Telomerase-A molecular marker for cervical cancer screening

Abstract. Telomerase-A molecular marker for cervical cancer screening.
Cervical cancer is one of the most common cancers in women and can be routinely screened for by the Papanicolaou smear. Screening for HPV high-risk types 16 and 18 has augmented the sensitivity of this test, but still some cases remain undetected. We have investigated the utility of assaying telomerase activity as a possible screening marker for cervical cancer. Telomerase activity was studied in relation to HPV 16/18 infection, Papanicolaou smear cytopathology, and biopsy histopathology in a total of 88 subjects, consisting of 29 cervical cancer cases, 19 control hysterectomy samples, 16 precancerous cervical scrapes, 6 cervical samples from other gynecological malignancies, and 18 normal healthy cervical scrapings. Telomerase activity was detected in 96.5% of cervical tumor samples and in 68.7% of premalignant cervical scrapings but was not detected in control hysterectomy samples and in cervical scrapings of normal healthy controls. Telomerase assay had a diagnostic accuracy of 95.8 in tissue samples, 79.1 in scrapings and 91.2 in all. Whereas HPV-16/18 subtyping had a diagnostic accuracy of 89.5% in tissue samples, 70.5% in scrapings, and 82.1% in all. There was also 71% agreement between telomerase activity and HPV-16/18 infection. The absence of telomerase activity in cervical scrapes from healthy women indicated the potential of telomerase to serve as a good screening marker for the early diagnosis of cervical cancer. For the first time we have also shown the ability of telomerase to detect micro and probably occult metastasis in gynecological malignancies.     

The prevalence and significance of high-risk human papillomavirus DNA test in southern Malaysia and Singapore

Aim of Study: To investigate the prevalence of high-risk human papillomavirus (HPV) and its associated cytological abnormalities among women attending cervical screening clinics in southern Malaysia and Singapore.
Method: Laboratory results of Hybrid Capture-II (Digene) HPV DNA and liquid-based cytology tests of consecutive women who had screening performed between January 2004 and December 2006 were studied retrospectively.
Results: Of 2364 women studied, the overall prevalence of high-risk HPV DNA detection rate was 25.6%. The prevalence peaked at 49.1% for women between 20 and 24 years old and declined to 23% among women between the age of 30 and 49 years. A small second peak of prevalence rate of 30% was observed among women above the age of 50 years old. 76.1% of the high-risk HPV infection regressed within the study period. An incidence infection rate of 16% was noted among a small group of women who had a second HPV DNA test. A total of 1153 women had both the HPV DNA and the cytology tests. Cytological abnormality (ASCUS or more) was detected in 8.9% in HPV DNA-positive group and in 3.1% in HPV DNA-negative group ( P  < 0.001). The risk ratio for HSIL was 9.8 for HPV-positive women compared to HPV-negative women. The prevalence of cytological abnormalities increased with increasing age of the women.
Conclusion: The epidemiology and clinical impact of high-risk HPV infection for women in Southern Malaysia and Singapore were indistinguishable from experience elsewhere. The apparent moderately high incidence of cervical cancer was explainable by suboptimal screening program.     

Caring for Women With Abnormal Papanicolaou Tests During Pregnancy

The Papanicolaou (Pap) test is one of the best screening tests available for cancer detection and has achieved widespread acceptance among women. Pregnancy provides a valuable opportunity to educate and screen women for cervical cancer when receiving prenatal care. However, evolving knowledge about the course of human papillomavirus infection (HPV) in women, new technologies, and the advent of vaccines are driving radical changes in practice and new ways to consider cervical cancer screening. Modifications in the 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests are most evident among adolescents. Because of high rates of HPV regression, pregnant adolescents with minor Pap abnormalities may now be followed rather than referred for immediate colposcopy. Postponing colposcopy in pregnant, reproductive‐age women with minor Pap changes until after delivery is now acceptable. Pregnant immunocompromised women with abnormal Pap tests are followed similarly to pregnant women in the general population. While a strong evidence base is gradually emerging to support guideline revisions, the highest quality evidence may not yet be available for all recommendations. Midwives can keep abreast of the science while using clinical judgment to provide safe and expert cancer screening care to women.     

