HPV, cervical neoplasia and smoking: knowledge among colposcopy patients.
Boardman LA, Cooper AS, Clark M, Weitzen S, Whiteley JA, Peipert JF. Department of Obstetrics and Gynecology, Women and Infants' Hospital, Providence, Rhode Island, USA. email@example.com
OBJECTIVE: To assess colposcopy patients' knowledge of human papillomavirus (HPV) infection and the role of smoking in cervical neoplasia and, if patients were current smokers, their willingness to quit smoking. STUDY DESIGN: Between January and June 2001, 250 women seen in a colposcopy clinic for the evaluation of an abnormal Pap smear or previously diagnosed cervical neoplasia participated in a survey designed to evaluate knowledge of HPV infection, smoking and neoplasia. Participants who smoked were questioned regarding their smoking behaviors and readiness to quit. In the analysis, the population was stratified by age (< 25 years versus > or = 25 years) to determine differences in knowledge, perception of risk and behaviors. RESULTS: The study population was in general young and racially/ethnically diverse. Fifty-seven percent (143 of 250) thought that HPV was a risk factor in cervical neoplasia, and 58% (146 of 250) associated smoking with neoplasia. Among smokers who discussed risk reduction with their providers, 75% (50 of 66) were advised to stop smoking. Of the 39% (98 of 250) who were current smokers, 63% (62 of 98) agreed that having an abnormal Pap smear would make them consider smoking cessation, and 58% (57 of 98) reported that they would use medical therapy (nicotine replacement or medication) to aid in that process. There were age-related differences in smoking behaviors and attitudes toward cessation (e.g., younger smokers were less likely to desire nicotine replacement). CONCLUSION: Given the high prevalence of smoking and a demonstrated desire by many of the colposcopy patients to stop smoking in the context of a cervical abnormality, further efforts at encouraging cessation are warranted.
Int J Cancer. 2004 Dec 10;112(5):854-9.
Type-specific associations of human papillomavirus load with risk of developing cervical carcinoma in situ.
Moberg M, Gustavsson I, Gyllensten U. Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden.
We have previously shown that high human papillomavirus (HPV) 16 load in Papanicolaou smears negative for dysplasia is strongly associated with risk for carcinoma in situ (CIS) of the cervix. Here we study the amount of HPV DNA for some of the most frequent high-risk HPV types as determinants of progression to cervical CIS. Real-time PCR is used to estimate the normalized viral load of HPV 16, 18, 31, 33, 35, 39, 45, 52, 58 and 67 in 457 cases of cervical CIS and 552 matched population controls. A total of 2,747 archival Pap smears from gynecologic health examinations, collected over a period of up to 26 years, were analyzed to assess viral load during the infection history. Cervical smear samples differ widely in amount of DNA, underscoring the need for normalization of HPV load to number of cells in the sample. The risk of developing cervical CIS increases with higher viral load for most of the HPV types studied. The range of copy numbers per cell does not differ between HPV types but the odds ratio for CIS in the percentile with highest viral load is substantially higher for HPV 16 (OR = 36.9; 95% CI = 8.9-153.2) than for HPV 31 (OR = 3.2; 95% CI = 1.1-9.1) or HPV 18/45 (OR = 2.6; 95% CI = 1.0-6.4). Therefore, HPV viral load may be predictive of future risk of cervical CIS at a stage when smears are negative for squamous abnormalities, but differences between HPV types need closer attention. (c) 2004 Wiley-Liss, Inc.
Gynecol Oncol. 2004 Dec;95(3):618-23.
Human papillomavirus DNA detection and histological findings in women referred for atypical glandular cells or adenocarcinoma in situ in their Pap smears.
Derchain SF, Rabelo-Santos SH, Sarian LO, Zeferino LC, de Oliveira Zambeli ER, do Amaral Westin MC, de Angelo Andrade LA, Syrjanen KJ. Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Rua Alexander Fleming 101, CEP:13083-970, Campinas, SP, Brazil.
OBJECTIVE: To evaluate the association between high-risk human papillomavirus (HPV) DNA detection and histological diagnosis in women referred for atypical glandular cells (AGC) or adenocarcinoma in situ (AIS) at Pap smear. METHODS: In this cross-sectional study, 146 women referred for AGC (124), AGC with high-grade squamous intraepithelial lesion (HSIL) (15), or AIS (7) were tested for HPV DNA using Hybrid Capture II (HC II). All women underwent colposcopic examination, and cervical biopsy was performed for 95 patients. Fifty-one women referred due to AGC with normal colposcopy and normal second Pap smear were scheduled for control visits every 4 months. RESULTS: The overall prevalence of HPV DNA was 38%. HPV DNA was detected in 93% of the women with HSIL associated with AGC and in 71% of women with AIS Pap smear, being significantly higher when compared with the prevalence (29%) in women with AGC alone. Forty-five women (30.8%) had clinically significant histological lesions (CIN 2 or worse). High-risk HPV DNA was detected in only 16% of the women without significant abnormalities in biopsy, in contrast to 96% of those who had CIN 2 or CIN 3 and 75% of women with AIS. Eighty-five percent of women with invasive cervical carcinoma (squamous or adenocarcinoma) tested positive for HPV DNA. HPV DNA detection was significantly associated with histological diagnosis of CIN 2 or worse, with an odds ratio (OR) = 51.8 (95% CI 14.3-199.9). CONCLUSION: HPV DNA detection was strongly associated with the severity of cervical lesion (CIN 2 or worse) in women referred for AGC or AIS in their Pap smear. These data implicate the use of HPV testing in triage of women with AGC Pap smears.
Minerva Ginecol. 2004 Oct;56(5):391-9.
Human papillomavirus of the female genital tract: prevalence in women attending a centre for early cancer detection.
Human Papilloma Virus Pictures - Article in Italian
Bianco V, Tassan Simonat P, Murina F, Valente I. Clinica Ostetrica e Ginecologica I, Universita degli Studi di Milano, Milan. firstname.lastname@example.org
AIM: The authors study the trend of cytologic human papillomavirus (HPV) detection in the period between 1980 and 2000 in women attending a clinic for genital cancer early detection. METHODS: Routine activity, besides pap smear, is based on clinical evaluation, colposcopy and target biopsy in the presence of a lesion. The cytological trend is compared with that of histologic and clinical findings of HPV lesions on the basis of data prospectively collected. RESULTS: About 5% of cytologic HPV detection is observed in the whole, with a pick of about 11% in the years 1992-1994, and values around 2-3% up to 1991 and after 1995. The finding does not change if the whole pap smear group is considered (46,862) or only the first pap smear per woman (16,810). A similar trend, but with a smaller pick, is observed in histologic findings, not in colposcopic findings. The clinical finding of condylomata is higher in the first period of observation, sloping down through the time intervals considered. Standardization on age or patient's recruiting does not change the evidence. CONCLUSION: The trend of the HPV parameters studied could represent an epidemiological model for HPV infection. The clinical epidemics is followed by a period of HPV cytological pick, which might be followed, at suitable time interval, by more cervical intraepithelial neoplasia/squamous intraepithelial lesions, according to the well known latency between infection and premalignant changes.