abrahamsen M, Papenfuss M, Harris R, Giuliano A. Factors Associated with Acquisition and Clearance of Human Papillomavirus Infection in a Cohort of US Men: A Prospective Study. J Infect Dis 2009; 199:362-71. [DOI: 10.1086/596050] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Flores R, Lu B, Beibei L, Nielson C, Abrahamsen M, Wolf K, Lee JH, Harris RB, Giuliano AR. Correlates of human papillomavirus viral load with infection site in asymptomatic men. Cancer Epidemiol Biomarkers Prev 2009; 17:3573-6. [PMID: 19064573 DOI: 10.1158/1055-9965.epi-08-0467] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Numerous studies have evaluated human papillomavirus (HPV) DNA load in women, especially HPV-16 viral load, and its role in cervical carcinogenicity. Few studies have examined HPV viral load in men, none among asymptomatic men. The aim of the current study is to quantify HPV-16 viral load in male anogenital specimens and to explore its correlates with anatomic sites. Two-hundred and ninety-four specimens from 42 men who tested positive for HPV-16 at one or more anatomic sites were evaluated. HPV DNA was detected with PGMY 09/11 primer and genotyped with reverse line blot assay followed by HPV-16 viral quantification using type-specific real-time PCR assay (TaqMan). The quantitative PCR assay showed a higher sensitivity in HPV-16 viral DNA detection compared with the reverse line blot assay. Viral load varied significantly by anatomic site (P = 0.019). Penile shaft specimens had significantly higher viral load than any other anatomic site evaluated except for the anal canal. HPV-16 viral load was positively correlated between proximal anatomic sites: perianal and anal canal (P = 0.003), perianal and scrotum (P = 0.011), scrotum and glans/corona (P = 0.045), and scrotum and penile shaft (P = 0.037). In conclusion, the penile shaft seemed to be the preferred site for HPV-16 viral replication. Viral load correlation between proximal sites suggested a possible autoinoculation in male HPV transmission.
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Affiliation(s)
- Roberto Flores
- Cancer Prevention Fellowship Program, National Cancer Institute, NIH, 6120 Executive Boulevard, EPS Suite T-41, Bethesda, MD 20892-7105, USA.
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Giuliano AR, Lazcano-Ponce E, Villa LL, Flores R, Salmeron J, Lee JH, Papenfuss MR, Abrahamsen M, Jolles E, Nielson CM, Baggio ML, Silva R, Quiterio M. The human papillomavirus infection in men study: human papillomavirus prevalence and type distribution among men residing in Brazil, Mexico, and the United States. Cancer Epidemiol Biomarkers Prev 2008; 17:2036-43. [PMID: 18708396 DOI: 10.1158/1055-9965.epi-08-0151] [Citation(s) in RCA: 233] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Male sexual behavior influences the rates of cervical dysplasia and invasive cervical cancer, as well as male human papillomavirus (HPV) infection and disease. Unfortunately, little is known regarding male HPV type distribution by age and across countries. In samples combined from the coronal sulcus, glans penis, shaft, and scrotum of 1,160 men from Brazil, Mexico, and the United States, overall HPV prevalence was 65.2%, with 12.0% oncogenic types only, 20.7% nononcogenic types only, 17.8% both oncogenic and nononcogenic, and 14.7% unclassified infections. Multiple HPV types were detected in 25.7% of study participants. HPV prevalence was higher in Brazil (72.3%) than in the United States (61.3%) and Mexico (61.9%). HPV16 (6.5%), HPV51 (5.3%), and HPV59 (5.3%) were the most commonly detected oncogenic infections, and HPV84 (7.7%), HPV62 (7.3%), and HPV6 (6.6%) were the most commonly detected nononcogenic infections. Overall HPV prevalence was not associated with age. However, significant associations with age were observed when specific categories of HPV, nononcogenic, and unclassified HPV infections were considered. Studies of HPV type distribution among a broad age range of men from multiple countries is needed to fill the information gap internationally with respect to our knowledge of HPV infection in men.
