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Wong A, Morgis R, Entenman J, Ramirez SI, Hays AL, Wright TS, Scartozzi CM, Ruffin MT, Moss JL. Exploratory Analysis of Concordance Between Clinician-Collected and Self-Sampled Human Papillomavirus Tests in a Small Cohort of Average- and High-Risk Patients. Womens Health Rep (New Rochelle) 2024; 5:259-266. [PMID: 38516651 PMCID: PMC10956530 DOI: 10.1089/whr.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Abstract
Objectives Cervical cancer screening rates have stagnated, but self-sampling modalities have the potential to increase uptake. This study compares the test characteristics of self-sampled high-risk human papillomavirus (hrHPV) tests with clinician-collected hrHPV tests in average-risk (i.e., undergoing routine screening) and high-risk patients (i.e., receiving follow-up after abnormal screening results). Methods In this cross-sectional study, a relatively small cohort of average-risk (n = 35) and high-risk (n = 12) participants completed both clinician-collected and self-sampled hrHPV testing, along with a brief phone survey. We assessed hrHPV positivity, concordance, positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity across both methods (for types 16, 18, or other hrHPV). We also explored the relationship between test concordance and sociodemographic/behavioral factors. Results Among average-risk participants, hrHPV positivity was 6% for both test methods (i.e., hrHPV-positive cases: n = 2), resulting in reported concordance, PPV, NPV, sensitivity, and specificity of 100%. Among high-risk participants, hrHPV positivity was 100% for clinician-collected tests but only 67% for self-sampled tests, showing varied concordance and sensitivity. Concordance was not associated with sociodemographic or behavioral factors. Conclusions Self-sampled hrHPV testing demonstrated high accuracy for average-risk patients in this exploratory study. However, its performance was less consistent in high-risk patients who had already received an abnormal screening result, which could be attributed to spontaneous viral clearance over time. The limited number of participants, particularly HPV-positive cases, suggests caution in interpreting these results. Further research with larger cohorts is necessary to validate these findings and to explore the integration of self-sampled hrHPV testing into routine clinical care, particularly for patients with a history of cervical abnormalities. Clinical Trial Registration NCT04591977, NCT04585243.
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Affiliation(s)
- Ashley Wong
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Rebecca Morgis
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Juliette Entenman
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Sarah I. Ramirez
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Amy L. Hays
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Tonya S. Wright
- Department of Obstetrics and Gynecology, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Christina M. Scartozzi
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Reading, Pennsylvania, USA
| | - Mack T. Ruffin
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jennifer L. Moss
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Harper DM, Yu TM, Fendrick AM. Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results. O G Open 2024; 1:e001. [PMID: 38533459 PMCID: PMC10964775 DOI: 10.1097/og9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To model the potential number of cancers prevented and life-years saved over a range of adherence rates to cervical cancer screening, surveillance follow-up, and follow-up colposcopy that may result from removing financial barriers to these essential clinical services. METHODS A previously validated decision-analytic Markov microsimulation model was used to evaluate the increase in adherence to screening, surveillance, and colposcopy after an abnormal cervical cancer screening result. For each incremental increase in adherence, we modeled the number of cervical cancer cases avoided, the stages at which the cancers were detected, the number of cervical cancer deaths avoided, and the number of life-years gained. RESULTS Compared with current adherence rates, the model estimated that an optimized scenario of perfect screening, surveillance, and colposcopy adherence per 100,000 women currently eligible for screening in the United States was 128 (95% CI, 66-199) fewer cervical cancers detected (23%), 62 (95% CI, 7-120) fewer cervical cancer deaths (20%), and 2,135 (95% CI, 1,363-3,057) more life-years saved. Sensitivity analysis revealed that any increase in adherence led to clinically meaningful health benefits. CONCLUSION The consequences of not attending routine screening or follow-up after an abnormal cervical cancer screening result are associated with preventable cervical cancer morbidity and premature mortality. Given the potential for the removal of consumer cost sharing to increase the use of necessary follow-up after abnormal screening results and to ultimately reduce cervical cancer morbidity and mortality, public and private payers should remove cost barriers to these essential services.
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Affiliation(s)
- Diane M Harper
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - Tiffany M Yu
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - A Mark Fendrick
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
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Zhao M, Zhou D, Zhang M, Kang P, Cui M, Zhu L, Luo L. Characteristic of persistent human papillomavirus infection in women worldwide: a meta-analysis. PeerJ 2023; 11:e16247. [PMID: 38025679 PMCID: PMC10655709 DOI: 10.7717/peerj.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives We aimed to estimate the genotype distribution of persistent human papillomavirus (HPV) infection in females worldwide, and provided a scientific basis for the prevention strategies of cervical cancer (CC) and the development of HPV vaccines. Methods Both English and Chinese databases were researched from the inception to July 2023. The pooled persistent HPV infection prevalence was calculated using a random effects model. The subgroup analysis was performed to explore the heterogeneity. Publication bias was evaluated using funnel plot, Egger's and Begg's test. Results Twenty-eight studies with 27,335 participants were included. The pooled prevalence of persistent HPV infection was 29.37% (95% CI [24.05%∼35.31%]), and the genotypes with the persistent infection prevalence were HPV16 (35.01%), HPV52 (28.19%), HPV58 (27.06%), HPV18 (25.99%), HPV33 (24.37%), HPV31 (23.35%), HPV59 (21.87%), HPV39 (19.54%), HPV68 (16.61%) and HPV45 (15.05%). The prevalence of multiple and single HPV persistent infection were 48.66% and 36.71%, respectively; the prevalence of persistent HPV infection in different age groups (<30, 30∼39, 40∼49, >50) were 29.83%, 28.39%, 22.24% and 30.22%, respectively. The follow-up time was significantly associated with heterogeneity by subgroup analysis (P < 0.05), and the prevalence of persistent infection decreased with longer follow-up time. Conclusions Multiple infections were more likely to occur persistent HPV infection than single infection. In addition to HPV vaccination, we should emphasize the follow-up management for women under 30 and over 50 years old, those with high-risk HPV infection (HPV59, 39, 68) and multiple infections.
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Affiliation(s)
- Ming Zhao
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China
| | - Dan Zhou
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China
| | - Min Zhang
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China
| | - Peipei Kang
- Shandong Mental Health Center, Shandong University, Jinan, Shandong, China
| | - Meimei Cui
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China
- School of Basic Medical, Weifang Medical College, Weifang, Shandong, China
| | - Liling Zhu
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Limei Luo
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China
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Feng T, Cheng B, Sun W, Yang Y. Outcome and associated factors of high-risk human papillomavirus infection without cervical lesions. BMC Womens Health 2023; 23:599. [PMID: 37957634 PMCID: PMC10644444 DOI: 10.1186/s12905-023-02764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To study the outcome of human papillomavirus (HPV) infection in women with cervical pathology results of non-cervical intraepithelial neoplasia (CIN) or cervical cancer and positive high-risk HPV test, as well as analyze the associated risk factors affecting the outcome of infection. METHODS To investigate the outcome of high-risk (HR)-HPV infection in the female genital tract and analyze the associated risk factors affecting their outcome, a total of 196 women with positive HR-HPV test results and non-CIN or cervical cancer cervical pathology results were selected for follow-up at the Cervical Disease Clinic of the Obstetrics and Gynecology Hospital, Zhejiang University School of Medicine from January 2017 to March 2020. The follow-up interval was every 6 months, and both cervical cytology (TCT) and HR-HPV testing were performed at each follow-up visit. If the cervical cytology results were normal upon recheck and the HR-HPV test was negative, the woman was considered to be cleared of the HPV infection and was entered into the routine cervical screening population. When the repeat HR-HPV test remained positive after 6 months, the woman was defined as having a persistent HR-HPV infection. If HR-HPV persisted but the TCT results were normal, follow-up was continued. If HR-HPV persisted and the TCT results were abnormal, a colposcopy-guided biopsy was performed immediately. In this situation, if the histological results were still non-CIN or cervical cancer, the follow-up was continued. If the histological results confirmed the development of CIN or invasive cancer, then enter another study follow-up to further track its development and outcome, and the woman commenced the treatment process. The HPV infection clearance time was analyzed by the Kaplan-Meier method, and the comparison of the HPV clearance rate and infection clearance time between each of the different groups was performed using aχ2 test or Fisher's exact test, as appropriate. After the univariate analysis, several significant factors were included in the Cox model and independent risk factors were analyzed. RESULTS A total of 163 women were enrolled in this study. The median age was 40.0 years (22-67 years) and the median follow-up time was 11.5 months (6-31 months). The spontaneous clearance rate of HR-HPV infection was 51.5%, and the median time to viral clearance was 14.5 months. Age and the initial viral load were high risk factors affecting the spontaneous clearance of HR-HPV infection. The factors significantly associated with HPV clearance rate and time to HPV clearance consisted of menopause and full-term delivery (P < 0.05). CONCLUSIONS In women with normal or low-grade lesions on the cell smear, the spontaneous clearance rate of HR-HPV infection was 51.5% and the time to clearance was 14.5 months. Age and the initial viral load were independent associated factors affecting the spontaneous clearance of HR-HPV infection in the female genital tract. These findings suggest that non-young women or those with high viral loads have a higher rate of persistent HR-HPV infection. Thus, intensive screening should be recommended.
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Affiliation(s)
- Ting Feng
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, No.369 Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang Province, China
| | - Bei Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310008, Zhejiang Province, China
| | - Wenchao Sun
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, No.369 Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang Province, China
| | - Yuhong Yang
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, No.369 Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang Province, China.
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Adebamowo SN, Befano B, Cheung LC, Rodriguez AC, Demarco M, Rydzak G, Chen X, Porras C, Herrero R, Kim JJ, Castle PE, Wentzensen N, Kreimer AR, Schiffman M, Campos NG. Different human papillomavirus types share early natural history transitions in immunocompetent women. Int J Cancer 2022; 151:920-929. [PMID: 35603904 PMCID: PMC9329241 DOI: 10.1002/ijc.34128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/07/2022]
Abstract
Necessary stages of cervical carcinogenesis include acquisition of a carcinogenic human papillomavirus (HPV) type, persistence associated with the development of precancerous lesions, and invasion. Using prospective data from immunocompetent women in the Guanacaste HPV Natural History Study (NHS), the ASCUS-LSIL Triage Study (ALTS) and the Costa Rica HPV Vaccine Trial (CVT), we compared the early natural history of HPV types to inform transition probabilities for health decision models. We excluded women with evidence of high-grade cervical abnormalities at any point during follow-up and restricted the analysis to incident infections in all women and prevalent infections in young women (aged <30 years). We used survival approaches accounting for interval-censoring to estimate the time to clearance distribution for 20 529 HPV infections (64% were incident and 51% were carcinogenic). Time to clearance was similar across HPV types and risk classes (HPV16, HPV18/45, HPV31/33/35/52/58, HPV 39/51/56/59 and noncarcinogenic HPV types); and by age group (18-29, 30-44 and 45-54 years), among carcinogenic and noncarcinogenic infections. Similar time to clearance across HPV types suggests that relative prevalence can predict relative incidence. We confirmed that there was a uniform linear association between incident and prevalent infections for all HPV types within each study cohort. In the absence of progression to precancer, we observed similar time to clearance for incident infections across HPV types and risk classes. A singular clearance function for incident HPV infections has important implications for the refinement of microsimulation models used to evaluate the cost-effectiveness of novel prevention technologies.
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Affiliation(s)
- Sally N. Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center; University of Maryland School of Medicine, Baltimore, MD, United States
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Brian Befano
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Information Management Services Inc, Information Management, Calverton, NY, United States
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Ana Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Maria Demarco
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Greg Rydzak
- Information Management Services Inc, Information Management, Calverton, NY, United States
| | - Xiaojian Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Jane J. Kim
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Aimée R. Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Nicole G. Campos
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Pauli S, Kops NL, Bessel M, Lina Villa L, Moreno Alves Souza F, Mendes Pereira GF, Neves Hugo F, Marcia Wendland E. Sexual practices and HPV infection in unvaccinated young adults. Sci Rep 2022; 12:12385. [PMID: 35859090 PMCID: PMC9300667 DOI: 10.1038/s41598-022-15088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022] Open
Abstract
The present study aimed to evaluate the association of genital and oral HPV infection among different sexual practices in both sexes. In total, 6388 unvaccinated men and women aged 16–25 years from all state capitals of Brazil were enrolled in through primary care services between September 2016 and November 2017. Genital and oral HPV genotyping was performed using the Roche Linear Array. Poisson regression analysis with robust variance was conducted to examine factors associated with overall HPV infection. A higher prevalence of genital HPV was found in women who practiced oral sex (57.85%) and in men who practiced all types of sex (65.87%). However, having more sexual partners and being younger were more important than the type of sex practiced. HPV 6 (7.1%) and 16 (10.5%) were significantly more prevalent in women who practiced oral sex, while HPV 6 (23.96%) and 11 (21.49%) were more prevalent in men who practiced anal sex. The type of sex was not associated with oral HPV prevalence. Genital and oral HPV infection were not associated by different sexual practices in the studied population.
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Affiliation(s)
- Sílvia Pauli
- Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Porto Alegre, RS, 90035-004, Brazil
| | - Natália Luiza Kops
- Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Porto Alegre, RS, 90035-004, Brazil
| | - Marina Bessel
- Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Porto Alegre, RS, 90035-004, Brazil
| | - Luisa Lina Villa
- Department of Radiology and Oncology, Medical School, Universidade de São Paulo (USP), and Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil
| | - Flávia Moreno Alves Souza
- Department of Chronic Conditions and Sexually Transmitted Infections, Ministry of Health, Brasília, DF, Brazil
| | | | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Eliana Marcia Wendland
- Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, Porto Alegre, RS, 90035-004, Brazil. .,Department of Public Health, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
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Plotti F, Rossini G, Ficarola F, De Cicco Nardone C, Montera R, Guzzo F, Luvero D, Fabris S, Angioli R, Terranova C. Early Mini-Invasive Treatment of Persistent Cervical Dysplasia: Clinical Outcome and Psycho-Relational Impact. Front Surg 2022; 9:888457. [PMID: 35662822 PMCID: PMC9160712 DOI: 10.3389/fsurg.2022.888457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAfter the diagnosis of L-SIL, 77. 3% had a persistent infection and anomalous Pap Test results. Many of these patients had highlighted psychological consequences such as anxiety, hypochondria, fear of cancer, and sexual problems. Several studies suggested that the clearance of HR-HPV infection could be accelerated by cervical excisional procedures, especially in L-SIL. In consideration of the psychological implications for HPV infection and related dysplasia in patients with CIN1 at PAP-smear and HR-HPV positivity at least for 6 months, we decided to plan a prospective study where we tried to anticipate excisional cervical using a minimally invasive treatment: thin loop electrosurgical excision procedure (t-LEEP). This study aims to analyze the clearance of HR-HPV after 6 and 12 months, clinical outcomes related to t-LEEP, and the psycho-relational impact at 12 months after t-LEEP.Materials and MethodsWe enrolled patients with the diagnosis of L-SIL at PAP-smear and HR-HPV positivity with a persistent CIN 1 (at least for 6 months), confirmed by cervical biopsy. All enrolled patients underwent t-LEEP. We followed prospectively and performed for all patients the HPV DNA test at 6 (T1) and 12 months (T2) and STAI-Y and FSFI scores at T0 and T2.ResultsWe prospectively enrolled 158 patients, 22 are excluded for the established criteria. Patients with HR-HPV and CIN 1 lesions treated with t-LEEP had an overall clearance of 83.8% at T2. In subgroups analysis at T2, we had a regression: in smoker 71.8%, in contraceptive users 69.5%, in patients aged <25 years 100%, aged 25–30 years 85%, aged 30–35 years 94.4%, aged 35–40 years 92%, and aged ≥40 years 89.1%, in HPV-16 96.4%, in HPV-53 89.5%, in HPV-18 87.5%, in HPV-31 86.6%, and in coinfected 3.5%. STAI-Y and FSFI after t-LEEP (T2) were statistically significant, reducing anxiety status and improving sexual function.ConclusionBased on these results, the use of t-LEEP in patients with persistent CIN 1 and HPV-HR at least for 6 months could be useful for accelerating HPV-HR clearance, in particular, for a subpopulation patient with an increased risk of progression and/or patients with psychological and sexual consequences of carrying an HR-HPV infection.
