Human papillomavirus screening in north Indian women

Systematic Literature Review on the Burden of Human Papillomavirus Infection and Related Diseases in India

Human papillomavirus (HPV)-related diseases pose public health concerns for both genders, yet their understanding remains limited in India. This review outlines HPV incidence and prevalence, genotype distribution, and attribution rates across different HPV-related disease types. A comprehensive literature search was performed to identify observational studies on individuals aged 15 years and older, and a total of 3702 publications were identified. A total of 139 studies were included in this review, involving 607,425 subjects aged 15.8-82.2 years, with a gender distribution of 38.13% males and 61.86% females. The prevalence of HPV infection in the anogenital area among healthy males and females was 41.07% and between 0.4% and 41.8%, respectively. Among individuals with HPV-related diseases, HPV infection prevalence was 26.1%-100% in unhealthy cervixes and cervical lesions, 3.1%-41% in anal lesions, 71.4% in vulva and vaginal lesions, and 0%-92.3% in head and neck cancer. The review highlights the variability in HPV prevalence across genders and age groups in India, likely due to population heterogeneity and testing differences. This study highlights the need for rigorous and uniform studies in India on the HPV disease burden and the importance of gathering evidence with a special focus on males.

Adult vaccination in India: A rapid review of current status & implementation challenges

Background & objectives The expanded programme on immunization launched in India in 1978, with its focus on preventing six diseases in children (tetanus, diphtheria, pertussis, poliomyelitis, typhoid, and childhood tuberculosis), was widened in its scope in 1985-86. This new avtaar, the Universal Immunization Programme (UIP), incorporated measles vaccine for children and rubella and adult diphtheria vaccines for pregnant women. We conducted this rapid review on adult immunization relevant for India, as recent COVID-19 experience revealed how newly emergent or re-emergent pathogens could have their onslaughts on the elderly and adults with comorbidities. Methods Three different bibliographic databases, namely PubMed, Scopus and Ovid were searched electronically to access the articles published in peer-reviewed journals. Relevant consensus guidelines by in-country professional groups were also collated. We conducted deduplication and screening of the outputs of these searches (1242 bibliographical records). Finally, 250 articles were found eligible for inclusion. As trials on the reduction of morbidities, mortalities and hospitalizations in adults due to proposed vaccines under Indian consensus guidelines were not available, no meta-analysis was conducted. Results Evidence from articles finally included in this synthesis were grouped under (i) preventing viral and bacterial infections in adults; (ii) adult vaccination and awareness tools; (iii) vaccine hesitancy/acceptance; and (iv) adult vaccination guidelines. In-country research revealed the need for introducing the Human Papilloma Virus (HPV) vaccine in adolescence or early-adulthood to prevent ano-genital cancers in elderly and later life. Importantly HPV prevalence among cervical cancer patients varied between 88 to 98 per cent in Andhra Pradesh, Odisha and Delhi. The importance of conducting regular surveillance of pneumococcal diseases and influenza, as well as tweaking the vaccines accordingly, was revealed in other articles. A poor uptake of influenza vaccine (≤2%) in adults (≥45 yr) was documented. The uptake of hepatitis B vaccine in Health Care Workers (HCWs) in Delhi and Mumbai was of concern and ranged from 55 to 64 per cent. The vulnerability of HCWs to rubella was investigated in a paediatric ophthalmic hospital in Madurai: a tenth of the selected HCWs were rubella seronegative and mounted good protective immunity following RA 27/3 vaccine administration. An outbreak of measles in college students in Pune emphasized the phenomenon of waning immunity. Similarly, a study in the infectious disease hospital in Kolkata and in-patients in Delhi revealed a lack of protective immunity against diphtheria and tetanus in adults. The researchers estimated the economic benefits of providing a typhoid vaccine to a household to be US$ 23 in a middle-income neighbourhood and US$ 14 in slum settings. The authors highlighted the importance of preventive strategies, finding that the cost of severe typhoid fever was US$ 119.1 in 18 centres across India. Both qualitative and quantitative investigations explored vaccine hesitancy, which was studied more during the COVID-19 pandemic than earlier. Interpretation & conclusions Vaccination programmes in India would require (i) increasing awareness around vaccine-preventable diseases among adults and HCWs; (ii) actively engaging health care systems and community-based organizations; and (iii) developing and producing affordable, safe, and country-appropriate vaccines. Effective communication strategies and tools will be the key to the success of such interventions.

