1-
The
present paper aims to explore awareness and acceptability of human
papillomavirus (HPV) vaccination and to identify factors influencing HPV
acceptability among women with physical disabilities in Taiwan. The
study participants were 438 adult women with physical disabilities, aged
18–69 years. The participants were all officially registered as having
physical disabilities in Taipei County, Taiwan, in March 2009. The major
findings were that 54.5% of the participants had previously heard about
the HPV vaccine and that vaccine acceptability was very low (3.2%) if
the participants would have had to pay for the vaccine but would
increase to 60% if the government were to provide the vaccine for free.
We found that those participants who had had a Pap smear test within the
past 1 year or 3 years were significantly more likely to be aware of
and willing to receive the HPV vaccine than those who had not. To
increase the HPV vaccination rate among women with physical
disabilities, the study suggests that the current health care system in
Taiwan should consider implementing free immunization for this group of
womenLoader.rt("abs_end");
Highlights
► To explore the
awareness and acceptability of future HPV vaccination, and to identify
factors for HPV acceptability among women with physical disabilities. ►
The main results revealed that there were 54.5% had heard about the HPV
vaccine, self-fund vaccine acceptability was only 3.2%, free vaccine
increase 60%. ► The study highlights that current health care system in
Taiwan should consider implementing public free immunization for this
group of women.
Loader.rt("abs_end");
Abstract
New prophylactic HPV
vaccines have the power to prevent many HPV infections, thus reducing
the burden of HPV-associated diseases. Two vaccines composed of HPV L1
proteins self assembled into virus-like particles (VLPs) have been
developed: one containing VLPS of HPV types 6, 11, 16 and 18, while the
other vaccine is composed of HPV 16 and 18 VLPs. Large phase II and III
clinical trials to assess prophylactic efficacy have been conducted in
which both HPV infection endpoints and disease endpoints were evaluated,
particularly high-grade cervical intraepithelial neoplasia – CIN2 or
CIN3 – as well as vulvar and vaginal intraepithelial neoplasias – VIN or
VaIN – and genital warts for the quadrivalent vaccine. Very high
efficacy rates were observed in different populations that included
young women between 16 and 26 years of age, and older (up to 55). More
recently, the quadrivalent vaccine has been shown to be efficacious in
men to prevent genital and anal infection and disease caused by the
types included in the vaccine. Based on demonstrated clinical efficacy
and favorable safety profile, HPV prophylactic vaccine are being
introduced worldwide aiming the reduction of the morbidity and mortality
of tumors caused by HPV. From 2006 when first approved in the USA,
hundreds of countries have licensed the HPV vaccines, a significant
proportion of which are offering the vaccine to young women in national
immunization programs supported by the government. The ultimate goal is
to implement worldwide cervical cancer control programs to include HPV
vaccination and screening with cytology and HPV DNA testing,
particularly in less-developed countries where it is most needed.
Loader.rt("abs_end");
Abstract
The study of cancer
is incomplete without taking into consideration of tumorigenic viruses.
Initially, searches for human cancer viruses were fruitless despite an
expansion of our knowledge in the same period concerning
acute-transforming retroviruses in animals. However, over the last
40 years, we have witnessed rapid progress in the tumor virology field.
Currently, acknowledged human cancer viruses include Epstein–Barr virus,
hepatitis B virus, hepatitis C virus, high-risk human papilloma
viruses, human T-cell lymphotropic virus type 1 and Kaposi’s
sarcoma-associated herpesvirus. Extensive epidemiological and
mechanistic studies have led to the development of novel preventive and
therapeutic approaches for managing some of these infections and
associated cancers. In addition, recent advances in molecular
technologies have enabled the discovery of a new potential human tumor
virus, Merkel cell polyomavirus, but its association with cancer remains
to be validated. It is anticipated that in the next few decades many
additional human cancer viruses will be discovered and the mechanisms
underlying viral oncogenesis delineated. Thus, it can be expected that
better tools for preventing and treating virus-associated cancer will be
available in the near future.
Keywords: Virus discovery; Cancer viruses;
Causality; Epstein–Barr virus, EBV; Hepatitis B virus, HBV; Human
papillomavirus, HPV; Human T-cell lymphotropic virus type 1, HTLV-1;
Hepatitis C virus, HCV; Kaposi’s sarcoma-associated herpesvirus, KSHV;
Merkel cell polyomavirus (MCPyV)
It has
been estimated that chronic infections with viruses, bacteria and
parasites are the causative agents of 8–17% of global cancers burden.
