Background: Most cancers of the uterine cervix are squamous cell carcinomas. Although the incidence of such carcinomas of the uterine cervix has declined over time, that of cervical adenocarcinoma ...has risen in recent years. The extent to which human papillomavirus (HPV) infection and cofactors may explain this differential trend is unclear. Methods: We pooled data from eight case–control studies of cervical cancer that were conducted on three continents. A total of 167 case patients with invasive cervical adenocarcinoma (112 with adenocarcinoma and 55 with adenosquamous carcinoma) and 1881 hospital-based control subjects were included. HPV DNA was analyzed in cervical specimens with the GP5+/6+ general primer system followed by type-specific hybridization for 33 HPV genotypes. Blood samples were analyzed for chlamydial and herpes simplex virus 2 (HSV-2) serology. Multivariable unconditional logistic regression modeling was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs). All tests of statistical significance were two-sided. Results: The adjusted overall odds ratio for cervical adenocarcinoma in HPV-positive women compared with HPV-negative women was 81.3 (95% CI = 42.0 to 157.1). HPV 16 and HPV 18 were the two most commonly detected HPV types in case patients and control subjects. These two types were present in 82% of the patients. Cofactors that showed clear statistically significant positive associations with cervical adenocarcinoma overall and among HPV-positive women included never schooling, poor hygiene, sexual behavior–related variables, long-term use of hormonal contraception, high parity, and HSV-2 seropositivity. Parity had a weaker association with adenocarcinoma and only among HPV-positive women. Use of an intrauterine device (IUD) had a statistically significant inverse association with risk of adenocarcinoma (for ever use of an IUD compared with never use, OR = .41 95% CI = 0.18 to 0.93). Smoking and chlamydial seropositivity were not associated with disease. Conclusions: HPV appears to be the key risk factor for cervical adenocarcinoma. HPV testing in primary screening using current mixtures of HPV types and HPV vaccination against main HPV types should reduce the incidence of this cancer worldwide.
Objective: Summary of the studies carried out by the IARC on HPV and cervical cancer is presented.
Results: the first one was the international prevalence survey of HPV types in invasive cervical ...cancer (ICC) conducted in up to 22 countries. Overall, 99.7% of 1000 cases with histologically confirmed ICC were also shown to be HPV DNA positive using the GP5+/GP6+ or E7 primers, indicating that HPV is a necessary cause of cervical cancer. The most prevalent HPV types were HPV 16 (53%), HPV 18 (15%), HPV 45 (9%), HPV 31 (6%) and HPV 33 (3%). HPV 16 was the most common type in all geographical regions, followed by HPV 18 that was particularly, common in South–East Asia. The second set of studies included case-control studies carried out in 13 countries. They included about 2000 cases and 2000 controls. Positivity, for any HPV DNA yielded a pooled odds ratio (OR) of 70. The association was equally strong for both squamous cell (OR=74) and adenocarcinoma (OR=50) and for HPV 16 and 18 as well as for the less common HPV types. Our results indicate that in addition to HPV 16 and 18, HPV 31, 33, 35, 45, 51, 52, 58 and 59 now can be considered as carcinogenic. The third group of studies is aimed to determine the HPV DNA prevalence in random, age-stratified (by 5 years, 15–19 to 65+) subsamples (1100 women) of the general population. Two age-peaks (<25 and >59 years), have been found in some countries (Costa-Rica, Mexico, Colombia) but not in all (Argentina). Whether the second peak is due to viral reactivation, variations in screening or represents a birth-cohort effect remains to be determined. The distribution of the most prevalent HPV types in the general population (HPV 16, 18, 45, 31, 58, 33, 35) resembles that for cervical cancer cases.
Conclusions: our studies provide the most solid epidemiological evidence, to conclude that HPV is not only the central cause of cervical cancer worldwide but also a necessary cause.