Strategies and implementation outcomes of HPV-based cervical screening studies to prevent cervical cancer in India: A systematic review

BACKGROUND

As Indian states consider HPV testing for cervical screening, there is a need to review evidence from prior studies to inform program design and evaluate implementation research gaps.

DESIGN

We conducted a systematic review of original articles in Medline, Embase, Global Health and Web of Science, published from 2000 to May 4, 2024. Articles describing use of HPV as a primary cervical screening test in India, in either community-based programs for the general population, or among women living with HIV, were included. We describe approaches to invitation, education, screening, and follow-up, and map determinants and outcomes to the RE-AIM and the Consolidated Framework for Implementation Research frameworks.

RESULTS

Of 71 included articles (51 unique studies), 19 reported on screening among women living with HIV, while 52 were community-based (general population of women). Self-collection was offered by 15 studies and was acceptable to most screened women. Community-based programs were mainly facility or outreach-based, with three studies offering only home-based self-collection, including one that integrated with cardiovascular risk screening. Studies from northeastern and tribal populations were scarce. Only one self-collection study used a screen and treat (at second visit) approach, but did not report follow-up, while none offered immediate treatment following a point-of-care test.

CONCLUSIONS

Community-based HPV testing, including self-collection, is feasible in India, with more research needed among underrepresented populations. Further implementation research is needed on integrating HPV screening with existing health systems, feasibility of HPV test and treat models and genotyping triage, to improve follow-up in low resource settings.

Towards adult vaccination in India: a narrative literature review

Despite vast improvements in childhood vaccination coverage in India, adult vaccination coverage is negligible. Our aim was, therefore, to create awareness about the importance of adult immunization. Although the true burden of vaccine-preventable diseases (VPDs) among Indian adults is unknown, adults are particularly vulnerable during outbreaks, due to a lack of immunization, waning immunity, age-related factors (e.g. chronic conditions and immunosenescence), and epidemiological shift. There are no national adult immunization guidelines in India, and although several medical societies have published adult immunization guidelines, these vary, making it unclear who should receive which vaccines (based on age, underlying conditions, etc.). Other barriers to adult immunization include vaccine hesitancy, missed opportunities, and cost. Steps to improve adult vaccination could include: adoption of national guidelines, education of healthcare providers and the public, and promotion of life-course immunization. Improving adult vaccine coverage could help reduce the burden of VPDs, particularly among older adults.

Bayesian adjustment for trend of colorectal cancer incidence in misclassified registering across Iranian provinces

Misclassification error is a common problem of cancer registries in developing countries that leads to biased cancer rates. The purpose of this research is to use Bayesian method for correcting misclassification in registered cancer incidence of eighteen provinces in Iran. Incidence data of patients with colorectal cancer were extracted from Iranian annual of national cancer registration reports from 2005 to 2008. A province with proper medical facilities can always be compared to its neighbors. Almost 28% of the misclassification was estimated between the province of East Azarbaijan and West Azarbaijan, 56% between Fars and Hormozgan, 43% between Isfahan and Charmahal and Bakhtyari, 46% between Isfahan and Lorestan, 58% between Razavi Khorasan and North Khorasan, 50% between Razavi Khorasan and South Khorasan, 74% between Razavi Khorasan and Sistan and Balochestan, 43% between Mazandaran and Golestan, 37% between Tehran and Qazvin, 45% between Tehran and Markazi, 42% between Tehran and Qom, 47% between Tehran and Zanjan. Correcting the regional misclassification and obtaining the correct rates of cancer incidence in different regions is necessary for making cancer control and prevention programs and in healthcare resource allocation.

