Cervical cancer in Thailand: 2023 update

Cervical cancer continues to pose a challenge to the health of Thai women, as the second most common cancer after breast cancer. Since high-risk human papillomavirus (HPV) types are the main cause for cervical cancer, cervical cancer screening and HPV vaccination are necessary to reduce the incidence of this disease. At present, the World Health Organization hopes to reduce the incidence of cervical cancer to 4 or less cases per 100,000 women-years using 90%- 70%-90% intervention by 2030. The first intervention involves vaccinating 90% of women aged 15 years with the HPV vaccine. The second intervention involves screening 70% of women between the ages of 35 and 45 years using a high-performance screening test. The third intervention involves detecting cervical lesions in 90% of affected women to enable diagnosis and treatment. In this context, this study reviews trends in the incidence and mortality rates of cervical cancer in Thailand, in addition to providing an up-to-date overview of the causes and necessary risk factors for cervical cancer, as well as reporting on cervical screening and HPV vaccination rates and cervical cancer during the coronavirus disease 2019 (COVID-19) pandemic. This study may prove useful for the formulation of policy aimed at eliminating cervical cancer in Thailand, such as the implementation of a free HPV vaccine service and providing athome kits for cervical screening through clinics and pharmacies. In addition, this review also highlights the need for further research on the effects of the COVID-19 pandemic on cervical cancer screening rates in Thailand.

Assessment of knowledge and attitude of cervical cancer among the youths in the Rayalaseema region of Andhra Pradesh - India

BACKGROUND

India suffers a quarter of the global burden of cervical cancer (CC) but is controllable by taking some precautions. The major issue is the low amount of participation among women in screening and vaccination for disease. The objective of the research is to evaluate knowledge, attitude, and practice (KAP) regarding CC among college going students residing in the Rayalaseema region of Andhra Pradesh-India.

MATERIAL AND METHODS

A cross-sectional study was conducted on a total of 380 subjects whose ages ranged from 15 to 25 and older. The questionnaires were circulated through google forms. The socio-demographic variables and KAP levels are represented by descriptive statistics. The Chi-square test is used to determine the relationship between sociodemographic factors and KAP levels.

RESULTS

Among 380 subjects, 172 (54.7%) are aware of CC, 71% have poor knowledge, and 20% have good knowledge about CC. More than three-fourths of women 374 (98.4%) are not having regular practice towards CC.

CONCLUSION

The awareness about CC is very low in the population, so prevention of CC relies on routine screening, proper vaccination, and treatment. Awareness programs and promoting knowledge about cervical health in social media are required.

Prevalence of human papillomavirus infection and associated factors among women attending cervical cancer screening in setting of Addis Ababa, Ethiopia

Human papillomaviruses (HPVs) are circular, nonenveloped small double-stranded DNA viruses that infect stratified epithelium and can cause a number of life-threatening diseases. HPV is the central risk factor for developing cervical cancer and is estimated that approximately 98% of this disease is associated with oncogenic types of HPV. HPV infection leads to an estimated 266,000 cervical cancer deaths annually. Therefore, the objective of this study was to determine the prevalence of HPV infection and risk factors associated with cervical lesion among women attending the cervical cancer screening clinic at the Ethiopian Family Guidance Association, Addis Ababa. A cross-sectional study was conducted to determine the prevalence of HPV infection. Data were collected using a questionnaire and samples leftover from cervical screening were taken. The leftover swab was air dried and DNA was extracted and amplified by using a PCR. A total of 247 women were included in the study. The prevalence of HPV was 9.72% among the population studied. Of all participants, 27.13% were positive for cervical intraepithelial neoplasia-1 (CIN1). CIN1 positivity was found in half of HPV positive women. Among HPV positive women, half of them had started sexual intercourse at ages 12-17 years and 41.66% were women who gave birth at ages 12-17 years. The high prevalence of HPV and the CIN1 positive group were ages 36-57 and women with multiple sexual partners. The other groups with the highest CIN1 positive were 22.39% grade (9-12) and 20.9% primary (1-8) and uneducated women. Among HPV positive women, 83.33% had an abortion history and 80% miscarried in the first trimester. Among the CIN1 positives, 53.73% had more than two sexual partners. Among HPV positive women, half of them were users of contraception methods. In conclusion, the highest prevalence of HPV is among women who began sexual intercourse earlier and who gave birth at 12-17 years of age, have an abortion history, with MSP and oral contraceptive methods users. In addition to HPV, early pregnancy and sexual intercourse at 12-17 years of age, abortion, MSP, and oral hormonal contraceptives are factors in cervical cancer. Finally, most women do not have enough knowledge and awareness about cervical cancer and the risk factor.

Second-hand smoke exposure and cervical cancer: a systematic review and meta-analysis

PURPOSE

The association between second-hand smoke (SHS) exposure and cervical cancer (CC) risk is still unclear. The aim of this study is to provide an accurate and updated estimate of this association.

METHODS

Through an original methodology to identify original publications, we conducted a systematic review and meta-analysis of all epidemiological studies published up to October 2022 evaluating the association between SHS exposure and CC risk among female non-smokers. Meta-analytic estimates were obtained using random-effects models and dose-response relationships were derived using log-linear functions.

RESULTS

Out of 25 eligible studies, 21 were included in the meta-analysis, providing a pooled relative risk (RR) of cervical intraepithelial neoplasia (CIN) of grade 2 or higher of 1.52 (95% confidence interval, CI 1.30-1.78, 21 studies) for overall SHS exposure versus non-exposure. When restricting the analysis to invasive CC, the pooled RR was 1.42 (95% CI 1.17-1.71, 13 studies), whereas the pooled RR for CIN was 1.50 (95% CI 1.22-1.84, 6 studies). Analyzing RR by setting or source of SHS exposure resulted in significant associations with CC risk for SHS exposure at home (RR for CIN2+  1.49, 95% CI 1.21-1.84, 14 studies), in non-specified settings (RR for CIN2+  1.64, 95% CI 1.20-2.23, 8 studies) and from partner (RR for CIN2+  1.55, 95% CI 1.25-1.94, 10 studies). The risk of CIN2+ significantly increased linearly with the intensity and pack-years of SHS exposure.

