新疆维吾尔族妇女宫颈癌组织中HPV16型E6基因突变分析

背景与目的：高危型人乳头状瘤病毒16和18(human papillomavirus type16 and 18,HPV16,HPV18)是宫颈癌主要病因之一,尤其以HPV16最为常见,其中HPV16E6是主要癌基因之一。在一些地区,特定的E6基因突变株是宫颈癌发生的危险因素。新疆南部维吾尔族聚居区足宫颈癌高发区,我们已在前期的研究中发现该地区HPV16E6基因发生突变。本研究旨在检测该突变在新疆南部维吾尔族妇女宫颈癌组织中的分布规律,并探讨其与该地区宫颈癌高发的关系。方法：从35例中国新疆南部维吾尔族妇女宫颈癌活检标本中提取组织DNA作为模板,PCR扩增HPV16E6全长基因,PCR产物直接测序或克隆后测序,分析新疆维吾尔族妇女宫颈癌组织中HPV16E6基因的突变。结果：PCR检测结果表明宫颈癌组织中HPV16E6阳性率为82．86％(29／35);26例中E6分离片段的测序和序列分析表明,15例(57．69％)分离株E6基因与原型相同,另有11例(42．31％)E6基因突变,其中9例(34．62％)分离株发生了L83V突变,2例(7．69％)分离株发生rL83V／D63E突变。结论：中国新疆南部地区HPV16E6基囚发生变异,其原型和变异型在该地区维吾尔族宫颈癌患者巾的分布规律可能与该地区宫颈癌高发存在一定关系。     

宫颈癌病因学研究进展

目前大量的研究已经证明,人乳头状瘤病毒(human papillomavirus,HPV)感染是宫颈癌发生的主要病因.本文主要介绍有关宫颈癌病因学研究的流行病学证据,以及病因学的研究进展对宫颈癌防治工作的重要指导意义.     

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。     

亚洲妇女宫颈癌中人乳头状瘤病毒型别分布的Meta分析

通过对84篇文献11429例宫颈癌中人乳头状瘤病毒（HPV）感染情况的Meta分析,了解亚洲女性中HPV的感染型别分布特点,为制定有效的地区性HPV的感染控制以及宫颈癌的预防策略提供科学依据。     

新疆维吾尔族妇女宫颈癌高危型HPV病毒载量与分型相关性研究

[目的]探讨新疆维吾尔族妇女宫颈癌中高危型人乳头状瘤病毒(HR-HPV)的载量与HPV分型之间的相关性。[方法]收集2009年1月～2010年6月就诊的诊断为宫颈鳞状细胞癌的新疆维吾尔族妇女共80例。采集其宫颈脱落细胞分别用第二代杂交捕获试验(HC-Ⅱ)进行HR-HPV病毒载量检测及反向膜杂交技术进行HPV分型。将HPV病毒载量分为:～1,1～500,500～1000,1000～。将反向膜杂交检测结果分为:单纯HPV16感染,HPV16合并高危型感染,HPV16合并低危型感染,非HPV16感染。[结果]两种检测方法对HPV-DNA检出率分别为94%及96%。使用Kruskal-Wallis检验对不同HPV型别感染组的HR-HPV病毒载量进行比较,P<0.001,认为HPV16合并其他不同型别HPV感染组的HR-HPV病毒载量有差异,Spearman秩相关分析,r=0.748,P<0.05,HPV16合并不同型别感染与HR-HPV病毒载量有直线相关关系。[结论]HPV的混合感染尤其是高危型的混合性感染可能对病毒负荷量有着一定的影响。     

新疆维吾尔族妇女宫颈癌组织HPV16型E6基因变异分析

目的:新疆维吾尔族妇女宫颈癌的发生主要与人乳头状瘤病毒16(HPV16)感染相关,特定的HPV16 E6突变株具有更高的致癌危险性.本研究通过检测维吾尔族妇女宫颈癌组织中HPV16 E6基因突变情况,探讨其与维吾尔族妇女宫颈癌高发的关系.方法:从140例维吾尔族妇女宫颈癌石蜡包埋组织中提取DNA作为模板,PCR 扩增HPV16 E6 全长基因,PCR 产物直接测序,进行突变分析.结果:本组维吾尔族妇女宫颈癌组织中HPV16的阳性率是73.6%(103/140),91例E6基因测序及分析结果表明,维吾尔族妇女宫颈癌组织中存在HPV16 E6变异株,其中49例(53.8%)分离株发生L83V突变,4例(4.39%)发生D25E突变,2例(2.20%)发生D64E/L83V突变,36例(39.6%)与野生型相同.结论:新疆维吾尔族妇女宫颈癌患者HPV16 E6基因发生变异,主要以L83V突变为主,HPV16变异株在维吾尔族妇女宫颈癌患者中的分布可能与维吾尔族妇女宫颈癌高发存在一定关系.     

