Oncogenic Human Papillomavirus Subtypes Research Articles

Positive margins in cervical H-SIL conization: Can we predict them?

Background: Cervical cancer is the second most common gynecological cancer in the female population. Cervical cancer screening includes cytology and tests for oncogenic subtypes of human papillomavirus (HPV), impacting on a significant decrease in mortality. In patients with a diagnosis of high-grade squamous intraepithelial lesion (HG SIL), the recommended management is excisional treatment (ET). The higher rate of persistent disease is associated with a positive margin status, larger lesion size, endocervical involvement and HPV positive test six months after treatment, especially HPV 16 subtype. Objective: To identify clinical and/or pathological features capable of predicting the compromise of the margins in the excisional treatment specimens. Methods: It is an observational, retrospective study carried out in Sanatorio Güemes between September 2017 and June 2020. All those patients with HG SIL who underwent excisional treatment were analyzed. The variables considered were the pre-treatment status of the endocervical canal, the size of the specimen (height), the type of transformation zone, the presence of greater pathology in the definitive specimen, the delay in consultation and the smoking habit. The relative risk of presenting compromised margins for each of the variables was analyzed. Findings: Our study shows 124 patients who received excisional treatment for HG SIL, 32 had compromised endocervical margins of the resection specimen. The delay in consultation between the biopsy and the ET has a significant impact on the state of the margins (RR 2,26; IC95 1,27-4; p 0,009). The presence of greater pathology (microinvasive carcinoma or higher stage) in the group with compromised margins (34,4% vs. 5,4%) highlights the importance of a comprehensive pre-treatment advisement to the patient concerning the diagnostic role of the ET in our population.

Past pregnancy, medical history, and sociodemographics are predictive of HPV vaccination status

The quadrivalent human papilloma virus (HPV) protein sub-unit vaccine nearly abolishes cervical cancer risk by preventing persistent infection with oncogenic subtypes of HPV. Unfortunately, HPV vaccination rates remain lower than anticipated. We aimed to study this trend within our region to identify what patient-specific factors influence HPV vaccination status.

Efficacy of a Coriolusversicolor-Based Vaginal Gel in Human Papillomavirus-Positive Women Older Than 40 Years: A Sub-Analysis of PALOMA Study.

In the PALOMA trial, Papilocare® demonstrated efficacy in repairing low-grade cervical lesions related to human papillomavirus (HPV). This sub-analysis aimed to evaluate its efficacy in repairing these cervical lesions and clearing HPV in women aged older than 40 years. This was a multicenter, randomized, open-label, parallel-group, controlled clinical trial. Patients with low-degree HPV-dependent cervical lesions receiving 6-month treatment with the vaginal gel were compared to those with a watchful waiting approach. Among the 41 women analyzed (aged 47.7 years), 31 presented high-risk (HR) oncogenic HPV subtypes, and 14 had 16-18-31 HPV genotypes. After 6 months, normalized cytology and concordant colposcopy were achieved by a greater percentage of treated women. The difference was significant in the total population (92.3% vs. 50.0%, p = 0.007), and HR-HPV subpopulation (90.5% vs. 33.3%, p = 0.003). In the HR HPVs-16-18-31 subpopulation, the values were 75.0% and 40.0% (p = 0.293). In the total population, 61.5% of treated patients obtained HPV clearance, compared to 50.0% in the control group. Regarding the HR-HPV subpopulation, these values were 66.7% and 44.4%, respectively. Papilocare® demonstrated significant efficacy in repairing low-degree HPV-related cervical lesions and a positive trend to clear HPV in women older than 40 years old in comparison to the watchful waiting approach.

A Digital Personal Health Library for Enabling Precision Health Promotion to Prevent Human Papilloma Virus-Associated Cancers.