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Affiliation(s)
- Anna R Giuliano
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC 2067D, Tampa, FL 33612, USA.
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Giuliano AR, Lu B, Nielson CM, Flores R, Papenfuss MR, Lee JH, Abrahamsen M, Harris RB. Age-specific prevalence, incidence, and duration of human papillomavirus infections in a cohort of 290 US men. J Infect Dis 2008; 198:827-35. [PMID: 18657037 DOI: 10.1086/591095] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infections cause disease in men and women, and male-to-female HPV transmission influences the risk of cancer in females. The purpose of the present study was to describe the overall and age-specific incidence and clearance of HPV infections in men. METHODS In a prospective cohort study of 290 men aged 18-44 years, participants were examined at baseline and every 6 months, with a mean duration of follow-up of 15.5 months. RESULTS The period prevalence was 52.8% for any, 31.7% for oncogenic, and 30.0% for nononcogenic HPV infection. The 12-month cumulative risk of acquiring a new HPV infection was 29.2%. Incidences of HPV types 6, 11, 16, and 18 were 2.8, 0.5, 4.8, and 0.8 per 1000 person-months, respectively. The median time to clearance of any HPV infection was 5.9 months (95% confidence interval, 5.7-6.1 months), with comparable times to clearance for oncogenic and nononcogenic infections. Approximately 75% of men tested negative for any HPV 12 months after initial HPV detection. Age was not significantly associated with HPV incidence or duration of infection in men. CONCLUSION HPV infection in men was common, with relatively rapid rates of acquisition and clearance.
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Affiliation(s)
- Anna R Giuliano
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612 , USA.
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Giuliano AR, Salmon D. The Case for a Gender-Neutral (Universal) Human Papillomavirus Vaccination Policy in the United States: Point. Cancer Epidemiol Biomarkers Prev 2008; 17:805-8. [DOI: 10.1158/1055-9965.epi-07-0741] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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30
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Giuliano AR. Human papillomavirus vaccination in males. Gynecol Oncol 2007; 107:S24-6. [DOI: 10.1016/j.ygyno.2007.07.075] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022]
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Giuliano AR, Nielson CM, Flores R, Dunne EF, Abrahamsen M, Papenfuss MR, Markowitz LE, Smith D, Harris RB. The optimal anatomic sites for sampling heterosexual men for human papillomavirus (HPV) detection: the HPV detection in men study. J Infect Dis 2007; 196:1146-52. [PMID: 17955432 DOI: 10.1086/521629] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 05/03/2007] [Indexed: 12/25/2022] Open
Abstract
Background. Human papillomavirus (HPV) infection in men contributes to infection and cervical disease in women as well as to disease in men. This study aimed to determine the optimal anatomic site(s) for HPV detection in heterosexual men.Methods. A cross-sectional study of HPV infection was conducted in 463 men from 2003 to 2006. Urethral, glans penis/coronal sulcus, penile shaft/prepuce, scrotal, perianal, anal canal, semen, and urine samples were obtained. Samples were analyzed for sample adequacy and HPV DNA by polymerase chain reaction and genotyping. To determine the optimal sites for estimating HPV prevalence, site-specific prevalences were calculated and compared with the overall prevalence. Sites and combinations of sites were excluded until a recalculated prevalence was reduced by <5% from the overall prevalence.Results. The overall prevalence of HPV was 65.4%. HPV detection was highest at the penile shaft (49.9% for the full cohort and 47.9% for the subcohort of men with complete sampling), followed by the glans penis/coronal sulcus (35.8% and 32.8%) and scrotum (34.2% and 32.8%). Detection was lowest in urethra (10.1% and 10.2%) and semen (5.3% and 4.8%) samples. Exclusion of urethra, semen, and either perianal, scrotal, or anal samples resulted in a <5% reduction in prevalence.Conclusions. At a minimum, the penile shaft and the glans penis/coronal sulcus should be sampled in heterosexual men. A scrotal, perianal, or anal sample should also be included for optimal HPV detection.