宫颈癌高发区新疆维吾尔族妇女宫颈癌组织中HPV DNA的测定

目的 研究我国宫颈癌高发区新疆维吾尔自治区维族妇女宫颈癌发病与人类乳头状瘤病毒（HPV）的关系。方法 对75例新疆维吾尔族宫颈癌患者癌组织及20例正常宫颈组织,采用PCR（聚合酶链反应）技术检测HPV－C（总的HPV）、HPV16、HPV18及HPV6／11。结果 HPV－C、HPV16、HPV18及HPV6／11在宫颈癌患者及正常宫颈组织中的检出率分别为86．7％、72．0％、12．0％、0及20．0％、10．0％、0、10．0％。HPV16在HPV阳性患者中所占的比例为83．1％,宫颈癌患者中HPV－C、HPV16检出率明显高于正常对照组,鳞癌HPV16阳性率明显高于腺癌,而腺癌HPV18检出率明显高于鳞癌（P＜0．05）。HPV总感染率及HPV16阳性率,在不同临床分期及不同病理分级宫颈癌组织间无显著性差异。结论 HPV感染与我国宫颈癌高发区新疆维吾尔族妇女宫颈癌发病有密切相关,其中HPV16感染在其发病中起主要作用,但HPV感染对宫颈癌的进展影响不大。     

广西宫颈癌患者HPV感染情况的分子流行病学调查

  目的  调查人乳头瘤状病毒（Human papillomavirus,HPV）各亚型在广西壮族自治区宫颈癌患者中的分布情况,为宫颈癌疫苗的研制提供理论依据。  方法  应用凯普HPV核酸扩增分型检测试剂盒对515例广西宫颈癌患者的宫颈组织DNA进行21种HPV亚型的检测;并应用实时荧光定量PCR对HPV16、18和58型阳性样本各50、48和41例的病毒负载量进行了绝对定量检测。  结果  1）检测的515例样本中473例HPV阳性,HPV总阳性率为91.84%。HPV16的阳性率最高,为81.40%;其次为HPV18（10.15%）;第三位是HPV58（8.67%）。排在前五位的HPV亚型依次为HPV 16、18、58、52及31。2）检测样本中HPV16、18和58型的病毒负载量几何均数分别为2.398 5、0.017 3、0.038 1。HPV16分别与HPV18和58型的病毒负载量比较,有显著性差异（P < 0.05）;HPV18与58型的病毒负载量比较,无显著性差异（P>0.05）。  结论  广西宫颈癌患者中有较高的HPV阳性率,其中HPV16型排在首位,HPV18和58虽然分列第二、三位,但阳性率明显低于HPV16。HPV16的病毒负载量远远高于HPV18和58,说明HPV16的高病毒负载量与其高阳性率可能存在一定关系。      

城市地区女性和医护人员对HPV及疫苗的认知调查

[目的]探讨中国城市地区女性和医护人员对HPV及疫苗的认知状况和接种意愿。[方法]采用Logisitic回归方法分析以医院为基础的机会性筛查的女性以及医护人员对HPV及疫苗的认知情况及影响接种意愿的因素。[结果]筛查女性中32.85%听说过HPV但72.31%愿意自己接种HPV疫苗,72.59%愿意让其女儿接种疫苗;而医护人员中89.62%知道HPV感染是宫颈癌的必要因素,且69.22%了解宫颈癌是可以通过疫苗预防,69.77%愿意自己接种疫苗,68.74%愿意让其女儿接种疫苗。高学历(OR=3.67～9.70)、高收入(OR=2.15～6.68)、初次性生活年龄较大(OR=1.14～1.50)、初次怀孕年龄较大(OR=1.36～1.98)、怀孕次数较少(OR=1.21～1.34)、生产次数较少(OR=1.77～2.66)的女性对HPV疫苗的接受程度较高,且均存在剂量反应关系(P<0.05);家人患有肿瘤(OR=1.41,95%CI:1.20～1.65)、听说过HPV(OR=2.68,95%CI:2.33～3.07)者更愿意接种疫苗。不愿意接种疫苗的主要原因是认为HPV疫苗还没有大面积推广(筛查女性占43.55%,医护人员占39.84%)且不认为自己有这方面的危险(筛查女性占26.21%,医护人员占38.28%);而对于疫苗的付费途径,希望国家负担全部费用的筛查女性占41.46%,医护人员占35.76%,希望国家负担部分费用的筛查女性占14.33%,医护人员占43.31%。[结论]筛查女性对HPV及疫苗认知低,但大多数女性均愿意接种疫苗,而高学历、高收入、家族有肿瘤史、听说过HPV者更愿意接种疫苗。因此,关于HPV及疫苗知识的宣传教育,应根据不同的社会文化背景来制定,尤其是针对医护人员,需要更多有关疫苗安全性和有效性的证据来提高接种意愿,达到疫苗防治宫颈癌的目的。     