Human papillomavirus (HPV) causes the most prevalent sexually transmitted infection (STI) in the United States. Sexually active young adults are susceptible to HPV, accounting for approximately 50% of new STIs. Oncogenic HPV subtypes 16 and 18 are associated with squamous intraepithelial lesions and cancers and are mostly preventable through prophylactic HPV vaccination. Accordingly, this study's objectives are to (1) summarize SDoH barriers and implication for low HPV vaccination rates among young adults (18–26 years), (2) propose a digital health solution that utilizes the PHL to collect, integrate, and manage personalized sexual and health information, and (3) describe the features of the PHL-based app. Through the application of novel techniques from artificial intelligence, specifically knowledge representation, semantic web, and natural language processing, this proposed PHL-based application will compile clinical, biomedical, and SDoH data from multi-dimensional sources. Therefore, this application will provide digital health interventions that are customized to individuals' specific needs and capacities. The PHL-based application could promote management and usage of personalized digital health information to facilitate precision health promotion thereby, informing health decision-making regarding HPV vaccinations, routine HPV/STI testing, cancer screenings, vaccine safety/efficacy/side effects, and safe sexual practices. In addition to detecting vaccine hesitancy, disparities and perceived barriers, this application could address participants' specific needs/challenges with navigating health literacy, technical skills, peer influence, education, language, cultural and spiritual beliefs. Precision health promotion focused on improving knowledge acquisition and information-seeking behaviors, promoting safe sexual practices, increasing HPV vaccinations, and facilitating cancer screenings could be effective in preventing HPV-associated cancers.

HUMAN PAPILLOMAVIRUS (HPV)-ASSOCIATED ORAL INTRAEPITHELIAL NEOPLASIA: A CASE REPORT

<h3>Background</h3> Human papillomavirus (HPV)-associated oral intraepithelial neoplasia is a subset of oral dysplastic lesions with the presence of transcriptionally active high-risk oncogenic HPV subtypes 16 and 18. There is limited evidence in the literature regarding the potential rate of transformation of this entity to oral squamous cell carcinoma. <h3>Case Report</h3> A 51-year-old male patient with a heavy smoking (35 pack-year) and alcohol consumption (6 standard drinks a day) history presented with widespread oral leukoplakia. Initial biopsies demonstrated the following:SiteHistopathology findings1.Floor of mouthKeratosis with moderate to focally severe epithelial dysplasia2.Left lower lipActinic keratosis with mild to moderate epithelial atypiaSubsequent mapping biopsies (sites 3, 4) and wide local excision (site 5) demonstrated:3.Left ventral tongueHPV-associated intraepithelial neoplasia4.Lower lipcarcinoma in situ5.Right anterior ventral tongue/floor of mouthHPV-associated intraepithelial neoplasia, with excision margins free of dysplasia <h3>Investigations</h3> For sites 3 and 5, immunoperoxidase stains demonstrated diffuse, positive p16 staining of dysplastic epithelium and HPV-16 in situ hybridization showed positive nuclear staining. Both sites demonstrated hyperkeratosis, basal cell hyperplasia, increased numbers of mitoses (including suprabasal), and interspersed apoptotic cells. <h3>Follow-Up</h3> Wide local excision of the anterior ventral tongue and floor of mouth demonstrated HPV-associated intraepithelial neoplasia with involved margins (p16 and HPV-16-ISH positive). The lower lip vermilionectomy showed carcinoma in situ with clear margins. There is ongoing 3 monthly mucosal surveillance. <h3>Discussion</h3> Further studies are required to evaluate the behavior and prognosis of this subset of HPV-related oral dysplastic lesions.

Molecular detection of oncogenic subtypes of human papillomavirus (HPV) in a group of women in the Amazon region of Brazil

The natural history of cervical cancer is strongly related to the presence of human papillomavirus (HPV) infection, with its relationship with cervical cancer being a matter of concern. It is estimated that 70% of all cervical cancers worldwide are caused by HPV 16 and 18. Accordingly, the present study aimed to contribute to the identification of HPV subtypes circulating in a group of women of Manaus-Brazil. Cervical samples were collected from 49 women, following the eligibility criteria of the study, and DNA was then extracted from the samples, which were analyzed for the presence of the virus in the genetic material through the polymerase chain reaction (PCR) using generic primers (GP05/06). Finally, identification of the viral subtypes was performed using specific primers for the detection of the main subtypes already examined (16 and 18). Positive HPV DNA was detected in 100% of the samples included in the study. Human papillomavirus 16 was the most prevalent subtype in the majority of lesions, accounting for 29 (59.2%) of the positive cases, and HPV 18 was detected in four (8.2%) women. In these 4 cases there was co-infection, with the presence of both HPV 18 and HPV 16. Therefore, 40.8% (20 cases) in which HPV DNA was detected presented infection with other subtypes of HPV not included in the study. This data has clinical implications related to cervical cancer prevention, as the current prophylactic HPV vaccines are only effective against high-risk HPV 16 and 18 subtypes.