Carcinogenesis associated with infections is a complex process, often
mediated by chronic inflammatory conditions and accumulating evidence
indicate that a smouldering inflammation is a component of the tumor
microenvironment and represents the 7th hallmark of cancer. Selected
infectious agents promote a cascade of events culminating in chronic
inflammatory responses, thus predisposing target tissues to increased
cancer susceptibility. A causal link also exists between an inflammatory
microenvironment, consisting of inflammatory cells and mediators, and
tumor progression. Tumor-Associated Macrophages (TAM) represent the
major inflammatory population present in tumors, orchestrating various
aspects of cancer, including: diversion and skewing of adaptive
responses; cell growth; angiogenesis; matrix deposition and remodelling;
construction of a metastatic niche and actual metastasis; response to
hormones and chemotherapeutic agents. Recent studies on human and murine
tumors indicate that TAM show a remarkable degree of plasticity and
functional heterogeneity, during tumour development. In established
tumors, TAM acquire an M2 polarized phenotype are engaged in
immunosuppression and the promotion of tumor angiogenesis and
metastasis. Being a first line of the innate defence mechanisms,
macrophages are also equipped with pathogen-recognition receptors, to
sense the presence of danger signals, including onco-pathogens.Here we discuss the evidence suggesting a causal
relationship between selected infectious agents and the pro-tumoral
reprogramming of inflammatory cells, as well as its significance in
tumor development. Finally, we discuss the implications of this
phenomenon for both cancer prevention and therapy.
Keywords: Inflammation; Cancer; Pathogens
Available online 20 June 2011.
Loader.rt("abs_end");
Human papillomavirus has been established
as the causal agent for cervical cancer. The identification of a clear
cause presents an unparalleled opportunity for cancer control. As such,
the development of prophylactic human papillomavirus vaccines has been
rightly hailed as one of the significant scientific triumphs of the past
20 years. This story of scientific triumph over disease, however, is
not yet complete. The fruit of scientific labour must be delivered to
the people in order to fulfil the underlying intent of the research
(i.e. to prevent cancer and save lives). The success of a vaccination
programme, however, does not depend on the biological efficacy of the
vaccine alone. Various other local factors, such as poverty, gender
inequality, cultural traditions, or religious beliefs, can significantly
constrain the success of any vaccination programme. In this chapter, we
provide an overview of how the human papillomavirus vaccine works and
its global uptake, as well as, how variations in local contexts can
affect the successful implementation of a vaccination programme. Other
factors besides vaccine costs also need serious attention. With better
understanding of such factors, policy makers and medical health
professionals will be better equipped to make informed decisions to
maximise the potential benefits of the human papillomavirus vaccines for
the most number of people in individual countries.
Keywords: cervical cancer; human papillomavirus
(HPV) vaccination; resource-constrained world; developed world; poverty
Loader.rt("abs_end");
Summary
Background
Australia introduced a human papillomavirus (HPV)
vaccination programme with the quadrivalent HPV vaccine for all women
aged 12–26 years between 2007 and 2009. We analysed trends in cervical
abnormalities in women in Victoria, Australia, before and after
introduction of the vaccination programme.Methods
With data from the Victorian Cervical Cytology
Registry between 2003 and 2009, we compared the incidence of
histopathologically defined high-grade cervical abnormalities (HGAs,
lesions coded as cervical intraepithelial neoplasia of grade 2 or worse
or adenocarcinoma in situ; primary outcome) and low-grade cytological
abnormalities (LGAs) in five age groups before (Jan 1, 2003, to March
31, 2007) and after (April 1, 2007, to Dec 31, 2009) the vaccination
programme began. Binary comparisons between the two periods were done
with Fisher's exact test. Poisson piecewise regression analysis was used
to compare incident rate trends.Findings
After the introduction of the vaccination
programme, we recorded a decrease in the incidence of HGAs by 0·38% (95%
CI 0·61–0·16) in girls younger than 18 years. This decrease was
progressive and significantly different to the linear trend in incidence
before introduction of the vaccination (incident rate ratio 1·14,
1·00–1·30, p=0·05). No similar temporal decline was recorded for LGAs or
in older age groups.Interpretation
This is the first report of a decrease in
incidence of HGAs within 3 years after the implementation of a
population-wide HPV vaccination programme. Linkage between vaccination
and screening registers is needed to confirm that this ecological
observation is attributable to vaccination and to monitor participation
in screening among vaccinated women.
