Knowledge about HPV,relation between HPV and cervix cancer and acceptance of HPV vaccine in women in eastern region of Turkey

Objective

The aim of this study is to determine the knowledge of the women living in the eastern region of Turkey about human papillomavirus (HPV) and cervix cancer and their approaches to HPV vaccine.

Methods

The questionnaire forms were distributed to 1,052 patients who applied to the Gynecology Department of Elazig Training and Research Hospital. The subjects were recruited from the general gynecology outpatient clinic of the hospital. The patients from sexually transmitted disease and oncology outpatient clinics were not included in the study. The information about 945 women who completely filled in the questionnaire form was included into the study. The questions set forth in the questionnaire form consisting of 20 questions were prepared by taking the studies previously performed as model.

Results

Ninety-five percent of the women were married and 83.5% were housewives (unemployed). Thirteen percent of the women were illiterate, only 12% were graduated from university. Seventy-four percent of the women did not hear about HPV, 78.4% did not know about HPV vaccine, 63% did not know about the fact that some viruses cause cancer, and 83% did not know about the relation between HPV and cervix cancer. According to the multivariate analysis, free-of-charge vaccination, vaccinated relatives or friends, graduation from university and being under the age of 25 predict to accept the vaccine for themselves.

Conclusion

The young population and the women who graduated from university seem to be more well-informed about HPV and more sensitive about being vaccinated. In addition, free vaccination will ensure the expansion of the vaccine.     

Risk Messages about HPV, Cervical Cancer, and the HPV Vaccine Gardasil in North American News Magazines

The human papillomavirus (HPV) vaccine (Gardasil) is a significant advancement in reducing women’s risk for cervical cancer. Public opinion of the vaccine can be influenced by the mass media. We used content analysis to assess the discussion of risks, fear-inducing messages about HPV, cervical cancer, and the HPV vaccine in four high circulating North American news magazines from January 2006 to December 2007. Risk messages about HPV and cervical cancer focused on threatening illness or injury. Reporting on the HPV vaccine emphasized it being poorly understood by science. News magazine articles on the HPV vaccine and cervical cancer included fear-inducing messages. Cancer educators need to be aware of media reporting in order to alleviate fears that the public may experience about the HPV vaccine.     

宫颈癌患者外周血中HPV6.11、HPV16.18、HSVⅡ及HCMV DNA的检测

目的：测定宫颈癌患者外周血中人乳头状瘤病毒（HPV）、单纯疱疹病毒（HSVⅡ）和人巨细胞病毒（HCMV）DNA，探讨其对HPV感染的高危妇女发生宫颈癌的追踪及监测作用。方法：采用HPV6．11、HPV16．18、HSVⅡ及HCMV PCR试剂盒，用PE Gene Amp PCR System 2400扩增，测定104例宫颈癌患者外周血中的HPV6．11、HPV16．18和80例HSVⅡ及HCMV的DNA，并以32例子宫肌瘤患者为对照组。用χ^2行差异性检测。结果：1）宫颈癌患者外周血中HPV6．11、HPV16．18、HSVⅡ和HCMV病毒DNA测定的阳性率分别为35．58％、20．19％、10．00％和3．75％。对照组分别为12．50％、9．37％、3．13％和0％。2）宫颈癌患者外周血中HPV6．11混合HSVⅡ或混合HCMV DNA阳性率分别为2．04％和1．92％；HPV16．18混合HSVⅡ或混合HCMV DNA阳性率分别为5．36％和3．30％。对照组无1例出现病毒DNA的混合阳性。结论：1）宫颈癌患者外周血中HPV、HSVⅡ和HCMV等病毒DNA阳性率高于对照组。2）宫颈癌患者外周血中的病毒DNA阳性率以HPV为主（P＜0．05）。3）宫颈癌患者外周血中各种病毒DNA混合阳性率较低，其协同的致癌作用有待进一步研究。4）在HPV感染的高危人群中定期进行宫颈涂片和检测外周血中HPV DNA，可起到对病情的追踪及监测作用。     

Knowledge of Pap smear, HPV and the HPV vaccine and the acceptability of the HPV vaccine by Thai women