MICA and KLRK1 genes and their impact in cervical intraepithelial neoplasia development in the southern Brazilian population

Cervical carcinoma and cervical intraepithelial neoplasia (CIN) are associated with persistent infection by oncogenic subtypes of HPV (Human Papillomavirus). Factors linked to immunity, genetics and others like oral contraceptive use, sexual behavior, coinfections with other microorganisms and smoking seem to influence the mechanisms that determine regression or progression to CIN and cervical cancer. We investigated the effect of the MHC class I chain-related gene A (MICA) and Killer Cell Lectin Like receptor K1 (KLRK1) genes on cervical cancer and CIN lesions susceptibility in a group of 195 patients from southern Brazil. There were found a significantly higher number of ex-smokers in the control group (p = 0.005). There were more oral contraceptives (OC) users in the patient group. MICA*008:01/04 allele showed a significant difference between patient and control groups (p = 0.03; OR = 0.63, 95% CI 0.41–0.96), as well as MICA*018:01(p = 0.004, OR = 0.15, 95% CI 0.03–0.64) and MICA*002:01/020 (p = 0.01; OR = 0.60, 95% CI 0.40–0.88). We also analyzed cases and controls according to the MICA-129 genotypes (Met/Val). There was found a difference (p = 0.02) with the Met/Val genotype in a higher frequency in controls and Val/Val and Val/MICA del at a higher frequency in the patient group. For the KLRK1 gene there was no significant difference between groups.

A Practical Risk Measure for Identification of Adults With Oncogenic Oral Human Papillomavirus: Potential Use in Primary Care.

Oral human papillomavirus (HPV) infection is the main cause of oropharyngeal cancer. However, there is no assessment tool for early detection and prevention of oropharyngeal cancer in practice. The purpose of the study was to develop and validate a risk assessment tool to predict the presence of HPV associated with oropharyngeal cancer. Using data from the National Health and Nutrition Examination Survey 2011-2014, 6,978 US adults aged 18 to 59 years who were tested for oral HPV infection were included for this study. We carried out an analysis to test and validate risk predictive models for oral HPV infection. Presence of one of the 20 HPV subtypes associated with oropharyngeal cancer was used for the outcome. Of 6,978 participants aged 18-59, 303 (4.3%; 6.6 million) were found to have oncogenic HPV subtypes. Our final model included sex, income-to-poverty ratio, current smoking, and the lifetime number of oral sex partners. The discriminatory power of the oral HPV risk score to predict the presence of oncogenic HPV was good (C-statistic=0.73). The risk score performed comparably in the validation population (C-statistic=0.72). The comparison between observed and estimated proportions of population with oncogenic oral HPV demonstrated excellent calibration. We developed and validated the oral HPV risk score that predicts the risk of oral HPV requiring only self-reported data and no laboratory testing. The Oral HPV risk score has the potential to provide clinicians with a no-cost, easy way to screen for patients at greater risk for oncogenic HPV infection.

Cobas 4800 HPV detection in cervical samples of Polish women.

IntroductionLong-term infection with human papillomavirus (HPV) is the cause of cervical cancer and its precursor – cervical intraepithelial neoplasia (CIN). The presence of HPV infection can be presumed in more than 99% of cases of cervical cancer worldwide. The introduction of DNA testing for the presence of HPV has increased the effectiveness of screening programs for the detection of this cancer. This study aimed to analyze the prevalence of high risk HPV DNA (HR HPV) in females from Poland.Material and methodsThe study was performed on 280 cervical smear samples. In this work we used the Roche Cobas 4800 HPV test to detect the HR HPV in cervical smear samples.Results56 patients (20%) proved to be positive regarding HPV-16 DNA and 40 patients (14.28%) regarding HPV-18 DNA. In overall assessment, in 94 patients (33.57%) we detected oncogenic HPV subtypes, other than the two mentioned above. In 90 patients (32.14%) no high risk HPV was detected.ConclusionsThe Roche Cobas 4800 HPV test is a viable, effective, easy and quick tool in detecting high risk HPV DNA.