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Affiliation(s)
- Anna R Giuliano
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA.
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Plett-Torres T, Cruz-Valdez A, Esquivel-Guadarrama F, Hernández-Nevarez P, Lazcano-Ponce E, Gutiérrez-Xicotencatl L. Frequency of antibodies against E4 and E7 from human papillomavirus type 16 in Mexican soldiers. Arch Virol 2006; 152:97-114. [PMID: 16896549 DOI: 10.1007/s00705-006-0829-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Accepted: 06/28/2006] [Indexed: 11/29/2022]
Abstract
The high prevalence of HPV in men's genitalia and the low frequency of virus-associated lesions gave rise to questions on the influence of infection-site on the HPV antibody profile. In a cross-sectional study, HPV infection in penis and urethra, and serum antibodies against HPV-16 E4 and E7 proteins were evaluated in 288 Mexican soldiers. The results showed that HPV prevalence was 31% (51% in penis, 11% in urethra and 38% in both sites), while 47% were multiple infections. Overall, seroprevalence was 13% for anti-E4 antibodies and 6% for anti-E7. However, the highest prevalence of anti-E4 antibodies was observed in men with HPV infection in urethra (30%), while for E7 antibodies, the highest prevalence (10%) was found in men who tested positive for HPV in penis. The prevalence of IgG and IgA anti-E4 was related to HPV-16 urethral infection, while detection of HPV-16 in penis was related to IgG anti-E7 prevalence. In conclusion, the high-risk sexual behavior observed in this population might be responsible for high HPV prevalence and multiple infections. However, the seroprevalence of E4 and E7 was similar to that observed in healthy Mexican women. These results suggest that the humoral immune response against HPV infection in men differs, depending on the site of infection.
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Affiliation(s)
- T Plett-Torres
- Center for Research on Infectious Diseases, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Arora R, Kumar A, Prusty BK, Kailash U, Batra S, Das BC. Prevalence of high-risk human papillomavirus (HR-HPV) types 16 and 18 in healthy women with cytologically negative Pap smear. Eur J Obstet Gynecol Reprod Biol 2005; 121:104-9. [PMID: 15950365 DOI: 10.1016/j.ejogrb.2004.11.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2004] [Revised: 11/17/2004] [Accepted: 11/25/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the prevalence of high-risk human papillomavirus (HR-HPV) types 16 and 18 in healthy women with negative Pap smears in identifying women with underlying cervical squamous intra-epithelial (SIL) lesions. METHODS A total of 3300 women who were attending the Gynecology OPD of Lok Nayak Hospital, one of the major government tertiary hospitals in New Delhi, were screened during a 1-year study period, and 2079 (63%) of them were found to have cytologically negative Pap smear with inflammation and the rest (37%) also had negative Pap report but without inflammation. Hundred and sixty of these sexually active women aged between 20 and 60 years were randomly selected, and were investigated by colposcopy and a guided biopsy was done wherever required. HPV types 16 and 18 DNA was detected in scraped cervical cells from all women using type-specific primers in polymerase chain reaction (PCR). RESULTS The high-risk HPV (type 16 and 18) prevalence by PCR was found to be 10% (16/160). Histopathological findings were obtained in 123 women, out of which 15 had LSIL and four had HSIL. High-risk HPV types 16/18 could be detected in nine out of these 19 (47.3%) squamous intra-epithelial lesions (p < 0.00008) which includes two out of the four women (50%) having HSIL, while only seven out of 104 (6.7%) of the subjects with normal (negative) Pap reports (p = 0.03) had infection of high-risk HPV. CONCLUSION The results indicate that about 10% of women who show a negative Pap smear, but have inflammation are positive for high-risk HPV types 16/18 and about 15% harbor squamous intra-epithelial lesions. It is suggested that high-risk HPV detection can be utilized as an adjunct to routine cytology screening programs to identify 'high risk' women who have concurrently negative Pap smears but may harbor oncogenic HPV infection and/or more likely to develop CIN lesions.
