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Sombal W, Khan NU, Khan BM, Ismail M, Almutairi MH, Khan S, Khan AU, Mustafa A, Iftikhar B, Ali I. Human epidermal growth receptor polymorphisms ( HER1-rs11543848 and HER2-rs1136201) exhibited significant association with breast cancer risk in Pashtun population of Khyber Pakhtunkhwa, Pakistan. Health Sci Rep 2024; 7:e1846. [PMID: 38317673 PMCID: PMC10839356 DOI: 10.1002/hsr2.1846] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Background and Aims Breast cancer is the most common type of cancer in women. The genetic polymorphism in HER (HER1-rs11543848 and HER2-rs1136201) were found to be associated with breast cancer risk in different ethnicities worldwide with inconsistent results. The aim of this research study was to evaluate the association of HER1-rs11543848 and HER2-rs1136201 polymorphisms as a risk of breast cancer in Pashtun population of Khyber Pakhtunkhwa, Pakistan. Methods A total of 314 women including 164 breast cancer patients and 150 age and gender-matched healthy controls were enrolled from June 2021 to May 2022. All the samples were subjected to DNA extraction followed by Tetra-ARMS-PCR for genotyping and gel electrophoresis. Results Our results indicated that HER1-rs11543848 risk allele A (p = 0.0001) and heterozygous genotype GA (p = 0.0001) displayed highly significant association with breast cancer, while the homozygous mutant genotype AA indicated association but nonsignificant results (odds ratio [OR] = 2.637, 95% confidence interval [CI] = 1.2258-5.6756, p = 0.0833). Similarly, the HER2-rs1136201 risk allele G (p = 0.0023), the heterozygous genotype AG (p = 0.0530) and homozygous mutant genotype GG showed significant association (OR = 2.5946, 95% CI = 0.9876-6.8165, p = 0.0530) with breast cancer risk. Both the SNPs presented a higher but nonsignificant risk of breast cancer in postmenopausal women (OR = 2.242, p = 0.08 and OR = 2.009, p = 0.06). However, both the SNPs showed significant association (p < 0.005) with family history, metastasis, stage, luminal B, and TNBC. Conclusion In conclusion, HER1-rs11543848 and HER2-rs1136201 polymorphisms are significantly associated with the higher risk of breast cancer in Pashtun population of Khyber Pakhtunkhwa, Pakistan. These findings advocate for further exploration with larger datasets, offering promising avenues for personalized approaches in breast cancer research and potentially enhancing clinical practices for better risk assessment and targeted management strategies.
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Affiliation(s)
- Wafa Sombal
- Institute of Biotechnology & Genetic Engineering (Health Division)The University of Agriculture PeshawarPeshawarPakistan
| | - Najeeb Ullah Khan
- Institute of Biotechnology & Genetic Engineering (Health Division)The University of Agriculture PeshawarPeshawarPakistan
| | - Bibi Maryam Khan
- School of Life ScienceJiangsu UniversityZhejiangJiangsu ProvincePeople's Republic of China
| | | | | | - Samiullah Khan
- Institute of Radiotherapy and Nuclear Medicine (IRNUM)PeshawarPakistan
| | - Aakif Ullah Khan
- Institute of Radiotherapy and Nuclear Medicine (IRNUM)PeshawarPakistan
| | - Adeela Mustafa
- Department of Community MedicineKhyber Medical CollegePeshawarPakistan
| | - Bushra Iftikhar
- Department of Community MedicineKhyber Medical CollegePeshawarPakistan
| | - Ijaz Ali
- Centre for Applied Mathematics and Bioinformatics (CAMB)Gulf University for Science and TechnologyHawallyKuwait
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Drokow EK, Effah CY, Agboyibor C, Budu JT, Arboh F, Kyei-Baffour PA, Xiao Y, Zhang F, Wu IXY. Microbial infections as potential risk factors for lung cancer: Investigating the role of human papillomavirus and chlamydia pneumoniae. AIMS Public Health 2023; 10:627-646. [PMID: 37842273 PMCID: PMC10567973 DOI: 10.3934/publichealth.2023044] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 10/17/2023] Open
Abstract