Objective
Women with HPV related pathology of the lower
genital tract are at higher risk for AIN and anal cancer than the
general population. A strategy to identify anal disease in these women
has not been formulated. The aim of this study is to examine the
feasibility of HPV related biomarker testing on anal smears, to identify
the risk factors for anal HPV positivity and to provide information of
the clinical implications of anal HPV infection in this population.Methods
In women referred for
colposcopy because of HPV related pathology of the lower genital tract
(cervical cancer, CIN, VIN, warts) a detailed questionnaire, an anal
smear and a cervical smear were taken. On each sample morphological
cytology, flow cytometric evaluation of E6&7 mRNA, and HPV DNA
detection and typing were performed. Women with a positive anal result
were referred for high resolution anoscopy.Results
So far 235 women have been included (mean age
34.3). HPV DNA, high-risk HPV DNA, high-risk mRNA was detected in 45%,
31% and 8% of the anal smears and in 56%, 39% and 25% of the cervical
smears respectively. Absolute or partial concordance of the types
between the cervix and the anus was seen in 74%. Positivity for mRNA was
significantly lower in the anus than the cervix (8% vs 25%). Logistic
regression analysis revealed risk factors for the presence of anal HPV
DNA (> 3 lifetime sexual partners and presence of cervical HPV DNA),
hr HPV DNA (presence of cervical hr HPV DNA), and hr mRNA (presence of
cervical hr mRNA). Twelve months after LLETZ 53% of women were cervical
HPV negative, but 25% of those were still HPV positive in the anus.Conclusions
HPV infection of the
anus is common in this group and is interlinked with the cervical
infection. Anal HPV E6&7 mRNA expression is less common than in the
cervix. Possible clinical implications of anal infection could be the
development of AIN and recurrence of CIN after treatment due to cervical
reinfection from the anal reservoir. The use of HPV biomarkers is
feasible in anal smears, although especially DNA testing as triage
method for referral to anoscopy is probably inappropriate due to high
positivity rate.
Loader.rt("abs_end");
Research highlights
► High
anal HPV DNA but low mRNA rates were found in women with genital HPV
lesions. ► Main determinant of anal HPV status is the cervical HPV
status. ► The anus might remain HPV positive after LEEP for CIN even if
the cervix is negative.
Keywords: HPV; Colposcopy; Anus; PCR; Flow cytometry
Loader.rt("abs_end");
Abstract
About 530,000
women develop cervical cancer worldwide and 275,000 die from the disease
each year. Eighty percent of these deaths occur in developing
countries. In Vietnam, cervical cancer has recently emerged as the most
common cancer of women, and there are no national screening programs for
cervical cancer. Since 2009, two different human papillomavirus (HPV)
vaccines have been licensed for use in Vietnam, but access to these
vaccines is generally limited to people who live in urban areas. Studies
have shown that HPV vaccination may be cost-effective in cervical
cancer prevention in Vietnam, depending on vaccination costs. Given that
current HPV vaccines are expensive and public health funding for
supporting a rapid introduction of the vaccine is limited, expanding and
sustaining access to the HPV vaccine may require alternative financing
mechanisms, such as fees-based immunization services.A conjoint analysis study was conducted with
mothers of girls 11 to 17 years of age in Vinh Long Province in Vietnam
to estimate the mothers' private demand for HPV vaccines for their
daughters and to measure the tradeoffs between vaccine fees and vaccine
uptake. The results suggest that the demand for HPV vaccines was high,
increased with vaccine effectiveness and duration of effectiveness, and
decreased with vaccine cost. Vaccine effectiveness was the most
important vaccine attribute to these mothers, followed by duration of
effectiveness. The predicted probability of respondents buying an HPV
vaccine that was 70% effective for 10 years varied by the price, ranging
from 30% when the vaccine price was $353, to 68% when the vaccine cost
$6 per course. As expected, demand and predicted purchase probability
were higher among groups with higher socioeconomic status.
