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Human Papilloma virus as a predictor of cervical cancer
June 22, 2000Two studies published in this week's issue of THE LANCET suggest that the detection of the amount of human papillomavirus (HPV) could help identify women at risk of cervical cancer. Infection with certain types of HPV - which is common among young women - increases the risk of cervical cancer.
However, less than 1% of young women positive for cancer-related types of HPV develop the disease. Agnetha Josefsson and colleagues from Uppsala University, Sweden, and a collaborating group from the Karolinska Institute, Stockholm, Sweden, investigated whether the amount of HPV DNA is a useful predictor of progression to cervical cancer.
They estimated the amount of HPV 16 DNA in 478 women with cervical cancer, and 608 individually matched controls. The investigators studied multiple smears (total 3835 archived samples) from each woman, taken over periods of up to 26 years, that covered normal cytology to development of cervical cancer. The risk of cervical cancer increased with the amount of HPV 16 DNA.
Analysis of the first smear from each woman, collected on average nearly 8 years before cancer diagnosis, showed that women with the 20% highest amount of HPV 16 DNA were at a 60-fold higher risk of developing cervical cancer than women negative for HPV 16.
They conclude that analysis of the amount of HPV DNA can predict cancer risk at a stage when current screening methods are uninformative; and that testing for the amount of HPV 16 DNA during gynaecological health checks might improve the ability to distinguish between infections that have a high or low risk of progressing into cervical cancer.
In the second study, Dr Nathalie Ylitalo from the Karolinska Institute and the same investigators from the first study, concluded that cervical cancer associated with HPV 16 occurs mainly in HPV-16-positive women who have consistently high viral loads long term. They did a case-control study of women participating in cytological screening in Sweden, and used a sensitive measurement to estimate HPV 16 viral load in multiple smears for each woman, taken during a period of up to 26 years before diagnosis. 2081 smears from 478 cases and 1754 smears from 608 controls were tested; among cases, the investigators found a consistently increased load of HPV 16 13 years or more before diagnosis, and when many smears were still cytologically normal. Women with high HPV 16 viral loads were at least 30 times more likely to develop cervical cancer than HPV-16-negative women more than a decade before diagnosis. About a quarter of women with a high viral load before age 25 developed cervical cancer within 15 years.
The investigators conclude that women at high risk could be identified by use of a quantitative HPV test in addition to cytological screening. In an accompanying Commentary (p 2179), Carolyn Johnston from the university of Michigan, USA, raises a number of questions arising from these two studies: 'What should be done for these ostensibly high-risk women, once they are identified? Since there is currently no vaccine or treatment for latent HPV infections, are these women candidates for chemoprevention trials? Considering accessibility, cost, and positive-predictive value, to what population should viral tests be applied to make the greatest impact?' Finally, she comments that the question of whether any substantial improvements can be made to current cervical screening programmes has yet to be answered.
Lancet
Analysis of the first smear from each woman, collected on average nearly 8 years before cancer diagnosis, showed that women with the 20% highest amount of HPV 16 DNA were at a 60-fold higher risk of developing cervical cancer than women negative for HPV 16.
They conclude that analysis of the amount of HPV DNA can predict cancer risk at a stage when current screening methods are uninformative; and that testing for the amount of HPV 16 DNA during gynaecological health checks might improve the ability to distinguish between infections that have a high or low risk of progressing into cervical cancer.
In the second study, Dr Nathalie Ylitalo from the Karolinska Institute and the same investigators from the first study, concluded that cervical cancer associated with HPV 16 occurs mainly in HPV-16-positive women who have consistently high viral loads long term. They did a case-control study of women participating in cytological screening in Sweden, and used a sensitive measurement to estimate HPV 16 viral load in multiple smears for each woman, taken during a period of up to 26 years before diagnosis. 2081 smears from 478 cases and 1754 smears from 608 controls were tested; among cases, the investigators found a consistently increased load of HPV 16 13 years or more before diagnosis, and when many smears were still cytologically normal. Women with high HPV 16 viral loads were at least 30 times more likely to develop cervical cancer than HPV-16-negative women more than a decade before diagnosis. About a quarter of women with a high viral load before age 25 developed cervical cancer within 15 years.
The investigators conclude that women at high risk could be identified by use of a quantitative HPV test in addition to cytological screening. In an accompanying Commentary (p 2179), Carolyn Johnston from the university of Michigan, USA, raises a number of questions arising from these two studies: 'What should be done for these ostensibly high-risk women, once they are identified? Since there is currently no vaccine or treatment for latent HPV infections, are these women candidates for chemoprevention trials? Considering accessibility, cost, and positive-predictive value, to what population should viral tests be applied to make the greatest impact?' Finally, she comments that the question of whether any substantial improvements can be made to current cervical screening programmes has yet to be answered.
Lancet
Cervical Cancer Current Events and Cervical Cancer News RSS1 disease, not 1 demographic
The Asian continent has nearly four billion people living in 47 different countries, and each of these groups has their own unique set of health issues. But when they come to the United States, they're often lumped into one large demographic: "Asian/Pacific Islander."
Alternatively spliced tissue factor identified as promising new biomarker for aggressive cancers
A recently discovered form of the protein that triggers blood clotting may play a key role in the molecular mechanisms leading to the growth of certain metastatic cancers, according to new research reported by an international team of scientists.
M. D. Anderson redefines screening guidelines for breast, cervical and colorectal cancers
Drawing on years of experience in cancer research and patient care, The University of Texas M. D. Anderson Cancer Center released today the most comprehensive, risk-based screening guidelines publicly available to date for breast, cervical and colorectal cancers.
Study finds delay in follow-up among African-American women receiving abnormal breast finding
A new analysis has identified a significant delay in follow-up times among African-American women after the finding of a suspicious breast abnormality.
UIC study finds girls aware of HPV vaccine's benefits
Contrary to concerns that the human papillomavirus vaccine might promote promiscuity, a national survey of girls and young women found that the majority of respondents did not believe the HPV vaccine protected them against other sexually transmitted infections.
Scientists identify common HPV genotypes in northern India, encourage vaccination
Although a wide spectrum of human papillomavirus is seen across the population of India, HPV-16 and HPV-18 are the most common types and a vaccination targeting these types could eliminate 75 percent of the cervical cancers in the region.
Vaccinating boys against human papillomavirus not cost-effective
Persistent infection with high-risk types of human papillomavirus (HPV), a sexually transmitted virus, is known to be a cause of cervical cancer.
Vaccination and testing for the human papilloma virus could eradicate cervical cancer
Cervical cancer could be eradicated within the next 50 years if countries implement national screening programmes based on detection of the human papilloma virus (HPV), which causes the disease, together with vaccination programmes against the virus, according to a cervical cancer screening expert.
Targeted heat therapy offers new standard treatment option for soft tissue sarcoma
Patients with soft-tissue sarcomas at high risk of spreading were 30% more likely to be alive and cancer free almost three years after starting treatment if their tumours were heated at the time they received chemotherapy, according to new research.
Even in a safety net health system, colorectal cancer screening disparities remain
Colorectal cancer screening rates are much lower among those in a safety net health system compared to the national average, and the number one predictor of screening is a combination of regular visits and insurance access.
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