Aims: The primary prevention for cervical cancer, a human papilloma virus (HPV) vaccine, has been available in Thailand for almost 3 years. The present study evaluates knowledge about the Papanicolaou (Pap) smear, HPV and the HPV vaccine and focuses on identifying predictors for the acceptability of the HPV vaccine. Methods: A sample of 764 women attending the gynecology clinic at Ramathibodi Hospital, Bangkok, was asked to answer a questionnaire on their personal background, their knowledge of the Pap smear and HPV and the HPV vaccine and the acceptability of the HPV vaccine for themselves and their daughters. Results: Knowledge of the Pap smear (96%) is higher than that of HPV (41%) and the HPV vaccine (36%). Only 40% of participants had previously heard about HPV. The acceptability of the HPV vaccine for participants and their daughters was high, 77% and 84%, respectively. Knowing about HPV increases acceptance for the HPV vaccine (adjusted OR = 1.7, 95% CI = 1.2–2.5, in the participants and OR = 2.3, 95% CI = 1.5–3.6 in their daughters). Participants younger than 45 years old (OR = 2.3 and 95% CI = 1.6–3.4 for themselves; OR = 2.2 and 95% CI = 1.4–3.3 for their daughters) were more likely to accept the vaccination than those aged 45 years old and above. Conclusion: Knowledge about HPV and the HPV vaccine is generally poor in Thai women. However, the acceptability of the HPV vaccine is good. Knowing about HPV and age under 45 years predict the acceptability of the HPV vaccine.     

Worldwide burden of cancer attributable to HPV by site,country and HPV type

HPV is the cause of almost all cervical cancer and is responsible for a substantial fraction of other anogenital cancers and oropharyngeal cancers. Understanding the HPV‐attributable cancer burden can boost programs of HPV vaccination and HPV‐based cervical screening. Attributable fractions (AFs) and the relative contributions of different HPV types were derived from published studies reporting on the prevalence of transforming HPV infection in cancer tissue. Maps of age‐standardized incidence rates of HPV‐attributable cancers by country from GLOBOCAN 2012 data are shown separately for the cervix, other anogenital tract and head and neck cancers. The relative contribution of HPV16/18 and HPV6/11/16/18/31/33/45/52/58 was also estimated. 4.5% of all cancers worldwide (630,000 new cancer cases per year) are attributable to HPV: 8.6% in women and 0.8% in men. AF in women ranges from <3% in Australia/New Zealand and the USA to >20% in India and sub‐Saharan Africa. Cervix accounts for 83% of HPV‐attributable cancer, two‐thirds of which occur in less developed countries. Other HPV‐attributable anogenital cancer includes 8,500 vulva; 12,000 vagina; 35,000 anus (half occurring in men) and 13,000 penis. In the head and neck, HPV‐attributable cancers represent 38,000 cases of which 21,000 are oropharyngeal cancers occurring in more developed countries. The relative contributions of HPV16/18 and HPV6/11/16/18/31/33/45/52/58 are 73% and 90%, respectively. Universal access to vaccination is the key to avoiding most cases of HPV‐attributable cancer. The preponderant burden of HPV16/18 and the possibility of cross‐protection emphasize the importance of the introduction of more affordable vaccines in less developed countries.     

Impact of HPV testing,HPV vaccine development,and changing screening frequency on national Pap test volume

BACKGROUND.

The frequently cited number of 50 million annual Papanicolaou cervical screening (Pap) tests performed in the US was based on the National Health Interview Survey (NHIS) of the 1980s. Since then, monumental changes have occurred. More change will soon follow when primary human papilloma virus (HPV) testing and/or HPV vaccine delivery are fully accepted and implemented. The objectives of this study were 1) to estimate the total annual Pap tests performed in the US based on recent NHIS surveys, and 2) to estimate the potential change in the total annual Pap volume produced by changing demographics, reduced screening frequency, HPV testing, and the HPV vaccine.

METHODS.

In the NHIS 2000 and NHIS 2005, women were asked to report the frequency of their Pap tests for the 6 years prior to the interview and to report whether they had abnormal findings. The authors analyzed the survey respondents answers to these questions by using SAS Survey Procedures (SAS Institute, NC). The results were stratified by age, and the total national volume was then extrapolated from a similarly stratified 2000 US census. The projected increase of total Pap tests for the next 25 years was determined by using the projected census data. Potential reductions of Pap tests performed secondarily to HPV testing of women >30 years old and of HPV vaccination were also determined.

RESULTS.

Based on NHIS 2000 and NHIS 2005, 66 million (95% CI, 65–68) and 65 million (95% CI, 64–67) Pap tests were performed in the US, respectively. Had HPV testing been performed in women older than 30 years who had both negative HPV and negative 3‐year Pap tests, then 30% (95% CI, 29–32%) of Pap tests would not have been performed. If both HPV testing and vaccination are performed, the total number of Pap tests performed annually is predicted to be reduced by 43% (95% CI, 35–38%).

CONCLUSIONS.

Therefore, despite an expected increase in the population of women eligible for Pap tests, the total number will likely decrease substantially in the future. This, in turn, will decrease the demand for a traditionally trained cytotechnology workforce. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.     