CONCLUSION

This comprehensive review and meta-analysis confirmed the association of SHS exposure with CC, further suggesting the need to raise concern about SHS exposure in the population.

Galectin-8 and -9 as prognostic factors for cervical cancer

Purpose

Galectins are carbohydrate-binding proteins with multiple effects on cell biology. Research shows that they play an important role in tumor development and progression. Therefore, in this study, the presence of Galectin-8 and -9 (Gal), both already known as prognostic factors in other tumor entities, were investigated in cervical cancer. Our aim was to examine the association of Gal-8 and -9 expression with histopathological markers and survival of the patients.

Methods

Gal-8 and -9 expression was investigated in 250 cervical cancer samples by immunohistochemistry. The staining was evaluated using the immunoreactive score (IRS). The results were correlated to clinical and pathological data. The correlation of Gal-8 and -9 expression with overall and relapse-free survival was analyzed.

Results

Expression of Gal-8 was associated with negative N-status and lower FIGO status. Detection of Gal-9 was connected to negative N-status and lower grading regarding all specimens. A correlation of Gal-9 with lower FIGO status was detected for squamous cell carcinoma (SCC) only. Expression of Gal-8 was associated with relapse-free survival of SCC patients in a positive manner. Gal-9 expression was associated with better overall survival.

Conclusion

Our results suggest that expression of both galectins is inversely associated with tumor stage and progression. Gal-8 expression is associated with relapse-free survival of patients with SCC, while presence of Gal-9 in cervical cancer is associated with a better prognosis in regard of overall survival.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00404-022-06449-9.

Determinants of positive cervical cancer screening among reproductive‐age women in South Wollo Zone, Northeast Ethiopia

Background

Cervical cancer is one of the reproductive organ cancers found in women which commonly arises from the cervix. It is the second most prevalent cancer among women in developing countries including Ethiopia. However, the association between positive cervical cancer screening and modifiable behavioral risk has not been well characterized in developing countries.

Objective

To identify determinants of positive cervical cancer screening among reproductive‐age women in the South Wollo Zone, Amhara region, northeast Ethiopia.

Method

An unmatched case‐control study design was conducted from January 28 to April 12, 2020 in the South Wollo Zone. Four hundred ten clients participated in the study with 82 cases 328 controls. Study subjects were selected by systematic random sampling. Data entered using Epi data version 3.1 and analyzed using SPSS version 24. A bivariable and multivariable logistic regression model was done. The adjusted odds ratio with its 95% confidence interval (CI) was used to measure the strength and direction of the association and P‐value <.05 was declared as significant.

Results

A total of 410 study subjects have participated with a 100% response rate. The mean age of respondents was found to be 35.58 (±8.05) years. Study participants having a history of sexually transmitted infections (adjusted odds ratio [AOR] = 3.69, 95% CI [1.70‐8.01]), having poor knowledge about cervical cancer (AOR = 2.31, 95% CI [1.32‐4.02]) and two or more lifetime sexual partners of women and husbands (AOR = 2.80, 2.55, 95% CI [1.22‐6.44, 1.28‐5.06]) respectively were independent predictors of positive cervical cancer screening.

Conclusion and recommendation

Risk factors that determine positive cervical cancer screening were identified. Comprehensive strategies that are focused on addressing sexual behavior and knowledge gaps should be designed. Efforts on improving and cultivating those significant factors should be done by stakeholders to prevent cervical cancer.

High parity is associated with increased risk of cervical cancer: Systematic review and meta-analysis of case-control studies

Background:

Cervical cancer is the fourth most common cancer among women. High parity has long been suspected with an increased risk of cervical cancer. Evidence from the existing epidemiological studies regarding the association between parity and cervical cancer is variable and inconsistent. Therefore, the objective of this systematic review and meta-analysis was to synthesize the best available evidence on the epidemiological association between parity and cervical cancer.

Methods:

Case–control studies reporting the association between parity and cervical cancer were systematically searched in databases like MEDLINE/PubMed, HINARI, Google scholar, Science direct, and Cochrane Libraries. All studies fulfilling the inclusion criteria and published between 2000 and 7 March 2020 were included in this meta-analysis. This study reported according to PRISMA guideline. Cochran’s Q-statistics and I² tests were performed to assess heterogeneity among included studies. Egger’s regression analysis was performed to assess publication bias. A random-effect meta-analysis model was used to compute pooled odds ratio of the association between parity and cervical cancer.

Results:

A total of 6685 participants (3227 patients and 3458 controls) were incorporated in the 12 studies included in this meta-analysis. The meta-analysis revealed that women with high parity had 2.65 times higher odds of developing cervical cancer compared to their counterparts (odds ratio = 2.65, 95% confidence interval = 2.08–3.38).

Conclusion:

High parity is positively associated with cervical cancer. Strong epidemiological studies are recommended to further explore the mechanisms and role of parity in the causation of cervical cancer.

Tobacco use and its association with HPV infection in normal uterine cervix: A study from a Sustainable Development Goals perspective

INTRODUCTION

To achieve the Sustainable Development Goals (SDGs) target 2030, the United Nations (UN) endorsed tobacco use reduction, which is essential in decreasing unnecessary deaths caused by tobacco-induced disease. This study investigates the association between tobacco use and Human Papillomavirus (HPV) infection in clinically normal uterine cervix populations from the SDGs perspective.

METHODS

This study is a 7-year cross-sectional study of a clinically normal uterine cervix population, based on negative Visual Inspection of Acetic Acid (VIA). Subjects were recruited consecutively from the medical records of several public and private health providers in Jakarta. The Statistical Product and Service Solutions (SPSS) for Windows version 20.0 were used to analyze the data.