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Affiliation(s)
- Raksha Arora
- Department of Obstetrics and Gynecology, Lok Nayak Hospital, New Delhi, India
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Baldwin SB, Wallace DR, Papenfuss MR, Abrahamsen M, Vaught LC, Giuliano AR. Condom use and other factors affecting penile human papillomavirus detection in men attending a sexually transmitted disease clinic. Sex Transm Dis 2005; 31:601-7. [PMID: 15388997 DOI: 10.1097/01.olq.0000140012.02703.10] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Human papillomavirus (HPV) is the primary cause of cervical, anal, and other anogenital cancers, but risk factors for penile HPV detection in men have not been well-characterized. GOAL The goal of this study was to identify correlates of penile HPV detection in ethnically diverse men attending a sexually transmitted disease clinic. STUDY A cross-sectional investigation was conducted among 393 men. Participants completed a risk-factor questionnaire and underwent testing for penile HPV DNA. Presence of HPV DNA was assessed using polymerase chain reaction with PGMY primers and reverse line blot genotyping. Logistic regression analyses were conducted to identify variables associated with any-type, oncogenic, and nononcogenic HPV. RESULTS Circumcision was associated with reduced risk for oncogenic, nononcogenic, and overall HPV. Regular condom use was associated with reduced risk for oncogenic and overall HPV. CONCLUSION These findings, if confirmed by other studies, could impact public health practices and messages regarding HPV.
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Affiliation(s)
- Susie B Baldwin
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, Arizona, USA.
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Lee PN. Environmental tobacco smoke and cancer of sites other than the lung in adult non-smokers. Food Chem Toxicol 2002; 40:747-66. [PMID: 11983270 DOI: 10.1016/s0278-6915(02)00027-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence from epidemiological studies relating environmental tobacco smoke (ETS) exposure to risk of cancer of sites other than the lung in adult non-smokers is reviewed. Problems common to many studies include small sample size, inadequate control of potential confounding, failure to consider the possibility of misclassification of smoking status, reliance on death certificate diagnosis, use of proxy respondents and the possibility of recall bias. A number of the studies have other obvious weaknesses. Publication bias is known to be a problem, with two very large prospective studies having reported only very limited results. For cancers of the digestive system, bladder and brain, there is little evidence of an association with ETS exposure. Some studies have reported a relationship with cancer of the breast, cervix or nasopharynx, but the overall evidence for these sites is inconsistent and inconclusive, as is that for total cancer incidence. All three studies of nasosinus cancer have reported a statistically significant association with ETS exposure, but they are small, control poorly for potential confounding and have other weaknesses. Taken as a whole, the epidemiological evidence provides little support for the view that ETS causes cancer of any of the sites considered.
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Affiliation(s)
- P N Lee
- P.N. Lee Statistics and Computing Ltd, Hamilton House, 17 Cedar Road, Sutton, Surrey SM2 5DA, UK.
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37
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Abstract
In the southern United States, North Carolina has attracted an unprecedented influx of Hispanic immigrants in the 1990s. Detailed data on the sexual behavior of these recent immigrants are lacking. This exploratory study used two methods, a survey and qualitative interviews. For both methods, participants were recruited using convenience sampling. All study participants were first-generation Mexican immigrants who had lived in North Carolina for at least six consecutive months. The survey, administered face-to-face, explored the sexual attitudes and behavior of 43 married Mexican men living in North Carolina. The qualitative interviews, conducted with men (n = 20) and women (n = 19), explored immigrants' perceptions of extramarital sex and sexually transmitted diseases (STDs). The study's results suggest that the sexual behavior of 'unaccompanied' married Mexican immigrant men, living alone in North Carolina, differs, at least in degree if not in kind, from that of 'accompanied' married men, residing in the state with their wives. Unaccompanied men who participated in the survey reported more lifetime sexual partners, more partners in the previous year, more extramarital partners and more contact with prostitutes than accompanied survey respondents. The qualitative interviews suggest that unaccompanied men's peculiar status as 'single' men in North Carolina may provide them with both motive and opportunity to have extramarital sexual relationships and that few married Mexican men and women perceive STDs as relevant to their lives. Overall, the study supports the need for male- and couple-focused STD prevention interventions for Hispanic immigrants.