The
present paper aims to explore awareness and acceptability of human
papillomavirus (HPV) vaccination and to identify factors influencing HPV
acceptability among women with physical disabilities in Taiwan. The
study participants were 438 adult women with physical disabilities, aged
18–69 years. The participants were all officially registered as having
physical disabilities in Taipei County, Taiwan, in March 2009. The major
findings were that 54.5% of the participants had previously heard about
the HPV vaccine and that vaccine acceptability was very low (3.2%) if
the participants would have had to pay for the vaccine but would
increase to 60% if the government were to provide the vaccine for free.
We found that those participants who had had a Pap smear test within the
past 1 year or 3 years were significantly more likely to be aware of
and willing to receive the HPV vaccine than those who had not. To
increase the HPV vaccination rate among women with physical
disabilities, the study suggests that the current health care system in
Taiwan should consider implementing free immunization for this group of
womenLoader.rt("abs_end");
Highlights
► To explore the
awareness and acceptability of future HPV vaccination, and to identify
factors for HPV acceptability among women with physical disabilities. ►
The main results revealed that there were 54.5% had heard about the HPV
vaccine, self-fund vaccine acceptability was only 3.2%, free vaccine
increase 60%. ► The study highlights that current health care system in
Taiwan should consider implementing public free immunization for this
group of women.
Loader.rt("abs_end");
Abstract
New prophylactic HPV
vaccines have the power to prevent many HPV infections, thus reducing
the burden of HPV-associated diseases. Two vaccines composed of HPV L1
proteins self assembled into virus-like particles (VLPs) have been
developed: one containing VLPS of HPV types 6, 11, 16 and 18, while the
other vaccine is composed of HPV 16 and 18 VLPs. Large phase II and III
clinical trials to assess prophylactic efficacy have been conducted in
which both HPV infection endpoints and disease endpoints were evaluated,
particularly high-grade cervical intraepithelial neoplasia – CIN2 or
CIN3 – as well as vulvar and vaginal intraepithelial neoplasias – VIN or
VaIN – and genital warts for the quadrivalent vaccine. Very high
efficacy rates were observed in different populations that included
young women between 16 and 26 years of age, and older (up to 55). More
recently, the quadrivalent vaccine has been shown to be efficacious in
men to prevent genital and anal infection and disease caused by the
types included in the vaccine. Based on demonstrated clinical efficacy
and favorable safety profile, HPV prophylactic vaccine are being
introduced worldwide aiming the reduction of the morbidity and mortality
of tumors caused by HPV. From 2006 when first approved in the USA,
hundreds of countries have licensed the HPV vaccines, a significant
proportion of which are offering the vaccine to young women in national
immunization programs supported by the government. The ultimate goal is
to implement worldwide cervical cancer control programs to include HPV
vaccination and screening with cytology and HPV DNA testing,
particularly in less-developed countries where it is most needed.
Loader.rt("abs_end");
Abstract
The study of cancer
is incomplete without taking into consideration of tumorigenic viruses.
Initially, searches for human cancer viruses were fruitless despite an
expansion of our knowledge in the same period concerning
acute-transforming retroviruses in animals. However, over the last
40 years, we have witnessed rapid progress in the tumor virology field.
Currently, acknowledged human cancer viruses include Epstein–Barr virus,
hepatitis B virus, hepatitis C virus, high-risk human papilloma
viruses, human T-cell lymphotropic virus type 1 and Kaposi’s
sarcoma-associated herpesvirus. Extensive epidemiological and
mechanistic studies have led to the development of novel preventive and
therapeutic approaches for managing some of these infections and
associated cancers. In addition, recent advances in molecular
technologies have enabled the discovery of a new potential human tumor
virus, Merkel cell polyomavirus, but its association with cancer remains
to be validated. It is anticipated that in the next few decades many
additional human cancer viruses will be discovered and the mechanisms
underlying viral oncogenesis delineated. Thus, it can be expected that
better tools for preventing and treating virus-associated cancer will be
available in the near future.
Keywords: Virus discovery; Cancer viruses;
Causality; Epstein–Barr virus, EBV; Hepatitis B virus, HBV; Human
papillomavirus, HPV; Human T-cell lymphotropic virus type 1, HTLV-1;
Hepatitis C virus, HCV; Kaposi’s sarcoma-associated herpesvirus, KSHV;
Merkel cell polyomavirus (MCPyV)
It has
been estimated that chronic infections with viruses, bacteria and
parasites are the causative agents of 8–17% of global cancers burden.