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Affiliation(s)
- Francesco Plotti
- Department of Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Gianmarco Rossini
- ASST of the Olona Valley, Department of Obstetrics and Gynecology, Varese, Italy
| | - Fernando Ficarola
- Department of Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
- *Correspondence: Fernando Ficarola
| | | | - Roberto Montera
- Department of Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Federica Guzzo
- Department of Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Daniela Luvero
- Department of Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Silvia Fabris
- National Center for Control and Emergency Against Animal Diseases and Central Crisis Unit–Office III, Directorate-General for Animal Health and Veterinary Drugs, Italian Ministry of Health, Rome, Italy
- Medical Statistics and Epidemiology Unit, Campus Bio-Medico University, Rome, Italy
| | - Roberto Angioli
- Department of Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Corrado Terranova
- Department of Gynecology, Campus Bio-Medico University Hospital Foundation, Rome, Italy
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Abstract
Cervical cancer remains a major public health problem, ranking as the fourth most common cause of cancer incidence and mortality in women worldwide. Wide variations in cervical cancer incidence and mortality were observed with highest incidence rates in Sub Saharan Africa and with 85% of deaths occurring in developing regions of the world. Non-existent or inadequate screening in public health care settings and limited access to the standard treatment options explains the large geographic variation in cervical cancer rates. Persistent infection with high-risk Human papillomavirus (HPV) types is the major risk factor for cervical cancer. High parity, long-term use of oral contraceptive pills, tobacco consumption, co-infection with other sexually transmitted agents, lifestyle factors such as multiple sexual partners, younger age at first sexual intercourse, immunosuppression, and diet have been identified as the co-factors most likely to influence the risk of acquisition of HPV infection and its further progress to cervical carcinogenesis. Differential screening rates and changes in epidemiological patterns have contributed to decreasing trends in cervical cancer in some developed regions of the world. Lower rates were also observed in North Africa and the Middle East, which may be attributed to cultural norms and conservative sexual behaviors. Across world regions, HPV prevalence was highest in women younger than 35 years of age, declining to a plateau in middle age and showed significant association between national age standardized incidence rates and corresponding estimates of HPV prevalence. The five most common HPV types in HPV-positive women worldwide were HPV16, HPV18, HPV31, HPV58, and HPV52, representing 50% of all HPV infections with HPV-16 and HPV-18 infections accounting for about 70% of the total infection burden. Tracking changing trends in the cervical cancer epidemiological patterns including HPV genotypes will immensely contribute toward effective prevention and control measures for cervical cancer elimination.
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Affiliation(s)
- Sharmila Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gauravi Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Ekanayake Weeramange C, Shu D, Tang KD, Batra J, Ladwa R, Kenny L, Vasani S, Frazer IH, Dolcetti R, Ellis JJ, Sturm RA, Leo P, Punyadeera C. Analysis of human leukocyte antigen associations in human papillomavirus-positive and -negative head and neck cancer: Comparison with cervical cancer. Cancer 2022; 128:1937-1947. [PMID: 35176174 PMCID: PMC9306518 DOI: 10.1002/cncr.34148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/08/2022]
Abstract
Background Although the majority of human papillomavirus (HPV) infections are cleared by the immune system, a small percentage of them progress to develop HPV‐driven cancers. Cervical cancer studies highlight that HPV persistence and cancer risk are associated with genetic factors, especially at the human leukocyte antigen (HLA) genes. This study was conducted to investigate such associations in head and neck cancer (HNC). Methods In all, 192 patients with HNC and 384 controls were genotyped with the Infinium Global Screening Array (Illumina, Inc). HLA variants were imputed with SNP2HLA, and an association analysis was performed by logistic regression. Results HPV‐positive HNCs were significantly associated with single‐nucleotide polymorphisms (SNPs) at DRB1_32660090 (P = 1.728 × 10–6) and DRB1_32660116 (P = 1.728 × 10–6) and with the amino acid variant DRB1_11_32660115 (P = 1.728 × 10–6). None of these associations were observed in the HPV‐negative cohort, and this suggested their specificity to convey risk for HPV‐associated HNCs. In general, associations observed for HPV‐negative HNC were relatively weak, and variants in the HLA‐DPA1 region were the strongest among them (P = 4.531 × 10–4). Several lead signals reported by previous HNC genome‐wide association studies, including SNPs rs3135001 (P = .012), rs1049055 (P = .012), and rs34518860 (P = .029) and allele HLA‐DQB1*06 (P = .009), were replicated in the current study. However, these associations were limited to the HPV‐positive HNC group. Several cervical cancer–associated HLA variants, including SNPs rs9272143 (P = .002) and rs9271858 (P = .002) and alleles HLA‐B‐1501 (P = .009) and HLA‐B‐15 (P = .015), were also exclusively associated with HPV‐positive HNC. Conclusions HPV‐positive HNC risk is associated with distinct HLA variants, and some of them are shared by both cervical cancer and HPV‐positive HNC. Human papillomavirus (HPV)–positive head and neck cancer (HNC) risk is associated with distinct human leukocyte antigen variants, and some of them are shared by both cervical cancer and HPV‐positive HNC. Lay Summary Cervical cancer studies highlight that human papillomavirus (HPV)–driven cancer risk is linked with human leukocyte antigen (HLA) polymorphism. Hence, the current study was designed to investigate the HLA associations in HPV‐positive and HPV‐negative head and neck cancer (HNC) and compare these associations with cervical cancer. Several lead signals reported by previous HNC and cervical genome‐wide association studies were replicated in the current study. However, these associations were limited to the HPV‐positive HNC group, and this suggests that HPV‐positive HNC risk is associated with distinct HLA variants, and some of them are shared by both cervical cancer and HPV‐positive HNC.
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Affiliation(s)
- Chameera Ekanayake Weeramange
- Centre for Biomedical Technologies, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery and Menzies Health Institute Queensland, Southport, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia.,Department of Medical Laboratory Sciences, Faculty of Health Sciences, Open University of Sri Lanka, Nugegoda, Sri Lanka
| | - Danhua Shu
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia.,Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kai Dun Tang
- Centre for Biomedical Technologies, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Jyotsna Batra
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Rahul Ladwa
- Department of Cancer Care Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Lizbeth Kenny
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Sarju Vasani
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Otolaryngology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Ian H Frazer
- Translational Research Institute, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Riccardo Dolcetti
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan J Ellis
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia.,Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Richard A Sturm
- Diamantina Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - Paul Leo
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia.,Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Chamindie Punyadeera
- Centre for Biomedical Technologies, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery and Menzies Health Institute Queensland, Southport, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
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10
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Lopicic M, Raonic J, Antunovic M, Milicic B, Mijovic G. Distribution of vaccine-related high-risk human papillomaviruses and their impact on the development of cervical dysplasia in women in Montenegro. Acta Microbiol Immunol Hung 2021:2021.01606. [PMID: 34735367 DOI: 10.1556/030.2021.01606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 12/09/2022]
Abstract
Cervical cancer (CC) is the third leading cause of death in women in Montenegro. Human papillomavirus (HPV) is the causative agent of CC however, HPV genotype distribution varies across regions. This study examined the distribution and impact of vaccine-related high-risk (HR)-HPVs on the development of cervical dysplasia in Montenegrin women. A total of 187 women who had a clinical indication for cervical biopsy were enrolled. Based on histopathological findings, women were classified into 2 groups, with and without dysplasia. HR-HPV was detected by real-time PCR. Twelve HR-HPV genotypes were detected in 40.6% of cervical samples. The 7 most prevalent HR-HPVs in order of decreasing frequency were HPV 16 (39.5%), 45 (23.7%), 31 (21.0%), 33 (17.1%), 18 (6.6%), 52 (6.6%), and 58 (6.6%), all of them are targeted by nonavalent vaccine. Vaccine-related HR-HPVs had a higher prevalence (92.1%) than the other HR-HPVs detected in HR-HPV-positive samples. Among HR-HPV-positive women, HPV 16 and 33 were more common in women with dysplasia than in those without dysplasia (HPV 16: 28.9 vs 7.2%; HPV 33: 11.8 vs 3.6%). HPV 16 was the most common HR-HPV genotype in cervical samples, followed by HPV 45, 31, 33, 18, 52, and 58. HPV 16 and 33 were shown to be associated with the development of cervical dysplasia. These results indicate that prophylactic nonavalent vaccine can potentially prevent approximately 90% of HR-HPV infections and 60% of cervical dysplasia cases in Montenegrin women.
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Affiliation(s)
- Milena Lopicic
- 1Institute of Public Health of Montenegro, Podgorica, Montenegro
| | - Janja Raonic
- 2Clinical Centre of Montenegro, Podgorica, Montenegro
| | | | | | - Gordana Mijovic
- 1Institute of Public Health of Montenegro, Podgorica, Montenegro
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11
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Garay OU, Maritano Furcada J, Ayerbe F, Pena Requejo Rave RA, Tatti SA. Cost-Effectiveness and Budget Impact Analysis of Primary Screening With Human Papillomavirus Test With Genotyping in Argentina. Value Health Reg Issues 2021; 26:160-168. [PMID: 34530292 DOI: 10.1016/j.vhri.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Cervical cancer (ICC) is the fourth leading cause of mortality in women in Argentina and primary screening with conventional cytology (Papanicolaou smear) is the most widely used strategy despite its limitations. Strategies based on human papillomavirus (HPV) testing have the potential to improve detection and reduce mortality. The objective of this study is to evaluate the cost-effectiveness and budgetary impact of a strategy based on HPV testing with genotyping. METHODS We used a decision model to compare the ICC screening strategies. The population consisted of 30- to 65-year-old females suitable for screening in Argentina. Inputs comprised epidemiologic, diagnostic performance, and costs data. The clinical impact was represented by the number of ICC detected and ICC-related mortality. Incremental cost-effectiveness ratio, estimated in terms of Argentinean pesos per life-year gained, and the budgetary impact were calculated at 5, 10, and 20 years. Univariate and probabilistic sensitivity analyses were performed. RESULTS Primary screening with HPV testing would prevent 1853 ICC deaths and reduce mortality by 13% at year 10 compared with Papanicolaou smear. With an incremental cost-effectiveness ratio of AR$329 042 in the base case, it would be cost-effective for a cost-effectiveness threshold of 1 gross domestic product per capita. It would imply an additional expense in the first 5 years and probably savings in the subsequent ones. Sensitivity analyses confirm the robustness of the findings. CONCLUSIONS The primary screening strategy based on HPV testing with genotyping compared with conventional cytology is most likely a cost-effective strategy in Argentina.
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12
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Huber J, Mueller A, Sailer M, Regidor PA. Human papillomavirus persistence or clearance after infection in reproductive age. What is the status? Review of the literature and new data of a vaginal gel containing silicate dioxide, citric acid, and selenite. ACTA ACUST UNITED AC 2021; 17:17455065211020702. [PMID: 34096424 PMCID: PMC8785287 DOI: 10.1177/17455065211020702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical cancer, the third most common cancer in women, is caused in nearly all cases by a persistent infection with high-risk types of the human papillomavirus. Although human papillomavirus infections are 80%-90% transient and disappear spontaneously within 24 months, human papillomavirus infections that remain are at risk of developing cervical lesions. Different therapeutical approaches have been tested to promote the regression of low-grade lesions or prevent progression. They include the application of 5-fluorouracil, curcumin, imiquimod, interferons, Vitamin D, and others. Also, the effect of probiotics and vaginal therapy with carboxy-methyl-beta glucan was assessed. Review of the literature and presentation of the last study data are presented. Clearance of high-risk human papillomavirus seemed to be promoted by treatment with a new vaginal gel containing a highly disperse SiO2 and an anti-oxidative combination of citric acid and sodium. This gel showed, after 6 months, an improvement of cytological Pap findings (ASC-US, LSIL, ASC-H, or HSIL) in 80.9% of the participants. Similarly, there was a clearing of hr-human papillomavirus in 53% of cases after 3 months of gel administration. The percentage increased slightly in the non-treated control group from 78.3% at baseline to 83% after 3 months. The percentage of patients who were tested positive for p16/Ki67 reduced from 75% at baseline to 5.3% in the treatment group after 6 months, while the percentage decreased only slightly in the non-treated group (baseline: 91.5%; 6 months: 75.2%). The examined vaginal gel may support the healing of conspicuous cytological findings (ASC-US, LSIL, ASC-H, or HSIL) and clearance of hr-human papillomavirus positive results.
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13
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Asti L, Hopley C, Avelis C, Bartsch SM, Mueller LE, Domino M, Cox SN, Andrews JC, Randall SL, Stokes-Cawley OJ, Asjes C, Lee BY. The Potential Clinical and Economic Value of a Human Papillomavirus Primary Screening Test That Additionally Identifies Genotypes 31, 45, 51, and 52 Individually. Sex Transm Dis 2021; 48:370-380. [PMID: 33156291 PMCID: PMC8281325 DOI: 10.1097/olq.0000000000001327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although current human papillomavirus (HPV) genotype screening tests identify genotypes 16 and 18 and do not specifically identify other high-risk types, a new extended genotyping test identifies additional individual (31, 45, 51, and 52) and groups (33/58, 35/39/68, and 56/59/66) of high-risk genotypes. METHODS We developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity (BD Diagnostics, Franklin Lakes, NJ) capable of extended genotyping in a cohort of women 30 years or older. Women with certain genotypes were later rescreened instead of undergoing immediate colposcopy and varied which genotypes were rescreened, disease progression rate, and test cost. RESULTS Assuming 100% compliance with screening, HPV primary screening using current tests resulted in 25,194 invasive procedures and 48 invasive cervical cancer (ICC) cases per 100,000 women. Screening with extended genotyping (100% compliance) and later rescreening women with certain genotypes averted 903 to 3163 invasive procedures and resulted in 0 to 3 more ICC cases compared with current HPV primary screening tests. Extended genotyping was cost-effective ($2298-$7236/quality-adjusted life year) when costing $75 and cost saving (median, $0.3-$1.0 million) when costing $43. When the probabilities of disease progression increased (2-4 times), extended genotyping was not cost-effective because it resulted in more ICC cases and accrued fewer quality-adjusted life years. CONCLUSIONS Our study identified the conditions under which extended genotyping was cost-effective and even cost saving compared with current tests. A key driver of cost-effectiveness is the risk of disease progression, which emphasizes the need to better understand such risks in different populations.