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Affiliation(s)
- C I Viadro
- Research Triangle Institute, Research Triangle Park, NC 27709-2194, USA.
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Sevin BU. Social implications of sexually transmitted cancer. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 1999; 8:759-66. [PMID: 10495257 DOI: 10.1089/152460999319084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The long, tedious search for the causes of and cure for the human nemesis, cancer, has not resulted in one astounding breakthrough discovery. Instead, researchers have slowly and painstakingly made small inroads into the understanding of the way cell growth goes awry and becomes malignant, destroying tissues and, if unchecked, spreading to other organs of the body and eventually causing death. One of those inroads is the discovery that a cancer of the uterine cervix is almost certainly caused by a virus transmitted through sexual contact. This article presents the biological, clinical, and psychosocial aspects of cervical cancer. Cancer of the cervix usually is preceded by a slowly progressive preinvasive lesion, dysplasia, which can be detected by a screening test, the Papanicolaou smear, and effectively treated with organ-preserving local therapy. Because dysplasia and early invasive cancer usually develop in young women, the need for conservative management is of utmost importance to preserve a woman's ability to have children. The social and psychological impacts of a cancer occurring in young women are enormous and are further magnified by the fact that this cancer may be caused by a sexually transmitted virus. Sexual practice patterns, number of sexual partners, smoking, and other behavioral aspects contribute to the complexity of this disease. However, early detection of preinvasive and invasive cancer is possible with fairly simple and inexpensive means, and curative therapy is available. The disastrous impact of cervical cancer theoretically could be contained if patients at risk regularly participate in early detection programs. Also, the disease could, to a large extent, be prevented altogether through healthful behavior and sexual practices. The social challenge is to provide this information to the public in a nonthreatening, nonmoralistic fashion. We especially need to help young people to accept that sex within a caring, responsible relationship is a healthy human response and, at the same time, understand that there are dangers associated with transmittable diseases that can have profound effects on their ability to have children and on their lives.
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Affiliation(s)
- B U Sevin
- Department of Obstetrics and Gynecology, Mayo Clinic Jacksonville, Florida, USA
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Nápoles-Springer A, Pérez-Stable EJ, Washington E. Risk factors for invasive cervical cancer in Latino women. J Med Syst 1996; 20:277-93. [PMID: 9001995 DOI: 10.1007/bf02257041] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Most invasive cervical cancer research in the United States has been conducted on non-Latino-White (NLW) and African-American women. Incidence, mortality, stage at diagnosis and survival indicators for invasive cervical cancer in Latino women in California are compared to NLW and African-American women. A model is presented which depicts structural, behavioral, genetic and biological risk factors for invasive cervical cancer. A literature review of risk factors and their association with invasive cervical cancer was conducted using MEDLINE and PsychINFO databases to determine if ethnic differences in risk factors explain observed differences in morbidity and mortality. Latino women experience a significantly higher incidence and mortality associated with invasive cervical cancer than NLW women. The review of risk factors found that rate differences of cervical cancer screening, early detection and human papilloma virus (HPV) type-specific infection explain much of the disparity in disease burden. Further research must clarify if ethnic differences exist in risk factors associated with ethnic variation in HPV-type prevalence in both cases and their sexual partners, in host immune responses, and multiparity.