RESULTS

A total of 1397 negative VIA subjects were collected, consisting of 4.9% (69/1397) tobacco users, and 95.1% (1328/1397) non-users. HPV-DNA positive were 4.3% (3/69) in the tobacco user group and 3.7% (49/1328) in the non-user group. Statistical analysis showed unadjusted OR was 1.19 (95% CI: 0.36–3.91, p=0.778) and adjusted OR was 1.18 (95% CI: 0.36–3.89, p=0.786). High-risk HPV (hrHPV) infections of tobacco and non-tobacco users’ groups were found in 2/3 and 27/49 (55.1%), respectively.

CONCLUSIONS

This study showed an insignificant statistical association between tobacco use and HPV infection in normal uterine cervix. However, the proportion of hrHPV infection was higher in tobacco users than non-users. From the SDGs perspective, cervical cancer is closely related to tobacco use and poverty. Further study is needed to support this result and evaluate other co-factor role-related cervical cancer history to achieve SDGs in 2030.

Genetic Polymorphisms of Vitamin D Receptor Gene are Associated with Cervical Cancer Risk in Northeastern Thailand

OBJECTIVE

This study aimed to explore whether VDR polymorphisms (Fok1, Apa1 and Taq1) are associated to the cervical cancer in Thai population.

MATERIALS AND METHODS

Subjects of 204 cervical cancer patient and 204 age-matched healthy control were enrolled in the case-control study. VDR polymorphisms were detected by using real-time PCR. Haplotype analysis of three loci was applied to the obtained genotypes.

RESULTS

Significantly increased risk for cervical cancer was observed in carriers of TT genotype (p = 0.0388) and T allele (p = 0.0357) of Fok1 and TC genotype (p = 0.0001), CC genotype (p = 0.0160) and the C allele of Taq1 (p = 0.0001). Haplotype analyses revealed a significant correlation between C-T-C, T-G-C and T-T-C haplotypes and elevated risk for cervical cancer (OR = 2.06; 95%CI = 1.06-4.00; p = 0.0313, OR = 2.15; 95%CI = 1.22-3.80; p = 0.0078 and OR = 2.81; 95%CI = 1.53-5.16; p = 0.0006, respectively). Furthermore, haplotype carrying C allele of Taq1 (C-G-C + C-T-C + T-G-C + T-T-C) significantly increased cervical cancer risk with OR of 1.92 (95%CI = 1.32-2.79, p = 0.0006).

CONCLUSION

Our finding revealed an association between VDR polymorphisms and cervical cancer risk. Taq1 C allele might be a molecular marker for cervical cancer development.<br />.

Genetic Polymorphisms of the Human Cytochrome P450 1A1 (CYP1A1) and Cervical Cancer Susceptibility among Northeast Thai Women

Background:

CYP1A1 is an enzyme in phase I of the cytochrome P450 (CYP) superfamily, and plays a key role in detoxification of carcinogens. Host genetic predisposition in the CYP1A1 may be associated with an increased susceptibility to cervical cancer.The study aimed to evaluate four common polymorphisms of the CYP1A1 and cervical cancer susceptibility among Northeast Thai women.

Methods:

A case-control study was conducted involving 204 patients with squamous cell cervical cancer (SCCA) and 204 age-matched healthy controls. DNA was extracted from peripheral blood leucocytes. CYP1A1 m1, m3, and m4 genotypes were detected using PCR-RFLP, whereas the CYP1A1 m2 genotype was investigated using real-time PCR. Haplotype analysis was performed using PHASE algorithm version 2.1.1.

Results:

CYP1A1 m3 was monomorphic. Association between the common CYP1A1 polymorphisms, m1 and m2, and cervical cancer risk was not observed (p>0.05), nor was any association found between the m1–m2–m4 haplotype and cervical cancer risk (p>0.05). Interestingly, the CA genotype of CYP1A1 m4 was observed in 30.88% of the cervical cancer patients but was absent in healthy controls.

Conclusion:

Our results demonstrated a possible involvement of the CYP1A1 m4 polymorphism but no other common polymorphisms (viz., m1, m2, and m3) in the risk for cervical cancer.This finding may be useful when screening for risk of cervical cancer among Northeast Thai women.

The Preventive Effect of Dietary Antioxidants Against Cervical Cancer Versus the Promotive Effect of Tobacco Smoking

Uterine cervical cancer is the fourth most common cancer in women, and its etiology has been recognized. High-risk human papilloma virus (HR-HPV) infection induces an opportunity for malignant transformation. This paper discusses the current issues based on a review of the literature and compares the impact of the dietary and nutrient intake to the impact of tobacco smoking on cervical cancer development. The important roles of diet/nutrition in cervical cancer are as prophylaxis against HR-HPV infection. Antioxidant vitamins can inhibit the proliferation of cancer cells, stabilize the p53 protein, prevent DNA damage, and reduce immunosuppression. In contrast, tobacco smoking not only causes DNA adducts and strand breaks, but it independently causes an increased viral load in HR-HPV-infected cells. Tobacco smoking induces the heightened expression of E6 and E7 and can inhibit the immune system response to HPV. What happens when two materials, which have opposite effects on cervical cells, are taken in at the same time? The negative effects of tobacco smoking may be stronger than the positive effects of vitamins, vegetables, and fruits on the regression of cervical disease such as cervical intraepithelial neoplasia (CIN). A relatively low intake of vitamins, vegetables, and fruits in combination with tobacco smoking was most associated with a high incidence of cervical neoplasia.

Association between secondhand smoke exposure and abnormal cervical cytology: A one-to-one matched case-control study

INTRODUCTION

The aim was to evaluate the association between secondhand smoke (SHS) exposure and abnormal cervical cytology among Chinese adult women.

METHODS

A one-to-one matched case-control study was conducted with outpatients of the First Hospital of Jilin University between October 2013 to September 2016. In all, 228 cytologic confirmed new cases of abnormal cervical cytology and the equivalent number of age and ethnic matched controls were interviewed about SHS exposure and related factors.