Telomerase activity in Papanicolaou smear-negative exfoliated cervical cells and its association with lesions and oncogenic human papillomaviruses

OBJECTIVE: The goal of this study was to evaluate telomerase activity in exfoliated cervical cells and its association with cytology, pathology, and human papillomavirus (HPV). METHODS: Telomerase activity and HPV DNA sequences were examined in the exfoliated cervical cells from a general population of 245 women aged more than 30 years undergoing routine cervical screening by Papanicolaou smear. The women who were found to have telomerase activity or abnormal cytology in their exfoliated cervical cells were examined for cervical lesions by colposcopy and biopsy. RESULTS: Cytology for our population (mean, 56 years) revealed only one abnormal smear (1/245, 0.4%), in which a cervical intraepithelial neoplasia grade I (CIN I) lesion was found. The exfoliated cervical cells used to prepare the smear were negative for telomerase and contained low-risk HPV DNA. Telomerase activity was found in 16 exfoliated cell samples (16/245, 6.5%); high-risk HPV DNA was found in 9 of these samples (9/16, 56%) and 9 of the biopsy specimens that could be evaluated from patients testing positive for telomerase revealed CIN I lesions (9/11, 82%). CONCLUSIONS: Telomerase activity is often associated with high-risk HPV infection and it is suggested that telomerase assay can help to detect occult cervical lesions.     

新一代杂交捕获技术在宫颈癌筛查中的应用

目的:了解新一代杂交捕获技术(DH2)在宫颈癌筛查与传统筛查方式的优势比较,探讨HPV16/18分型检测对DH2初筛阳性患者分流管理的临床意义。方法:2013年、2014年、2015年分别对浙江省慈溪市79847例、81702例、61072例妇女采用巴氏涂片的方法进行宫颈癌筛查,在2015年、2016年分别对浙江省慈溪市35657例、59634例妇女使用DH2检测14种高危型HPV的方法进行宫颈癌筛查。以病理诊断作为金标准,分析高危型HPV检测与巴氏涂片在LSIL以上病变的检出率情况。同时对DH2阳性患者进行HPV16/18检测,对照和比较HPV16/18分流策略的检出情况。结果:2013年、2014年、2015年采用巴氏涂片的方法对LSIL以上病变的检出率分别为0.048%、0.105%、0.134%;2015年、2016年使用DH2检测14种高危型HPV的方法对LSIL以上病变的检出率分别为0.415%、0.550%。2015年采用DH2检测14种高危型HPV初筛模式,LSIL以上病变在DH2阳性及在HPV16/18阳性中的占比分别为4.644%、15.370%;2016年采用DH2检测14种高危型HPV初筛及初筛阳性患者HPV16/18分流的模式,LSIL以上病变在DH2阳性及在HPV16/18阳性中的占比分别为6.365%、22.430%。结论:使用DH2检测14种高危型HPV的方法比传统巴氏涂片对LSIL以上病变的检出率更高,DH2可作为宫颈癌初筛的可行方法;DH2初筛及初筛阳性患者HPV16/18分流管理模式对宫颈癌高危人群进行风险分层管理,重点关注HPV16/18阳性人群,可以进一步提高宫颈癌筛查中的LSIL以上病变检出率。     

Liquid-based Papanicolaou smears without a transformation zone component: should clinicians worry?

OBJECTIVE: To evaluate whether ThinPrep smears without versus those with a transformation zone component were more likely to have falsely negative cytology findings. METHODS: Women aged 18-50 (N = 4389) attended one of three Planned Parenthood clinics between 1997 and 2001 for screening by ThinPrep Papanicolaou and polymerase chain reaction-based human papillomavirus (HPV) DNA testing. Women with 1) any cytologic abnormality, 2) high-risk HPV types, and 3) a random sample with normal Papanicolaou and negative HPV tests were offered repeat cytology, colposcopy, and biopsy. Cytology and biopsy diagnoses at the colposcopy visit were reviewed according to the presence (n = 3689) or absence (n = 700) of a transformation zone component at screening. RESULTS: Among women with normal cytology at screening, histologic detection of at least cervical intraepithelial neoplasia grade 2 (odds ratio 1.3, 95% confidence interval 0.5, 3.3) at colposcopy did not differ significantly between transformation zone-positive and zone-negative smears. Histologically confirmed cervical intraepithelial neoplasia grade 1 was detected more often among smears lacking a transformation zone component (odds ratio 2.0, confidence interval 1.0, 3.8). Transformation zone-negative smears were more common among older women, current oral contraceptive users, those past the 14th day of their last menstrual period, and those negative for high-risk HPV types. CONCLUSION: Absence of a transformation zone component in a screening ThinPrep Papanicolaou test was not associated with missed high-grade lesions. Based upon our data, we do not recommend repeat screening of reproductive-aged women with negative liquid-based tests and no cytologic evidence of a transformation zone component.     