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Affiliation(s)
- A Nápoles-Springer
- Department of Medicine, University of California, San Francisco 94143, USA
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Levine LA, Elterman L, Rukstalis DB. Treatment of subclinical intraurethral human papilloma virus infection with interferon alfa-2b. Urology 1996; 47:553-7. [PMID: 8638367 DOI: 10.1016/s0090-4295(99)80494-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Anogenital human papilloma virus (HPV) infection represents a growing concern among physicians in the United States. An intraurethral reservoir of the virus has been suggested as a possible source for reinfection between sexual partners, and may contribute to the increase in the number of affected individuals. Treatment reports of intraurethral HPV infection with adequate follow-up have been lacking. Our goals in this study were to identify the patients with cytologic evidence of HPV intraurethral infection, and to attempt treatment with intraurethral instillations of interferon alfa-2b. METHODS Eighty-nine men with anogenital lesions or known exposure to HPV underwent cytologic examination using a urethral swab after all visible disease was adequately treated. Sixteen patients with positive cytology results were treated with weekly instillations of 25 million U of interferon alfa-2b solution for 6 weeks. Urethral cytology was monitored at 2 and 6 weeks post-treatment, as well as every 3 months thereafter up to a year. Those who had a recurrence during the study were retreated with a 6-week course using 50 million U per instillation. Patients were monitored for possible side effects. RESULTS Seventeen (19%) of 89 patients who entered the study had urethral cytology positive for HPV infection with no evidence of visible disease. Seven (41%) of these 17 patients did not show external (meatal or skin) manifestations of the disease. Fourteen of 16 (88%) men who underwent the therapy were followed for an average of 11.8 months. Nine of those 14 (64%) remained disease free throughout the follow-up. Of the 5 who had a recurrence, 3 were successfully retreated, with a mean of 7.2 months of disease-free follow-up after the second course. No adverse effects of the treatment were noted by blood testing, semen analysis, and patient report. CONCLUSIONS The urethra is a significant HPV reservoir and should be investigated in patients exposed to the virus. Interferon is a potentially safe and effective treatment option for intraurethral HPV.
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Affiliation(s)
- L A Levine
- Rush-Presbyterian St. Luke's Medical Center, Department of Urology, Chicago, Illinois 60612-3864, USA
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41
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Abstract
Epidemiologic and laboratory data suggest that cervical cancer typically arises from a series of causal steps. Each step can be studied separately in the hope of better etiologic understanding and improved cancer prevention. The earliest identified etiologic step is infection of young women with specific types of venereally transmissible human papillomaviruses (HPVs). Cervical HPV infections often lead to low grade squamous intraepithelial lesions (mildly abnormal Pap smears). Human papillomavirus infections and their associated lesions are extremely common among young, sexually active women. The infections typically resolve spontaneously even at the molecular level within months to a few years. Uncommonly, HPV infections and/or low grade lesions persist and progress to high grade lesions. The risk factors for progression are mainly unknown but include HPV type and intensity, cell-mediated immunity, and reproductive factors. Nutritional factors or co-infection with other pathogens may also be involved at this apparently critical etiologic step between common low grade and uncommon high grade intraepithelial lesions. Except for advancing age, no epidemiologic risk factors have been found for the next step between high grade intraepithelial lesions and invasive cancer. At the molecular level, invasion is associated with integration of viral DNA. Based on worldwide research, the steps in cervical carcinogenesis appear to be fundamentally the same everywhere, with a central role for HPV infection. The importance of etiologic cofactors like smoking, however, may vary by region.
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Affiliation(s)
- M H Schiffman
- Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, Maryland 20892-7374, USA
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Abstract
Screening for cervical neoplasia has been effective in decreasing invasive cervical cancer. As the understanding of the association of HPV with cervical neoplasia increases, new screening interventions may be developed. Classification of cytologic abnormalities and the management of abnormal smears continue to evolve. Ancillary screening techniques such as HPV typing and cervicography may be useful but need further study.