Retrospective Analysis of Prevalence of High-risk and Low-risk Human Papillomavirus (HPV) Genotypes in Iranian Women During 2013-2016

Background and objective: Considering the importance of HPV in cancer etiology, awareness of HPV prevalence and frequency of high-risk genotypes could help improve health care system management. We analyzed HPV prevalence in women forms different provinces of Iran that is the largest sample till now. Material and Methods: In this retrospective cross-sectional study, 2969 outpatient and suspicious women aged 17- 78 referred to Noor pathobiology laboratory from 24 provinces of Iran were studies. DNA extraction and PCR were performed on samples and then HPV genotypes were also determined using hybridization kit. Results: HPV DNA was detected in 29.3% of valid liquid-based samples. Among HPV positive cases, 67.2% and 52.0% accounted for high-risk and low-risk HPV subtypes, respectively. In patients with high-risk HPV types, HPV16 was confirmed as predominate type (30.5%) followed by HPV53 (17.3%) and HPV39 (13.3 %). HPV6 was found as the most common low-risk HPV type with 60.6% frequency rate followed by HPV11 (17.9%) and HPV81 (8.6%) in this age group. It was apparent that age group &gt;25 years accounted the highest frequency of HPV positivity. The prevalence of HPV was significantly different among different age groups (p&lt;0.0001). Conclusion: It can be concluded that HPV infection is currently at a considerable high level in Iran. Looking at the high risk and oncogenic HPV subtypes frequency especially in younger age groups, a concern could be noticed about HPV relevant cancers which can be prevented by commercial and approved HPV vaccines.

The Cytoskeletal Adaptor Obscurin-Like 1 Interacts with the Human Papillomavirus 16 (HPV16) Capsid Protein L2 and Is Required for HPV16 Endocytosis.

Human papillomaviruses infect mucosal and cutaneous epithelia, and the high-risk HPV types account for 5% of cancer cases worldwide. As recently discovered, HPV entry occurs by a clathrin-, caveolin-, and dynamin-independent endocytosis via tetraspanin-enriched microdomains. At present, the cellular proteins involved in the underlying mechanism of this type of endocytosis are under investigation. In this study, the cytoskeletal adaptor OBSL1 was discovered as a previously unrecognized interaction partner of the minor capsid protein L2 and was identified as a proviral host factor required for HPV16 endocytosis into target cells. The findings of this study advance the understanding of a so far less well-characterized endocytic pathway that is used by oncogenic HPV subtypes.

Role of human papillomavirus and tumor suppressor genes in oral cancer.

The incidence of oral cancer remains high and is associated with many deaths in both Western and Asian countries. Several risk factors for the development of oral cancer are now well known, including smoking, drinking and consumption of smokeless tobacco products. Genetic predisposition to oral cancer has been found in certain cases, but its components are not yet entirely clear. In accordance with the multi-step theory of carcinogenesis, the natural history of oral cancer seems to gradually evolve through transitional precursor lesions from normal epithelium to a full-blown metastatic phenotype. A number of genomic lesions accompany this transformation and a wealth of related results has appeared in recent literature and is being summarized here. Furthermore, several key genes have been implicated, especially well-known tumor suppressors such as the cyclin-dependent kinase inhibitors, TP53 and RB1 and oncogenes such as the cyclin family, epidermal growth factor receptor and RAS. Viral infections, particularly oncogenic human papillomavirus subtypes and Epstein–Barr virus, can have a tumorigenic effect on oral epithelia and their role is discussed, along with potential therapeutic interventions. A brief explanatory theoretical model of oral carcinogenesis is provided and potential avenues for further research are highlighted.