Bayesian adjustment for over-estimation and under-estimation of gastric cancer incidence across Iranian provinces

AIM

To correct the misclassification in registered gastric cancer incidence across Iranian provinces in cancer registry data.

METHODS

Gastric cancer data is extracted from Iranian annual of national cancer registration report 2008. A Bayesian method with beta prior is implemented to estimate the rate of misclassification in registering patient's permanent residence in neighboring province. Each time two neighboring provinces with lower and higher than 100% expected coverage of cancer cases are selected to be entered in the model. The expected coverage of cancerous patient is reported by medical university of each province. It is assumed that some cancer cases from a province with a lower than 100% expected coverage are registered in their neighboring province with more than 100% expected coverage.

RESULTS

The condition was true for 21 provinces from a total of 30 provinces of Iran. It was estimated that 43% of gastric cancer cases of North and South Khorasan provinces in north-east of Iran was registered in Razavi Khorasan as the neighboring facilitate province; also 72% misclassification was estimated between Sistan and balochestan province and Razavi Khorasan. The misclassification rate was estimated to be 36% between West Azerbaijan province and East Azerbaijan province, 21% between Ardebil province and East Azerbaijan, 63% between Hormozgan province and Fars province, 8% between Chaharmahal and bakhtyari province and Isfahan province, 8% between Kogiloye and boyerahmad province and Isfahan, 43% Golestan province and Mazandaran province, 54% between Bushehr province and Khozestan province, 26% between Ilam province and Khuzestan province, 32% between Qazvin province and Tehran province (capital of Iran), 43% between Markazi province and Tehran, and 37% between Qom province and Tehran.

CONCLUSION

Policy makers should consider the regional misclassification in the time of programming for cancer control, prevention and resource allocation.

Augmented Activity of Cyclooxygenase-2 in Tissue and Serum of Patients With Cervical Cancer

BACKGROUND

Cyclooxygenase-2 (Cox-2) is frequently overexpressed in cervical carcinoma, but little is known about its altered serum concentration. Hence, this study evaluates clinical utility of cellular and serum level of Cox-2 enzyme in cervical cancer.

METHODS

The expression of Cox-2 was evaluated in cervical tissues and serum samples collected from normal controls (n = 100; n = 68), cervical intraepithelial neoplasia patients (CIN, n = 67; n = 12), and invasive squamous cell carcinoma patients (SCCs; n = 153; n = 127) by immunohistochemical and enzyme-linked immunosorbent assay (ELISA) analyses.

RESULTS

The significant cytoplasmic overexpression of Cox-2 was noted in 50.7% of CIN and 69.9% of SCCs as compared with normal (P = 0.0001). Serum level of Cox-2 was also found to be elevated both in CIN (median 4.35 ng/ml) and in SCCs (median 19.39 ng/ml) with respect to normal (median 0.44 ng/ml; P = 0.0001), respectively. The ROC analysis revealed the potential of serum Cox-2 over its cellular expression to distinguish CIN and SCCs from normal.

CONCLUSION

Augmented Cox-2 activity is implicated in the pathogenesis of cervical cancer, and its serum level could serve a potential to distinguish this malignancy. Therefore, it is suggested that serum Cox-2 may be useful in monitoring the diagnosis and treatment outcome of patients.

Spousal migration and human papillomavirus infection among women in rural western Nepal

BACKGROUND

In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal.

METHODS

Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status.

RESULTS

In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration.

CONCLUSION

Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age.