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Affiliation(s)
- J Appleby
- Department of Medicine, University of Texas Health Science Center at San Antonio
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Formenti SC, Meyerowitz BE, Ell K, Muderspach L, Groshen S, Leedham B, Klement V, Morrow PC. Inadequate adherence to radiotherapy in Latina immigrants with carcinoma of the cervix. Potential impact on disease free survival. Cancer 1995; 75:1135-40. [PMID: 7850712 DOI: 10.1002/1097-0142(19950301)75:5<1135::aid-cncr2820750513>3.0.co;2-m] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Radiation therapy plays an important role in the loco-regional control of carcinoma of the cervix. Strict adherence to the radiation protocol, without the introduction of time breaks, has been shown to favorably affect loco-regional control and survival, making adherence a crucial variable for optimal outcome. Because carcinoma of the cervix is a common disease among Latinas, with survival rates worse than those of other ethnic groups in this country, the pattern of adherence to the prescribed radiation treatment among Latina patients seen at Los Angeles County Hospital were studied. METHODS The records of 69 consecutive Latina patients with cervical cancer who received radiation therapy at Los Angeles County Hospital were reviewed. Semi-structured interviews in a successive group of 30 similar patients were conducted to acquire preliminary information about their psychosocial characteristics. RESULTS The results demonstrate inferior rates of optimal adherence to radiation treatment among Latina immigrant patients when compared with the rates reported in the literature for the general population of cervical cancer patients in United States (16 vs. 63%). Furthermore, a large subset of patients (20%) in the series elected to discontinue treatment without a medical reason. When a comparable group of Latina patients was interviewed, potential practical, psychologic, and cultural barriers to optimal care were identified. CONCLUSIONS The results from this exploratory study support the need for further studies to document the pattern of adherence to radiotherapy in the rest of the country among this minority population. The results suggest that an intervention to improve information and adherence to radiation therapy may be necessary to assure Latinas a chance for rates of cure comparable with the national standards.
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Affiliation(s)
- S C Formenti
- Department of Radiation Oncology, University of Southern California, Los Angeles 90033
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Abstract
Despite recent calls for greater collaboration between medical anthropologists and epidemiologists, examples of synthetic, interdisciplinary anthropological-epidemiological research are frankly rare, due in large part to perceptions among medical anthropologists that anthropology and epidemiology diverge considerably in their topics of inquiry, epistemological assumptions, methods of data collection and notions of risk and responsibility for illness. In this article, five of these perceived areas of divergence are examined, with an attempt to reconceptualize them as areas of potential convergence.
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Affiliation(s)
- M C Inhorn
- Department of Anthropology, Emory University, Atlanta, GA 30322
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45
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Abstract
The data on the etiological factors presented here may enable us to suggest a synergism between the various factors associated with the pathogenesis of cervical cancer. Infection of the cervix by HPV 16/18 may result in persistence of viral DNA. The persistent HPV-DNA undergoes disruption at the E2 region, when integrated into the host genome. The transcriptional products E6 and E7 oncoproteins bind to and cause the degradation of p53 and Rb tumor-suppressor gene products. It is possible that, at that point, other cofactors may be involved in the progression toward a precancerous or cancerous condition. Those cofactors may include cigarette smoking, by introducing co-carcinogens to the tissue or by suppressing the local or systemic immune resistance similar to the effect of depressed immune resistance seen in AIDS or immunosuppression of transplant patients; hormones, by enhancing growth of HPV and transformation of HPV infected cells; low serum vitamin levels leading to decreased tissue resistance; or other infections causing local inflammation and the production of free radicals. CIN develops, leading eventually to cervical cancer.