Prevalence of Pap smear abnormalities among women who attend Sexually Transmitted Diseases (STD) clinic, Colombo

Introduction: Cervical cancer ranks as the second most frequent cancer among women in Sri Lanka. It has been now well established that oncogenic subtypes of human papillomavirus (HPV) is a necessary cause of cervical cancer. An abnormal Pap smear may indicate an infection, inflammation or cervical cytological abnormality. Objectives: The objective of this study was to ascertain the prevalence of Pap smear abnormalities among women who attend Sexually Transmitted Disease (STD) clinic, Colombo Method: A total of 1300 females who underwent routine Pap smear screening at STD clinic, Colombo in the year 2010 and 2011 were analysed for the prevalence of all forms of Pap smear abnormalities including cervical cytological abnormalities. Cytology was interpreted according to the national guideline which is based on Bethesda system 2001. Results: Prevalence of all forms of abnormal Pap smears was 24.2% while the prevalence of cervical cytological abnormalities was only 2.2% in the sample, out of which 1 .4% were low grade squamous intraepithelial lesions (LGSIL), 0.5% were high grade squamous intraepithelial lesions (HGSIL) and 0.3% were glandular cell atypia. The cervical cancer prevalence in the sample was 0.077%. Conclusions: All forms of Pap smear abnormalities among STD clinic attendees were relatively high (24.2%) due to concurrent infections and inflammation. The rate of cervical cytological abnormalities was 2.2% while the cervical cancer rate was 0.077% in the sample. There was no significant difference between groups with and without cervical cytological changes. Sri Lanka Journal of Venereology Vol.5(1) 2014: 20-30

HPV and Adolescent Males with HIV 2007-2009

Objective: Human Papillomavirus (HPV) infection is found to be more prevalent in HIV-infected than uninfected men (73% vs. 43%). Young men who have sex with men (YMSM) with HIV with HPV anal lesions often deny or are unaware of these lesions. Unless screened, these lesions will remain undiagnosed with a potential for transmission to sexual partners and disease progression. We explored screening practices for HPV and therapeutic/diagnostic outcome of HPV screening among YMSM with HIV, including co-infection with other STIs. Methods: Chart review of all HIV+ adolescent males, age 13-24 years, reporting MSM, engaged in care, 2007-2009, at an inner city HIV clinic for adolescents and young adults. Results: The average number of males enrolled in care was 143 per year (range 127-166) and none received HPV vaccination. By visual inspection 50 YMSM were identified with anal HPV lesions: 46% received anal cytology, 30% were identified as abnormal (ASCUS, LGSIL, or HGSIL); 90% received medical treatment (Imiquimod or Podophylline); 72.3% with no evidence that lesions cleared; 68.6% were referred to Colorectal surgical clinic. In addition, 62% had STIs diagnosed: syphilis (42%); gonorrhea (39%); chlamydia (26%), and HSV (19%), Hepatitis B (6%); Hepatitis C (3%). Clearance of HPV was associated with having more than one STI (p=0.03). Conclusions: Detecting genital warts by visual inspection without acetic acid is an insensitive screening, thus the number of males suspected to have HPV would be higher than the 50 identified by visual inspection. In this cohort of HIV+ YMSM with HPV, a third were identified as having abnormal cytology, which is worrisome for infection with oncogenic HPV subtypes. Not all received HPV medical and or referred for surgical treatment. The majority of the cohort was co-infected with STIs, and having more than one STI was associated with clinical clearance of HPV lesions

Potential role of human papilloma virus in the pathogenesis of gastric cancer.