Background Lung cancer is the leading cause of cancer morbidity and mortality worldwide. Apart from tobacco smoke and dietary factors, microbial infections have been reported as the third leading cause of cancers globally. Deciphering the association between microbiome and lung cancer will provide potential biomarkers and novel insight in lung cancer progression. In this current study, we performed a meta-analysis to decipher the possible association between C. pneumoniae and human papillomavirus (HPV) and the risk of lung cancer. Methods Literature search was conducted in most English and Chinese databases. Data were analyzed using CMA v.3.0 and RevMan v.5.3 software (Cochrane-Mantel-Haenszel method) by random-effects (DerSimonian and Laird) model. Results The overall pooled estimates for HPV studies revealed that HPV infections in patients with lung cancer were significantly higher than those in the control group (OR = 2.33, 95% CI = 1.57-3.37, p < 0.001). Base on subgroup analysis, HPV infection rate was significantly higher in Asians (OR = 6.38, 95% CI = 2.33-17.46, p < 0.001), in tissues (OR = 5.04, 95% CI = 2.27-11.19, p < 0.001) and blood samples (OR = 1.40, 95% CI = 1.02-1.93, p = 0.04) of lung cancer patients but non-significantly lower in males (OR = 0.84, 95% CI = 0.57-1.22, p =0.35) and among lung cancer patients at clinical stage I-II (OR = 0.95, 95% CI = 0.61-1.49, p = 0.82). The overall pooled estimates from C. pneumoniae studies revealed that C. pneumoniae infection is a risk factor among lung cancer patients who are IgA seropositive (OR = 1.88, 95% CI = 1.30-2.70, p < 0.001) and IgG seropositive (OR = 1.50, 95% CI = 1.10-2.04, p = 0.010). All seronegative IgA (OR = 0.69, 95% CI = 0.42-1.16, p = 0.16) and IgG (OR = 0.66, 95% CI = 0.42-105, p = 0.08) titers are not associative risk factors to lung cancer. Conclusions Immunoglobulin (IgA) and IgG seropositive titers of C. pneumoniae and lungs infected with HPV types 16 and 18 are potential risk factors associated with lung cancer.
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Affiliation(s)
- Emmanuel Kwateng Drokow
- Hunan Provinical Key Laboratory of Clinical Epidemiology, Central South University, Changsha 410083, Hunan, China
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha 410083, Hunan, China
| | - Clement Yaw Effah
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou 450003, China
| | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | | | - Francisca Arboh
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, 212013 Jiangsu Province, China
| | | | - Yao Xiao
- University of Ghana Medical Center, Accra, Ghana
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Fan Zhang
- Department of Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan, China, 410008
| | - Irene XY Wu
- Hunan Provinical Key Laboratory of Clinical Epidemiology, Central South University, Changsha 410083, Hunan, China
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha 410083, Hunan, China
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Köster PC, Malheiros AF, Shaw JJ, Balasegaram S, Prendergast A, Lucaccioni H, Moreira LM, Lemos LMS, Dashti A, Bailo B, Marcili A, Sousa Soares H, Gennari SM, Calero-Bernal R, González-Barrio D, Carmena D. Multilocus Genotyping of Giardia duodenalis in Mostly Asymptomatic Indigenous People from the Tapirapé Tribe, Brazilian Amazon. Pathogens 2021; 10:206. [PMID: 33672794 DOI: 10.3390/pathogens10020206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/14/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
Little information is available on the occurrence and genetic variability of the diarrhoea-causing enteric protozoan parasite Giardia duodenalis in indigenous communities in Brazil. This cross-sectional epidemiological survey describes the frequency, genotypes, and risk associations for this pathogen in Tapirapé people (Brazilian Amazon) at four sampling campaigns during 2008–2009. Microscopy was used as a screening test, and molecular (PCR and Sanger sequencing) assays targeting the small subunit ribosomal RNA, the glutamate dehydrogenase, the beta-giardin, and the triosephosphate isomerase genes as confirmatory/genotyping methods. Associations between G. duodenalis and sociodemographic and clinical variables were investigated using Chi-squared test and univariable/multivariable logistic regression models. Overall, 574 individuals belonging to six tribes participated in the study, with G. duodenalis prevalence rates varying from 13.5–21.7%. The infection was positively linked to younger age and tribe. Infected children <15 years old reported more frequent gastrointestinal symptoms compared to adults. Assemblage B accounted for three out of four G. duodenalis infections and showed a high genetic diversity. No association between assemblage and age or occurrence of diarrhoea was demonstrated. These data indicate that the most likely source of infection was anthropic and that different pathways (e.g., drinking water) may be involved in the transmission of the parasite.