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Affiliation(s)
- Lindsey Asti
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
| | - Colin Hopley
- Health Economics and Outcomes Research, BD Diagnostics, 1 Becton Drive, Franklin Lakes, New Jersey, 07417, USA
| | - Cameron Avelis
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
| | - Sarah M. Bartsch
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
| | - Leslie E. Mueller
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
| | - Molly Domino
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
| | - Sarah N. Cox
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
| | - Jeffrey C. Andrews
- Women’s Health & Cancer, BD Diagnostics, 7 Loveton Circle, Sparks, Maryland 21152
| | - Samuel L. Randall
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
| | - Owen J. Stokes-Cawley
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
| | - Caitlin Asjes
- Health Economics and Outcomes Research, BD Diagnostics, 1 Becton Drive, Franklin Lakes, New Jersey, 07417, USA
| | - Bruce Y. Lee
- Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, 55 W 125th Street, New York City, New York 10027
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14
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Burger EA, de Kok IMCM, Groene E, Killen J, Canfell K, Kulasingam S, Kuntz KM, Matthijsse S, Regan C, Simms KT, Smith MA, Sy S, Alarid-Escudero F, Vaidyanathan V, van Ballegooijen M, Kim JJ. Estimating the Natural History of Cervical Carcinogenesis Using Simulation Models: A CISNET Comparative Analysis. J Natl Cancer Inst 2021; 112:955-963. [PMID: 31821501 DOI: 10.1093/jnci/djz227] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The natural history of human papillomavirus (HPV)-induced cervical cancer (CC) is not directly observable, yet the age of HPV acquisition and duration of preclinical disease (dwell time) influences the effectiveness of alternative preventive policies. We performed a Cancer Intervention and Surveillance Modeling Network (CISNET) comparative modeling analysis to characterize the age of acquisition of cancer-causing HPV infections and implied dwell times for distinct phases of cervical carcinogenesis. METHODS Using four CISNET-cervical models with varying underlying structures but fit to common US epidemiological data, we estimated the age of acquisition of causal HPV infections and dwell times associated with three phases of cancer development: HPV, high-grade precancer, and cancer sojourn time. We stratified these estimates by HPV genotype under both natural history and CC screening scenarios, because screening prevents cancer development that affects the mix of detected cancers. RESULTS The median time from HPV acquisition to cancer detection ranged from 17.5 to 26.0 years across the four models. Three models projected that 50% of unscreened women acquired their causal HPV infection between ages 19 and 23 years, whereas one model projected these infections occurred later (age 34 years). In the context of imperfect compliance with US screening guidelines, the median age of causal infection was 4.4-15.9 years later compared with model projections in the absence of screening. CONCLUSIONS These validated CISNET-CC models, which reflect some uncertainty in the development of CC, elucidate important drivers of HPV vaccination and CC screening policies and emphasize the value of comparative modeling when evaluating public health policies.
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Affiliation(s)
- Emily A Burger
- Harvard T.H. Chan School of Public Health, Boston, MA.,University of Oslo, Oslo, Norway
| | | | | | - James Killen
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | | | | | | | | | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Sy
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Fernando Alarid-Escudero
- Drug Policy Program, Center for Research and Teaching in Economics (CIDE)-CONACyT, Aguascalientes, Mexico
| | | | | | - Jane J Kim
- Harvard T.H. Chan School of Public Health, Boston, MA
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15
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Yang Y, Zhang L, Zhang Y, Huo W, Qi R, Guo H, Li X, Wu X, Bai F, Liu K, Qiao Y, Piguet V, Croitoru D, Chen HD, Gao XH. Local hyperthermia at 44 ºC is effective to clear cervical high-risk HPVs: a proof of concept, randomized, controlled clinical trial. Clin Infect Dis 2021; 73:1642-1649. [PMID: 33905482 DOI: 10.1093/cid/ciab369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Persistent infection by high risk human papillomavirus (HPV) is the leading cause of cervical intraepithelial neoplasia and cervical carcinoma. Local hyperthermia at 44ºC has been proven efficacious to clear cutaneous or anogenital warts caused by HPV infection. This study aims to assess the effect of hyperthermia at 44ºC on the clearance of high-risk HPV. METHODS A randomized, patient blind, sham treatment-controlled trial was conducted in four medical centers. We enrolled patients with positive high-risk HPVs and normal or insignificant cytological findings (Negative/ASCUS/LSIL). Participants were randomly assigned (1:1) to receive either hyperthermia at 44 ºC or 37 ºC, for 30mins in each session. Patients in both groups received treatment once a day for three consecutive days, plus two more sessions 10 ± 3 days later. The primary outcome was clearance rate of HPV three months after the treatment. RESULTS After a 3-month follow-up, hyperthermia treatment at 44 ºC and 37 ºC achieved HPV clearance rates of 85.19% (23/27) and 50% (13/26), respectively (p=0.014). There was no significant difference of treatment response between patients with single and multiple type of HPV by 44 ºC hyperthermia treatment. There were no significant adverse events recorded during the treatment period in both groups. CONCLUSIONS Local hyperthermia at 44 ºC safely and significantly aids in clearing cervical high-risk HPVs, the effect of which helps halting the progression of cervical transformation and transmission of the virus.
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Affiliation(s)
- Yang Yang
- Department of Dermatology, The First Hospital of China Medical University and National joint Engineering Research Center for Theranostics of Immunological Skin Diseases, The First Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, China
| | - Lan Zhang
- Department of Dermatology, The First Hospital of China Medical University and National joint Engineering Research Center for Theranostics of Immunological Skin Diseases, The First Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, China
| | - Yuqing Zhang
- GCP Center, The First Hospital of China Medical University, Shenyang, China
| | - Wei Huo
- Department of Dermatology, The First Hospital of China Medical University and National joint Engineering Research Center for Theranostics of Immunological Skin Diseases, The First Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, China
| | - Ruiqun Qi
- Department of Dermatology, The First Hospital of China Medical University and National joint Engineering Research Center for Theranostics of Immunological Skin Diseases, The First Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, China
| | - Hao Guo
- Department of Dermatology, The First Hospital of China Medical University and National joint Engineering Research Center for Theranostics of Immunological Skin Diseases, The First Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, China
| | - Xiaodong Li
- Department of Dermatology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China
| | - Xin Wu
- Department of Obstetrics and Gynecology,The First Hospital of China Medical University, Shenyang, China
| | - Feng Bai
- Department of Obstetrics and Gynecology, Liaoning Province People's Republic of China, Shenyang, China
| | - Kuiran Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital affiliated to China Medical University, Shenyang, China
| | - Youlin Qiao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking, China
| | - Vincent Piguet
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hong-Duo Chen
- Department of Dermatology, The First Hospital of China Medical University and National joint Engineering Research Center for Theranostics of Immunological Skin Diseases, The First Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital of China Medical University and National joint Engineering Research Center for Theranostics of Immunological Skin Diseases, The First Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, China
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16
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Cang W, Gu L, Hong Z, Wu A, Di W, Qiu L. Effectiveness of photodynamic therapy with 5-aminolevulinic acid on HPV clearance in women without cervical lesions. Photodiagnosis Photodyn Ther 2021; 34:102293. [PMID: 33857599 DOI: 10.1016/j.pdpdt.2021.102293] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND High-risk HPV (hrHPV) not only increases the risk of cervical precancerous lesions and cervical cancer, but also adds psychological burden to HPV-positive women. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a non-invasive and highly tissue-selective therapy. We aim to investigate the clinical efficacy of ALA-PDT for elimination of cervical hrHPV infection in HPV-positive women without cervical lesions. METHODS A total of 57 hrHPV-positive women without pathologically proved cervical lesions received three treatments of ALA-PDT in total. HPV DNA testing and pap cytology were performed in all patients. Patients with positive HPV16/18 or abnormal TCT results received colposcopic biopsy during the follow-up. RESULTS hrHPV clearance rate was 56.1 % (32/57) at 3-month follow-up and 68.1 % at 6-month follow-up. 100 % of HPV 18 and 87.5 % of HPV16 infections were cleared while the clearance rate was 48.8 % among those positive for 12 other high-risk types. Multivariate analysis showed HPV16/18 infection was associated with significantly higher clearance rate. HPV clearance rate in patients with multiple-type HPV infection was significantly lower than that in patients with single-type HPV infections. CONCLUSIONS ALA-PDT is effective on treating hrHPV infection in patients with no cervical lesions. HPV16/18 positive cases can benefit most from ALA-PDT. Multitype-infected women need more sessions of 5- ALA-PDT to eradicate hrHPV infection.
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Affiliation(s)
- Wei Cang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Liying Gu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zubei Hong
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Anyue Wu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wen Di
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Lihua Qiu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Serrano L, López AC, González SP, Palacios S, Dexeus D, Centeno-Mediavilla C, Coronado P, de la Fuente J, López JA, Vanrell C, Cortés J. Efficacy of a Coriolus versicolor-Based Vaginal Gel in Women With Human Papillomavirus-Dependent Cervical Lesions: The PALOMA Study. J Low Genit Tract Dis 2021; 25:130-136. [PMID: 33746195 PMCID: PMC7984756 DOI: 10.1097/lgt.0000000000000596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the efficacy of Papilocare, a Coriolus versicolor-based vaginal gel, in repairing human papillomavirus (HPV)-related low-grade cervical lesions. METHODS The study is a multicenter, open-label, randomized, parallel-group, watchful waiting approach-controlled trial involving 91 HPV-positive women with low-grade Pap smear alterations and consistent colposcopy. RESULTS The percentage of patients with normal Pap smear and concordant colposcopy 3 and 6 months after receiving treatment (78.0% and 84.9%) was significantly higher than without treatment (54.8% and 64.5%), especially in high-risk HPV patients (79.5% and 87.8% vs 52.0% and 56.0%). At 6-month visit, overall HPV clearance was achieved by a greater number of patients receiving treatment (59.6%) compared with those without treatment (41.9%), especially high-risk HPV ones (62.5% vs 40.0%). The cervical re-epithelization score was significantly higher with treatment (mean = 4.5) than without (mean = 4.1). Compared with baseline, perceived stress decreased in the treatment group (from 21.1 to 19.0) and increased in the control group (from 17.7 to 20.7). A total of 7 possible or probable treatment-related adverse events were reported, most of them (n = 6) being mild or moderate in severity. CONCLUSIONS Treatment with Papilocare has demonstrated a better clinical benefit than the conventional watchful waiting approach in clinical practice for total and high-risk HPV patients in terms of its efficacy to treat HPV-related cervical lesions and to clear all HPV strains after a single 6-month period. It has demonstrated an adequate safety and tolerability and confers additional benefits such as higher re-epithelization, stress reduction, and high treatment adherence.
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Ernstson A, Forslund O, Borgfeldt C. Promotion of Cervical Screening among Long-term Non-attendees by Human Papillomavirus Self-sampling. J Cancer Prev 2021; 26:25-31. [PMID: 33842403 PMCID: PMC8020173 DOI: 10.15430/jcp.2021.26.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 01/06/2023] Open
Abstract
Cervical cancer is preventable through gynecological screening. To promote participation among non-attending women, self-collected vaginal samples for detection of high-risk human papillomavirus (hr-HPV) is an option. The aims of this study were to investigate the response of self-collected vaginal samples for hr-HPV testing among long-term non-attendees, to explore the attendance at follow-up among HPV-positive women, and to analyze the prevalence of hr-HPV and severe cervical dysplasia or cancer among the responders. A vaginal self-sampling kit was sent to 19,766 women aged 30-70 years who had not provided a cervical screening sample for ≥ 7 years in Skåne, Sweden. The self-sample was analyzed by the Aptima HPV mRNA assay (Hologic). Women testing positive for HPV were invited for follow-up. The response was 18.5% (3,646/19,757). The prevalence of HPV mRNA was 11.3% (412/3,636). Among HPV-positive women, 85.7% (353/412) attended follow-up, and of these, 44.8% (158/353) had HPV in the cervical sample. The HPV mRNA test of self-samples showed a positive predictive value of 9.3% ([33/353], 95% CI = 6.5-12.9) for detection of cytologically severe dysplasia. Histologically severe dysplasia or cancer was detected in 0.88% ([32/3,636], 95% CI = 0.6-1.2) among responders, including two cervical- and one vaginal cancer. In conclusion, almost one fifth of the long-term non-attendees participated in self-collected vaginal hr-HPV sampling. The prevalence of histologically confirmed high grade squamous intraepithelial lesion or cervical cancer was not increased significantly compared to regularly screened women in Sweden. The relatively high HPV prevalence among the self-samples indicates the importance of diagnostic follow-up with cervical HPV testing and reflex-cytology of HPV-positive cases.
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Affiliation(s)
- Avalon Ernstson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ola Forslund
- Department of Medical Microbiology, Laboratory Medicine Region Skåne, Lund University, Lund, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
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Loopik DL, Koenjer LM, Siebers AG, Melchers WJG, Bekkers RLM. Benefit and burden in the Dutch cytology-based vs high-risk human papillomavirus-based cervical cancer screening program. Am J Obstet Gynecol 2021; 224:200.e1-200.e9. [PMID: 32800820 DOI: 10.1016/j.ajog.2020.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND In 2017, the Dutch cervical cancer screening program had replaced the primary cytology-based screening with primary high-risk human papillomavirus-based screening, including the opportunity to participate through self-sampling. Evaluation and balancing benefit (detection of high-grade cervical intraepithelial neoplasia) and burden of screening (unnecessary referrals, invasive diagnostics, and overtreatment) is needed. OBJECTIVE This study aimed to compare the referral rates, detection of high-grade cervical intraepithelial neoplasia, overdiagnosis, and overtreatment in the new high-risk human papillomavirus-based screening program, including physician-sampled and self-sampled material, with the previous cytology-based screening program in the Netherlands. STUDY DESIGN A retrospective cohort study was conducted within the Dutch population-based cervical cancer screening program. Screenees with referrals for colposcopy between 2014 and 2015 (cytology-based screening) and 2017 and 2018 (high-risk human papillomavirus-based screening) were included. Data were retrieved from the Dutch Pathology Registry (PALGA) and compared between the 2 screening programs. The main outcome measures were referral rate, detection of high-grade cervical intraepithelial neoplasia or worse, overdiagnosis (cervical intraepithelial neoplasia grade 1 or less in the histologic specimen), and overtreatment (cervical intraepithelial neoplasia grade 1 or less in the treatment specimen). RESULTS Of the women included in the study, 19,109 received cytology-based screening, and 26,171 received high-risk human papillomavirus-based screening. Referral rates increased from 2.5% in cytology-based screening to 4.2% in high-risk human papillomavirus-based screening (+70.2%). Detection rates increased to 46.2% for cervical intraepithelial neoplasia grade 2 or worse, 32.2% for cervical intraepithelial neoplasia grade 3 or worse, and 31.0% for cervical cancer, and overdiagnosis increased to 143.4% with high-risk human papillomavirus-based screening. Overtreatment rates were similar in both screening periods. The positive predictive value of referral for detection of cervical intraepithelial neoplasia grade 2 or worse in high-risk human papillomavirus-based screening was 34.6% compared with 40.2% in cytology-based screening. Women screened through self-sampling were at higher risk of cervical intraepithelial neoplasia grade 2 or worse detection (odds ratio, 1.38; 95% confidence interval, 1.20-1.59) and receiving treatment (odds ratio, 1.31; 95% confidence interval, 1.16-1.48) than those screened through physician-sampling. CONCLUSION Compared with cytology-based screening, high-risk human papillomavirus-based screening increases detection of high-grade cervical intraepithelial neoplasia, with 462 more cervical intraepithelial neoplasia grade 2 or worse cases per 100,000 women but at the expense of 850 more cases per 100,000 women with invasive diagnostics indicating cervical intraepithelial neoplasia grade 1 or less.