RESULTS

Although 78.3% of all the participants had been exposed to SHS (78.1% subjects vs 78.5% controls), there were no statistical significance of cervical cytological abnormalities and SHS exposure status (never, former, current exposure), exposure intensity in cigarettes per day (none, 1–9, 10–19, and ≥20), SHS exposure duration in years (none, 1–9, 10–19, and ≥20) and the Brinkman Index (BI) (none, 1–99, 100–399, ≥400) between the two groups. The univariate analysis results showed that there were statistical differences between subjects and controls in marital status, sexual frequency in past year, number of sexual partners, age at first intercourse, age at first delivery. The stratified Cox regression model only showed that the age at first sexual intercourse was associated with the cervical cytological abnormalities (OR=1.206, 95% CI: 1.104–1.319).

CONCLUSIONS

Studies on the association between SHS exposure and cervical lesions have been equivocal. In this study, the SHS exposure could not be detected as an independent risk factor of abnormal cervical cytology among Chinese adult women.

Combined Effect of Secondhand Smoking and Alcohol Drinking on Risk of Persistent Human Papillomavirus Infection

Tobacco smoking is established as a cofactor of human papillomavirus (HPV) for cervical cancer risk. However, the role of secondhand smoking in cervical carcinogenesis is controversial. We aimed to assess the association between secondhand smoking and high risk- (HR-) HPV persistence, a pivotal event in development of cervical cancer. In total, 9,846 women who underwent health-screening examinations from 2002 to 2011 at the National Cancer Center, Korea, were included. Secondhand smoking was defined as being exposed to secondhand smoke at home or in the workplace. Multivariate logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) for risks of HR-HPV infection at baseline (N, 9,846, negative vs. positive), 1-year persistence (n, 1,237, 1-year negative vs. 1-year persistence), and 2-year persistence (n, 481, 2-year negative vs. 2-year persistence). Active smoking, secondhand smoking, and secondhand smoking in nonactive smokers had no association with these risks. Among alcohol drinkers, secondhand smoking in nonactive smokers had higher risks of HR-HPV infection at baseline (OR = 1.25, 95% CI = 1.05-1.48, p for multiplicative interaction = 0.003), 1-year persistence (1.75, 1.14-2.68, 0.004), and 2-year persistence (2.96, 1.42-6.15, 0.006), when compared to HR-HPV negative, 1-year negative, and 2-year negative categories, respectively. However, among nonalcohol drinkers, there was no association between smoking or secondhand smoking status and these risks. These findings suggest that women exposed to secondhand smoking at home or in the workplace might be at high risk of HR-HPV persistence when it is combined with alcohol drinking, even though neither active smoking nor secondhand smoking independently affects the risk.

The relation of passive smoking with cervical cancer: A systematic review and meta-analysis

BACKGROUND

Published studies about passive smoking and cervical cancer have found inconsistent results. Hence, the present meta-analysis was performed to assess this association.

METHODS

A systematical search was performed to identify eligible cohort and case-control studies in PubMed, Scopus, Elsevier ScienceDirect, and Web of Science databases (up to March, 2018). The quality of included studies was assessed by the Newcastle-Ottawa quality scale (NOS). The random effects model (REM) was used to calculate the pooled odds ratio (ORs). Subgroup and sensitivity analyses were performed. Publication bias was assessed by funnel plot, using Begg's test and Egger's test.

RESULTS

Around 14 eligible studies were included for analysis, which included a total of 384,995 participants. The pooled ORs of passive smoking with cervical cancer risk was 1.70 (95% CI: 1.40-2.07, I = 64.3%). Subgroups stratified by continent, study design, quality score, and cervical cancer types/phases suggested that the result was robust. For instance, the pooled ORs for the cohort and case-control studies was 1.37 (95% CI: 1.16-1.62, I = 0%) and 2.09 (95% CI: 1.52-2.89, I = 76.6%), respectively. The pooled ORs ranged from 1.61 (95%CI: 1.34-1.92) to 1.77 (95%CI: 1.44-2.16) after one study was removed each time in the sensitivity analyses, indicating that the result was stable. Publication bias was detected by funnel plot and Egger's tests. The recalculated ORs were 1.33 (95% CI: 1.21-1.47).

CONCLUSIONS

This meta-analysis provides evidence that passive smoking is associated with an increased risk of cervical cancer.

Exploring Iranian women's perceptions and experiences regarding cervical cancer-preventive behaviors

BACKGROUND

Preventive behaviors regarding cervical cancer are essential for women's health. Even though many studies have addressed women's knowledge and attitudes toward cervical cancer, little information is available about their experiences of cervical cancer-preventive behaviors. Thus, the aim of this study is to explore the perceptions and experiences of Iranian women regarding cervical cancer-preventive behaviors.

METHODS

This study used a qualitative approach and was conducted in Zanjan, Iran. Participants included 27 women, aged 20-60 years, with no previous history of cervical cancer symptoms or diagnosis. Data were obtained through semi-structured in-depth interviews and focus group discussions. Inductive qualitative content analysis was employed to converge and compare themes through participant data.

RESULTS

The following six main themes emerged from the analysis: attitudes toward cervical cancer and preventive behaviors, preventive behaviors' concept, self-care, religion and culture, perceived social support, and awareness about cervical cancer and preventive behavior. The findings revealed that several women had misconceptions about cervical cancer and were even superstitious about the causes of it. Fear, shame, and embarrassment were reasons for not undertaking cervical cancer screening. Cervical cancer was also linked to worries about decreased marital satisfaction, sexuality, and femininity. However, religion was considered a positive factor to conducting cancer-preventive behaviors.

CONCLUSIONS

This study showed that improving knowledge about the causes of cervical cancer, increasing awareness of the potential consequences of it, and creating positive attitudes toward screening behavior might encourage Iranian women to perform cervical cancer-preventive behaviors.