Update knowledge on cervical cancer incidence and prevalence in Asia

Cervical cancer is the second most common cause of cancer-related death among women worldwide, with over 500,000 new cases diagnosed annually and 50% mortality rate in Asia. In the United States, approximately 10,370 new cases of cervical cancer are diagnosed annually, and estimated 3,710 deaths occur from the disease, making it the sixth most common cause of malignancy among American women. This study aims to provide awareness about cervical cancer as well as an updated knowledge about the prevalence and incidence of cervical cancer in Asia.

Knowledge, attitudes and behaviors of women over 20 years old on cervix cancer in Istanbul, Turkey

PURPOSE

The aim of the study was to evaluate knowledge, attitudes and behaviors of Turkish women over 20 years old on cervix cancer.

MATERIALS AND METHODS

This descriptive study was performed at a primary care center covering 246 women using a questionnaire composed of 3 sections and 38 questions. The data were analyzed using descriptive statistics, chi-square test in univariate analysis and multivariate hierarchical logistic regression analysis.

RESULTS

Of the 93.7% women who knew about cervical cancer, 68.0% of them had heard pap smear test and 46.1% had actually undergone a Pap smear once or more throughout their lives. According to the results of the hierarchical logistic regression analysis about factors affecting the Pap smear test; in Model 1, increase in age and education levels, in Model 2 and Model 3 increase in age and cervical cancer information points were determined. The most important information source for cervical cancer was TV-radio/media (59.9%) and health care workers (62.8%) for pap smear test.

CONCLUSIONS

Although most women have heard of cervical cancer, knowledge about cervical cancer and also Pap smear screening rate are significantly lower. Having Pap smear test for women was affected by age and knowledge level about cervical cancer. Informing women about cervical cancer would be an important intervention.

Development and clinical evaluation of dendritic cell vaccines for HPV related cervical cancer--a feasibility study

Human papillomavirus infection (HPV) and HPV related immune perturbation play important roles in the development of cervical cancer. Since mature dendritic cells (DCs) are potent antigen-presenting cells (APC), they could be primed by HPV antigens against cervical cancers. In this study we were able to generate, maintain and characterize, both phenotypically and functionally, patient specific dendritic cells in vitro. A randomized Phase I trial with three arms--saline control (arm I), unprimed mature DC (arm II) and autologous tumor lysate primed mature DC (arm III) and fourteen patients was conducted. According to WHO criteria, grade 0 or grade one toxicity was observed in three patients. One patient who received tumor lysate primed dendritic cells and later cis-platin chemotherapy showed a complete clinical response of her large metastatic disease and remained disease free for more than 72 months. Our findings indicate that DC vaccines hold promise as adjuvants for cervical cancer treatment and further studies to improve their efficacy need to be conducted.

Type-specific prevalence of human papillomavirus by cervical cytology among women in Brasov, Romania

The oncogenic role of human papillomavirus (HPV) in triggering cervical cancer, the second most common cancer in women worldwide, is well established. Romania ranks in first place in Europe in terms of the incidence of cervical cancer. Geographical widespread data on HPV type-distribution are essential for estimating the impact of HPV vaccines and cervical cancer screening programmes. In this study we aimed to identify the prevalence of HPV genotypes and to establish correlations with abnormal cervical cytology among the female population of Brasov County, Romania. A total of 1,000 women aged 17.3-57 years, attending routine cervical examination in the Obstetrics and Gynecology Hospital of Brasov, Romania, and undergoing both cytological examination and HPV genotyping were screened. Infection with 35 different HPV genotypes was detected in 39.6% of cytological specimens. Overall HPV infections were highest in young women under 25 years (p<0.0001), in which cervical cytological abnormalities also reached the highest prevalence. Patients infected by HPV-16 or HPV-18 showed the highest prevalence of cervical cytological abnormalities. Some 48.2% of women with abnormal cytology were infected with high-risk HPV types whereas less than 3% of them were infected only with low-risk HPV types. Our study showed that the prevalence of high-risk HPV infection among Romanian women is higher compared to other studies in other geographic areas. Thus, we consider that in areas where there is an increased prevalence of high-risk HPV infections, HPV genotyping should be performed in all women aged between 18 and 45 years, and Pap test should be performed every 6 months in women with high-risk HPV infection, even those with previous normal cervical cytology.