Acceptability of Self-Sampling HPV Testing Among Thai Women for Cervical Cancer Screening

Background: Acceptability of self-sampling HPV testing is confirmed worldwide. However, some cultural differences may affect this question. Therefore, this study was conducted to evaluate the acceptability of selfsampling HPV testing in Thai women. Materials and Methods: One hundred women aged 30-65 years with anintact cervix were included in this study. The participants were asked to do the Pap test by physicians and then brush type self-sampling instruments were assigned for self-collection and finally completed a questionnaire for acceptability evaluation. The questionnaire contains 2 parts. Part one covered general information of the participants and part two is the acceptability questions. Results: Mean age was 40.6 years. The incidence of high risk HPV detection in this study was 16%. The most common reason for doing Pap smear was for annualcheckup. On the topic of ease of use, 85 % of the subjects agreed. Most of the participants (82%) reported that they felt less pain. However, reliability of the result was not satisfactory because 37% of the participants hesitated to rely on the results of the test. According to the price, if the price is less than 1,000 Baht (32.59 Baht = 1USD), 82% of the subjects would use it for their next screening. Conclusions: The acceptability of self-sampling device in this study is quite good but the reliability of the test was questioned by some of the participants. Moreover, the price of the test in Thailand may also influence the acceptability of the test.     

Awareness of Cervical Cancer and Pap Smear Testing Among Omani Women

Background: In developed countries, awareness of cervical cancer screening is well documented. In contrast, in Oman as a developing country, public responses regarding cervical screening are unclear. This study aimed to assess the level of awareness about cervical cancer and Papanicolau (Pap) smear testing and to establish any correlations between knowledge and demographic factors among Omani women. Methods: In this cross-sectional survey, participants were divided into three groups: patients who attended the Outpatient Gynecology Department in Sultan Qaboos University Hospital (SQUH), Oman, female staff from SQUH, College of Medicine and College of Nursing at Sultan Qaboos University (SQU) and graduating female students at SQU. Data collection was through interview-based and online self-administered questionnaires. Cumulative scoring was used for data analysis. Results: There were 204 outpatients, 133 staff and 157 students. Outpatients (79.4%), staff (97.7%) and students (75.2%) had heard of cervical cancer. Nevertheless, their specific knowledge, regarding signs and symptoms, risk factors and Pap smear, was low at 38.7%, 35.3% and 7.6% among outpatients, staff and students, respectively. Some 39.9% of the married outpatients had adequate overall knowledge as compared to none of the single women. Educational level was found to be significantly associated with outpatient knowledge with the highest awareness levels among postgraduates and medical university graduates (61.5%). Conclusion: Specific knowledge of cervical cancer, its risk factors and cervical Pap smear is generally poor among Omani women. This lack of knowledge may be one of the contributing factors for the high incidence of cervical cancer in Oman relative to that in developed countries.     

Development of In-House Multiplex Real Time PCR for Human Papillomavirus Genotyping in Iranian Women with Cervical Cancer and Cervical Intraepithelial Neoplasia

Background: HPV related cervical cancer as one of the most common women cancers in developing countries. Regarding accessibility of commercial vaccines, any long or short term modality for integrating preventive immunization against HPV in a national program needs comprehensive information about HPV prevalence and its genotypes. The important role of selecting most accurate diagnostic technologies for obtaining relevant data is underlined by different assays proposed in the literature. The main objective of the present study wasto introduce an in-house HPV typing assay using multiplex real time PCR with reliable results and affordable cost for molecular epidemiology surveys and diagnosis. Materials and Methods: 112 samples of formalin fixed paraffin embedded tissues and liquid based cytology specimens from patients with known different grades of cervical dysplasia and invasive cancer, were examined by this method and the result were verified by WHO HPV LabNet proficiency program in 2013. Results: HPV was detected in 105 (93.7%) out of 112 samples. The dominant types were HPV 18 (61.6%) and HPV 16 (42.9%). Among the mixed genotypes, HPV 16 and 18 in combination were seen in 12.4% of specimens. Conclusions: According to acceptable performance, easy access to primers, probes and other consumables, affordable cost per test, this method can be used as a diagnostic assay in molecular laboratories and for further planning of cervical carcinoma prevention programs.     