Association of Combined Tobacco Smoking, Hormonal Contraceptive use and Status Matrimonial with Cervical Cancer Evolution in Tunisian Women

Status matrimonial, cigarette smoking and hormonal contraceptive (HC) use have been associated with cervical cancer (CC) establishment by influencing the CC carcinogenesis process. In the present study, we aim to confirm this correlation between these factors and the risk of CC occurrence among Tunisian population. To evaluate the role of matrimonial status, smoking and HC as cofactors of CC installation, we performed a random selection of 600 women from Salah Azeiz institute in Tunisia and a questionnaire was conducted by doctors for each patient. Logistic regression after adjustment for potential confounding factors, relative excess risk due to interaction (RERI) and synergy index (S) were used to evaluate the additive interaction. Subgroup analysis was conducted to examine whether the relative risks changed with CC stages. There were an excess risk among smoker patients and patient with HC use (p < 0.001) for CC installation. Women who are smokers have a 14 times greater risk of suffering from cervical cancer and approximately 24 times greater to develop an advanced form of CC malignancy. Having a history of using birth control pills increase CC occurrence and aggravation (OR~2). The matrimonial status seems an important factor for CC appearance (OR = 3.58 and 2.46) among CC Tunisian patient. However, no significant biological interaction from this three joint exposure was observed in the early FIGO stages but the risk increase in advanced FIGO stages. In our Tunisian cohort, oral contraception, smoking habit and matrimonial status are associated with an overall increased risk of CC development. Indeed, it may damage the local immunity system and may affect the disease severity in patient carriers of some genetic risk biomarkers. The balance of cancer risks may vary among Tunisian CC patient, depending on some environmental co-factors.

Prevalence of human papillomavirus types associated with cervical lesions in Sergipe state, Northeastern Brazil: high frequency of a possibly carcinogenic type

Persistent infection with high-risk human papillomavirus (HPV) is the main cause of cervical cancer and the prevalence of HPV types varies depending on the geographic region. Therefore, this study assessed the prevalence of HPV types in women with cervical lesions from Sergipe state, Northeastern Brazil. A cross-sectional study was conducted in women with cervical lesions from March to December 2014. These lesions were investigated by PCR and HPV types were identified by DNA sequencing. 432 patients were included, of which 337 patients tested positive for HPV. Eighteen different HPV types were detected, and high-risk HPV types were detected in 69.2%. HPV 16 (63.4%) was the most prevalent HPV type found, followed by HPV 66 (4.6%), HPV 18 (1.6%) and HPV 45 (1.4%). These results highlight the importance of the high prevalence of HPV 66, which is a possibly carcinogenic virus type not covered by the available vaccines. The prevalence of HPV 16 was high in the studied population, reaffirming the importance of young vaccination. However, the high prevalence of HPV 66 found in this study shows the importance of monitoring the diversity of HPV types in different populations and geographic regions to better understand the impacts of current HPV vaccines.

Genetic Polymorphism of the Glutathione S-transferase Pi 1 (GSTP1) and Susceptibility to Cervical Cancer in Human Papilloma Virus Infected Northeastern Thai Women

Objective:

We aimed to investigate any association between a genetic polymorphism of the detoxification GSTP1 gene and risk of cervical cancer in northeastern Thailand.

Materials and Methods:

Genotyping of GSTP1 was performed for 198 squamous cell cervical cancer (SCCA) patients and 198 age-matched healthy controls with the PCR-RFLP method.

Results:

The respective frequencies of the G allele were 0.33 and 0.26 in the controls and cases, the difference being significant (OR = 0.69 [95% CI: 0.50-0.95, p=0.0192]). Among women infected with high-risk types of HPV, being a heterozygous carrier was associated with a reduced risk of cervical cancer (adjusted OR = 0.32 [95% CI: 0.12-0.91, p=0.031]). Similarly, a decreased risk was observed in heterozygous women with a non-smoking partner (adjusted OR = 0.27 [95% CI: 0.09-0.83, p=0.023]).

Conclusions:

GSTP1 polymorphism could influence susceptibility to cervical cancer among northeast Thai women; either as a independent factor or in combination with high-risk HPV infection. Dual-testing of HPV and the GSTP1 might prove an effective screening tool for cervical cancer.

Association Between Passive Smoking and the Risk of Cervical Intraepithelial Neoplasia 1 in Korean Women

Background

The role of passive smoking on cervical carcinogenesis remains controversial. We investigated the association of passive smoking with the risk of cervical intraepithelial neoplasia (CIN) and cervical cancer.

Methods

The study recruited 1,322 women, aged 18–65 with normal cytology (n = 592), CIN1 (n = 420), CIN2/3 (n = 165), and cervical cancer (n = 145) from 2006 to 2009. This study is a cross-sectional analysis using the baseline data from the Korean human papillomavirus (HPV) cohort study. Detailed information on smoking behaviors and lifestyles were collected using questionnaires. Multinomial logistic regression analysis was performed to estimate multivariable-adjusted odds ratios (ORs).

Results

Passive smoking was not statistically related to the risk of CINs and cervical cancer. However, passive smoking among non-smokers was associated with higher CIN 1 risk (OR 1.53; 95% confidence interval [CI], 1.07–2.18), compared to not passive smoking, after adjusting for demographic factors, lifestyles, and oncogenic-HPV infection status. CIN 1 risk increased with longer time exposed to passive smoking (P for trend <0.0003). Multivariate odds of <2 hours/day of passive smoking and that of ≥2 hours/day of passive smoking were 2.48 (95% CI, 1.49–4.14) and 2.28 (95% CI, 1.21–4.26) for CIN 1, compared to not passive smoking.

Conclusions

This study found that passive smoking among non-smoking women is associated with the risk of CIN 1.

Socio-Demographic, Reproductive and Clinical Profile of Women Diagnosed with Advanced Cervical Cancer in a Tertiary Care Institute of Delhi

INTRODUCTION

Cervical cancer is one of the leading cancers among Indian women with estimated 123,000 new cases and 67,477 deaths in 2012. Cervical cancer is a multi-etiological disease. Factors such as low socioeconomic status, tobacco use, sexual and reproductive factors, HIV and other sexually transmitted diseases and long-term oral contraceptive use have been suggested as determinants. Assessment of socio-demographic profile and reproductive history gives a better picture of the determinants of cervical carcinoma in low-resource settings.