Shanxi Province Cervical Cancer Screening Study: a cross-sectional comparative trial of multiple techniques to detect cervical neoplasia

OBJECTIVE: The aim of this study was to design a cervical cancer screening algorithm for the developing world that is highly sensitive for cervical intraepithelial neoplasia (CIN) II, III, and cancer and highly specific for CIN II and III, making it possible to ablate the transformation zone without histologic confirmation. METHODS: In rural Shanxi Province, China, we examined 1997 women ages 35-45. Each subject underwent a self-test for intermediate and high-risk HPV (by HC-II assay), fluorescence spectroscopy, a liquid-based Pap (read manually and by computer and used as a direct test for HPV), a visual inspection (VIA) diagnosis, and colposcopy with multiple cervical biopsies. RESULTS: Mean age was 39.1 +/- 3.16 years, mean number of births was 2.6 +/- 0.93. Based on tests administered, 4.3% subjects had > or =CIN II. All subjects with > or =CIN II had either a ThinPrep Pap (> or =ASCUS) or a positive HPV direct test. The sensitivity and specificity for the detection of > or =CIN II were, respectively, 83 and 86% for the HPV self-test, 95 and 85% for the HPV direct test, 94 and 78% for the ThinPrep Pap (> or =ASCUS), 77 and 98% for the ThinPrep Pap (> or =HGSIL), 94 and 9% for fluorescence spectroscopy, 71 and 74% for VIA, and 81 and 77% for colposcopy. CONCLUSION: Based on these data and the existing healthcare infrastructure in China, we believe that further refinement of primary HPV screening using centralized labs is indicated. Self-testing in the local villages may be effective with improvements in the devices and techniques.     

Human papillomavirus

Human papillomaviruses are ancient small DNA viruses and represent the most common sexually transmitted infection in the world. In the majority, HPV infection is cleared by an incompletely understood immune response. HPV is a necessary but not sufficient cause of cervical cancer, and responsible for a proportion of other anogenital cancers including vulval, vaginal, anal and oropharyngeal. Oncogenesis is likely mediated through viral proteins which hijack host-cell machinery in epithelial keratinocytes and disrupt host tumour-suppressor proteins. Much work has been undertaken to further characterise the natural history of HPV infection and cervical disease. Such efforts have been translated to important public health interventions like the introduction of HPV tests in cervical screening. HPV vaccination programmes are expected to further reduce the incidence of high-risk HPV infections and resultantly HPV-related disease.     

Increased frequency of genital human papillomavirus infection in human immunodeficiency virus-seropositive Taiwanese women.

BACKGROUND AND PURPOSE: Human papillomavirus (HPV) infection is associated with increased incidence and severity of HPV-related cervical dysplasia and cervical cancer in women with human immunodeficiency virus (HIV) infection. This study examined the incidence of genital HPV infection in HIV-infected Taiwanese women and its relationship with cervical neoplasia. METHODS: This hospital-based, case-control study enrolled 31 consecutive HIV-seropositive women and 124 age-matched women who were free from HIV infection. Polymerase chain reaction (PCR) was used to distinguish high-risk (types 16, 18, 31, 33, 52 and 58) and low-risk HPV (types 6 and 11). The occurrence of genital HPV infection was compared between women with and without HIV infection. In addition, CD4 lymphocyte counts were determined by flow cytometry and Papanicolaou test was done in women with HIV infection. RESULTS: HPV and Papanicolaou test were done soon after the diagnosis of HIV infection. HIV seropositive women had a significantly greater high-risk HPV infection rate (48.4%; 15/31) than women without HIV infection (20.2%; 25/124; odds ratio, 3.71; p = 0.001). However, the prevalence of cervical intraepithelial neoplasia was similar between women with and without HIV infection. The CD4 lymphocyte counts in HIV-seropositive women were similar between those with and without genital HPV infection. CONCLUSIONS: The risk of genital HPV infection was significantly increased in HIV-infected women. Due to the association between high-risk HPV infection and the development of cervical dysplasia and cervical cancer, regular follow-up of Papanicolaou test is necessary in these women.     