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Mishra V, Kowtal P, Rane P, Sarin R. Genetic risk association of CDKN1A and RET gene SNPs with medullary thyroid carcinoma: Results from the largest MTC cohort and meta-analysis. Cancer Med 2019; 8:6151-6161. [PMID: 31408923 PMCID: PMC6792509 DOI: 10.1002/cam4.2443] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 12/26/2022] Open
Abstract
Background Medullary thyroid carcinoma (MTC) is a rare subtype of thyroid cancer. Other than gain‐of‐function RET mutations, no other genetic, lifestyle or environmental risk associations have been established for MTC. Several case‐control studies and meta‐analysis have examined the risk association of different SNPs with MTC in different populations but with contradictory or inconclusive results. Methods In a large cohort of 438 Indian MTC cases and 489 gender and ethnicity matched healthy controls from 1000 genome project, a comprehensive risk association of 13 SNPs of three pathways—detoxification, cell cycle regulation and RET was performed along with meta‐analysis of RET SNPs. Results Multivariate logistic regression analysis identified a protective risk association of CDKN1ASer31Arg SNP with both hereditary (OR 0.26; 95% confidence interval [CI] 0.13‐0.55; P < .001) and sporadic MTC (OR 0.53; 95% CI 0.36‐0.78; P = .001). An increased risk association was identified for NAT2Y94Y SNP (OR 1.62, 95% CI 1.17‐2.25, P = .004) and CDKN2A3′UTR SNP (OR 1.89, 95% CI 1.19‐2.98, P = .006) with sporadic MTC and RET S904S with hereditary MTC (OR 2.82, 95% CI 1.64‐4.86, P < .001). Meta‐analysis of RET SNPs including our cohort identified increased risk association of all four RET SNPs with MTC. Conclusion In this largest SNP risk association study for MTC and the only risk association study of the 13 most commonly studied MTC associated SNPs in a single cohort of this rare cancer, a significant protective risk association of CDKN1ASer31Arg SNP with MTC was shown for the first time. Meta‐analysis identified significant risk association of all four RET SNPs, not observed in previous meta‐analysis.