METHODS

This hospital-based cross-sectional study was undertaken at a tertiary healthcare institute at New Delhi, India. Sixty-seven newly diagnosed women with advanced cervical cancer (stage 2B-4B), who were undertaking radio- and/or chemotherapy, were included to assess their socio-demographic, reproductive and clinical profile.

RESULTS

The mean age of women at the time of detection of cervical cancer was 52.28 ± 11.29 years (range 30-75 years). More than 60 % of patients were illiterate and belonged to middle socioeconomic status. Thirty-nine percentage of the study subjects had their first sexual experience before 15 years of age. Nearly 54 % women had 5 or more pregnancies. Nearly 73 % of women had all deliveries at home. Majority (69 %) of women had symptoms suggestive of reproductive tract infection. Among them, unusual discharge from vagina (73.13 %) followed by bleeding after menopause (55.10 %) and pain in abdomen (44.77 %) were the most common presenting complaints. Pallor was present in nearly two-third (63.93 %) study subjects. More than half (56.72 %) study subjects had moderate anemia, and 7.46 % had severe anemia before treatment. Mean hemoglobin level of the study subjects was 10.35 ± 1.72 gm% before treatment and 9.69 ± 1.29 gm% after treatment. This difference was statistically significant. Around 97 % of the study subjects had squamous cell carcinoma of the cervix. Majority (53.73 %) of the study subjects were in stage 3B of cervical cancer. Combination of radiotherapy and chemotherapy was the most common (77.67 %) modality of treatment.

CONCLUSIONS AND RECOMMENDATIONS

Illiteracy, low socioeconomic status, early sexual debut, high fertility, home delivery, reproductive tract infections, use of insanitary clothes during menstruation and anemia were observed in majority of women with advanced cancer cervix. Presence of these factors indicates possible risk of cervical cancer and should be kept in mind when women seek health services. Early diagnosis through high risk or opportunistic screening and timely management of cervical cancer needs to be ensured for better outcomes.

Preliminary evaluation of the in vitro efficacy of 1, 2-di (quinazolin-4-yl) diselane against SiHa cervical cancer cells

Cervical cancer is one the most common malignancies among females. In recent years, its incidence rate has shown a rising trend in some countries so that development of anticancer drugs for cervical cancer is an urgent priority. In our recent anticancer drug discovery screen, 1, 2-di (quinazolin-4-yl)diselane (LG003) was found to possess wide spectrum anticancer efficacy. In the present work, the in vitro anticancer activity of LG003 was evaluated in the SiHa cervical cancer cell line. Compared with commercial anticancer drugs 10-hydroxycamptothecin, epirubicin hydrochloride, taxol and oxaliplatin, LG003 showed better anticancer activity. Furthermore, inhibition effects were time- and dose-dependent. Morphological observation exhibited LG003 treatment results in apoptosis like shrinking and blebbing, and cell membrane damage. Lactate dehydrogenase release assay revealed that LG003 exerts such effects in SiHa cells through a physiology pathway rather than cytotoxicity, which suggests that title compound LG003 can be a potential candidate agent for cervical cancer.

Socio-demographic and reproductive determinants of cervical neoplasia in seven sub-Sahara African countries

BACKGROUND

Since most human papilloma virus (HPV) infections regress without any intervention, HPV is a necessary but may not be a solely sufficient cause of cervical intraepithelial neoplasia (CIN) and cervical cancer. Hence, the influence of cofactors on progression from cervical HPV infection to high-grade CIN and invasive cervical cancer has been a subject of intensive research.

OBJECTIVE

We assessed the effect of socio-demographic and sexual reproductive factors on the prevalence of invasive cervical cancer and CIN diagnosed in cross-sectional cervical cancer screening projects carried out in seven sites of different sub-Saharan countries.

METHODS

Between January 2000 and August 2007, healthy women aged 25-59 who participated in the screening projects were interviewed for socio-demographic, reproductive, and behavioral characteristics, investigated for disease confirmation with colposcopy, and had biopsies directed from colposcopically abnormal areas by trained local physicians. Odds ratios (ORs) and their 95% confidence intervals (CIs) from logistic regression analyses were used to assess the effect of women characteristics on CIN 1, CIN 2-3, CIN 3, and invasive cancer outcome measures.

RESULTS

Among 47,361 women screened and investigated for disease confirmation, CIN 1 was diagnosed in 1,069 (2.3%), CIN 2 in 517 (1.1%), CIN 3 in 175 (0.5%), and invasive cancer in 485 (1.0%). The site-specific prevalence of CIN 2-3 lesions ranged from 0.3 to 5.1% and from 0.2 to 1.9% for invasive cancers. Risk factors for CIN 2-3 were being widowed or separated versus currently married (OR 1.3, 95% CI 1.0-1.7 a); and having had at least four pregnancies versus zero or one pregnancy (OR at least 1.4-fold, 95% CI 1.1-1.8). Risk factors for invasive cancer were being widowed or separated versus currently married (OR 2.0, 95% CI 1.3-3.1); and having had at least three pregnancies versus zero or one pregnancy (OR at least 3.0-fold, 95% CI 2.1-4.2). Additionally, cervical cancer risk increased with increasing age, age at menarche, and age at marriage, while the risk decreased with increasing level of education and in those with some form of employment compared to housewives.

CONCLUSION

The exposure of the exocervix and/or the increased levels of estrogen and progesterone for more prolonged periods during pregnancy in multiparous women and the vulnerability of widowed/separated women in society might result in increased risk of cervical neoplasia more so among women exposed to HPV infection. High parity probably explains the persistently high rates of cervical cancer in sub-Saharan Africa.