Carcinogenesis associated with infections is a complex process, often
mediated by chronic inflammatory conditions and accumulating evidence
indicate that a smouldering inflammation is a component of the tumor
microenvironment and represents the 7th hallmark of cancer. Selected
infectious agents promote a cascade of events culminating in chronic
inflammatory responses, thus predisposing target tissues to increased
cancer susceptibility. A causal link also exists between an inflammatory
microenvironment, consisting of inflammatory cells and mediators, and
tumor progression. Tumor-Associated Macrophages (TAM) represent the
major inflammatory population present in tumors, orchestrating various
aspects of cancer, including: diversion and skewing of adaptive
responses; cell growth; angiogenesis; matrix deposition and remodelling;
construction of a metastatic niche and actual metastasis; response to
hormones and chemotherapeutic agents. Recent studies on human and murine
tumors indicate that TAM show a remarkable degree of plasticity and
functional heterogeneity, during tumour development. In established
tumors, TAM acquire an M2 polarized phenotype are engaged in
immunosuppression and the promotion of tumor angiogenesis and
metastasis. Being a first line of the innate defence mechanisms,
macrophages are also equipped with pathogen-recognition receptors, to
sense the presence of danger signals, including onco-pathogens.Here we discuss the evidence suggesting a causal
relationship between selected infectious agents and the pro-tumoral
reprogramming of inflammatory cells, as well as its significance in
tumor development. Finally, we discuss the implications of this
phenomenon for both cancer prevention and therapy.
Keywords: Inflammation; Cancer; Pathogens
Available online 20 June 2011.
Loader.rt("abs_end");
Human papillomavirus has been established
as the causal agent for cervical cancer. The identification of a clear
cause presents an unparalleled opportunity for cancer control. As such,
the development of prophylactic human papillomavirus vaccines has been
rightly hailed as one of the significant scientific triumphs of the past
20 years. This story of scientific triumph over disease, however, is
not yet complete. The fruit of scientific labour must be delivered to
the people in order to fulfil the underlying intent of the research
(i.e. to prevent cancer and save lives). The success of a vaccination
programme, however, does not depend on the biological efficacy of the
vaccine alone. Various other local factors, such as poverty, gender
inequality, cultural traditions, or religious beliefs, can significantly
constrain the success of any vaccination programme. In this chapter, we
provide an overview of how the human papillomavirus vaccine works and
its global uptake, as well as, how variations in local contexts can
affect the successful implementation of a vaccination programme. Other
factors besides vaccine costs also need serious attention. With better
understanding of such factors, policy makers and medical health
professionals will be better equipped to make informed decisions to
maximise the potential benefits of the human papillomavirus vaccines for
the most number of people in individual countries.
Keywords: cervical cancer; human papillomavirus
(HPV) vaccination; resource-constrained world; developed world; poverty
Summary
Background
Australia introduced a human papillomavirus (HPV)
vaccination programme with the quadrivalent HPV vaccine for all women
aged 12–26 years between 2007 and 2009. We analysed trends in cervical
abnormalities in women in Victoria, Australia, before and after
introduction of the vaccination programme.Methods
With data from the Victorian Cervical Cytology
Registry between 2003 and 2009, we compared the incidence of
histopathologically defined high-grade cervical abnormalities (HGAs,
lesions coded as cervical intraepithelial neoplasia of grade 2 or worse
or adenocarcinoma in situ; primary outcome) and low-grade cytological
abnormalities (LGAs) in five age groups before (Jan 1, 2003, to March
31, 2007) and after (April 1, 2007, to Dec 31, 2009) the vaccination
programme began. Binary comparisons between the two periods were done
with Fisher's exact test. Poisson piecewise regression analysis was used
to compare incident rate trends.Findings
After the introduction of the vaccination
programme, we recorded a decrease in the incidence of HGAs by 0·38% (95%
CI 0·61–0·16) in girls younger than 18 years. This decrease was
progressive and significantly different to the linear trend in incidence
before introduction of the vaccination (incident rate ratio 1·14,
1·00–1·30, p=0·05). No similar temporal decline was recorded for LGAs or
in older age groups.Interpretation
This is the first report of a decrease in
incidence of HGAs within 3 years after the implementation of a
population-wide HPV vaccination programme. Linkage between vaccination
and screening registers is needed to confirm that this ecological
observation is attributable to vaccination and to monitor participation
in screening among vaccinated women.