新疆维吾尔族妇女宫颈癌筛查方法横断面比较研究

[目的]探讨适合新疆维吾尔族妇女宫颈癌的筛查方法。[方法]于2006～2007年采用整群抽样方法,选择新疆维吾尔族妇女883名,采用自我采样HPV检测,液基细胞学检查,医生采样HPV检测,肉眼筛查(VIA)进行宫颈癌筛查。分析和比较不同筛查方法的灵敏度、特异度、阳性预测值、阴性预测值。[结果]医师采样HPV检测的灵敏度和特异度均为最高(P<0.01),自我采样的灵敏度与细胞学检查相似(P>0.05),但自我采样HPV检测的特异度高于细胞学检查(P<0.01),与医生采样HPV检测相似(P>0.05)。肉眼筛查的灵敏度和特异度为最低。[结论]新疆维吾尔族妇女的宫颈癌筛查方案应首选医生采样HPV检测,自我采样HPV检测是比较适合于新疆民族地区妇女的方案,在偏远和缺少设备的地区,肉眼筛查也是一种可行的筛查方法。     

Knowledge and Barriers Towards Cervical Cancer Screening Among Young Women in Malaysia

Objectives: This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. Methodology: A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty’s registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13. Results: The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents was having more than one sex partner (77.5%), whereas the lowest was the relationship between HPV and cervical cancer (51.2%). Age, marital status, ethnicity, monthly family income and faculty were significantly associated with knowledge of cervical cancer screening (p=0.003; p=0.001; p=0.002; p=0.002; p=0.001 & p=0.002; respectively). The most common barriers of cervical cancer screening were the Pap smear test will make them worry (95.8%) whereas the least common barrier reported among participants was no encouragement from the partner (8.8%). Conclusion: Some misconceptions and barriers in uptaking Pap smear test are still serious problems among young women. Although knowledge about cervical cancer screening is adequate they have a very poor practice of Pap smear test. The introduction of reproductive health subjects is warranted for all university students.     

Knowledge and Awareness of Human Papillomavirus (HPV), Cervical Cancer and HPV Vaccine among Women in Two Distinct Nepali Communities

Background: This study assessed human papillomavirus (HPV), cervical cancer, and HPV vaccine knowledgeand awareness among women in two sub-populations in Nepal - Khokana, a traditional Newari village in theLalitpur District about eight kilometers south of Kathmandu, and Sanphebagar, a village development committeewithin Achham District in rural Far-Western Nepal. Methods: Study participants were recruited during healthcamps conducted by Nepal Fertility Care Center, a Nepali non-governmental organization. Experienced staffadministered a Nepali language survey instrument that included questions on socio-demographics, reproductivehealth and knowledge on HPV, cervical cancer, and the HPV vaccine. Results: Of the 749 participants, 387 (51.7%)were from Khokana and 362 (48.3%) were from Sanphebagar. Overall, 53.3% (n=372) of women were awareof cervical cancer with a significant difference between Khokana and Sanphebagar (63.3% vs 43.0%; p=0.001).Overall, 15.4% (n=107) of women had heard of HPV and 32% (n=34) of these women reported having heard ofthe HPV vaccine. If freely available, 77.5% of the women reported willingness to have their children vaccinatedagainst HPV. Factors associated with cervical cancer awareness included knowledge of HPV (Khokana: OddsRatio (OR)=24.5; (95% Confidence Interval (CI): 3.1-190.2, Sanphebagar: OR=14.8; 95% CI: 3.7-58.4)) andsexually transmitted infections (Khokana: OR=6.18; 95% CI: 3.1-12.4; Sanphebagar: OR=17.0; 95% CI: 7.3-39.7) among other risk factors. Conclusions: Knowledge and awareness of HPV, cervical cancer, and the HPVvaccine remains low among women in Khokana and Sanphebagar. Acceptance of a freely available HPV vaccinefor children was high, indicating potentially high uptake rates in these communities.     