Association of Combined Tobacco Smoking and Oral Contraceptive Use With Cervical Intraepithelial Neoplasia 2 or 3 in Korean Women

Background

Cigarette smoking and oral contraceptive (OC) use have been associated with cervical neoplasia, and the combination of smoking and OC use could influence cervical carcinogenesis. We aimed to assess the joint effect of smoking and OC use on the risk of cervical intraepithelial neoplasia (CIN).

Methods

From a cohort of human papillomavirus-positive subjects recruited from 6 hospitals in Korea from March 2006 to November 2012, a total of 678 subjects (411 control, 133 CIN 1, and 134 CIN 2 or 3 cases) were selected for this study (mean age, 43 years). The risk of CIN associated with smoking and OC use on additive and multiplicative scales was estimated via multinomial logistic regression after adjustment for potential confounding factors. The relative excess risk due to interaction (RERI) and the synergy index (S) were used to evaluate the additive interaction.

Results

OC users (odds ratio [OR] 1.98; 95% confidence interval [CI], 1.07–3.69) and long-term OC use (≥20 months; OR 2.71; 95% CI, 1.11–6.59) had a higher risk of CIN 2/3, but had no association with CIN 1, compared to non-OC users. Smokers and heavy smoking (≥8 cigarettes/day) were not associated with any CIN grade. Combined smoking and OC use (OR 4.91; 95% CI, 1.68–14.4; RERI/S, 3.77/27.4; P for multiplicative interaction = 0.003) and combined heavy smoking and long-term OC use (OR 11.5; 95% CI, 1.88–70.4; RERI/S, 9.93/18.8; P for multiplicative interaction = 0.009) had a higher risk of CIN 2/3 but had no association with CIN 1 compared to combined non-smoking and non-OC use.

Conclusions

OC use and smoking acted synergistically to increase the risk of CIN 2 or 3 in Korean women.

Knowledge, attitude and practices of women in maldives related to the risk factors, prevention and early detection of cervical cancer

BACKGROUND

A population-based cervical cancer screening program using visual inspection with acetic acid was launched in Maldives in 2014. Our study aimed to assess the knowledge, attitude and practices of women in relation to risk factors of cervical cancer, early detection of the disease and its prevention.

MATERIALS AND METHODS

The questionnaire based survey was conducted among 20 to 50 year old women, systematically sampled to represent three regions of Maldives. Trained investigators interviewed a total of 2,845 women at home.

RESULTS

The prevalence of the risk factors of cervical cancer like early age at marriage and childbirth, multiple marriages, multiple marriages of the husbands, and multiple pregnancies was high. More women knew about breast cancer than cervical cancer. Even among the small number of women who knew of cervical cancer, only 34.6% had the knowledge of at least one early symptom. Very few women knew that the cancer could be prevented by any test. Only 6.2% of the women reported having ever undergone a Pap smear. Many women had the misconception that cervical cancer was infectious. In Maldives the younger women have high literacy rate due to the policy of universal free education and those with higher levels of education had improved knowledge of cervical cancer and its risk factors. The prevalence of risk factors also reduced with improved literacy.

CONCLUSIONS

Awareness about risk factors and prevention of cervical cancer is limited among Maldivian women in spite of having high exposure to some of the risk factors. A universal literacy program in the country has helped to improve the knowledge of cervical cancer prevention and to reduce the exposure to various risk factors in the younger population.

Fludeoxyglucose F 18 PET-Computed Tomography: Management Changes Effecting Patient Outcomes in Gynecologic Malignancies

Outcome analysis in oncologic imaging is complex because of the multiple variables that can affect survival, including how early disease is diagnosed, the accuracy of staging at diagnosis, and where and how the patient is treated. Risk for tumor recurrence is estimated based on tumor histologic grade, stage at diagnosis, and other factors, including expressed molecular markers. This article reviews the data supporting the use of F 18 fluorodeoxyglucose PET-computed tomography in endometrial, ovarian, and cervical malignancies, with emphasis on the impact of imaging on treatment stratification and prognosis.

Effects of active, passive, and combined smoking on cervical cancer mortality: a nationwide proportional mortality study in Chinese urban women

PURPOSE

To determine whether smoking, in any form, is a risk factor in the development of cervical cancer (CC) among urban Chinese women.

METHODS

We ascertained retrospectively the smoking habits of 1,865 women (aged 35+) who had died from CC (cases) and 48,781 who had died from causes unrelated to smoking (controls) in 24 cities using data from a large national survey of smoking and mortality in 1989-1991. We assessed the risk of smoking on CC mortality with and without considering passive smoke exposure from a spouse using a proportional mortality study design.

RESULTS

Overall, there was a 51.0 % excess risk of death from CC among smokers. When the spouse's exposure was further considered, the RR (95 % CI) for exposed versus unexposed women was 1.28 (1.04-1.57) for passive smokers, 1.49 (1.02-2.20) for active smokers, and 1.69 (1.27-2.26) for women with both exposures (all p < 0.001). Significant dose-response associations were observed between smoking and CC for all categories of exposure. For example, individuals with both smoking exposure had the highest risk of CC mortality with moderate [RR = 1.67 (1.18-2.38)] and high [RR = 1.88 (1.04-3.41)] daily cigarette consumption, and they also had the highest risk with ≤15 years exposure [RR = 1.73 (1.19-2.52)] and >15 years exposure [RR = 1.95 (1.15-3.32)], compared with the active and passive groups (p for trend <0.001).

CONCLUSIONS

Younger trend of CC death and the rapid increase in smoking among young women may have a profound impact on future incidence of CC. Our findings emphasize the need for preventive efforts among both women and men in China.

Prevalence of human papillomavirus types and phylogenetic analysis of HPV-16 L1 variants from Southern India

BACKGROUND

The human papillomavirus (HPV) and its variants show wide geographical distribution and have been reported to cause cervical lesions. With cervical neoplasia as the leading cancer in Indian women, the aim of the present study was to evaluate the multiple infection HPV type distribution and variant genotypes in cervical samples from the coastal Karnataka region, India.