To demonstrate the presence and biological activity of human papilloma virus (HPV) in gastric cancer (GAC) tissues. The study involved 84 surgically treated patients with gastric adenocarcinoma, regardless of the clinical stage of the disease. The presence of HPV DNA of high oncogenic risk types in formalin-fixed, paraffin-embedded tumor samples was determined using quantitative polymerase chain reaction analysis. A stringent protocol of prevention of cross- and environmental contamination was applied during DNA isolation, and amplification, as well as confirmation of the biological activity of the virus in tumor cells, was implemented. The study utilized the Real-time High Risk HPV test, which detects the DNA of 14 HPV subtypes that are considered to have high oncogenic potential. The overexpression of the p16(INK4a) protein assessed immunohistochemically was considered confirmation of the HPV infection. Among the 89 patients initially included in the study group, diagnostic results were obtained for 84 individuals. In five cases, either the histopathological material was too scant to isolate the necessary amount of DNA, or the isolated DNA was significantly degraded, resulting in the failure of internal control amplification within the predefined number of 35 cycles. Those patients were excluded from further analysis. The amplification of HPV DNA was demonstrated in none of the 84 tissue samples; thus, all cases were considered to have a negative DNA status of highly oncogenic HPV subtypes. Immunohistochemical staining provided diagnostic results for all of the examined tissue samples, and excluded the accumulation of the p16(INK4a) protein in tumor cells, thus confirming the lack of active HPV infection in all of the individuals. The study does not confirm the presence or biological activity of HPV in tumor tissues. Thus, the relationship between GAC and HPV infection, in the Central European population seems doubtful.

Concordant Oral-Genital HPV Infection in South Africa Couples: Evidence for Transmission

Objective: Cervical cancer is a leading cause of cancer mortality in South Africa. However, little is known about oral human papillomavirus (HPV) infection in high human immunodeficiency virus (HIV) seroprevalence settings.Method: Thirty-four adult heterosexual couples attending an HIV testing center in Soweto, South Africa were enrolled. Each participant provided an oral rinse sample and genital swab, which were tested for 37 types of HPV DNA, and completed a risk behavior survey.Results: Median age was 31 years and 9% (3/34) of men and 29% (10/34) of women enrolled tested HIV-positive; median CD4 count was 437 cells/mm3. Oral HPV prevalence was similar in women and men (12 vs. 18%, p = 0.48), and was non-significantly higher in HIV-infected vs. HIV-uninfected (23 vs. 13%, p = 0.34) subjects. Most men (82%) and women (84%) reported ever performing oral sex. Median number of lifetime sexual partners was “2–5” while median number of lifetime oral sex partners was 1. Oncogenic HPV subtypes were detected in 4% of oral, 26% of penile, and 74% of vaginal samples, including HPV16 in 1, 12, and 21% of these samples respectively. Genital HPV prevalence was significantly higher than oral HPV prevalence (75 vs. 15%, p ≤ 0.001). Thirty-five percent of couples (12/34) had at least one type-specific concordant vaginal-penile HPV infection but only one of nine couples with oral HPV had concordant oral–oral infection. However, 67% (4/6) of men and 25% (1/4) of women with oral HPV infection had partners with concordant genital HPV infection.Implications and Impact: Oral–oral HPV concordance between couples is low, but oral-genital and genital–genital HPV concordance is higher, including concordance of male oral HPV infection with their partners’ vaginal HPV infection. This data is consistent with possible transmission of vaginal HPV infection to the oral cavity of sexual partners performing oral sex.

Behavioral Correlates of HPV Vaccine Acceptability in the 2007 Health Information National Trends Survey (HINTS)

The development of a prophylactic vaccine to prevent infection with oncogenic subtypes of human papillomavirus (HPV) is an important step in reducing cervical cancer incidence and mortality. However, national data indicate that only 37% of 13- to 17-year-old females have initiated the vaccine series. Prior studies have examined demographic, medical history, and psychosocial variables associated with parental HPV vaccine acceptability, although few have investigated the behavioral correlates of vaccine acceptability. The primary purpose of the current study is to report on national acceptability of the HPV vaccine among U.S. adults with female children in the household and to investigate the health behavior correlates of vaccine acceptability. Data were drawn from the 2007 Health Information National Trends Survey (HINTS). The study sample comprised 1,383 adults who reported having a female child under the age of 18 in their household (52% female, 59% white; mean age = 40 years). More than half (58%) reported they would have a daughter get the HPV vaccine, 25% were not sure, and 18% would not have a daughter vaccinated. Behavioral factors significantly associated with lower acceptance of the HPV vaccine included lack of physical activity in the past month (P = 0.002), past year use of complementary or alternative therapies (P = 0.021), and no history of smoking (P = 0.005). These results suggest that behavioral health factors may be associated with vaccine acceptability and further our understanding of how behavioral patterns may contribute to the uptake of new cancer prevention strategies.