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Affiliation(s)
- Diede L Loopik
- Department of Obstetrics and Gynaecology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Lisanne M Koenjer
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert G Siebers
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands; PALGA Foundation, Houten, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands; Department of Obstetrics and Gynaecology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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20
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Gori S, Battagello J, Gustinucci D, Campari C, Zorzi M, Frayle H, Passamonti B, Sartori G, Bulletti S, Fodero C, Cesarini E, Faggiano R, Del Mistro A. Clinical relevance of partial HPV16/18 genotyping in stratifying HPV-positive women attending routine cervical cancer screening: a population-based cohort study. BJOG 2021; 128:1353-1362. [PMID: 33326680 PMCID: PMC8248328 DOI: 10.1111/1471-0528.16631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 12/14/2022]
Abstract
Objective To evaluate partial HPV16/18 genotyping as a possible biomarker to select women attending HPV‐based cervical cancer screening at higher risk to be referred to colposcopy. Design Population‐based cohort study. Setting Organised cervical cancer screening programmes (Italy). Population Women with high‐risk HPV infection (period: 2015–2019). Methods We analysed the association between partial HPV16/18 genotyping, cytology triage and histologically confirmed diagnosis of high‐grade cervical intraepithelial neoplasia (CIN3+) lesions. Main outcome measures Detection rate (DR) and positive predictive value (PPV) for histologically confirmed CIN3+ (any episode in the 2 years after baseline); sensitivity for CIN3+ and number of colposcopies needed for lesion detection. Results The study included 145 437 women screened with HPV testing by the clinically validated COBAS 4800 HPV assay (Roche). Overall, 9601 (6.6%) women were HPV+ at baseline; HPV16 and HPV18 were present in 1865 and 594 samples, respectively. The cumulative (baseline plus 1‐year repeat) cytology positivity was 42.8% and high‐grade cytology was significantly higher (P < 0.0001) among women with HPV16 infection at baseline (15.2%). The cumulative CIN3+ DR for women with HPV16, HPV18 and other HPV‐type infections was 9.8%, 3.4% and 1.8%, respectively. Conclusions Partial HPV16 genotyping may play a role in triage, whereas HPV18 seems to behave much more similarly to the other HPV types and does not provide additional stratification. HPV16 genotyping combined with high‐grade cytology can be envisaged as a triage biomarker in cervical screening to maximise CIN3+ detection while minimising colposcopy at baseline or 1‐year repeat. Tweetable abstract HPV16 genotyping combined with high‐grade cytology can be used as triage biomarker for CIN3+ in HPV‐positive women. HPV16 genotyping combined with high‐grade cytology can be used as a triage biomarker for CIN3+ in HPV‐positive women.
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Affiliation(s)
- S Gori
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - J Battagello
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - D Gustinucci
- Laboratorio Unico di Screening USL Umbria 1, Perugia, Italy
| | - C Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - H Frayle
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - B Passamonti
- Laboratorio Unico di Screening USL Umbria 1, Perugia, Italy
| | - G Sartori
- Laboratorio citologia cervico-vaginale, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Bulletti
- Cancer Screening Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - C Fodero
- Laboratorio citologia cervico-vaginale, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Cesarini
- Laboratorio Unico di Screening USL Umbria 1, Perugia, Italy
| | - R Faggiano
- Cancer Screening Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Del Mistro
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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21
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Li M, Liu T, Luo G, Sun X, Hu G, Lu Y, H Xu R, Zou H, Luo X. Incidence, persistence and clearance of cervical human papillomavirus among women in Guangdong, China 2007-2018: A retrospective cohort study. J Infect Public Health 2020; 14:42-49. [PMID: 33341483 DOI: 10.1016/j.jiph.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies showed the incidence, persistence and clearance of cervical human papillomavirus (HPV) among women varies from regions. There is no study on dynamic changes of HPV infection among women in Guangdong. METHODS It is a retrospective cohort study that included gynecological outpatients aged ≥15 years and retested for HPV within 24 months in Guangdong Women and Children Hospital to estimate HPV incidence, persistence and clearance. Outcomes were estimated through the proportion of HPV incidence, persistence and clearance in HPV-negative or HPV-positive women. Moreover, we examined HPV incidence, persistence and clearance among women who retested in four calendar periods: 0-6, 6-12, 12-18, 18-24 months after the first test. RESULTS 33,328 gynecological outpatients were included in our study. Incidence rates of any HPV, high-risk (HR) HPV and low-risk (LR) HPV were 10.58%, 8.68% and 4.83%. The most common incident HR HPV were HPV52 (2.69%), HPV16 (1.23%) and HPV58 (1.23%). Persistence rates of any HPV, HR HPV and LR HPV were 47.55%, 42.77% and 33.88%. HPV52 (42.33%), HPV58 (40.74%) and HPV68 (32.36%) were commonly found persistent types. And clearance rates of any HPV, HR HPV and LR HPV were 52.44%, 57.23% and 66.12%.The lowest clearance rates were observed for HPV52 (57.67%), HPV68 (67.64%) and HPV39 (68.56%). HPV incidence and persistence were higher among women aged 15-19 years and ≥55 years. HPV incidence and persistence were found higher among women who retested within 6 months than others in other periods. CONCLUSIONS HPV52, 58, 68, and 39 were the more likely to cause incident and persistent infection, and less likely to be cleared among women in Guangdong. HPV incidence and persistent infection were higher among women aged both younger and older women compared to middle aged women. HPV retesting period may impact the detection of HPV incidence, persistence and clearance.
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Affiliation(s)
- Meijuan Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
| | - Tingyan Liu
- Department of Gynecology, Guangdong Provincial Women and Children Hospital, Guangzhou, PR China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
| | - Xiaoli Sun
- Department of Gynecology, Guangdong Provincial Women and Children Hospital, Guangzhou, PR China
| | - Guiying Hu
- Department of Gynecology, Guangdong Provincial Women and Children Hospital, Guangzhou, PR China
| | - Ying Lu
- Department of Gynecology, Guangdong Provincial Women and Children Hospital, Guangzhou, PR China
| | - Richie H Xu
- School of Public Health, University of Minnesota, MN, USA
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China; School of Public Health, Shanghai Jiao Tong University, Shanghai, PR China.
| | - Xiping Luo
- Department of Gynecology, Guangdong Provincial Women and Children Hospital, Guangzhou, PR China.
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22
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Inturrisi F, Bogaards JA, Heideman DAM, Meijer CJLM, Berkhof J. Risk of Cervical Intraepithelial Neoplasia Grade 3 or Worse in HPV-Positive Women with Normal Cytology and Five-Year Type Concordance: A Randomized Comparison. Cancer Epidemiol Biomarkers Prev 2020; 30:485-491. [PMID: 33293342 DOI: 10.1158/1055-9965.epi-20-1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In human papillomavirus (HPV)-based cervical screening programs, management of HPV-positive women with normal cytology is debated. Longitudinal information on HPV type persistence may be employed for risk stratification. METHODS We assessed the risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) after repeatedly testing positive for the same HPV type(s) in the randomized population-based screening study Amsterdam (POBASCAM). We compared 18-month CIN3+ risks in HPV-positive women (intervention, n = 1,066) to those in HPV-positive/cytology-negative women who tested HPV-positive in the next screening round (control, n = 111) five years later, stratified for HPV type concordance. RESULTS The 18-month CIN3+ risk was 15% in HPV-positive women in the intervention group, 40% in the control group after two-round type concordance (relative risk 2.6, 95% confidence interval 1.9-3.4), and 20% in the control group after a type switch (1.3, 0.5-3.2). The relative increase in CIN3+ risk after two-round type concordance was similar in <35-year-old (3.0, 2.0-4.4) and older women (2.2, 1.4-3.5), and was high in high-risk HPV-positive women who were HPV16/18/31/33/45-negative in both rounds (9.9, 4.4-21.9). CONCLUSIONS Five-year HPV type concordance signals high CIN3+ risk and warrants referral for colposcopy without additional cytology triage. IMPACT HPV screening programs become highly efficient when HPV-positive women with negative triage testing at baseline are offered repeat HPV genotyping after five years.
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Affiliation(s)
- Federica Inturrisi
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands.
| | - Johannes A Bogaards
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands.,Amsterdam UMC, University of Amsterdam, Epidemiology and Data Science, Academic Medical Centre, Amsterdam, the Netherlands
| | - Daniëlle A M Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands
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23
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Orang'o EO, Were E, Rode O, Muthoka K, Byczkowski M, Sartor H, Vanden Broeck D, Schmidt D, Reuschenbach M, von Knebel Doeberitz M, Bussmann H. Novel concepts in cervical cancer screening: a comparison of VIA, HPV DNA test and p16 INK4a/Ki-67 dual stain cytology in Western Kenya. Infect Agent Cancer 2020; 15:57. [PMID: 33024449 PMCID: PMC7531147 DOI: 10.1186/s13027-020-00323-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background Screening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology. Methods We prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a p16INK4a /Ki-67 (CINtecPLUS®) dual stained slide that was prepared using the ThinPrep® 2000 Processor and evaluated by a pathologist trained in the methodology. Results In 701 of a total of 800 women aged 18–64 years, all three investigations were performed and data could be analyzed. The HPV, VIA and dual stain cytology positivity were 33%, 7%, and 2% respectively. The HPV positivity rate of VIA positive cases was 32%. The five most common HPV types were HPV16, 52, 68, 58 and 35. The OR among HIV infected women of an HPV infection, VIA positivity and positive dual stain cytology were 2.6 (95%CI 1.5–4.3), 1.9 (95%CI 0.89–4.4) and 3.4 (95%CI 1.07–10.9) respectively. The sensitivity of VIA to detect a p16INK4a/Ki-67 positive transforming infection was 13% (95%CI 2–38). Conclusions Primary HPV testing appears feasible and should be considered as a primary screening test also in LMICs. The poor sensitivity of VIA renders it unsuitable as a triage test for HPV positive women. The utility of p16INK4a/Ki-67 dual stain cytology as a triage test for HPV positive women in LMICs should be further studied.
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Affiliation(s)
- Elkanah Omenge Orang'o
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Edwin Were
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Oliver Rode
- Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kapten Muthoka
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Heike Sartor
- Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Davy Vanden Broeck
- International Centre of Reproductive Health, Ghent University, Ghent, Belgium.,National Reference Centre for HPV, Brussels, Belgium.,Laboratory of Molecular Pathology, AML, Antwerp, Belgium
| | - Dietmar Schmidt
- MVZ of Histology, Cytology and Molecular Diagnostics, Department of Cytopathology, Trier, Germany
| | - Miriam Reuschenbach
- Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Hermann Bussmann
- Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
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24
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McBride E, Marlow LAV, Bennett KF, Stearns S, Waller J. Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study. Psychooncology 2020; 30:84-92. [PMID: 32909308 PMCID: PMC8436740 DOI: 10.1002/pon.5540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/01/2023]
Abstract
Objective To explore reasons for variations in anxiety in women testing positive for human papillomavirus (HPV) with normal cytology at routine HPV primary cervical cancer screening. Methods In‐depth interviews were conducted with 30 women who had tested HPV‐positive with normal cytology, including 15 with low‐to‐normal anxiety and 15 with high anxiety. Data were analysed using Framework Analysis to compare themes between low and high anxiety groups. Results Several HPV‐related themes were shared across anxiety groups, but only highly anxious women expressed fear and worry, fatalistic cognitions about cancer, fertility‐related cognitions, adverse physiological responses and changes in health behaviour(s). In comparison to those with low anxiety, women with high anxiety more strongly voiced cognitions about the 12‐month wait for follow‐up screening, relationship infidelity, a lower internal locus of control and HPV‐related symptom attributions. Conclusions Receiving an HPV‐positive with normal cytology result related to various emotional, cognitive, behavioural and physiological responses; some of which were specific to, or more pronounced in, women with high anxiety. If our observations are confirmed in hypothesis‐driven quantitative studies, the identification of distinct themes relevant to women experiencing high anxiety can inform targeted patient communications and HPV primary screening implementation policy. To our knowledge, this is the first qualitative study to explore anxiety in women testing human papillomavirus (HPV)‐positive with normal cytology at routine HPV primary screening. Our comparative qualitative design allowed thematic nuances to emerge between women who had experienced low versus high anxiety following their result. Only highly anxious women expressed fear and worry, fatalistic cognitions about cancer, fertility‐related cognitions, adverse physiological responses and changes in health behaviour(s). Highly anxious women also more strongly voiced cognitions about the 12‐month wait for follow‐up screen, reltionship infidelity, a lower internal locus of control and HPV‐related symptom attributions. These distinct themes can be used to minimise unnecessary anxiety through the development of evidence‐based patient communications at HPV primary screening.
