Abstract
Simple SummaryThis observational study aimed to investigate the possible influence of sexual behavior and demographic characteristics in the expression of HPV-related biomarkers in a colposcopy population. Lifestyle factors that impacted HPV DNA positivity in a statistically significant manner were younger age at first sexual intercourse, a history of more than four sexual partners as well as a partner change during the last year before HPV DNA assessment. Although ambitious, the development and validation of lifestyle scoring systems that combine molecular and epidemiological patient data to effectively predict underlying cervical pathology will represent a milestone in the quest of cervical cancer prevention.Despite the significant scientific evolution in primary and secondary cervical cancer prevention in the battle started by George Papanicolaou in the previous century, global cervical cancer mortality rates remain disappointing. The widespread implementation of HPV-related molecular markers has paved the way to tremendous developments in cervical cancer screening, with the transition from cytological approach to the more accurate and cost-effective HPV testing modalities. However, the academic audience and different health systems have not yet adopted a universal approach in screening strategies, and even artificial intelligence modalities have been utilized from the multidisciplinary scientific armamentarium. Combination algorithms, scoring systems as well as artificial intelligent models have been so far proposed for cervical screening and management. The impact of sexual lifestyle inherently possesses a key role in the prevalence of HPV-related biomarkers. This study aimed to investigate any possible influence of sexual behavior and demographic characteristics in the expression of HPV-related biomarkers in a colposcopy population from October 2016 to June 2017, and corroborated the determining role of age at fist intercourse; the older the age, the lower the probability for DNA positivity. Multivariate analysis illustrated additionally that a number of sexual partners exceeding 4.2 was crucial, with women with ≤5 partners being approximately four times less likely to harbor a positive HPV DNA test (p < 0.0001). Similarly, a reported partner change during the last year before HPV DNA assessment contributed to 2.5 times higher odds for DNA positivity (p = 0.0006). From this perspective, the further development and validation of scoring systems quantifying lifestyle factors that could reflect cervical precancer risk seems paramount.
Highlights
Cervical cancer remains the fourth most frequently diagnosed cancer and the fourth leading cause among cancer deaths, with an estimated 604,000 new cases and 342,000 deaths worldwide in 2020 [1]
We examined the relation between the number of sexual partners and the coitarche using the Spearman correlation coefficient since normality could not be ensured for these variables
We evaluated if these two characteristics can be used as single predictors of HPV DNA and mRNA positivity using the receiver operating characteristics (ROC) area under curve (AUC)
Summary
Cervical cancer remains the fourth most frequently diagnosed cancer and the fourth leading cause among cancer deaths, with an estimated 604,000 new cases and 342,000 deaths worldwide in 2020 [1]. In spite of robust evidence that persistent infection with highrisk human papillomavirus genotypes (hrHPV) represents a necessary but not sufficient cause of cervical cancer, other important cofactors including some sexually transmitted infections, such as HIV and Chlamydia trachomatis, smoking, higher number of lifetime childbirths and long-term use of oral contraceptives, have been linked subsequently to hrHPV acquisition and development of cervical pre-cancer and cancer [2,3,4,5]. The deployment of cytology-based cervical cancer screening strategies with early detection and treatment of precancerous lesions has significantly reduced both the incidence and mortality from cervical cancer in the developed world [1,6]. The current understanding is that the implementation of hrHPV testing for primary cervical screening offers significantly greater protection against invasive cancer than cytology-based screening [7,8]. Despite Greece being among the first countries to incorporate a free of charge anti-HPV vaccination (2-valent and 4-valent vaccines) schedule in the national immunization program, the existing data on vaccination coverage are disappointing with just approximately 30–35% of the eligible target-group cohorts having received the full regimen until recently [9]
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