Population-based cervical cancer screening using high-risk HPV DNA test and liquid-based cytology in northern Thailand

BACKGROUND

Northern Thailand is a region with a high cervical cancer incidence. Combined high-risk HPV (hrHPV) DNA testing and cytology (co-testing) has increasingly gained acceptance for cervical cancer screening. However, to our knowledge, data from a population-based screening using co-testing have not been available in this region. This study therefore aimed to evaluate the performance of cytology and hrHPV test in women in northern Thailand.

MATERIALS AND METHODS

Cervical samples were collected for hybrid capture 2 (HC2) testing and liquid-based cytology from women aged 30 to 60 years who were residents in 3 prefectures of Chiang Mai in northern Thailand between May and September 2011. Women with positive cytology were referred to colposcopy, while women with positive for HC2 only were followed for 2 years.

RESULTS

Of 2,752 women included in this study, 3.0% were positive in both tests, 4.1% for HC2 only, and 1.3% had positive cytology only. At baseline screening, positive HC2 was observed in 70.6% among cytology-positive women compared with 4.3% among cytology-negative women. The prevalence of positive HC2 or cytology peaked in the age group 35-39 years and was lowest in the age group 55-60 years. High-grade squamous intraepithelial lesion or worse lesions (HSIL+) were histologically detected in 23.5% of women with positive baseline cytology and in 9.8% of women with positive baseline HC2 only on follow-up. All women with histologic HSIL+ had positive baseline HC2.

CONCLUSIONS

The hrHPV test is superior to cytology in the early detection of high-grade cervical epithelial lesions. In this study, the prevalence of histologic HSIL+ on follow-up of women with positive hrHPV test was rather high, and these women should be kept under careful surveillance. In northern Thailand, hrHPV testing has a potential to be used as a primary screening test for cervical cancer with cytology applied as a triage test.

Acceptability of self-sampling HPV testing among Thai women for cervical cancer screening

BACKGROUND

Acceptability of self-sampling HPV testing is confirmed worldwide. However, some cultural differences may affect this question. Therefore, this study was conducted to evaluate the acceptability of self- sampling HPV testing in Thai women.

MATERIALS AND METHODS

One hundred women aged 30-65 years with an intact cervix were included in this study. The participants were asked to do the Pap test by physicians and then brush type self-sampling instruments were assigned for self-collection and finally completed a questionnaire for acceptability evaluation. The questionnaire contains 2 parts. Part one covered general information of the participants and part two is the acceptability questions.

RESULTS

Mean age was 40.6 years. The incidence of high risk HPV detection in this study was 16%. The most common reason for doing Pap smear was for annual checkup. On the topic of ease of use, 85 % of the subjects agreed. Most of the participants (82%) reported that they felt less pain. However, reliability of the result was not satisfactory because 37% of the participants hesitated to rely on the results of the test. According to the price, if the price is less than 1,000 Baht (32.59 Baht = 1USD), 82% of the subjects would use it for their next screening.

CONCLUSIONS

The acceptability of self-sampling device in this study is quite good but the reliability of the test was questioned by some of the participants. Moreover, the price of the test in Thailand may also influence the acceptability of the test.

Investigation of Transition Types of HPV DNA Test Results over Time in Korean Women

BACKGROUND

Understanding the history of human papilloma virus (HPV) infection is important for interpretation of a positive HPV DNA screening test, future work-up and treatment. We investigated the transition of HPV DNA test results in Korean women, and analyzed the association of cytology result with transition type.