MATERIALS AND METHODS

A total of 212 samples were screened by nested polymerase chain reaction using PGMY9/11 and GP5+/6+ primers. HPV positive samples were sequenced to identify the types and a phylogenetic tree was constructed using the neighbor-joining method.

RESULTS

Sequence analysis identified a total of 14 HPV types distributed in 20%, 73.3% and 82.5% of non-malignant, pre-malignant [low grade squamous intraepithelial lesion (LSIL) and high grade squamous intraepithelial lesion (HSIL)] and cervical cancer samples. The distribution of high risk HPV in cancer samples was HPV 16, 76.4%, HPV18, 11.7%, HPV81, 2.9%, HPV31, 1.4%, HPV35, 1.4% and HPV 45, 1.4%. Multiple infections were observed in 11.8% of tumor samples with HPV 16 contributing to 62.5% of cases. In non-malignant samples, 20% of HPV positive samples were detected with HPV16, 82.3%, HPV33, 5.8% and HPV58, 5.8% and very low incidence of multiple infections. Comparative phylogenetic analysis of HPV variants identified 9 HPV sequences as new papillomavirus species, predominantly classified as European lineage type.

CONCLUSIONS

The findings for HPV infections associated with progression of cervical cancer in coastal Karnataka region and HPV variant analysis provide baseline data for prevention and HPV vaccination programs.

Lack of significant effects of Chlamydia trachomatis infection on cervical cancer risk in a nested case-control study in North-East Thailand

Cervical cancer continues to be an important public health problem in Thailand. While the high risk human papillomavirus (HPV) types have been established as the principle causative agent of both malignancies and the precursor lesions, cervical intraepithelial neoplasia (CIN), other factors may also be involved like other sexually transmitted diseases, as well as smoking. Chlamydia trachomatis is an obligate intracellular Gram-negative bacterium which has a tendency to cause chronic infection featuring inflammation and therefore might be expected to increase the risk of cervical cancer. In the present nested case-control study, 61 cases of cervical cancer and 288 matched controls with original serum samples were identified from the Khon Kaen Cohort, established in the North-East of Thailand, by linkage to the Khon Kaen population based cancer registry. C. trachomatis specific IgG antibodies at recruitment were measured by microimmunofluorescence and assessed for association with cervical cancer using STATA release10. No significant link was noted either with all cancers or after removal of adenocarcinomas. The results suggest no association between Chlamydia infection and cervical cancer development in North-East Thailand, but possible influencing factors must be considered in any future research on this topic.

Risk factors for cervical cancer in rural areas of Wuhan China: a matched case-control study

Cervical cancer is a serious public health problem in developing countries. We investigated possible risk factors for cervical cancer in rural areas of Wuhan China using a matched case-control study with 33 women diagnosed with cervical cancer and 132 healthy women selected from the same area as matched controls. A questionnaire, which included questions about general demography conditions, environmental and genetic factors, the first sexual intercourse, first marriage age, age at first pregnancy, pregnancy first child's age, female personal health history, social psychological factors, dietary habits, smoking and alcohol status and other living habits was presented to all participants. At the same time, HPV infection of every participant was examined in laboratory testing. Results showed HPV infection (P<0.000, OR=23.4) and pregnancy first child's age (P<0.000, OR=13.1) to be risk factors for cervical cancer. Menopause (P=0.003, OR=0.073) was a protective factor against cervical cancer. However, there was no indication of associations of environmental (drinking water, insecticide, disinfectant) genetic (cancer family history), or life-style factors (smoking status, alcohol status, physical training, sleep quality), including dietary habits (intake of fruit and vegetable, meat, fried food, bean products and pickled food) or social psychological factors with cervical cancer. The results suggest that the risk of cervical cancer in Chinese rural women may be associated with HPV infection, menopause and the pregnancy first child's age.

Differences in risk factors for cervical dysplasia with the applied diagnostic method in Serbia

BACKGROUND

In the etiology of cervical cancer not only HPV infection is important, but also other factors such as demographic influences and sexual and reproductive health attitudes, as well as others related to preventive measure usage (or non usage). The aim of this study was to examine factors associated with cervical dysplasia in asymptomatic women who were examined by routine cytology and cervical biopsy for early detection of cervical cancer.

MATERIALS AND METHODS

Socio-demographic and other characteristics were obtained from medical files of 85 examinees with pathologic cytologic findings (Pap test) and histopathologic (HP) findings after biopsy.

RESULTS

According to the Pap test result, a greater probability for development of cervical dysplasia was noted with examinees having a larger number of sexual partners (OR= 5.01, 95% CI 1.04-24.10), and those who are afraid of the Pap finding. Risk factors for development of cervical dysplasia according to the bioptic finding were early beginning with sexual activities, presence of any STD in personal medical history and fear of the Pap test finding.

CONCLUSIONS

The only risk factor found to be important for both methods was fear of the Pap testing finding.

Statistical modelling and forecasting of cervix cancer cases in radiation oncology treatment: a hospital based study from Western Nepal

BACKGROUND

To estimate the numbers and trends in cervix cancer cases visiting the Radiotherapy Department at Manipal Teaching Hospital, Pokhara, Nepal, statistical modelling from retrospective data was applied.

MATERIALS AND METHODS

A retrospective study was carried out on data for a total of 159 patients treated for cervix cancer at Manipal Teaching Hospital, Pokhara, Nepal, between 28th September 2000 and 31st December 2008. Theoretical statistics were used for statistical modelling and forecasting.

RESULTS

Using curve fitting method, Linear, Logarithmic, Inverse, Quadratic, Cubic, Compound, Power and Exponential growth models were validated. Including the constant term, none of the models fit the data well. Excluding the constant term, the cubic model demonstrated the best fit, with R2=0.871 (p=0.004). In 2008, the observed and estimated numbers of cases were same (12). According to our model, 273 patients with cervical cancer are expected to visit the hospital in 2015.

CONCLUSIONS

Our data predict a significant increase in cervical cancer cases in this region in the near future. This observation suggests the need for more focus and resource allocation on cervical cancer screening and treatment.