Human papillomavirus detection in self-collected vaginal specimens and matched clinician-collected cervical specimens

Human papillomavirus (HPV) detection is an integral part of cervical cancer screening, and a range of specimen collection procedures are being tested. Preliminary studies have found that the majority of women prefer self-collection of vaginal specimens instead of clinician-collected specimens of the cervix. The purposes of the current study were to explore the social and behavioral predictors of acceptance of self-collection of vaginal specimens among patients and to assess concordance in detection of HPV between clinician-collected cervical specimens and self-collected vaginal specimens. The study was conducted at a university family medicine clinic using a cross-sectional study design, and enrollment of women presenting for routine gynecological examination consecutively in a period of 1 year, self-administered questionnaires, collection of paired vaginal and cervical specimens for HPV DNA using Hybrid Capture 2, and cytologic analysis. Most women (79.8% [398/499]) agreed to collect vaginal specimens. In our study, 76.6% (216/282) African American women (AA), 88.1% (156/176) white non-Hispanic (WNH) women, and 63.4% (26/41) women of other races (P < 0.0001) agreed to self-collect vaginal specimens. HPV was detected in 16.0% (80/499) of clinician-collected cervical specimens and 26.1% (104/398) of self-collected vaginal specimens (P < 0.001). HPV detection was concordant in 13.4% (53/398) women in both cervical and vaginal specimens. Self-collection of vaginal specimens for HPV DNA detection is acceptable to most women presenting for routine gynecological examination. WNH women were more likely to obtain self-collected specimens than AA women. Vaginal specimens were more likely to be positive for HPV than were cervical specimens.     

Visual inspection with acetic acid as a feasible screening test for cervical neoplasia in Iran

The aim of this study was to estimate the sensitivity and specificity of visual inspection of the uterine cervix with acetic acid (VIA) as a screening test for cervical carcinoma and its precursors. One thousand and two hundred eligible women were screened by VIA and Papanicolaou smear. Those positive on one or both of these screening tests (n = 308) or those who had clinically suspicious lesions, even if the tests were negative [25% of remainders (n = 290)], were referred for colposcopy. Three hundred and fifty five of 598 women at colposcopy underwent biopsies or endocervical curettage. Those with cervical intraepithelial neoplasia I (CIN I) or worse lesions, diagnosed by histology, were considered true positive. VIA was positive in 191 women (16.1%). In 175 true-positive cases, VIA detected 130 cases, yielding a sensitivity of 74.3% and a specificity of 94%. By considering atypical squamous cell of undetermined significance or worse lesions on Papanicolaou smear as referring threshold for colposcopy, the sensitivity and specificity of cytology were 72 and 90.2%, respectively. In conclusion, the sensitivity and specificity of VIA is high and comparable with that of cytology. Hence, VIA can be undertaken as a feasible method of screening in cervical cancer in countries where access to cytopathology is limited.     

Attitudes to self-sampling of vaginal smear for human papilloma virus analysis among women not attending organized cytological screening

BACKGROUND: The major problem with the cytological screening is the non-optimal participation rate among women invited for cervical smear collection. The aim of the present investigation was to examine the attitudes of the non-responding women to perform self-sampling of vaginal smear at home as a method to increase the coverage of the screening and to examine the prevalence of high-risk human papilloma virus (HPV) among the responding women. METHODS: From the database of the Department of Cytology, University Hospital of Uppsala 198 women, aged 35-55 years, who had not attended the organized gynaecological screening for over 6 years were identified. They were sent a letter of information about the study and one week later a self-sampling device aimed to collect vaginal smear. The vaginal smear of the women responding to the offer of self-sampling was analysed for high-risk HPV using Hybrid Capture 2 method or polymerase chain reaction amplification of HPV DNA. All women in the study also received a questionnaire in order to investigate their attitudes towards self-sampling as an alternative in the organized screening. RESULTS: Of the 198 women 15 women had to be excluded. Fifty-eight per cent of the women responded and collected vaginal smear at home and among them 7% were positive for high-risk HPV. The questionnaire revealed no significant difference of age, country of birth and occupation or marital status, on using self-sampling of vaginal smear at home. The attitudes among responding and non-responding women differed. The responding women who contributed by sampling vaginal smear were more positive to self-sampling of vaginal smear (p<0.01). CONCLUSIONS: Offering self-sampling of vaginal smear in women not attending the organized cytological screening increases the coverage and identifies an additional group of women with an increased risk to develop cervical cancer. The attitude towards self-sampling was mainly positive.     