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Affiliation(s)
- Vasudha Mishra
- Sarin Lab, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Pradnya Kowtal
- Sarin Lab, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Pallavi Rane
- Clinical Research Centre (CRC), Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Rajiv Sarin
- Sarin Lab, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute, Mumbai, India.,Cancer Genetics Clinic, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
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Lin T, Zirpoli GR, McCann SE, Moysich KB, Ambrosone CB, Tang L. Trends in Cruciferous Vegetable Consumption and Associations with Breast Cancer Risk: A Case-Control Study. Curr Dev Nutr 2017; 1:e000448. [PMID: 29955715 PMCID: PMC5998357 DOI: 10.3945/cdn.117.000448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/12/2017] [Accepted: 07/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The chemopreventive activities of cruciferous vegetables were recognized in the early 1990s, followed by a growth of evidence in various cancer models, including breast cancer. To our knowledge, no studies have examined whether consumption of cruciferous vegetables has changed accordingly, and what impact, if any, on breast cancer risk may have resulted. Objective: The time trend in cruciferous vegetable intake was investigated between 1982 and 1998, and its associations with breast cancer risk were examined. Methods: In a hospital-based case-control study in 1491 patients with breast cancer and 1482 controls, loess curves were constructed to describe the relation between median consumption of cruciferous vegetables and year of admission. ORs and 95% CIs were calculated with unconditional logistic regression, adjusting for age, year of admission, family income, body mass index, cigarette smoking, age at menarche, parity, age at first birth, family history of breast cancer, hormone replacement therapy, and total meat intake. Results: Consumption patterns differed between cases and controls. A slow but steady increase in cruciferous vegetable intake was observed in the cases, although among controls, cruciferous vegetable consumption increased from 1982 to 1987, reached a plateau during 1988-1992, and then declined from 1993 to 1998. Accordingly, although an overall inverse association with breast cancer risk was observed for cruciferous vegetable intake (highest compared with lowest quartile-OR: 0.68; 95% CI: 0.55, 0.86; P-trend = 0.0006), the inverse association tended to be more pronounced within more recent-year strata, with an OR of 0.52 (95% CI: 0.33, 0.83) for 1993-1998 compared with an OR of 0.89 (95% CI: 0.64, 1.23) for 1982-1987. Conclusions: The consumption of cruciferous vegetables increased during the past 2 decades, showing different trends in cases and controls. The subtle but sustained increase in cruciferous vegetable intake reported by the cases could influence association studies with breast cancer risk.
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Affiliation(s)
- Tengda Lin
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY
| | - Gary R Zirpoli
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY
| | - Susan E McCann
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY
| | - Kirsten B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY
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Avirmed S, Wang BS, Selenge B, Sanjaajamts A, Ganbat B, Erdenebileg U, Purevsuren M, Jigjidsuren S, Batmunkh M, Lee YJ. Association between MDM2-SNP309 and p53R72P polymorphisms and the risk of bladder cancer in the Mongolian population. Mol Clin Oncol 2017; 7:412-420. [PMID: 28781817 DOI: 10.3892/mco.2017.1317] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 04/13/2017] [Indexed: 11/06/2022] Open
Abstract
The current study aims to investigate whether MDM2-SNP309 and p53R72P polymorphisms were associated with the risk of bladder cancer in Mongolian populations. These polymorphisms were evaluated in 79 controls and 63 bladder cancer cases using a PCR-restriction fragment length polymorphism assay, followed by analysis using multivariate logistic regression model and the Kaplan-Meier model to determine the odds ratio (OR) and age at onset of bladder cancer, respectively. The results revealed that the homozygous (G/G) genotype of MDM2-SNP309 increased the risk of bladder cancer compared to the wild-type (T/T) genotype [OR=1.629; 95% confidence interval (CI)=0.622-4.266] among Mongolians. On the other hand, the homozygous (P/P) genotype of p53R72P tended to protect the population from bladder cancer compared with the wild-type (R/R) genotype (OR=0.445; 95% CI=0.1727-2.147). It also showed that G/G genotype of MDM2-SNP309 increased the risk of bladder cancer when combined with the R/R genotype of p53R72P (OR=3.355; 95% CI=0.3914-28.766). Stratification by smoking and history of chronic urinary tract diseases tended towards increasing the risk association of the G/G (OR=2.3704; 95% CI=0.4308-3.044) and T/G genotypes (OR=5; 95% CI=0.8442-30.4088) of MDM2-SNP309 with bladder cancer, respectively. The protective role of P/P of p53R72P remained following stratification. MDM2-SNP309 and p53R72P were not involved in early age onset of bladder cancer in Mongolian patients. Taken together, MDM2-SNP309 and p53R72P had no significant association with bladder cancer in Mongolian patients. The two SNPs were also not able to predict early age at onset of bladder cancer.