Prevention of cervical, vaginal, and vulval cancers: role of the quadrivalent human papillomavirus (6, 11, 16, 18) recombinant vaccine.

The relationship between the human papillomavirus (HPV) and malignancies of the uterine cervix, vagina, and vulva has been established. The development of a quadrivalent HPV recombinant prophylactic vaccine represents the first time in history that primary prevention of these cancers is offered to girls and women. The prevalence of oncogenic HPV subtypes in cervical cancers has been the most studied, but prevalence has also been established for vaginal and vulvar cancers. Clinical trials demonstrate impressive efficacy in disease prevention as well as excellent safety and tolerability. The role the quadrivalent HPV recombinant vaccine promises to have in the reduction of gynecologic malignancies will depend on various factors, including acceptance and accessibility of the vaccine, duration of immunity, and cross-protection against other oncogenic HPV subtypes. The HPV vaccine's role in disease reduction will probably be viewed in the context of a strategy that involves continued secondary screening and lifestyle modification to reduce modifiable risk factors, along with widespread vaccination.

HPV vaccination in women over 25 years of age: Asian Cervical Cancer Prevention Advisory Board recommendations

Cervical cancer is the second most common cancer among women worldwide and is responsible for more than 270 000 deaths every year, the majority of which occur in Asia. The Asian Cervical Cancer Prevention Advisory Board (ACCPAB) was established in 2005 with a mission to raise awareness of the significant disease burden of cervical cancer in Asia and the strategies for its prevention. Persistent infection with oncogenic subtypes of human papillomavirus (HPV) is the necessary cause of cervical cancer. Vaccines against the two most carcinogenic subtypes of HPV (HPV 16 and 18) are available and have the potential to prevent cervical cancer in 70-80% of HPV- naïve women. HPV vaccines have been first licensed for use in girls and women aged 9-26 years. However, women over 25 years of age are also vulnerable to HPV infection and are likely to benefit from vaccination. Current evidence shows that even women previously infected with HPV who have subsequently cleared the infection can obtain complete protection against the HPV types contained in the vaccines. Therefore, vaccinating sexually active women aged over 25 years offers significant benefits and may be expected to decrease the incidence of cervical cancer. The ACCPAB advocates the adoption of preventive measures against HPV infection, including vaccination, with a view to protecting women of all ages from developing cervical cancer.

Presumed previous human papillomavirus (HPV) related gynecological cancer in women diagnosed with anal cancer in the province of Ontario

Objective The oncogenic HPV subtypes responsible for gynecologic malignancies have also been implicated in the development of squamous cell cancer of the anus (SCAC). SCAC is more common in women, typically presenting at an older age than gynecologic cancers. The aim of this study was determine whether women diagnosed with anal cancer are more likely to have a history of HPV-related gynecological cancer as compared to a matched control group. Methods We performed a population-based, case-control study at the Institute for Clinical Evaluative Sciences (ICES) which houses the administrative databases for all residents of the province of Ontario, Canada. All women diagnosed with SCAC between 1992 and 2005, identified using ICD-9 codes (154.2, 154.3, 154.8) for anatomic site and ICD-O codes (8070–8075, 8120, 8123, 8124) for histologic subtype, were included as cases. Up to 5 female controls, matched for age, socioeconomic status, health region and number of years enrolled in the provincial health plan, were selected for each case. The exposure of interest was previous HPV-related gynecologic cancer, specifically cervical cancer, vulvar cancer and vaginal cancer. Conditional logistic regression was performed to assess the relationship between this exposure and SCAC. Results A total of 674 women with SCAC were identified whose median age was 61. Amongst the cases, there were 7 cervical, 3 vulvar and 1 vaginal cancers compared with 5 cervical, 0 vulvar and vaginal cancers in the 3264 controls. Previous HPV-related gynecological cancer (cervical, vaginal or vulvar cancer) was significantly associated with SCAC (OR: 10.5, 95% C.I.: 3.6 to 30.3). The median time between the diagnosis of anal cancer and previous cervical cancer was 20 years. Conclusions Previous HPV-related gynecological cancers are strongly associated with anal cancer and may occur decades before the anal cancer.