Is human papillomavirus testing an effective triage method for detection of high-grade (grade 2 or 3) cervical intraepithelial neoplasia?

OBJECTIVE: Our purpose was to assess the usefulness of the polymerase chain reaction assay for detection of human papillomavirus infection for prognostic value in the triage strategies for high-grade (grade 2 or 3) cervical intraepithelial neoplasia in women referred for colposcopy after abnormal Papanicolaou smears. STUDY DESIGN: A total of 1007 women referred to a colposcopic clinic providing care for an indigent population were studied. Four hundred fifty-four women were referred after two Papanicolaou smears reported as atypical squamous cells of undetermined significance or low grade-squamous cervical intraepithelial lesion, and 553 were referred after a single smear reported as high-grade squamous intraepithelial lesion. All women had a cervical smear, colposcopy-directed biopsy, and endocervical curettage performed. A sample for human papillomavirus deoxyribonucleic acid detection by polymerase chain reaction was obtained. RESULTS: High-risk human papillomavirus types were detected in 463 (46%) of 1007 women studied. There was a significant increase of the frequency of high-risk human papillomavirus by the increasing severity of biopsy findings ranging from 32.7% in women without cervical intraepithelial neoplasia on biopsy to 60% in women having grade 2 or 3 on the biopsy specimen. Women having a negative Papanicolaou smear found to have high-risk human papillomavirus deoxyribonucleic acid at the time of colposcopy had a significantly higher rate of grade 2 or 3 cervical intraepithelial neoplasia on the biopsy specimen than did women without high-risk human papillomavirus. There was no such difference observed in women with a cytologic finding of low- or high-grade squamous intraepithelial lesions at the time of colposcopy. The polymerase chain reaction assay appears to be more sensitive than the commercial human papillomavirus profile test. The positive predictive value for grade 2 or 3 cervical intraepithelial neoplasia of both tests was similar (21.7% and 22.8%, respectively). CONCLUSION: The human papillomavirus is associated with high-grade cervical intraepithelial neoplasia, but the screening for human papillomavirus deoxyribonucleic acid does not have prognostic value in women reported as having atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions on two precolposcopy Papanicolaou smears. (Am J Obstet Gynecol 1998;178:1235-44.)     

Amerindian women of the Brazilian Amazon and STD

Papanicolaou tests, PCR for HPV, C. trachomatis, HSV-1/2 and N. gonorrhoea, and Hybrid Capture II were performed for high- and low-risk HPV groups during screening for cervical cancer in 49 women of the Parakana tribe. Cytological diagnoses of HPV were suggested in three samples: PCR showed 12 (22.4%) cases of DNA positive HPV, 16 (1), 18 (2), 58 (3), 39 (1), 61 (1), 33 (1), 35 (1), unknown (2), and HCII analyzed 48 samples: 19 positive (39.58%) for the high-risk group and four (18.33%) for the low-risk group. The prevalence of HPV was 42.85% (p = 0.001) by molecular biology methods. The largest viral load was 1588.11 pg/ml for HPV 39 in a 16-year-old. PCR was positive for C. trachomatis and negative for HSV-1/2 and N. gonorrhoea. Parakana women present a high risk for the development of cervical cancer.     

Infecciones vaginales y lesiones celulares cervicales(I). Programa de cribado de otras infecciones y ETS simultáneas

Objective

To evaluate a screening program for simultaneous detection of sexually-transmitted diseases and other infections in women with vaginal infections and cervical cell abnormalities diagnosed by cervicovaginal cytology.