El presente artículo busca transferir la pedagogía de la educación ambiental hacia el fortalecimiento de conductas proambientales en entornos cotidianos a través de un enfoque conceptual y ...metodológico. Esto se evidencia en una propuesta formativa implementada con la comunidad educativa del Colegio Jorge Gaitán Cortés, de la ciudad de Bogotá, en la que se desarrollaron cinco grupos de intervenciones pedagógicas: (1) la resignificación de las relaciones con el ambiente mediante recorridos interpretativos, (2) la articulación interinstitucional para la formación ambiental, (3) el abordaje curricular de comportamientos ambientalmente relevantes, (4) la implementación del servicio social ambiental y (5) la gestión institucional para la sostenibilidad ambiental. Se proponen referentes alrededor de tres perspectivas: la educación ambiental orientada a la generación de comportamientos y prácticas culturales proambientales, la concepción de ciudad educadora y el abordaje interdisciplinar de aspectos ambientales. Este ejercicio académico permitió identificar la necesidad de transferir las acciones pedagógicas al entorno inmediato y a la cotidianidad de los miembros de la comunidad educativa, y convocó la convergencia de las perspectivas experiencial y cognitiva para propiciar el reconocimiento socioambiental de escenarios ecológicos de la ciudad y la formación de identidad y vínculos afectivos con el territorio. De otra parte, el énfasis pedagógico hacia la acción proambiental facilitó a los estudiantes la concepción de alternativas de solución a problemáticas relevantes para ellos. El camino hacia la construcción de cultura para la sostenibilidad ambiental, y particularmente la consolidación de los logros de las intervenciones pedagógicas, requieren procesos de mediano y largo plazo que incidan en los hábitos y estilos de vida de los miembros de la comunidad educativa.
Summary Background Intrauterine device (IUD) use has been shown to reduce the risk of endometrial cancer, but little is known about its association with cervical cancer risk. We assessed whether IUD ...use affects cervical human papillomavirus (HPV) infection and the risk of developing cervical cancer. Methods We did a pooled analysis of individual data from two large studies by the International Agency for Research on Cancer and Institut Català d'Oncologia research programme on HPV and cervical cancer; one study included data from ten case–control studies of cervical cancer done in eight countries, and the other included data from 16 HPV prevalence surveys of women from the general population in 14 countries. 2205 women with cervical cancer and 2214 matched control women without cervical cancer were included from the case–control studies, and 15 272 healthy women from the HPV surveys. Information on IUD use was obtained by personal interview. HPV DNA was tested by PCR-based assays. Odds ratios and 95% CIs were estimated using multivariate unconditional logistic regression for the associations between IUD use, cervical HPV DNA, and cervical cancer. Findings After adjusting for relevant covariates, including cervical HPV DNA and number of previous Papanicolaou smears, a strong inverse association was found between ever use of IUDs and cervical cancer (odds ratio 0·55, 95% CI 0·42–0·70; p<0·0001). A protective association was noted for squamous-cell carcinoma (0·56, 0·43–0·72; p<0·0001), adenocarcinoma and adenosquamous carcinoma (0·46, 0·22–0·97; p=0·035), but not among HPV-positive women (0·68, 0·44–1·06; p=0·11). No association was found between IUD use and detection of cervical HPV DNA among women without cervical cancer. Interpretation Our data suggest that IUD use might act as a protective cofactor in cervical carcinogenesis. Cellular immunity triggered by the device might be one of several mechanisms that could explain our findings. Funding Instituto de Salud Carlos III; Agència de Gestió d'Ajuts Universitaris i Recerca; Marató TV3 Foundation; Bill & Melinda Gates Foundation; International Agency for Research on Cancer; European Community; Fondo de Investigaciones Sanitarias, Spain; Preventiefonds, Netherlands; Programa Interministerial de Investigación y Desarrollo, Spain; Conselho Nacional de Desenvolvimiento Cientifico e Tecnologico, Brazil; and Department of Reproductive Health & Research, WHO.
It is too early to know which will be the final death toll from the Covid-19 or SARS-CoV-2 virus epidemy in Latin America since the epidemy is still active and we will not know when it will end. The ...curve for new infections and deaths has not reached yet a peak (Figure 1). In addition, we know little about the epidemiology of this new virus. The daily litany of the number of people infected with the number of admissions to hospitals and intensive care units and the number of deaths guides health authorities to plan health services and politicians to gauge the degree of confinement necessary to control the transmission of the virus, but it says little about the magnitude of the problem if we do not relate it to the population at risk. At the end of the pandemic, we will be able to estimate age-standardized death rates for the different countries, but until then the crude death rates will provide a first glance or snapshot of the death toll and impact of the pandemic from March to May 2020. These rates are well below those estimated in other countries in Europe and North America: Belgium (82.6), Spain (58.0), the United Kingdom (57.5), Italy (55.0), France (42.9), Sweden (41.4), and the US (30.7). (Johns Hopkins CSSE, May 30, 2020). However, in the European countries and the US the number of deaths has reached a peak, while this is not the case in Latin American countries. (Figure 1). It should be taken into account that the above rates are crude and therefore, some of the differences could be due to the fact that European countries have a larger proportion of the population over 70 years of age in whom higher mortality rates have been reported.