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Affiliation(s)
- Shiirevnyamba Avirmed
- Division of Urology, Department of Surgery, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
| | - Bo-Shen Wang
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Engineering, National Yang-Ming University, Taipei 112, Taiwan
| | - Baasansuren Selenge
- Division of Urology, Department of Surgery, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
| | - Amarsaikhan Sanjaajamts
- Division of Urology, Department of Surgery, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
| | - Batmunkh Ganbat
- Division of Urology, Department of Surgery, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
| | - Ulziisaikhan Erdenebileg
- Division of Urology, Department of Surgery, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
| | - Myagmarsuren Purevsuren
- Division of Urology, Department of Surgery, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia.,Department of Urology, First Central Hospital of Mongolia, Ulaanbaatar 210648, Mongolia
| | - Sarantsetseg Jigjidsuren
- Department of Clinical Laboratory, First Central Hospital of Mongolia, Ulaanbaatar 210648, Mongolia
| | - Munkhbat Batmunkh
- Science Technology Center, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
| | - Yi-Jang Lee
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Engineering, National Yang-Ming University, Taipei 112, Taiwan.,Biophotonics and Molecular Imaging Research Center (BMIRC), National Yang-Ming University, Taipei 112, Taiwan
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Fu Xi L, Schiffman M, Ke Y, Hughes JP, Galloway DA, He Z, Hulbert A, Winer RL, Koutsky LA, Kiviat NB. Type-dependent association between risk of cervical intraepithelial neoplasia and viral load of oncogenic human papillomavirus types other than types 16 and 18. Int J Cancer 2017; 140:1747-1756. [PMID: 28052328 DOI: 10.1002/ijc.30594] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 08/05/2016] [Revised: 11/03/2016] [Accepted: 12/05/2016] [Indexed: 01/31/2023]
Abstract
Studies of the clinical relevance of human papillomavirus (HPV) DNA load have focused mainly on HPV16 and HPV18. Data on other oncogenic types are rare. Study subjects were women enrolled in the atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) triage study who had ≥1 of 11 non-HPV16/18 oncogenic types detected during a 2-year follow-up at 6-month intervals. Viral load measurements were performed on the first type-specific HPV-positive specimens. The association of cervical intraepithelial neoplasia grades 2-3 (CIN2/3) with type-specific HPV DNA load was assessed with discrete-time Cox regression. Overall, the increase in the cumulative risk of CIN2/3 per 1 unit increase in log10 -transformed viral load was statistically significant for four types within species 9 including HPV31 (adjusted hazard ratio [HR adjusted ] = 1.32: 95% confidence interval [CI], 1.14-1.52), HPV35 (HR adjusted = 1.47; 95% CI, 1.23-1.76), HPV52 (HR adjusted = 1.14; 95% CI, 1.01-1.30) and HPV58 (HR adjusted = 1.49; 95% CI, 1.23-1.82). The association was marginally significant for HPV33 (species 9) and HPV45 (species 7) and was not appreciable for other types. The per 1 log10 -unit increase in viral load of a group of species 9 non-HPV16 oncogenic types was statistically significantly associated with risk of CIN2/3 for women with a cytologic diagnosis of within normal limits, ASC-US, or LSIL at the first HPV-positive visit but not for those with high-grade SIL. Findings suggest that the viral load-associated risk of CIN2/3 is type-dependent, and mainly restricted to the species of HPV types related to HPV16, which shares this association.
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Affiliation(s)
- Long Fu Xi
- Department of Pathology, School of Medicine, University of Washington, Seattle, WA.,Department of Epidemiology, University of Washington, Seattle, WA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research, Peking University School of Oncology, Beijing, People's Republic of China
| | - James P Hughes
- Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, WA
| | - Denise A Galloway
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research, Peking University School of Oncology, Beijing, People's Republic of China
| | - Ayaka Hulbert
- Department of Pathology, School of Medicine, University of Washington, Seattle, WA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Laura A Koutsky
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Nancy B Kiviat
- Department of Pathology, School of Medicine, University of Washington, Seattle, WA
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