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Affiliation(s)
- J Bornstein
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
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Mehal WZ, Lo YM, Herrington CS, Evans MF, Papadopoulos MC, Odunis K, Ganesan TS, McGee JO, Bell JI, Fleming KA. Role of human papillomavirus in determining the HLA associated risk of cervical carcinogenesis. J Clin Pathol 1994; 47:1077-81. [PMID: 7876378 PMCID: PMC502196 DOI: 10.1136/jcp.47.12.1077] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS To investigate the role of human papillomavirus (HPV) in the association between HLA DQw3 and squamous cell cancer of the cervix (SCCC). METHODS Tissue from 194 cervical samples, ranging from normal, through cervical intraepithelial neoplasia, to SCCC, were typed for HPV by amplification of the L1 gene using degenerate consensus primers, followed by oligonucleotide probing. HLA DQw3 typing was undertaken in the same samples using a new PCR amplification system using primers common to all DQ loci, followed by restriction digestion with Mlu 1 to differentiate HLA DQw3 types--null, heterozygous, and homozygous. The data were analysed using chi 2 analysis and by calculating relative risks with the 95% confidence interval. RESULTS Samples (n = 188) were successfully typed for HPV and 177 were typed for HLA DQw3. There was a nonsignificant rise in the prevalence of HLA DQw3 in SCCC (64.3%) compared with the group with normal histology (53.2%). Analysis of the prevalence of HLA DQw3 on the basis of HPV infection rather than histology showed that 63 of 95 (66.3%) of the HPV positive samples contained HLA DQw3 alleles, compared with 39 of 78 (50.0%) of the HPV negative samples (chi 2 4.06; p < 0.05). CONCLUSIONS There was a significant association between HLA DQw3 and cervical HPV infection. This may be because people with HLA DQw3 are less able to mount an effective immune response to HPV, which predisposes them to the development of SCCC.
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Affiliation(s)
- W Z Mehal
- Nuffield Department of Pathology and Bacteriology, University of Oxford, John Radcliffe Hospital
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Kant A, Palm I, van den Hoogen H, van Weel C. Feasibility of comparing risk profiles for cervical cancer between participants and nonparticipants in a screening programme. Scand J Prim Health Care 1994; 12:204-8. [PMID: 7997700 DOI: 10.3109/02813439409003700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Feasibility of comparing risk profiles by questionnaire of participants and nonparticipants in a cervical screening programme: does asking information on sexual behaviour by means of a questionnaire lead to high non-response? is the non-response selective (related to participation in the screening) and if so how can we limit this? DESIGN A postal survey on risk factors for cervical cancer, including sexual behaviour, in a group of participants and nonparticipants. SETTING Two villages, Wijchen and Beuningen, situated near Nijmegen in The Netherlands. SUBJECTS 139 participants and 99 nonparticipants in the national screening programme in 1989 or 1990. RESULTS Overall, the response to the questionnaire was high: 83%. Collecting the questionnaire by asking the women to return it by mail in a stamped addressed envelope and one reminder by phone showed a response rate of 79%. This response was selective: 93% of the participants in the screening responded and 61% of the nonparticipants. Collecting them personally showed an extremely high response of 96% which was not selective. Only 3 respondents did not answer the questions about sexual behaviour. MAIN CONCLUSION Obtaining information on sexual behaviour by questionnaire is feasible. Selective response can be limited by an extremely high response rate, which can be achieved by collecting the questionnaires personally.
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Affiliation(s)
- A Kant
- Department of Pathology, University of Nijmegen, The Netherlands
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Affiliation(s)
- C A Graham
- Oncology Program, Harris Methodist Fort Worth, TX
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49
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Goodkin K, Antoni MH, Sevin B, Fox BH. A partially testable, predictive model of psychosocial factors in the etiology of cervical cancer i. Biological, psychological and social aspects. Psychooncology 1993. [DOI: 10.1002/pon.2960020203] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Birthistle K, Kaminski G, McKenna P, Hillary I. Use of the polymerase chain reaction to detect human papillomavirus type 16 in the cervical scrapes of Irish women with varying grades of cervical intraepithelial neoplasia. J Eur Acad Dermatol Venereol 1992. [DOI: 10.1111/j.1468-3083.1992.tb00649.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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