Human Papillomavirus Genotypes and Cervical Cancer in Northeast Thailand

Human papillomavirus (HPV) is a major cause of cervical cancer. More than 100 HPV genotypes have beenidentified; however the distribution varies geographically and according to ethnicity. The purpose of this studywas to investigate the prevalence and distribution of HPV subtypes among Northeast Thai women. Subjectsincluded 198 cases of SCCA and 198 age-matched, healthy controls. HPV-DNA was amplified by PCR using theconsensus primers GP5+/6+ system followed by reverse line blot hybridization genotyping. The prevalence ofhigh-risk HPV infection was 21 (10.1%) and 152 (76.8%) in the controls and in the cases, respectively. High-riskHPV significantly increased the risk for cervical cancer with an OR of 42.4 (95%CI: 22.4-81.4, p<0.001) and anadjusted OR of 40.7-fold (95%CI: 21.5-76.8, p <0.001). HPV-16 was the most prevalent HPV type in the SCCA(56.2%) followed by HPV-58 (17.8%) and HPV-18 (13.6%); whereas HPV-58 (46.4%) was a prominent genotypein the controls followed by HPV-16 (39.3%) and unidentified HPV types (25.0%). These findings indicate thatHPV infection remains a critical risk factor for SCCA; particularly, HPV-16, HPV-58 and HPV-18. In orderto eradicate cervical cancer, sustained health education, promoted use of prophylactics and a HPV-58 vaccineshould be introduced in this region.     

Community Education on Cervical Cancer Amongst Market Women in an Urban Area of Lagos,Nigeria

Background: Cervical cancer is one of the most common forms of carcinoma among women worldwide,accounting for about 12% of all cancers. Tragically, studies have shown generally low awareness levels on itssymptoms, risk factors and prevention. This study evaluated the effect of a health education program onknowledge of cervical cancer amongst women at risk in Africa. Method: This study was conducted in the city ofLagos, Nigeria, using a multistage sampling technique. Two model markets were chosen by simple randomsampling method from a total of 10 local governments with model markets. One was designated the intervention/experimental group while the other was the control. Systematic sampling method was used in selecting 350women comprising of 175 participants from each model market. A baseline survey on cervical cancer awarenessand screening practices was carried out in both sample groups with the aid of interviewer-administered, structuredand pre-tested questionnaires. Thereafter, respondents in the intervention group received sessions of communitybasededucational messages on cervical cancer and its prevention. Subsequently, participants in both groupswere reassessed to evaluate the effect of the educational program. Data analysis was conducted with Epi-infostatistical software. Results: Knowledge level was low on cervical cancer at baseline; only about 15% and 6.9%of participants in the intervention and control groups respectively had heard of cervical cancer. The most commonsources of information were friends and media prior to the intervention. Significant increase in proportionswere found in the intervention/experimental group on awareness of cervical cancer (61.7%), associated symptomsand risk factors such as early sexual debut, promiscuity and smoking. Conclusion: It is apparent that effortsmust be put in place by all stakeholders in reaching women at risk of cervical cancer through well organizededucational campaigns using culturally sensitive information, education and communication.     

A Qualitative Exploration of Barriers to Treatment Among HPV-Positive Women in a Cervical Cancer Screening Study in Western Kenya

BackgroundCervical cancer screening through self-collected high-risk human papillomavirus (HPV) testing has increased screening uptake, particularly in low-resource settings. Improvement ultimately depends, however, on women with positive results accessing follow-up treatment. Identifying the barriers to timely treatment is needed to tailor service delivery for maximum impact.Materials and MethodsThis qualitative study was conducted within a self-collected HPV screening trial in Migori County, Kenya. HPV-positive women were referred for no-cost cryotherapy treatment at the county hospital. Women not attending within 60 days of receiving HPV-positive results were randomly selected for in-depth interviews (IDIs). IDIs were coded and analyzed to develop an analytical framework and identify treatment barriers.ResultsEighty-one women were interviewed. IDIs showed a poor understanding of HPV and cervical cancer, impacting comprehension of screening results and treatment instructions. All 81 had not undergone treatment but reported intending to in the future. Eight reported seeking treatment unsuccessfully or not qualifying, primarily due to pregnancy. Transportation costs and long distances to the hospital were the most reported barriers to treatment. Other obstacles included work, household obligations, and fear of treatment. Impacts of social influences were mixed; some women reported their husbands prevented seeking treatment, others reported their husbands provided financial or emotional support. Few women experienced peer support.ConclusionsWomen faced many barriers to treatment following HPV screening in rural Kenya. Transportation barriers highlight a need for local treatment capacity or screen-and-treat approaches. Ensuring women understand their results and how to seek treatment is essential to improving cervical cancer screening in low-resource settings.