MATERIALS AND METHODS

We retrospectively reviewed annual HPV DNA test results for 5,274 subjects between January 2005 and December 2012. Each subject had a minimum of five annual tests over the eight-year period. Based on the pattern of results, the transition type for each subject was assigned to one of the following: negative, persistent, latent, transient, and unclassifiable. Associations of cytology results with the HPV DNA transition types, number of positive results, and the durations of positive results were also analyzed.

RESULTS

The proportion of abnormal cytology findings decreased in the following order of transition patterns: persistent, latent, transient, and negative. Among transient patterns, a duration of three years or more significantly correlated with cytology results of non-high grade squamous intraepithelial lesion (HSIL; p<0.001). In the persistent group, duration of five years or more correlated with both non-HSIL and HSIL (p<0.001). Latent group showed no correlation with duration. Irrespective of patterns, having five or more positive results was significantly associated with HSIL (p<0.001).

CONCLUSIONS

Our findings may contribute to better understanding of HPV infection, interpretation of HPV DNA screening results, and prediction of prognosis according to transition type.

Knowledge and acceptability of human papillomavirus vaccination and cervical cancer screening among women in Karnataka, India

Cervical cancer is the leading cause of cancer-related mortality among women in India; however, participation in prevention and screening is low and the reasons for this are not well understood. In a cross-sectional survey in August 2008, 202 healthy women in Karnataka, India completed a questionnaire regarding knowledge, attitudes, and practices related to human papillomavirus (HPV) and cervical cancer. Factors associated with vaccination and Papanicolau (Pap) smear screening acceptance were explored. Thirty-six percent of women had heard of HPV while 15% had heard of cervical cancer. Five percent of women reported ever having a Pap smear, and 4% of women felt at risk of HPV infection. Forty-six percent of women were accepting of vaccination, but fewer (21%) were willing to have a Pap smear. Overall, knowledge related to HPV and cervical cancer topics was low. Women with negative attitudes toward HPV infection were 5.3 (95% confidence interval (CI) 2.8-10) times more likely to accept vaccination but were not significantly more likely to accept Pap smear (odds ratio 1.5, 95% CI 0.7-3.0). Cost and a low level of perceived risk were the most frequent factors cited as potential barriers. Improving awareness of HPV and cervical cancer through health care providers in addition to increasing access to vaccination and screening through government-sponsored programs may be feasible and effective methods to reduce cervical cancer burden in India.

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.

Estimation of cancer cases using capture-recapture method in Northwest Iran

BACKGROUND

Under-ascertainment and over-ascertainment are common phenomena in surveillance and registry systems of health-related events. Capture-recapture is one of the methods which is applied to determine the sensitivity of surveillance or registry systems to recognize cancer cases. This study aimed to estimate the number of cancers using data available both in the Cancer Registry Center of Northwestern Iran and in the Population-based Cancer Registry Center of Iran.

MATERIAL AND METHODS

The studied population consisted of all cancerous cases in the northwest of Iran from 2008 to 2010. All data were extracted from two resources and entered into Microsoft Excel software. After removing common and repeat cases the data were statistically analyzed using a capture-recapture studies' specific software "CARE 1.4". Estimations were calculated by Chapman and Petersen methods with the approximate confidence interval of 95%.

RESULTS

From 2008 to 2010, the number of all cancer cases was estimated to be 21,652 (CI 95%: 19,863-22,101). Sensitivity rate of all cancer cases was 83.9% and that of Population-based Cancer Registry Center of Iran was 52%. It was 93.1% considering both resources.

CONCLUSION

Using two resources and the capture-recapture method rather than a single resource may be a more reliable method to estimate the number of cancer cases.