Material and methods

There were 399 women with vaginal infections due to the following: Candida (95 cases), bacterial vaginosis (234 cases), Gardnerella vaginalis (14 cases), Candida plus bacterial vaginosis (9 cases), Trichomonas vaginalis (9 cases), bacterial vaginosis plus Trichomonas (1 case), human papillomavirus (HPV) (16 cases), and a history of HPV infection (21 cases). Thirty-two women had cervical cell abnormalities: atypical squamous cells of undetermined significance (ASCUS) (7 cases), atypical glandular cells of undetermined significance (AGUS) (1 case), low-grade squamous intraepithelial lesion (LSIL) (22 cases) and high-grade squamous intraepithelial lesion (HSIL) (2 cases). Analysis included erythrocyte sedimentation rate (ESR), C reactive protein (CRP), leukocyte count and lymphocyte count; HBsAg serology, hepatitis C virus (HCV) antibodies, HIV antibodies, herpes simplex virus (HSV)-2 antibodies, rapid plasma reagin (RPR), and DNA-HPV probe (Digene HPV) for high-risk (HR) and low-risk (LR) HPV.

Results

A total of 131 women (30.39%) were foreigners. The most frequent infections were bacterial vaginosis, with 234 cases (58.64%), and Candida infections with 95 cases (23.80%). HPV, a history of HPV and cervical abnormalities affected the younger women; among this group, there were fewer pregnancies and deliveries and a greater number of nulligravidas. Bacterial vaginosis and Candida infections affected the older women. Candida plus bacterial vaginosis showed lower CRP concentrations, and higher leukocyte count, indicating a greater response to mixed infection. With Trichomonas, lymphocyte levels were low, indicating immunodepression. The data on HPV types were as follows: the highest values were found in HPV (HR in 68.75% and LR in 62.5%), and in those with antecedents of HPV [HR in 52.38% and LR in 23.80%]. In LSIL, 72.72% were HR and 31.81% were LR. The two cases of HSIL were HR. Serology detected 33 cases of HSV-2 (7.65%), 3 cases of HBsAg (0.69%), 4 cases of HCV (0.92%), and 1 case of HIV and syphilis each (0.23%).

Conclusions

Screening for STD and other infections is recommended in the general population, especially in groups at high risk and showing a high prevalence of these infections, such as younger persons, in whom we identified previously undetected HPV. We recommend vaccination in cases with negative results on DNA-HPV probe, independently of age. Serology also identified known, as well as previously unknown, infections with HIV, syphilis, and hepatitis B and C viruses, demonstrating the value of screening, and allowing these infections to be treated and followed-up.In summary, we recommended screening programs for STD and other infections in women with a diagnosis of vaginal infection or cervical abnormalities in Papanicolaou cytology.     

Acceptability and Preferences of Dry HR HPV Self-Sampling Mailed Kits Among Canadian Women: A Cross-Sectional Study

Human papillomavirus (HPV), a sexually transmitted disease, is identified as the source of 99.7% of cervical cancers. Screening for cervical cancer using oncogenic HPV (high-risk [HR] HPV) detection is more sensitive than traditional cytology. However, few Canadian data exist on HR HPV self-sampling.ObjectiveTo evaluate the acceptability of HR HPV self-sampling by patients, the percentage of correctly collected samples, the return rate of mailed kits, and the HPV positivity rate in a population sample based on different cervical cancer risk factors.MethodsWe conducted an observational cross-sectional study on HPV primary cervical cancer screening with self-collected cervicovaginal samples through mail service.ResultsA total of 400 kits were mailed and 310 kits were returned, making a return rate of 77.5%. Of these, 84.2% of patients were very satisfied with this method and 95.8% (297/310) of patients would choose self-sampling over cytology as their primary screening method. All patients would recommend this screening method to their friends or family members. Of the samples, 93.8% could be analyzed correctly and the HPV positivity rate was 11.7%.ConclusionIn this large and random sample, there was a strong interest in self-testing. Offering HR HPV self-sampling could increase access to cervical cancer screening. The self-screening method could also be a part of the solution to reaching under-screened populations, in particular, those who do not have a family doctor or avoid gynaecologic exams because of pain or anxiety.     