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Affiliation(s)
- Emily McBride
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London, UK
| | - Laura A V Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London (KCL), London, UK
| | - Kirsty F Bennett
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London, UK
| | - Selma Stearns
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London (KCL), London, UK
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25
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McBride E, Tatar O, Rosberger Z, Rockliffe L, Marlow LAV, Moss-Morris R, Kaur N, Wade K, Waller J. Emotional response to testing positive for human papillomavirus at cervical cancer screening: a mixed method systematic review with meta-analysis. Health Psychol Rev 2020; 15:395-429. [PMID: 32449477 DOI: 10.1080/17437199.2020.1762106] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tens-of-millions of women every year test positive for human papillomavirus (HPV) at routine cervical screening. We performed a mixed-methods systematic review using a results-based convergent design to provide the first comprehensive overview of emotional response to testing positive for HPV (HPV+). We mapped our findings using the cognitive behavioural framework. Six electronic databases were searched from inception to 09-Nov-2019 and 33 papers were included. Random-effects meta-analyses revealed that HPV+ women with abnormal or normal cytology displayed higher short-term anxiety than those with normal results (MD on State-Trait Anxiety Inventory = 7.6, 95% CI: 4.59-10.60 and MD = 6.33, CI: 1.31-11.35, respectively); there were no long-term differences. Psychological distress (general/sexual/test-specific) was higher in HPV+ women with abnormal cytology in the short-term and long-term (SMD = 0.68, CI: 0.32-1.03 and SMD = 0.42, CI: 0.05-0.80, respectively). Testing HPV+ was also related to disgust/shame, surprise and fear about cancer. Broadly, adverse response related to eight cognitive constructs (low control, confusion, cancer-related concerns, relationship concerns, sexual concerns, uncertainty, stigma, low trust) and six behavioural constructs (relationship problems, social impact, non-disclosure of results, idiosyncratic prevention, indirect clinical interaction, changes to sexual practice). Almost exclusive use of observational and qualitative designs limited inferences of causality and conclusions regarding clinical significance.
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Affiliation(s)
- Emily McBride
- Department of Behavioural Science and Health, University College London (UCL), London, UK
| | - Ovidiu Tatar
- Research Center-Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, QC, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychology, Psychiatry and Oncology, McGill University, Montreal, Canada
| | - Lauren Rockliffe
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Laura A V Marlow
- School of Cancer and Pharmaceutical Sciences, King's College London (KCL), London, UK
| | - Rona Moss-Morris
- Department of Psychology, King's College London (KCL), London, UK
| | - Navdeep Kaur
- Research Center-Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London (KCL), London, UK
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Demarco M, Hyun N, Carter-Pokras O, Raine-Bennett TR, Cheung L, Chen X, Hammer A, Campos N, Kinney W, Gage JC, Befano B, Perkins RB, He X, Dallal C, Chen J, Poitras N, Mayrand MH, Coutlee F, Burk RD, Lorey T, Castle PE, Wentzensen N, Schiffman M. A study of type-specific HPV natural history and implications for contemporary cervical cancer screening programs. EClinicalMedicine 2020; 22:100293. [PMID: 32510043 PMCID: PMC7264956 DOI: 10.1016/j.eclinm.2020.100293] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND HPV testing is replacing cytology for cervical cancer screening because of greater sensitivity and superior reassurance following negative tests for the dozen HPV genotypes that cause cervical cancer. Management of women testing positive is unresolved. The need for identification of individual HPV genotypes for clinical use is debated. Also, it is unclear how long to observe persistent infections when precancer is not initially found. METHODS In the longitudinal NCI-Kaiser Permanente Northern California Persistence and Progression (PaP) Study, we observed the clinical outcomes (clearance, progression to CIN3+, or persistence without progression) of 11,573 HPV-positive women aged 30-65 yielding 14,158 type-specific infections. FINDINGS Risks of CIN3+ progression differed substantially by type, with HPV16 conveying uniquely elevated risk (26% of infections with seven-year CIN3+ risk of 22%). The other carcinogenic HPV types fell into 3 distinct seven-year CIN3+ risk groups: HPV18, 45 (13% of infections, risks >5%, with known elevated cancer risk); HPV31, 33, 35, 52, 58 (39%, risks >5%); and HPV39, 51, 56, 59, 68 (23%, risks <5%). In the absence of progression, HPV clearance rates were similar by type, with 80% of infections no longer detected within three years; persistence to seven years without progression was uncommon. The predictive value of abnormal cytology was most evident for prevalent CIN3+, but less evident in follow-up. A woman's age did not modify risk; rather it was the duration of persistence that was important. INTERPRETATION HPV type and persistence are the major predictors of progression to CIN3+; at a minimum, distinguishing HPV16 is clinically important. Dividing the other HPV types into three risk-groups is worth considering.
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Key Words
- AGC, Atypical glandular cells
- AIS, Adenocarcinoma in-situ
- ASC-H+, Atypical squamous cells - cannot exclude HSIL
- ASC-US, Atypical squamous cells of undetermined significance
- BD, Becton Dickinson
- CIN, Cervical intraepithelial neoplasia
- HC2, Hybrid Capture 2
- HPV genotype
- HPV outcome, Clearance
- HPV, human papillomavirus
- KPNC, Kaiser Permanente Northern California
- LSIL, Low-grade squamous intraepithelial lesion
- NCI, National Cancer Institute
- NILM, Negative for intraepithelial lesion or malignancy
- PCR, Polymerase chain reaction
- PaP, Persistence and Progression
- Persistence
- Progression
- STM, Specimen transport medium
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Affiliation(s)
- Maria Demarco
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- University of Maryland School of Public Health, College Park, MD, United States
| | - Noorie Hyun
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Tina R. Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Li Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Xiaojian Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Anne Hammer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Nicole Campos
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Walter Kinney
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States
| | - Julia C. Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Brian Befano
- Information Management Services Inc., Calverton, MD, United States
| | - Rebecca B. Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, MA, United States
| | - Xin He
- University of Maryland School of Public Health, College Park, MD, United States
| | - Cher Dallal
- University of Maryland School of Public Health, College Park, MD, United States
| | - Jie Chen
- University of Maryland School of Public Health, College Park, MD, United States
| | - Nancy Poitras
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States
| | - Marie-Helene Mayrand
- Department of Obstetrics and Gynecology, Université de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Francois Coutlee
- Department of Microbiology, Université de Montréal and CRCHUM, Montreal, Canada
| | - Robert D. Burk
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
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Skroumpelos A, Agorastos T, Constantinidis T, Chatzistamatiou K, Kyriopoulos J. Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece. PLoS One 2019; 14:e0226335. [PMID: 31830114 PMCID: PMC6907825 DOI: 10.1371/journal.pone.0226335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 11/24/2019] [Indexed: 11/20/2022] Open
Abstract
Background HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV test as primary screening method for CC. Methods A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25–65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted. Results All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized. Conclusions HPV 16/18 genotyping as a primary screening method for CC appears to be one of the most effective strategies and dominates current practice in respect to both cost and outcomes. Even when compared with all other strategies, the outcomes that it generates justify the cost that it requires, representing a good value for money alternative.
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Affiliation(s)
| | | | | | | | - John Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
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28
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Liu Y, Sigel K, Gaisa MM. Human Papillomavirus Genotypes Predict Progression of Anal Low-Grade Squamous Intraepithelial Lesions. J Infect Dis 2019; 218:1746-1752. [PMID: 30053247 DOI: 10.1093/infdis/jiy463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/20/2018] [Indexed: 01/10/2023] Open
Abstract
Background High-risk human papillomavirus (hrHPV)-induced anal low-grade squamous intraepithelial lesions (LSILs) have the potential to progress to high-grade squamous intraepithelial lesions (HSILs). We investigated whether anal hrHPV infections, particularly types 16 and 18, predict LSIL-to-HSIL progression. Methods One hundred forty-six human immunodeficiency virus (HIV)-infected and 22 HIV-uninfected patients with anal LSILs underwent cytology, HPV genotyping (16, 18, and pooled 12 hrHPV types), and high-resolution anoscopy-guided biopsy at baseline and surveillance. The associations between the rate of LSIL-to-HSIL progression and HPV types as well as longitudinal HPV-16/18 status were assessed by fitting separate Cox regression models. Results At baseline, 91% of patients harbored hrHPV: HPV-16/18 (44%) and non-16/18 (86%). Upon follow-up (median, 20 [range, 6-36] months), 41% developed HSIL (84% at the same anatomic location as the initial LSIL and 16% at a different location). Baseline HPV-16/18-positive patients had greater probability of progression than patients with non-16/18 types or negative (67%, 25%, and 7%, respectively; P < .001). Persistent HPV-16/18 conferred the highest probability of progression (70%), followed by intermittent HPV-16/18 positivity (52%). In unadjusted and adjusted analyses, baseline and persistent HPV-16/18 were significantly associated with LSIL-to-HSIL progression. Conclusions Anal LSIL patients who are positive for hrHPV, especially HPV-16/18, have an increased risk of developing HSIL. Type-specific HPV testing could serve as a risk stratification tool, providing prognostic information.
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Affiliation(s)
- Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keith Sigel
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael M Gaisa
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
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29
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Li W, Meng Y, Wang Y, Cheng X, Wang C, Xiao S, Zhang X, Deng Z, Hu M, Shen P, Xu S, Fu C, Jiang W, Wu B, Li K, Chen G, Wei J, Xi L, Hu J, Ma D, Xue M, Xie X, Wu P. Association of age and viral factors with high-risk HPV persistence: A retrospective follow-up study. Gynecol Oncol 2019; 154:345-353. [DOI: 10.1016/j.ygyno.2019.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/06/2019] [Accepted: 05/28/2019] [Indexed: 01/20/2023]
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30
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Yang Y, Meng YL, Duan SM, Zhan SB, Guan RL, Yue TF, Kong LH, Zhou L, Deng LH, Huang C, Wang S, Wang GY, Wu DF, Zhang CF, Chen F. REBACIN® as a noninvasive clinical intervention for high-risk human papillomavirus persistent infection. Int J Cancer 2019; 145:2712-2719. [PMID: 30989655 DOI: 10.1002/ijc.32344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/18/2019] [Accepted: 04/08/2019] [Indexed: 12/21/2022]
Abstract
The development of highly sensitive HPV-genotyping tests has opened the possibility of treating HPV-infected women before high-grade lesions appear. The lack of efficient intervention for persistent high-risk HPV infection necessitates the need for development of novel therapeutic strategy. Here we demonstrate that REBACIN®, a proprietary antiviral biologics, has shown potent efficacy in the clearance of persistent HPV infections. Two independent parallel clinical studies were investigated, which a total of 199 patients were enrolled and randomly divided into a REBACIN®-test group and a control group without treatment. The viral clearance rates for the REBACIN® groups were 61.5% (24/39) and 62.5% (35/56), respectively, for the two independent parallel studies. In contrast, the nontreatment groups showed self-clearance rates at 20.0% (8/40) and 12.5% (8/64). We further found that REBACIN® was able to significantly repress the expression of HPV E6 and E7 oncogenes in TC-1 and Hela cells. The two viral genes are well known for the development of high-grade premalignancy lesion and cervical cancer. In a mouse model, REBACIN® was indicated to notably suppress E6/E7-induced tumor growth, suggesting E6 and E7 oncogenes as a potential target of REBACIN®. Taken together, our studies shed light into the development of a novel noninvasive therapeutic intervention for clearance of persistent HPV infection with significant efficacy.
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Affiliation(s)
- Yi Yang
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
| | - Ya-Li Meng
- Department of Obstetrics and Gynaecology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Obstetrics and Gynaecology, Tianjin Port Hospital, Tianjin, China
| | - Shu-Min Duan
- National Institute for Viral Disease Control and Prevention, Beijing, China
| | - Shao-Bing Zhan
- National Institute for Viral Disease Control and Prevention, Beijing, China
| | - Ruo-Li Guan
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
| | - Tian-Fu Yue
- Department of Obstetrics and Gynaecology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ling-Hua Kong
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
| | - Ling Zhou
- National Institute for Viral Disease Control and Prevention, Beijing, China
| | - Liu-Hong Deng
- Division of Medical Biology, Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, Hainan, China
| | - Chao Huang
- Division of Medical Biology, Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, Hainan, China
| | - Sheng Wang
- Division of Medical Biology, Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, Hainan, China
| | - Gui-Yu Wang
- Division of Medical Biology, Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, Hainan, China
| | - Dai-Fei Wu
- SR Life Sciences Institute, Clarksburg, MD
| | | | - Fei Chen
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
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31
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Stoler MH, Wright TC, Parvu V, Yanson K, Cooper CK, Andrews J. Stratified risk of high-grade cervical disease using onclarity HPV extended genotyping in women, ≥25 years of age, with NILM cytology. Gynecol Oncol 2019; 153:26-33. [DOI: 10.1016/j.ygyno.2018.12.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 11/21/2022]
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32
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Luo M, Yu J, Zhu S, Huang L, Chen Y, Wei S. Detoxification therapy of traditional Chinese medicine for genital tract high-risk human papillomavirus infection: A systematic review and meta-analysis. PLoS One 2019; 14:e0213062. [PMID: 30822331 PMCID: PMC6396931 DOI: 10.1371/journal.pone.0213062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Persistence of high-risk human papillomavirus (hr-HPV) infections is the most critical risk factor for cervical intraepithelial neoplasia (CIN) and cervical cancer (CC). Treatment of persistent oncogenic HPV-positive women after 12-24 months follow-up is still controversy. Detoxification therapy of Chinese medicine (DTCM) has been conducted recently. However, the conclusions are still unclear. We planned to conduct a systematic review and meta-analysis to explore DTCM in the treatment of persistent hr-HPV infections. METHODS Nine electronic databases were systematically searched from their inception to 30 September 2018. Randomized controlled trials comparing DTCM with follow-up or placebo were included. Risk of bias was assessed by the Cochrane 'Risk of Bias' tool. Review Manager 5.3 was used for statistical analyses. Relative ratios (RR) and 95% confidence intervals were used for dichotomous data, and the mean difference (MD) was used for continuous data. We assessed the quality of trials by the GRADE. RESULTS Seventeen RCTs from 2011 to 2018 with 1906 participants were included. The evidence showed that DTCM had a pooled efficacy difference in favor of increasing the HPV clearance rate compared to placebo groups (RR = 2.62, 95% CI 1.28 to 5.33, very low quality) and follow-up groups (RR = 1.88, 95% CI 1.60 to 2.22, low quality). The median HPV persistence tended to decline from 50% within six months to 41.5% at 12 months, and 31.5% at 24 months. A significantly increased regression rate of CIN was found in the DTCM compared with placebo groups (RR = 3.61, 95% CI 1.21 to 10.83, very low quality) and follow-up groups (RR = 1.79, 95% CI 1.31 to 2.45, very low quality). Additionally, we found DTCM have an impact on TNF-α (MD = 2.99, 95% CI 1.90 to 4.07; very low quality), IFN-α (MD = 3.47, 95% CI 2.42 to 4.52; very low quality), CD4+/CD8+ cells (MD = 0.21, 95% CI 0.05 to 0.37; very low quality) compared with follow up groups in some trials with small sample sizes. The major adverse events were genital mucosal irritation symptoms (10%, 5/50). CONCLUSIONS DTCM have favorable outcomes on improving the HPV clearance rate, increasing the regression rate of CIN, and impacting the proportion of some immune cells and cytokine levels. However, most of the evidence was of low quality. Any future high-quality trials and a more extended follow-up period of 24 months or more should be performed.