Reduced expression of autophagy markers correlates with high-risk human papillomavirus infection in human cervical squamous cell carcinoma

Infection by an oncogenic human papillomavirus (HPV), in particular HPV16 and 18, is a high risk factor for developing cervical cancer; however, viral infection alone is not sufficient for cancer progression. Autophagy is hypothesized to be an important process during carcinogenesis. The aim of the present study was to investigate the association between autophagy and high-risk HPV (hrHPV) infection in human cervical squamous cell carcinomas (SCCs), and to analyze the clinical significance of this association. Quantum dot (QD)-based immunofluorescence histochemistry was used to detect the expression of autophagy markers, Beclin-1 and microtubule-associated proteins 1A/1B light chain 3B (LC3B) proteins, in 104 cases of cervical cancer (including 80 SCCs and 24 adenocarcinomas) and 20 normal cervical tissues. hrHPV (HPV16/18) infection was detected by QDs based fluorescence in situ hybridization in cervical cancers. The results revealed that the expression levels of Beclin-1 and LC3B were significantly lower in cervical cancer cells when compared with those of normal cervical squamous epithelial cells, and were found to negatively correlate with hrHPV infection. The expression levels of Beclin-1 and LC3B were not associated with age, tumor grade, tumor stage, tumor node metastasis stage or lymph node metastasis. However, a positive correlation was identified between Beclin-1 and LC3B protein expression. In addition, the absence of autophagy in combination with hrHPV infection may accelerate the progression of cervical SCC. In conclusion, decreased expression of Beclin-1 and LC3B may be important in cervical carcinogenesis. The hrHPV-host cell interaction may inhibit autophagy, which may aid virus duplication and infection, as well as cervical cancer development.

Hybrid capture 2 assay based evaluation of high-risk HPV status in healthy women of north-east India

BACKGROUND

High risk HPV (HR-HPV) testing has been recommended as an effective tool along with cytology screening in identification of cervical intraepithelial lesions (CINs) and prevention of their progress towards invasive cervical cancer. The aim of this study was to assess the HR-HPV DNA status by Hybrid Capture 2 (HC2) assay in healthy asymptomatic women of North-East India.

MATERIALS AND METHODS

This study examined cervical cell samples of forty three (n=43) healthy women by HC2 assay. A High Risk HPV DNA kit (Qiagen) was used which can detect 13 high risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68.

RESULTS

The mean relative light units (RLU) for samples was in the range of 141-5, 94, 619. HR-HPV DNA was confirmed in 16% (7/43) of participant women samples. Among demographic and clinical parameters, menstrual irregularity (p=0.039) and infection history (p=0.028) has shown statistically significant differences between the HR-HPV-positive and negative groups. In the HR-HPV positive group, two women were confirmed for CINs after colposcopy and histopathologic examination.

CONCLUSIONS

We suggest that there may be an association between irregular menstruation and infection history of the urogenital tract with HR-HPV DNA prevalence in North-East Indian asymptomatic women. HC2 assay can be a valuable tool for HR-HPV screening.

Autophagy in cervical cancer: an emerging therapeutic target

Cervical cancer is a leading cause of morbidity and mortality in women worldwide. Although the human papillomavirus (HPV) is considered the major causative agent of cervical cancer, yet the viral infection alone is not sufficient for cancer progression. The etiopathogenesis of cervical cancer is indeed complex; a precise understanding of the complex cellular/molecular mechanisms underlying the initiation, progression and/ or prevention of the uterine cervix is therefore essential. Autophagy is emerging as an important biological mechanism in targeting human cancers, including cervical cancer. Furthermore, autophagy, a process of cytoplasm and cellular organelle degradation in lysosomes, has been implicated in homeostasis. Autophagic flux may vary depending on the cell/tissue type, thereby altering cell fate under stress conditions leading to cell survival and/or cell death. Autophagy may in turn govern tumor metastasis and subsequent carcinogenesis. Inflammation is a known hallmark of cancer. Vascular insufficiency in tumors, including cervical tissue, leads to depletion of glucose and/or oxygen perturbing the osmotic milieu causing extracellular acidosis in the tumor microenvironment that may eventually result in autophagy. Thus, targeted manipulation of complex autophagic signaling may prove to be an innovative strategy in identification of clinically relevant biomarkers in cervical cancer in the near future.