Abstract Objective Human papillomavirus (HPV) vaccines can potentially control cervical cancer and help to reduce other HPV-related cancers. We aimed to estimate the relative contribution (RC) of the ...nine types (HPVs 16/18/31/33/45/52/58/6/11) included in the recently approved 9-valent HPV vaccine in female anogenital cancers and precancerous lesions (cervix, vulva, vagina and anus). Methods Estimations were based on an international study designed and coordinated at the Catalan Institute of Oncology (Barcelona-Spain), including information on 10,575 invasive cervical cancer (ICC), 1709 vulvar, 408 vaginal and 329 female anal cancer cases and 587 Vulvar Intraepitelial Neoplasia grade 2/3 (VIN2/3), 189 Vaginal Intraepitelial Neoplasia grade 2/3 (VaIN2/3) and 29 Anal Intraepitelial Neoplasia grade 2/3 (AIN2/3) lesions. Consecutive histologically confirmed paraffin-embedded cases were obtained from hospital pathology archives from 48 countries worldwide. HPV DNA-detection and typing was performed by SPF10 -DEIA-LiPA25 system and RC was expressed as the proportion of type-specific cases among HPV positive samples. Multiple infections were added to single infections using a proportional weighting attribution. Results HPV DNA prevalence was 84.9%, 28.6%, 74.3% and 90.0% for ICC, vulvar, vaginal and anal cancers, respectively, and 86.7%, 95.8% and 100% for VIN2/3, VaIN2/3 and AIN2/3, respectively. RC of the combined nine HPV types was 89.5% (95% confidence interval (CI): 88.8–90.1)-ICC, 87.1% (83.8–89.9)-vulvar, 85.5% (81.0–89.2)-vaginal, 95.9% (93.0–97.9)-female anal cancer, 94.1% (91.7–96.0)-VIN2/3, 78.7% (71.7–84.2)-VaIN2/3 and 86.2% (68.3–96.1)-AIN2/3. HPV16 was the most frequent type in all lesions. Variations in the RC of HPVs 31/33/45/52/58 by cancer site were observed, ranging from 7.8% (5.0–11.4)-female anal cancer to 20.5% (16.1–25.4)-vaginal cancer. Conclusions The addition of HPVs 31/33/45/52/58 to HPV types included in current vaccines (HPV16/18) could prevent almost 90% of HPV positive female anogenital lesions worldwide. Taking into account that most HPV-related cancers are ICC ones, the 9-valent HPV vaccine could potentially avoid almost 88% of all female anogenital cancers.
Data on the incidence and determinants of human papillomavirus (HPV) infection in women 130 years old are scarce. To address this, a cohort of 1610 women—15–85 years old, HPV negative, and with ...normal cytological results at baseline—was monitored every 6 months for an average of 4.1 years. Information on risk factors and cervical samples for cytological testing and detection and typing of HPV DNA were obtained at each visit. The incidence of high-risk types was higher than that of low-risk types (5.0 vs. 2.0 cases/100 woman-years). The agespecific incidence curve for high-risk types was bimodal, whereas the incidence of low-risk types gradually decreased with age. Infections with high-risk types lasted longer than infections with low-risk types (14.8 vs. 11.1 months). In this cohort of cytologically normal women, the incidence of cervical HPV infection was high, and the epidemiological profile of high-risk HPV types was different from that of low-risk types.
Prophylactic human papillomavirus (HPV) vaccination programs constitute major public health initiatives worldwide. We assessed the global effect of quadrivalent HPV (4vHPV) vaccination on HPV ...infection and disease. PubMed and Embase were systematically searched for peer-reviewed articles from January 2007 through February 2016 to identify observational studies reporting the impact or effectiveness of 4vHPV vaccination on infection, anogenital warts, and cervical cancer or precancerous lesions. Over the last decade, the impact of HPV vaccination in real-world settings has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. Maximal reductions of approximately 90% for HPV 6/11/16/18 infection, approximately 90% for genital warts, approximately 45% for low-grade cytological cervical abnormalities, and approximately 85% for high-grade histologically proven cervical abnormalities have been reported. The full public health potential of HPV vaccination is not yet realized. HPV-related disease remains a significant source of morbidity and mortality in developing and developed nations, underscoring the need for HPV vaccination programs with high population coverage.
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