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Affiliation(s)
- Mei Luo
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
- Department of Gynecology, Hospital of Chongqing Institute of Traditional Chinese Medicine, Chongqing, P.R. China
| | - JiaJie Yu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - ShuYi Zhu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
| | - Li Huang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
| | - Yu Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
| | - ShaoBin Wei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
- * E-mail:
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33
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Pista A, Costa C, Saldanha C, Moutinho JAF, Moutinho JM, Arrobas F, Catalão C, Kempers J. Budget impact analysis of cervical cancer screening in Portugal: comparison of cytology and primary HPV screening strategies. BMC Public Health 2019; 19:235. [PMID: 30808324 DOI: 10.1186/s12889-019-6536-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/12/2019] [Indexed: 11/22/2022] Open
Abstract
Background Primary Human Papilloma Virus (HPV) testing is the currently recommended cervical cancer (CxCa) screening strategy by the Portuguese Society of Gynecology (SPG) clinical consensus. However, primary HPV testing has not yet been adopted by the Portuguese organized screening programs. This modelling study compares clinical benefits and costs of replacing the current practice, namely cytology with ASCUS HPV triage, with 2 comparative strategies: 1) HPV (pooled) test with cytology triage, or 2) HPV test with 16/18 genotyping and cytology triage, in organized CxCa screenings in Portugal. Methods A budget impact model compares screening performance, clinical outcomes and budget impact of the 3 screening strategies. A hypothetical cohort of 2,078,039 Portuguese women aged 25–64 years old women is followed for two screening cycles. Screening intervals are 3 years for cytology and 5 years for the HPV strategies. Model inputs include epidemiological, test performance and medical cost data. Clinical impacts are assessed with the numbers of CIN2–3 and CxCa detected. Annual costs, budget impact and cost of detecting one CIN2+ were calculated from a public healthcare payer’s perspective. Results HPV testing with HPV16/18 genotyping and cytology triage (comparator 2) shows the best clinical outcomes at the same cost as comparator 1 and is the most cost-effective CxCa screening strategy in the Portuguese context. Compared to screening with cytology, it would reduce annual CxCa incidence from 9.3 to 5.3 per 100,000, and CxCa mortality from 2.7 to 1.1 per 100,000. Further, it generates substantial cost savings by reducing the annual costs by €9.16 million (− 24%). The cost of detecting CIN2+ decreases from the current €15,845 to €12,795. On the other hand, HPV (pooled) test with cytology triage (comparator 1) reduces annual incidence of CxCa to 6.9 per 100,000 and CxCa mortality to 1.6 per 100,000, with a cost of €13,227 per CIN2+ detected with annual savings of €9.36 million (− 24%). The savings are mainly caused by increasing the length of routine screening intervals from three to five years. Conclusion The results support current clinical recommendations to replace cytology with HPV with 16/18 genotyping with cytology triage as screening algorithm.
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34
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Polman NJ, Snijders PJF, Kenter GG, Berkhof J, Meijer CJLM. HPV-based cervical screening: Rationale, expectations and future perspectives of the new Dutch screening programme. Prev Med 2019; 119:108-117. [PMID: 30594536 DOI: 10.1016/j.ypmed.2018.12.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022]
Abstract
Based on scientific data showing that HPV testing provides better protection against cervical precancer and cancer than cytology, in 2011 the Dutch Health Council advised the Minister of Welfare, Health and Sports to replace cytology by HPV testing in the Dutch population-based screening programme. After a successful evaluation of the feasibility of HPV-based screening in 2014, primary HPV testing for cervical screening was implemented in 2017. The Netherlands has been one of the first countries worldwide to implement nationwide HPV-based screening and its experience with the new programme is therefore followed with great interest. In this manuscript, we present an overview of the studies that were instrumental in the choice of HPV assay and triage strategy, the adjustment of screening starting and exit ages and intervals, and the implementation of HPV self-sampling. Finally, we review the cost-effectiveness of the proposed new screening algorithm and we explore future perspectives. The rationale behind the new Dutch HPV-based screening programme, which is based on risk management, could serve as a guidance to other countries that are planning to implement HPV-based screening in the near future.
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Affiliation(s)
- N J Polman
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - P J F Snijders
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G G Kenter
- Department of Gynecologic Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - C J L M Meijer
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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35
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Krings A, Boateng G, Dunyo P, Amuah JE, Adams RA, Adunyame L, Nkansah DO, Wormenor CM, Hansen BT, Gedzah I, Asmah RH, Wiredu EK, Kaufmann AM. Dynamics of genotype-specific HPV clearance and reinfection in rural Ghana may compromise HPV screening approaches. Papillomavirus Res 2019; 7:45-51. [PMID: 30625379 PMCID: PMC6350109 DOI: 10.1016/j.pvr.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/20/2018] [Accepted: 12/26/2018] [Indexed: 11/14/2022]
Abstract
Persistent Human Papillomavirus (HPV) infection is a prerequisite for cervical cancer development. Few studies investigated clearance of high-risk HPV in low-and-middle-income countries. Our study investigated HPV clearance and persistence over four years in women from North Tongu District, Ghana. In 2010/2011, cervical swabs of 500 patients were collected and HPV genotyped (nested multiplex PCR) in Accra, Ghana. In 2014, 104 women who previously tested positive for high-risk HPV and remained untreated were re-tested for HPV. Cytobrush samples were genotyped (GP5+/6+ PCR & Luminex-MPG readout) in Berlin, Germany. Positively tested patients underwent colposcopy and treatment if indicated. Of 104 women, who tested high-risk HPV+ in 2010/2011, seven (6,7%; 95%CI: 2.7–13.4%) had ≥1 persistent high-risk‐infection after ~4 years (mean age 39 years). Ninety-seven (93,3%; 95%CI: 86.6–97.3%) had cleared the original infection, while 22 (21.2%; 95%CI: 13.8–30.3%) had acquired new high-risk infections with other genotypes. Persistent types found were HPV 16, 18, 35, 39, 51, 52, 58, and 68. Among those patients, one case of CIN2 (HPV 68) and one micro-invasive cervical cancer (HPV 16) were detected. This longitudinal observational data suggest that single HPV screening rounds may lead to over-referral. Including type-specific HPV re-testing or additional triage methods could help reduce follow-up rates. High-risk HPV genotype-specific clearance rates of 93.3% after 4 years. New infections with other high-risk HPV were 21.2%. New infections may overestimate women at risk if non-genotyping repeat HPV-testing is used for triage. Type-specific HPV genotyping reduces follow-up rates, for example by colposcopy.
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Affiliation(s)
- Amrei Krings
- Clinic for Gynecology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
| | - Gifty Boateng
- National Public Health and Reference Laboratory, Korle Bu, Accra, Ghana
| | | | - Joseph E Amuah
- School of Epidemiology & Public Health, University of Ottawa, Canada
| | - Rashid A Adams
- School of Biomedical and Allied Health Sciences, University of Ghana College of Health Sciences, Korle Bu, Accra, Ghana.
| | - Lois Adunyame
- School of Biomedical and Allied Health Sciences, University of Ghana College of Health Sciences, Korle Bu, Accra, Ghana
| | - Dinah O Nkansah
- School of Biomedical and Allied Health Sciences, University of Ghana College of Health Sciences, Korle Bu, Accra, Ghana
| | | | | | | | - Richard H Asmah
- School of Biomedical and Allied Health Sciences, University of Ghana College of Health Sciences, Korle Bu, Accra, Ghana.
| | - Edwin K Wiredu
- School of Biomedical and Allied Health Sciences, University of Ghana College of Health Sciences, Korle Bu, Accra, Ghana.
| | - Andreas M Kaufmann
- Clinic for Gynecology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
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Polman NJ, Veldhuijzen NJ, Heideman DAM, Snijders PJF, Meijer CJLM, Berkhof J. Management of HPV-positive women in cervical screening using results from two consecutive screening rounds. Int J Cancer 2019; 144:2339-2346. [PMID: 30565673 DOI: 10.1002/ijc.32004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/21/2018] [Accepted: 10/31/2018] [Indexed: 11/11/2022]
Abstract
We studied whether triage of human papillomavirus (HPV)-positive women participating in an HPV-based screening programme can be improved by including the HPV result at the previous screen in the triage algorithm. We analyzed data of a subgroup of 366 women from the POBASCAM trial, screened by cytology and HPV cotesting. Women were included if they tested HPV-positive in the second HPV-based screening round. We evaluated the clinical performance of 16 strategies, consisting of cytology, HPV genotyping, and/or previous screen HPV result. The clinical endpoint was cervical precancer or cancer (CIN3+). The current Dutch triage testing policy for HPV-positive women is to refer women for colposcopy if they have abnormal cytology at baseline or after 6-18 months. In the second HPV-based screening round, this strategy yielded a negative predictive value (NPV) of 95.8% (95% confidence interval: 91.9-98.2) and colposcopy referral rate of 37.6% (32.3-43.2%). Replacing repeat cytology by the previous screen HPV result yielded a similar NPV (96.9%, 93.3-98.9) and colposcopy referral rate (38.8%, 33.4-44.4). A higher NPV (99.2%, 96.3-100%) at the cost of a higher colposcopy referral rate (49.2%, 43.6-54.8) was achieved when cytology was combined with HPV16/18 genotyping. The other 13 triage strategies yielded a lower NPV, a higher colposcopy referral rate or performed similarly but required additional testing. HPV-positive women in the second HPV-based screening round can be suitably managed by cytology, HPV16/18 genotyping and the HPV result at the previous screen, obviating the need for repeat testing of HPV-positive, cytology negative women.
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Affiliation(s)
- Nicole J Polman
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nienke J Veldhuijzen
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle A M Heideman
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter J F Snijders
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris J L M Meijer
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Termrungruanglert W, Khemapech N, Tantitamit T, Havanond P. Cost effectiveness analysis of HPV primary screening and dual stain cytology triage compared with cervical cytology. J Gynecol Oncol 2018; 30:e17. [PMID: 30740950 PMCID: PMC6393632 DOI: 10.3802/jgo.2019.30.e17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives To assess the clinical and cost-effectiveness of human papillomavirus (HPV) primary screening triage with p16/Ki-67 dual stain cytology compared to cytology. Methods We conducted an Excel®-based budget impact model to estimate the preinvasive and invasive cervical cancer cases identified, mortality rate, direct medical costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness analysis of two strategies from the healthcare payer perspective. The study population is a cohort of women 30–65 years of age presenting for cervical screening. Results HPV primary screening triage with p16/Ki-67 dual stain showed higher sensitivity without losing specificity compared to conventional Pap smear. The improving the screening performance leads to decrease the prevalence of precancerous lesion, annual incidence and mortality of cervical cancer. The incidence of cervical cancer case detected by new algorithm compared with conventional method were 31,607 and 38,927, respectively. In addition, the new algorithm was more effective and more costly (average QALY 24.03, annual cost $13,262,693) than conventional cytology (average QALY 23.98, annual cost $7,713,251). The incremental cost-effective ratio (ICER) per QALY gained was $1,395. The sensitivity analysis showed if the cost of cytology and HPV test increased three times, the ICER would fall to $303/QALY gained and increased to $4,970/QALY gained, respectively. Conclusion Our model results suggest that screening by use of HPV genotyping test as a primary screening test combined with dual stain cytology as the triage of HPV positive women in Thai population 30–65 years old is expected to be more cost-effective than conventional Pap cytology.
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Affiliation(s)
- Wichai Termrungruanglert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Nipon Khemapech
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanitra Tantitamit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhonnayok, Thailand
| | - Piyalamporn Havanond
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Buchegger K, Viscarra T, Andana A, Ili C, López J, Zanella L, Carmona-López MI, Fernández JJ, Espinel IC, Sánchez R, Roa JC, Brebi P. Detection and genotyping of human papillomavirus virus (HPV): a comparative analysis of clinical performance in cervical and urine samples in Chilean women. Int J Clin Exp Pathol 2018; 11:5413-5421. [PMID: 31949624 PMCID: PMC6963012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/22/2018] [Indexed: 06/10/2023]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infectious agent and is the main cause of cervical cancer (CC). In Chile, CC is the second leading cause of death by cancer in women aged 20-44 years, four times higher than in developed countries. Currently, the detection of HPV infection using a cervical brush is recommended; however, this is an invasive procedure that many women try to avoid. The aim of this study was to evaluate the clinical performance of a self-collected, urine-based HPV detection method using conventional PCR followed by a reverse line blot. A PCR-based HPV genotyping was performed on 190 paired cervical and urine samples from gynecological exams at public health centers in the Araucania Region, Chile. HPV DNA detection and genotyping were performed by PCR and reverse line blot assay. Carcinogenic HPV types were present in 64.7% and 65.8% of the cervical and urine samples; the infection rates of HPV16 were 34.7% and 33.2%, respectively. The overall percent agreement between carcinogenic HPV detection in cervical and urine samples was 73.7%, with a moderate concordance rate of carcinogenic HPV detection (kappa = 0.42). Clinical sensitivities for cervical and urine-based sampling methods to diagnose cervical intraepithelial neoplasia 2/3 (CIN2/3) by histology were 93.4% and 90.2%, respectively. These results suggest that both cervical brush and urine-based sampling show a good clinical performance in the detection of HPV infection. The urine-based sampling method represents a valuable alternative with a great impact on public health, allowing increased cervical cancer screening coverage among women who do not undergo pelvic examinations.
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Affiliation(s)
- Kurt Buchegger
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Tamara Viscarra
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Alejandra Andana
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Carmen Ili
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Jaime López
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Louise Zanella
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - María Inés Carmona-López
- Instituto de Ciencias Biomédicas (ICBM) y Centro de Investigaciones Multidisciplinares de La Araucanía (CIMA)Universidad Autónoma de Chile
| | - Juan José Fernández
- Instituto de Ciencias Biomédicas (ICBM) y Centro de Investigaciones Multidisciplinares de La Araucanía (CIMA)Universidad Autónoma de Chile
| | - Irene Cartas Espinel
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
| | - Raúl Sánchez
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Department of Preclinical Science, School of Medicine, Universidad de La FronteraTemuco, Chile
| | - Juan Carlos Roa
- Department of Pathology, UC Centre for Investigational Oncology (CITO), Advanced Centre for Chronic Diseases (ACCDiS), Pontificia Universidad Católica de ChileSantiago de Chile, Chile
| | - Priscilla Brebi
- Laboratory of Molecular Pathology, Department of Pathology, School of Medicine, Universidad de La FronteraTemuco, Chile
- Centro de Excelencia en Medicina Traslacional (CEMT), Universidad de La FronteraCasilla 54-D, Temuco, Chile
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La FronteraCasilla 54-D, Temuco, Chile
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Shmagel A, Skemp-Dymond G, Langsetmo L, Schousboe JT, Ensrud K, Foley R. Population-Wide Associations between Common Viral Pathogens and Self-Reported Arthritis: NHANES 2009-2012. Int J Rheumatol 2018; 2018:7684942. [PMID: 30364066 PMCID: PMC6188724 DOI: 10.1155/2018/7684942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/26/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Persistent infectious agents have been implicated in chronic and recurrent inflammation, which may trigger or worsen many types of arthritis. Our objective was to determine whether exposure to herpes simplex virus (HSV) and human papillomavirus (HPV) is associated with self-reported arthritis among US adults. METHODS We used data from two consecutive cycles of the National Health and Nutrition Examination Survey (NHANES) from 2009 until 2012 (N of examined adults ages 20-69 = 9483). Participants were classified as having arthritis by self-report. Viral serology for HSV-1 and HSV-2 and HPV PCR studies from oral rinse and vaginal swabs were available for analysis. We compared HSV-1 and HSV-2 seropositivity as well as oral and vaginal HPV DNA positivity between participants with self-reported arthritis vs. those without, adjusting for age, gender, race, income, education, BMI, and the use of immunosuppressive medications. We used three comparator outcomes, gout, kidney stones, and hypertension, to evaluate whether the associations were specific or not to arthritis. RESULTS Arthritis was associated with older age, female gender, non-Hispanic White and Non-Hispanic Black race, higher BMI, and lower socioeconomic status. HSV-2 seropositivity, but not HSV-1 seropositivity, was independently associated with arthritis after adjustment for age, gender, race, income, education, BMI, and the use of immunosuppressive medications: AOR 1.48 (1.10-1.99). Oral HPV DNA positivity was also independently associated with arthritis: AOR 1.63 (1.17-2.28). After adjustment, there was no statistically significant difference in vaginal HPV DNA positivity between those with vs. those without arthritis: AOR 1.22 (0.90-1.66). There were no significant associations between viral exposures and any of the comparator outcomes. CONCLUSIONS HSV-2 seropositivity and oral HPV DNA positivity were associated with self-reported arthritis and not with comparator outcomes, after adjustment for multiple potential confounders. These findings should be confirmed in longitudinal studies.