子宫颈癌患者人乳头瘤病毒16、18检测

 目的　探讨人乳头瘤病毒（HPV）16、18型在子宫颈癌的发生、发展中的意义。方法　应用实时荧光定量聚合酶链反应技术对子宫颈原位癌13例，子宫颈癌Ⅰ期32例，子宫颈上皮内瘤样病变（CIN）Ⅰ~Ⅱ级12例，对照组54例（慢性子宫颈炎组37例、非研究疾病组17例）进行HPV16、HPV18型荧光基因定量检测，计算出HPV DNA的拷贝数。结果　研究组、对照组HPV16、HPV18的感染率差异有统计学意义（P＜0.05），在子宫颈癌发生的不同阶段，HPV16、HPV18的感染定量差异亦有统计学意义。子宫颈癌HPV含量与肿瘤直径大小、浸润间质深度、淋巴结阳性个数无相关性（r = 0.168， r = 0.280， r = 0.333，P＞0.05）；局部肿瘤的直径大小与浸润间质深度呈正相关（r = 0.473，P＜0.05）。结论　致癌性HPV的持续、高浓度存在是子宫颈癌发生、发展的主要因素之一。     

Performance of oral HPV DNA,oral HPV mRNA and circulating tumor HPV DNA in the detection of HPV-related oropharyngeal cancer and cancer of unknown primary

A biomarker that is useful for the detection of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) and cancer of unknown primary (CUP) is indispensable. We evaluated the diagnostic performance of HPV DNA and mRNA in oral gargle samples and circulating tumor HPV16 DNA (ctHPV16DNA) in blood samples. Oral HPV DNA and mRNA were analyzed using commercially available HPV assays of the GENOSEARCH HPV31 and Aptima, respectively. ctHPV16DNA was analyzed using in-house droplet digital polymerase chain reaction. Seventy-four patients with OPC and eight patients with CUP were included. The sensitivity and specificity of oral HPV DNA, oral HPV mRNA, and ctHPV16DNA were 82% (95% confidence interval [CI] = 66-92) and 100% (95% CI = 88-100), 85% (95% CI = 69-94) and 94% (95% CI = 73-100), and 93% (95% CI = 81-99) and 97% (95% CI = 84-100), respectively, for HPV16-related OPC, while those were 20% (95% CI = 1-72) and 100% (95% CI = 3-100), 0% (95% CI = 0-52) and 100% (95% CI = 3-100), and 100% (95% CI = 54-100) and 100% (95% CI = 16-100), respectively, for HPV16-related CUP. The sensitivity of ctHPV16DNA for HPV16-related OPC was higher than that of oral biomarkers, though the difference was not statistically significant. ctHPV16DNA remarkably correlated with the anatomic extent of disease, total metabolic tumor volume and HPV16 copy number per tumor genome in patients with HPV16-related OPC/CUP, whereas oral biomarkers did not. In conclusion, ctHPV16DNA is a potentially promising biomarker for HPV16-related OPC, while further studies are required for HPV16-related CUP.     

HPV infection in Europe

In order to estimate the impact of primary cervical cancer screening with human papillomavirus (HPV) testing, and implementation of the current HPV vaccines, we have summarised the most recent and largest HPV studies in Europe. Eighteen studies including between 897 and 46,900 women from 14, mostly Northern and Western European, countries were included. Everywhere, high-risk (HR) HPV prevalence peaked before age 25 or 30 years with steady declines thereafter. For women in the 30–64-year age-range, for whom primary HPV testing is considered, age-adjusted HR HPV prevalence ranged from 2% in Spain to approximately 12% in Belgium and France, where sustained elevated levels were found in women aged ?35 years. HPV16 and 18, the two HR types prevented by current HPV vaccines, accounted for 30% (range 19–43%) and 12% (range 0–22%) of all HR HPV positives, respectively, and varied according to the presence of cervical lesions. Based on an updated meta-analysis of HPV type distribution in the whole of Europe, HPV16 and/or 18 are estimated to be present in 52%, 61% and 76% of cytologically detected high-grade squamous intraepithelial lesions, histologically confirmed cervical intraepithelial neoplasia grade 2/3, and invasive cervical carcinoma, respectively.     