Association between HLA-DQB1 and cervical dysplasia in Vietnamese women

Host genetic background seems to play a key role in cervical carcinogenesis as only a small subset of women infected with high-risk human papillomaviruses (HPVs) develop cervical cancer. The rate of cervical cancer in Vietnamese women is notably high. To explore the association of human leukocyte antigen (HLA)-DQB1 alleles, HPV infection, and cervical dysplasia in this population, cervical smears were obtained from 101 women attending the obstetrics and gynecology clinic of Da Nang General Hospital in Vietnam. Besides the Papanicolaou test, HPV and HLA-DQB1 genotyping were performed using cervical smear DNA. Additionally, a subset of 30 blood samples was used as the gold standard for HLA genotyping. HLA-DQB1 alleles showed no association with HPV infection status. However, a positive association with cervical dysplasia was found for HLA-DQB1*0302 (P= 0.0229, relative risk (RR) = 4.737) and HLA-DQB1*0601 (P= 0.0370, RR = 4.038), whereas HLA-DQB1*0301 (P= 0.0152, RR = 0.221) was found negatively associated. The low diversity of HLA-DQB1 alleles, wide spectrum of HPV genotypes, and high prevalence of HPV 16 and HPV 18 observed in the study population suggest a permissive/susceptible genetic background that deserves further research. Total concordance of HLA-DQB1 genotyping results between blood and cervical cells confirms the potential value of cervical smears as an effective tool for the development of cervical cancer biomarkers.     

Genital Human Papillomavirus Infection in Women

OBJECTIVE: To enhance nurse clinicians' knowledge of genital human papillomavirus infection in women. DATA SOURCES: Several literature searches using the following terms, dating back to 1986: human papillomavirus (HPV), females, human, cervical neoplasia, risk factors, condylomata acuminata, detection, epidemiology, pathology, psychology, Papanicolaou test, immunosuppression, HIV infection, and AIDS. STUDY SELECTIONS: Forty-three formal research studies regarding the association of various types of HPV infection with cervical intraepithelial lesions, the putative precursor lesions for cervical neoplasia; the outcomes of diagnostic techniques for HPV types; the outcomes of diagnostic/screening techniques for abnormal cervical cells; the association of risk factors for acquiring HPV infection; or the outcomes of therapy. Some additional references were chosen for their presentation of epidemiologic or surveillance data, others for their scientific discussions on related topics. DATA EXTRACTION: Data were abstracted according to summary measures of the parameter of interest in the sample studied. In most instances, it was the prevalence of HPV, cervical neoplasia, or frequency of use of screening tests. DATA SYNTHESIS: Immunosuppressed clients are at particular risk for HPV-mediated cervical neoplasia. CONCLUSION: Because Papanicolaou tests are an effective screening tool, cervical cancer is easily detectable. The nurse may facilitate treatment. This is an especially important issue for young women, among whom sexual activity is growing--with attendant increases of HPV and HIV infection.     

21～24岁年轻女性子宫颈癌筛查建议及子宫颈病变的处理

21～24岁年轻女性子宫颈癌及癌前病变发生率较低,且该年龄段子宫颈病变逆转可能性大,因此对21～24岁年轻女性初级筛查建议采用单独子宫颈脱落细胞学检测;对于子宫颈细胞学筛查结果异常推荐随访为主;异常组织病理学趋于保守处理,根据病变级别和细胞学筛查结果实施分层管理,并采取子宫颈脱落细胞学、高危型HPV检测以及阴道镜检查随访。     

A Study of Cervical Intraepithelial Neoplasia in Pregnancy

Objective

To find the incidence of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in pregnant women and compare Pap smear with the HPV DNA test in detecting HPV infection.

Materials and Methods

Hundred antenatal women, irrespective of gestational age, were enrolled as subjects in this prospective pilot study for blood investigations, wet mount examination of cervical discharge, Pap smear, and high-risk HPV DNA detection of cervical scrape by PCR. Women showing abnormality in Pap smear and/or those who were high-risk HPV DNA positive were subjected to colposcopy.

Results

The incidence of HPV-positive pregnant women was 18 %. Koilocytosis on Pap smear was observed in six women. Three high-risk HPV DNA-positive women showed changes consistent with CIN 1 on colposcopy.

Conclusions

The HPV DNA test is the most sensitive and reliable in detecting HPV infection as compared to Pap smear, but considering the cost of PCR, Pap smear screening of all antenatal women was recommended.