Objective
Women with HPV related pathology of the lower
genital tract are at higher risk for AIN and anal cancer than the
general population. A strategy to identify anal disease in these women
has not been formulated. The aim of this study is to examine the
feasibility of HPV related biomarker testing on anal smears, to identify
the risk factors for anal HPV positivity and to provide information of
the clinical implications of anal HPV infection in this population.Methods
In women referred for
colposcopy because of HPV related pathology of the lower genital tract
(cervical cancer, CIN, VIN, warts) a detailed questionnaire, an anal
smear and a cervical smear were taken. On each sample morphological
cytology, flow cytometric evaluation of E6&7 mRNA, and HPV DNA
detection and typing were performed. Women with a positive anal result
were referred for high resolution anoscopy.Results
So far 235 women have been included (mean age
34.3). HPV DNA, high-risk HPV DNA, high-risk mRNA was detected in 45%,
31% and 8% of the anal smears and in 56%, 39% and 25% of the cervical
smears respectively. Absolute or partial concordance of the types
between the cervix and the anus was seen in 74%. Positivity for mRNA was
significantly lower in the anus than the cervix (8% vs 25%). Logistic
regression analysis revealed risk factors for the presence of anal HPV
DNA (> 3 lifetime sexual partners and presence of cervical HPV DNA),
hr HPV DNA (presence of cervical hr HPV DNA), and hr mRNA (presence of
cervical hr mRNA). Twelve months after LLETZ 53% of women were cervical
HPV negative, but 25% of those were still HPV positive in the anus.Conclusions
HPV infection of the
anus is common in this group and is interlinked with the cervical
infection. Anal HPV E6&7 mRNA expression is less common than in the
cervix. Possible clinical implications of anal infection could be the
development of AIN and recurrence of CIN after treatment due to cervical
reinfection from the anal reservoir. The use of HPV biomarkers is
feasible in anal smears, although especially DNA testing as triage
method for referral to anoscopy is probably inappropriate due to high
positivity rate.
Loader.rt("abs_end");
Research highlights
► High
anal HPV DNA but low mRNA rates were found in women with genital HPV
lesions. ► Main determinant of anal HPV status is the cervical HPV
status. ► The anus might remain HPV positive after LEEP for CIN even if
the cervix is negative.
Keywords: HPV; Colposcopy; Anus; PCR; Flow cytometry
Loader.rt("abs_end");
Abstract
About 530,000
women develop cervical cancer worldwide and 275,000 die from the disease
each year. Eighty percent of these deaths occur in developing
countries. In Vietnam, cervical cancer has recently emerged as the most
common cancer of women, and there are no national screening programs for
cervical cancer. Since 2009, two different human papillomavirus (HPV)
vaccines have been licensed for use in Vietnam, but access to these
vaccines is generally limited to people who live in urban areas. Studies
have shown that HPV vaccination may be cost-effective in cervical
cancer prevention in Vietnam, depending on vaccination costs. Given that
current HPV vaccines are expensive and public health funding for
supporting a rapid introduction of the vaccine is limited, expanding and
sustaining access to the HPV vaccine may require alternative financing
mechanisms, such as fees-based immunization services.A conjoint analysis study was conducted with
mothers of girls 11 to 17 years of age in Vinh Long Province in Vietnam
to estimate the mothers' private demand for HPV vaccines for their
daughters and to measure the tradeoffs between vaccine fees and vaccine
uptake. The results suggest that the demand for HPV vaccines was high,
increased with vaccine effectiveness and duration of effectiveness, and
decreased with vaccine cost. Vaccine effectiveness was the most
important vaccine attribute to these mothers, followed by duration of
effectiveness. The predicted probability of respondents buying an HPV
vaccine that was 70% effective for 10 years varied by the price, ranging
from 30% when the vaccine price was $353, to 68% when the vaccine cost
$6 per course. As expected, demand and predicted purchase probability
were higher among groups with higher socioeconomic status.