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Affiliation(s)
- Anna Shmagel
- Assistant Professor of Medicine in the Division of Rheumatic and Autoimmune Diseases at the University of Minnesota, Division of Rheumatic and Autoimmune Diseases, 420 Delaware Street SE, MMC 108, Minneapolis, MN 55455, USA
| | - Grace Skemp-Dymond
- General Internist at the Center for Outpatient Care in Edina, Minnesota, USA
| | - Lisa Langsetmo
- Senior Research Associate for Epidemiology and Community Health at the University of Minnesota, USA
| | - John T. Schousboe
- Rheumatologist, Department of Rheumatology, Park Nicollet Clinic and HealthPartners Institute, Bloomington, Minnesota, USA
- Assistant Professor, Division of Health Policy and Management at the University of Minnesota, USA
| | - Kristine Ensrud
- Professor of Medicine and Epidemiology & Community Health, University of Minnesota, Core Investigator at the Minneapolis VA Center for Chronic Disease Outcomes Research, USA
| | - Robert Foley
- Associate Professor of Medicine at the University of Minnesota, Division of Renal Diseases and Hypertension, USA
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Abstract
BACKGROUND The scarcity of country data (e.g. a cancer registry) for the burden of cervical cancer (CC) in low-income countries (LCIs) such as Swaziland remains a huge challenge. Such data are critical to inform local decision-making regarding resource allocation [1]. We aimed to estimate likely cervical cancer incidence in Swaziland using three different methodologies (triangulation), to help better inform local policy guidance regarding likely higher "true" burden and increased resource allocation required for treatment, cervical cancer screening and HPV vaccine implementation. METHODS Three methods were applied to estimate CC incidence, namely: 1) application of age-specific CC incidence rates for Southern African region from GLOBOCAN 2012 extrapolated to the 2014 Swaziland female population; 2) a linear regression based model with transformed age-standardised CC incidence against hr-HPV (with and without HIV as a covariate) prevalence among women with normal cervical cytology; and 3) a mathematical model, using a natural history approach based on parameter estimates from various available literature and local survey estimates. We then triangulated estimates and uncertainty from the three models to estimate the most likely CC incidence rate for Swaziland in 2015. RESULTS The projected incidence estimates for models 1-3 were 69.4 (95% CI: 66.7-72.1), 62.6 per 100,000 (95%CI: 53.7-71.8) and 44.6 per 100,000 (41.5 to 52.1) respectively. Model 2 with HIV prevalence as covariate estimated a higher CC incidence rate estimate of 101.1 per 100,000 (95%CI: 90.3-112.2). The triangulated ('averaged') age-standardized CC incidence based across the 3 models for 2015 was estimated at 69.4 per 100,000 (95% CI: 63.0-77.1) in Swaziland. CONCLUSION It is widely accepted that cancer incidence (and in this case CC) is underestimated in settings with poor and lacking registry data. Our findings suggest that the projected burden of CC is higher than that suggested from other sources. Local health policy decisions and decision-makers need to re-assess resource allocation to prevent and treat CC effectively, which is likely to persist given the very high burden of hr-HPV within the country.
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Affiliation(s)
- Themba G Ginindza
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, 2nd Floor George Campbell Building, Mazisi Kunene Road, Durban, 4041, South Africa.
| | - Benn Sartorius
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, 2nd Floor George Campbell Building, Mazisi Kunene Road, Durban, 4041, South Africa
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Wang H, Cheng X, Ye J, Xu X, Hong Y, Sui L, You Z, Xie X. Distribution of human papilloma virus genotype prevalence in invasive cervical carcinomas and precancerous lesions in the Yangtze River Delta area, China. BMC Cancer 2018; 18:487. [PMID: 29703167 PMCID: PMC5924433 DOI: 10.1186/s12885-018-4330-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
Abstract
Background This study aimed to provide more information for cancer prevention strategies by determining the distribution of human papilloma virus (HPV) genotype prevalence in invasive cervical carcinoma (ICC) and precancerous lesion patients in the Yangtze River Delta area in China. Methods This multi-centre descriptive cross-sectional study involves four university hospitals in the Jiangzhehu area. Women with histologically confirmed cervical intraepithelial neoplasia (CIN) 1, CIN2, CIN3 or ICC who were diagnosed and treated in the four selected hospitals between February 2012 and April 2014 were eligible for recruitment. The average age of the patients was 40.93 ± 11.87 years old, among whom the youngest was 17 years old and the oldest was 76 years old.Those with immunodeficiency diseases or a previous history of cancer or CIN were excluded. HPV genotyping was performed by a central laboratory. The distribution and age and disease specificity of the HPV genotype prevalence were analysed. Results Of the 2181 collected samples, 251 were ICC and 1930 were CIN. The mean age of cervical cancer and CIN patients was 40.93 ± 11.8 years (range, 17–76 years). The five most commonly identified HPV types in each lesion class were as follows: CIN1: 52, 58, 16, 33, and CP; CIN2: 16, 58, 52, 33, and 31; CIN3: 16, 58, 33, 52, and 31; and ICC: 16, 58, 18, 52, and 33. CIN1 had an earlier age of onset (30–40 years) than CIN2, CIN3, and cervical cancer. The age of onset of cervical cancer exhibited two peaks at 40–44 and 50–54 years of age. In all infected patients, the frequency of HPV infection with a single type was 62.9%, and with multiple types, it was 38.1%. There was no difference in the frequencies of multiple types amongst the different cervical lesions. Conclusions The most prevalent genotypes in the investigated area (52, 58, 16 and 18) justify the necessity of anti-HPV vaccination in teenagers and young girls under 24 years old in the Yangtze River Delta area in China. Infection with multiple high-risk HPV types versus single infection does not increase the risk for ≥ CIN2 in ICC development.
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Affiliation(s)
- Hongyun Wang
- Department of Gynecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China.,Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaodong Cheng
- Department of Gynecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Jing Ye
- Department of Gynecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Xiuyun Xu
- Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ying Hong
- Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Long Sui
- Obstetrics and Gynecology Hospital of Fudan University, Fudan, China
| | - Zhixue You
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Xie
- Department of Gynecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
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Kajitani N, Glahder J, Wu C, Yu H, Nilsson K, Schwartz S. hnRNP L controls HPV16 RNA polyadenylation and splicing in an Akt kinase-dependent manner. Nucleic Acids Res 2017; 45:9654-9678. [PMID: 28934469 PMCID: PMC5766200 DOI: 10.1093/nar/gkx606] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/04/2017] [Indexed: 11/14/2022] Open
Abstract
Inhibition of the Akt kinase activates HPV16 late gene expression by reducing HPV16 early polyadenylation and by activating HPV16 late L1 mRNA splicing. We identified ‘hot spots’ for RNA binding proteins at the early polyA signal and at splice sites on HPV16 late mRNAs. We observed that hnRNP L was associated with sequences at all HPV16 late splice sites and at the early polyA signal. Akt kinase inhibition resulted in hnRNP L dephosphorylation and reduced association of hnRNP L with HPV16 mRNAs. This was accompanied by an increased binding of U2AF65 and Sam68 to HPV16 mRNAs. Furthermore, siRNA knock-down of hnRNP L or Akt induced HPV16 gene expression. Treatment of HPV16 immortalized keratinocytes with Akt kinase inhibitor reduced hnRNP L binding to HPV16 mRNAs and induced HPV16 L1 mRNA production. Finally, deletion of the hnRNP L binding sites in HPV16 subgenomic expression plasmids resulted in activation of HPV16 late gene expression. In conclusion, the Akt kinase inhibits HPV16 late gene expression at the level of RNA processing by controlling the RNA-binding protein hnRNP L. We speculate that Akt kinase activity upholds an intracellular milieu that favours HPV16 early gene expression and suppresses HPV16 late gene expression.
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Affiliation(s)
- Naoko Kajitani
- Department of Laboratory Medicine, Lund University, BMC-B13, 223 62 Lund, Sweden
| | - Jacob Glahder
- Department of Laboratory Medicine, Lund University, BMC-B13, 223 62 Lund, Sweden
| | - Chengjun Wu
- Department of Laboratory Medicine, Lund University, BMC-B13, 223 62 Lund, Sweden
| | - Haoran Yu
- Department of Laboratory Medicine, Lund University, BMC-B13, 223 62 Lund, Sweden
| | - Kersti Nilsson
- Department of Laboratory Medicine, Lund University, BMC-B13, 223 62 Lund, Sweden
| | - Stefan Schwartz
- Department of Laboratory Medicine, Lund University, BMC-B13, 223 62 Lund, Sweden
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Heydari N, Oskouee MA, Vaezi T, Shoja Z, Esmaeili HA, Hamkar R, Shahmahmoodi S, Jalilvand S. Type-specific human papillomavirus prevalence in cervical intraepithelial neoplasia and cancer in Iran. J Med Virol 2017; 90:172-176. [PMID: 28786495 DOI: 10.1002/jmv.24908] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/14/2017] [Indexed: 01/19/2023]
Abstract
In Iran, human papillomavirus (HPV) vaccination is not currently included in the national vaccination program and there are no comprehensive approaches to cervical screening program. Regional data on distribution of HPV types in women is important to predict the impact of current HPV vaccines. Although several studies on distribution of HPV types in cervical precancer and cancer have been conducted in Iran, in most of them HPV positive samples were subjected to specific-primer genotyping (mainly 16 and 18), and leaving the other HPV genotypes almost undetermined. Therefore, the present study aimed to investigate the distribution of HPV types in cervical neoplasia from West and Northwest of Iran. A total of 112 women with atypia, cervical intraepithelial neoplasia, and invasive cervical cancer were included. A PCR assay was performed in all samples to detect the presence of the HPV genome using the GP5+/6+ L1 consensus primer set. All HPV positive samples were subjected for sequencing. In overall, HPV prevalence was 20% in atypica, 44.5% in cervical intraepithelial neoplasia I, 92.3% in cervical intraepithelial neoplasia II-III, and 98.2% in invasive cervical cancer. The most frequent HPV type was HPV 16 (79.2%), which was followed by HPV types 18, 6, and 33 at the frequencies of 6.5%, 5.1%, and 2.7%, respectively. The least HPV types were found to be 31, 45, 53, 58, and 66. In conclusion, this study shows that the current HPV vaccines could have great impact to reduce the burden of cervical cancer in Iran.
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Affiliation(s)
- Nasrin Heydari
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahin A Oskouee
- Faculty of Medicine, Department of Microbiology and Virology, Tabriz University of Medical Sciences, Infectious and Tropical Disease Research Center, Tabriz, Iran
| | - Tayebeh Vaezi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Heidar A Esmaeili
- Department of Pathobiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rasool Hamkar
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Shahmahmoodi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Tehran University of Medical Sciences, Food Microbiology Research Center, Tehran, Iran
| | - Somayeh Jalilvand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Stewart J, Calderon M, Hathaway A, Winer RL, Zunt J. Human papillomavirus infection among male clients of female sex workers soliciting sex in brothels in Peru. Int J STD AIDS 2017; 29:178-184. [PMID: 28747145 DOI: 10.1177/0956462417721563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of high-risk human papillomavirus (HR-HPV) has been reported to be three times higher in female sex workers (FSWs) in Callao, Peru than in the general population of women in Peru. Prevalence of HR-HPV among male clients has not yet been reported. A total of 150 men soliciting intercourse in sex work venues submitted questionnaires, samples for sexually transmitted infection (STI) testing, and self-collected penile samples prior to and following intercourse for HPV genotyping. We identified variables associated with pre-coital HR-HPV, and compared HR-HPV detection pre- and post-coitus. Prior to intercourse, HR-HPV prevalence was 41.9%. Married clients were less likely than unmarried clients to have HR-HPV detected ( p = 0.03). While post-coital HR-HPV prevalence was higher (47.6%), the difference was not statistically significant. However, there was a significant increase in the mean number of HR-HPV DNA strains detected before (0.75) and after (0.94) intercourse ( p = 0.02). No cases of gonorrhoea or syphilis and six (4.1%) cases of chlamydial infection were detected. Despite low prevalence of other STIs, male clients had a high HR-HPV prevalence. The increase in detection of HR-HPV following intercourse demonstrates a potential for transmission of HR-HPV despite high self-reported condom use.