Risk of cervical cancer associated with Chlamydia trachomatis antibodies by histology, HPV type and HPV cofactors

Human papillomavirus (HPV) is the central etiologic factor for cervical cancer, and prior studies suggested C. trachomatis may act as an HPV cofactor. We examined the C. trachomatis-cervical cancer association by serotype, histology, HPV type in the tumor, and other HPV cofactors. We conducted a population-based study in the Seattle-Puget Sound area of 302 women with invasive squamous cell carcinomas (SCC), 185 women with adenocarcinomas of the cervix (AC), and 318 HPV seropositive control women. The risk of SCC associated with antibodies to C. trachomatis was increased (OR 1.6, 95% CI 1.1-2.2) but not for AC (OR 1.0, 95% CI 0.6-1.5). This association was independent of HPV type in the SCC tumor tissue. There was an association between specific serotypes of C. trachomatis and SCC for 6 of the 10 serotypes: B (OR 3.6, 95% CI 1.5-8.4), D (OR 2.1, 95% CI, 1.2-3.5), E (OR 2.4, 95% CI, 1.4-3.9), G (OR 3.0, 95% CI, 1.1-7.9), I (OR 4.2, 95% CI, 1.5-11.7), and J (OR 2.3, 95% CI, 1.0-5.1), but not for the 4 types (C, F, H, and K) that were present at very low prevalence in this population. There was an increased risk of SCC, but not AC, associated with antibodies to C. trachomatis that was not serotype specific.     

应用组织芯片研究HPV6/11、HPV16/18与子宫颈病变的关系

目的 通过检测低危型HPV6/11及高危型HPV16/18在慢性子宫颈炎、子宫颈尖锐湿疣不伴非典型增生、子宫颈鳞状上皮CIN Ⅰ级、子宫颈鳞状上皮CIN Ⅲ级、子宫颈浸润性鳞状细胞癌五种子宫颈病变中的表达情况,探讨HPV与子宫颈病变的相关性、作用机制及其临床意义.方法 应用组织芯片技术,将150例子宫颈病变患者的标本制成组织芯片,用原位杂交法对其进行6/11型及16/18型HPV的测定,应用SPSS 10.0统计软件进行数据分析.结果 低危型HPV6/11在慢性子宫颈炎、子宫颈尖锐湿疣、子宫颈鳞状上皮CIN Ⅰ级、子宫颈鳞状上皮CIN Ⅲ级、子宫颈浸润性鳞状细胞癌中的阳性表达率分别为:13.33%、90%、33.33%、0、0,其中尖锐湿疣组HPV6/11的阳性表达率显著高于其他各组(均P＜0.001);CIN Ⅰ组与CIN Ⅲ及癌比较差异有统计学意义(P=0.001,＜0.05);运用Spearman相关分析表明,HPV6/11在上述五种病变中的阳性表达率与恶性度呈负相关(rs=-0.370,P＜0.001).高危型HPV16/18在慢性子宫颈炎、尖锐湿疣、CIN Ⅰ级、CIN Ⅲ级、鳞状细胞癌中的阳性表达率分别为0、6.67%、10%、56.67%、76.67%,CIN Ⅲ及鳞癌与其他各组间比较均有统计学意义(P＜0.001),但CIN Ⅲ与鳞癌之间无统计学意义(P=0.10);运用Spearman相关分析表明,HPV16/18在上述五种病变中的阳性表达率与恶性度呈正相关(rs=0.628,P＜0.001).结论 低危型HPV6/11主要引起子宫颈尖锐湿疣及CIN Ⅰ;高危型HPV16/18与CIN Ⅲ及子宫颈浸润性鳞癌关系密切,是引起子宫颈CIN Ⅲ及浸润性癌的主要因素.对HPV在子宫颈病变中检测及分型有助于对子宫颈病变的诊断和监测,尤其是对子宫颈癌的预防、早期诊断及早期治疗具有重要意义.     

北京市社区妇女人乳头瘤病毒感染率及其对HPV和疫苗认知情况的调查分析

[目的]评估北京市社区妇女人乳头瘤病毒（HPV）的感染率;调查社区人群对HPV的认知情况以及对HPV疫苗接种的态度。[方法]采用横断面调查方法,对北京市展览路社区15￣54岁女性进行HPV认知和流行病学问卷调查,并留取了宫颈脱落细胞或会阴部标本进行HPV DNA检测。[结果]1013名女性接受了问卷调查,832例HPV DNA检测结果纳入了统计学分析。HPV总检出率为15.38%,高、低危型HPV感染率分别为13.34%和3.25%,同时感染高、低危型HPV的检出率为1.20%。1013名调查对象中有30.7%听说过HPV,其中51.78%知道HPV感染与宫颈癌有关;HPV的知晓率与年龄和教育程度有关（P〈0.05）;经过简单宣教后,75.91%愿意接种HPV疫苗。[结论]北京市社区妇女HPV现患率较高,对HPV的知晓率也较高。开展公众健康教育,提高人群的认识水平是疫苗计划获得成功的关键因素。