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Affiliation(s)
- Jenell Stewart
- 1 Department of Medicine, 7284 University of Washington , Seattle, WA, USA
| | | | - Alison Hathaway
- 3 16230 Yale University School of Nursing , Hartford, CT, USA
| | - Rachel L Winer
- 4 Department of Epidemiology, 7284 University of Washington , Seattle, WA, USA
| | - Joseph Zunt
- 1 Department of Medicine, 7284 University of Washington , Seattle, WA, USA.,4 Department of Epidemiology, 7284 University of Washington , Seattle, WA, USA.,5 Department of Neurology, 7284 University of Washington , Seattle, WA, USA.,6 Global Health, 7284 University of Washington , Seattle, WA, USA
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45
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Dixon EP, King LM, Nelson R, Simkins SG, Knapp SL, Brough GH, Lenz KL, Henderson DT, Whitehead CM, Hessling J, Brown CA, Malinowski DP. Characterization and clinical validation of MCM2 and TOP2A monoclonal antibodies in the BD ProEx™ C assay: An immunoassay which detects aberrant S-phase induction in cervical tissue. J Immunol Methods 2017; 442:35-41. [PMID: 28093271 DOI: 10.1016/j.jim.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/11/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The Papanicolaou (Pap) screen has been successful in reducing cervical cancer; but exhibits low sensitivity when detecting cervical dysplasia. Use of molecular biomarkers in Pap tests may improve diagnostic accuracy. DESIGN Monoclonal antibodies to Minichromosome Maintenance Protein 2 (MCM2) and DNA Topoisomerase II α (TOP2A) were selected for use in IHC based on their ability to differentiate normal from diseased cervical tissues in tissue microarrays. Enhanced Green Fluorescent Protein Western blot analysis was used to help identify binding epitopes specific to MCM2 and TOP2A antibody clones. Antibody affinity was determined by solution phase affinity measurement and immunohistochemistry was performed using high affinity MCM2 or TOP2A antibodies on serial histological sections. RESULTS Antibody clones to MCM2 and TOP2A clones were selected based on their ability to detect over expression in abnormal cervical epithelia. In IHC, MCM2-27C5.6 and MCM2-26H6.19 demonstrated superior staining in abnormal cervical tissue over the MCM2-CRCT2.1 antibody. A combination of MCM2 and TOP2A antibodies showed greater staining when compared to staining with any of the antibodies alone on serial histological sections. Distinct linear epitopes were elucidated for each of the MCM2 and TOP2A clones. Affinity values (Kd) for MCM2 or TOP2A antibodies had a similar range. In a research study, the MCM2 and TOP2A (BD ProEx™ C) antibody cocktail showed increased epithelia staining with increasing dysplasia. The use of BD ProEx™ C in combination with H&E staining enhanced immunohistochemical discrimination of dysplastic and non-dysplastic FFPE cervical tissue specimens. CONCLUSIONS BD ProEx™ C containing MCM2 and TOP2A antibodies showed strong specific nuclear staining that correlated with increased dysplasia and lesion severity. Enhanced performance of the antibodies was linked to their unique topography recognition. BD ProEx™ C incorporates antibodies that enhance detection of CIN2+ cervical disease.
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Affiliation(s)
- Eric P Dixon
- BD Diagnostics - Women's Health and Cancer, Durham, NC, USA.
| | | | - Ramona Nelson
- BD Diagnostics - Women's Health and Cancer, Durham, NC, USA
| | | | - Steven L Knapp
- BD Diagnostics - Women's Health and Cancer, Durham, NC, USA
| | | | - Karen L Lenz
- BD Diagnostics - Women's Health and Cancer, Durham, NC, USA
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Yu LL, Kang LN, Zhao FH, Lei XQ, Qin Y, Wu ZN, Wang H, Chen W, Qiao YL. Elevated Expression of Human Papillomavirus-16/18 E6 Oncoprotein Associates with Persistence of Viral Infection: A 3-Year Prospective Study in China. Cancer Epidemiol Biomarkers Prev 2016; 25:1167-74. [PMID: 27197295 DOI: 10.1158/1055-9965.epi-15-1057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/26/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND An association between high-risk human papillomavirus (HR-HPV) oncoprotein expression and viral persistence has been suggested by the outcome of etiology studies, but there are no epidemiologic studies evaluating that link. METHODS We performed a 3-year prospective study in which 2,498 Chinese women ages 25 to 65 years were screened by six screening tests, including the Onco E6: Cervical Test (Arbor Vita Corporation) in 2011 (baseline). Six-hundred and ninety women who were positive for any of the tests and a random sample of 164 women with all negative results received colposcopy, and cervical specimens for the cobas 4800 HPV test ("cobas," Roche Molecular Systems) were collected before colposcopy; of this group, 737 cervical specimens were collected to perform cobas and Onco E6: Cervical Test in 2014 (follow-up). Twenty-four cases of HPV16/18 E6 positives and 204 selected controls at baseline, 13 cases of HPV16/18 E6 positive and another 204 selected controls at follow-up were analyzed separately using unconditional logistical regression models to estimate ORs and 95% confidence intervals (CI). RESULTS Compared with women who were HPV16 E6 oncoprotein negative at baseline, women in the E6-positive group had a much higher risk of HPV persistence (adjusted OR, 54.64; 95% CI, 7.19-415.09) at 3-year follow-up; a statistically strong association was also found between HPV16/18 HPV persistence and E6 oncoprotein expression detected at follow-up (adjusted OR, 360.57; 95% CI, 28.30-4,593.55). CONCLUSIONS A single detection of HPV16/18 E6 oncoprotein expression was strongly associated with viral persistence. IMPACT HPV16/18 E6 oncoprotein constitutes a marker for risk of HPV persistence. Cancer Epidemiol Biomarkers Prev; 25(7); 1167-74. ©2016 AACR.
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Affiliation(s)
- Lu-Lu Yu
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Le-Ni Kang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Fang-Hui Zhao
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Xiao-Qin Lei
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Yu Qin
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Ze-Ni Wu
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Hong Wang
- The First Hospital of Fangshan District, Beijing, PR China
| | - Wen Chen
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
| | - You-Lin Qiao
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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Naber SK, de Kok IMCM, Matthijsse SM, van Ballegooijen M. The potential harms of primary human papillomavirus screening in over-screened women: a microsimulation study. Cancer Causes Control 2016; 27:569-81. [PMID: 26970740 PMCID: PMC4796367 DOI: 10.1007/s10552-016-0732-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is well acknowledged that HPV testing should not be performed at young age and at short intervals. Cytological screening practices have shown that over-screening, i.e., from a younger age and at shorter intervals than recommended, is hard to avoid. We quantified the consequences of a switch to primary HPV screening for over-screened women, taking into account its higher sensitivity but lower specificity than cytology. METHODS The health effects of using the HPV test instead of cytology as the primary screening method were determined with the MISCAN-Cervix model. We varied the age women start screening and the interval between screens. In the sensitivity analyses, we varied the background risk of cervical cancer, the HPV prevalence, the discount rate, the triage strategy after cytology, and the test characteristics of both cytology and the HPV test. RESULTS For women screened 5 yearly from age 30, 32 extra deaths per 100,000 simulated women were prevented when switching from primary cytology to primary HPV testing. For annual screening from age 20, such a switch resulted in 6 extra deaths prevented. It was associated with 9,044 more positive primary screens in the former scenario versus 76,480 in the latter. Under all conditions, for women screened annually, switching to HPV screening resulted in a net loss of quality-adjusted life years. CONCLUSION For over-screened women, the harms associated with a lower test specificity outweigh the life years gained when switching from primary cytology to primary HPV testing. The extent of over-screening should be considered when deciding on inclusion of primary HPV screening in cervical cancer screening guidelines.
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Affiliation(s)
- Steffie K Naber
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Inge M C M de Kok
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Cook DA, Mei W, Smith LW, van Niekerk DJ, Ceballos K, Franco EL, Coldman AJ, Ogilvie GS, Krajden M. Comparison of the Roche cobas® 4800 and Digene Hybrid Capture® 2 HPV tests for primary cervical cancer screening in the HPV FOCAL trial. BMC Cancer 2015; 15:968. [PMID: 26674353 PMCID: PMC4682219 DOI: 10.1186/s12885-015-1959-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/30/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND HPV FOCAL is a randomized trial (ISRCTN79347302, registered 20 Apr 2007) comparing high-risk (hr) HPV testing vs. liquid-based cytology (LBC) for cervical cancer screening of women aged 25-65. We compared the Digene Hybrid Capture® 2 High-Risk HPV DNA Test® (HC2) and the Roche cobas® 4800 HPV Test (COBAS) for primary screening. METHODS Women (n=6,172) were screened at baseline by HC2 and COBAS and by LBC 24 months later. We assessed HPV genotyping and reflex LBC for colposcopy triage of baseline HPV positive women. RESULTS Overall HC2/COBAS agreement was 96.1% (kappa 0.75) and positive agreement was 77.5%. Baseline CIN2 and CIN3+ rates based on HPV screening were 8.6/1,000 and 6.6/1,000 respectively; 24 month rates were 0.7/1,000 and 0.4/1,000 (LBC screening). HC2 and COBAS were concordant positive for 91% of round 1 CIN2 and 98% of CIN3+. CIN3+ was significantly associated with HPV 16 (Odds Ratio [OR] 5.11; 95% confidence interval [CI] 2.30, 11.37), but not HPV 18 (OR 2.62; 95% CI 0.73, 9.49), vs. non-HPV 16/18 HPV at baseline. There was no significant association between HPV genotype and CIN2. CIN3+ was significantly more likely for high-grade (OR 5.99; 95% CI 2.53, 14.18), but not low-grade (OR 0.54; 95% CI 0.20, 1.49), vs. negative LBC. No significant association was observed between LBC grade and CIN2. HPV 16 and 18 were associated with 33% of CIN2 and 68% of CIN3+ identified at baseline. CONCLUSIONS For hrHPV positive women, abnormal reflex LBC is appropriate for colposcopy triage. In addition, immediate referral of women with HPV 16/18 and normal cytology may allow for earlier detection of CIN2+ lesions which would not be detected until after follow-up testing.
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Affiliation(s)
- Darrel A Cook
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada.,BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Wendy Mei
- Lower Mainland Pathology and Laboratory Medicine, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Laurie W Smith
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada
| | - Dirk J van Niekerk
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada.,Lower Mainland Pathology and Laboratory Medicine, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Kathy Ceballos
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada.,Lower Mainland Pathology and Laboratory Medicine, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | | | - Andrew J Coldman
- BC Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Gina S Ogilvie
- BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Mel Krajden
- BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada. .,Lower Mainland Pathology and Laboratory Medicine, 655 West 12th Ave, Vancouver, BC, V5Z 4R4, Canada. .,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
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49
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Ossel J, Litjens RJ, Reijans M, Brink AATP, Ummelen M, Ramaekers FC, Hopman AHN, Simons G. Human papillomavirus typing by single tube multiplex amplification in real time (SMART): the PapillomaFinder® SMART 20 assay. J Clin Virol 2014; 61:540-7. [PMID: 25453331 DOI: 10.1016/j.jcv.2014.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/20/2014] [Accepted: 10/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND High-risk (hr) human papillomavirus (HPV) infections play a causal role in the development of cervical cancer. The detection of hrHPV is, therefore, advocated in cervical cancer screening programs. OBJECTIVES The aim of this study was to determine the performance of a novel HPV typing assay, PapillomaFinder® SMART 20. This is a one-tube-per-sample method, to be performed on standard real-time PCR platforms, using melting curve analysis to distinguish targets. The assay detects all 14 hrHPV types, of which 16, 18, 31, 33, 35, 39, 45, 52, 56 and 58 individually. HrHPV types 51, 59, 66 and 68 are detected in an hrHPV pool, and low-risk (lr) HPV types 6, 11, 40, 42, 43 and 44 in an lrHPV pool. STUDY DESIGN The method was tested on HPV plasmid models, WHO and QCMD proficiency panels and a series of clinical cytological samples (n=45), the latter in comparison with a clinically validated real-time quantitative PCR. RESULTS Type-specificity of the test was 100% using plasmids, the WHO and QCMD panels. Sensitivity for hrHPV in single infections was 100% using the WHO and QCMD panels and cytological samples, with an analytical sensitivity of 10-25 copies per reaction for all HPV types tested. Of the 34 HPV types present in the 8 multiple infections in the WHO panel, 30 were detected. In all cytological samples at least one hrHPV type was found, in concordance with the clinically validated method. Only when the viral load of the dominant HPV types in multiple infections greatly exceeded that of the other types in the infection, those other types were not always detected. CONCLUSIONS PapillomaFinder® SMART 20 is a rapid, easy to perform, single tube HPV typing assay. The assay detects the 14 hrHPV types, and the 6 most important lrHPV types with a high sensitivity and type-specificity.
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Affiliation(s)
- J Ossel
- PathoFinder BV, Maastricht, The Netherlands
| | - R J Litjens
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Molecular Cell Biology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Reijans
- PathoFinder BV, Maastricht, The Netherlands
| | | | - M Ummelen
- Department of Molecular Cell Biology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F C Ramaekers
- Department of Molecular Cell Biology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A H N Hopman
- Department of Molecular Cell Biology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Simons
- PathoFinder BV, Maastricht, The Netherlands.
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50
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Veldhuijzen NJ, Berkhof J, Gillio-Tos A, De Marco L, Carozzi F, Del Mistro A, Snijders PJF, Meijer CJLM, Ronco G. The age distribution of type-specific high-risk human papillomavirus incidence in two population-based screening trials. Cancer Epidemiol Biomarkers Prev 2014; 24:111-8. [PMID: 25300476 DOI: 10.1158/1055-9965.epi-14-0628] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Age- and type-specific high-risk human papillomavirus (hrHPV) incidence estimates in screen-eligible women are relevant from a public health perspective because they provide an indication of the effect of vaccination on the occurrence of screen-positives in HPV-based screening. However, limited data from women over 25 years of age are available. METHODS In 24,105 hrHPV-negative women participating in Dutch (Population-Based Screening Study Amsterdam: POBASCAM) and Italian (New Technologies for Cervical Cancer: NTCC) population-based randomized controlled screening trials the age- and type-specific distribution of incident hrHPV infections detected at the next screening round was assessed. HPV types were grouped into vaccine (bivalent: HPV16/18; polyvalent HPV16/18/31/33/45/52/58) and nonvaccine types. RESULTS The incidence of screen-detected hrHPV among women ages 29 to 56 years was 2.54% (95% confidence interval, 2.30-2.78) in POBASCAM and 2.77% (2.36-3.19) in NTCC. In both studies, the incidence of bivalent, polyvalent, and nonpolyvalent infections decreased with age (P < 0.0001). Among women with incident infection(s), vaccine-type positivity changed quadratically with age, in particular for the polyvalent vaccine (P values: POBASCAM: bivalent 0.264, polyvalent 0.038; NTCC bivalent 0.039, polyvalent 0.005). However, more than 20% and 50% of women with incident hrHPV were positive for bivalent and polyvalent vaccine types, respectively, in all ages in both studies. CONCLUSIONS We observed decreasing age trends of hrHPV vaccine and nonvaccine type incidences and age-related differences in the vaccine-type positivity among women with incident infections. Most importantly, hrHPV infections continued to be detected in all ages and the contribution of vaccine types remained substantial. IMPACT Our results indicate a considerable reduction of new hrHPV infections in vaccinated cohorts, ensuing revision of screening guidelines.
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Affiliation(s)
- Nienke J Veldhuijzen
- Department of Epidemiology & Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands.
| | - Johannes Berkhof
- Department of Epidemiology & Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Anna Gillio-Tos
- Cancer Epidemiology Unit, CERMS, University of Turin, Turin, Italy
| | - Laura De Marco
- Cancer Epidemiology Unit, CERMS, University of Turin, Turin, Italy
| | | | | | - Peter J F Snijders
- Department of Pathology, VU University Medical Centre (VUmc), Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Centre (VUmc), Amsterdam, the Netherlands
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention, AO City of Health and Science, Turin, Italy
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