RESUMO
We assessed whether contemporary immunosuppression agents were associated with cancer among kidney transplant recipients (KTR), and if this association varied by age and sex. We studied a retrospective province-wide cohort of primary KTR (1997-2016). Employing multivariable Cox models, we estimated associations of cumulative doses of prednisone, mycophenolate and tacrolimus administered over the past 10 years, lagged by 2 years, with the incidence of primary malignant neoplasms (PMN). We assessed interactions with age and sex. To assess the impact of exposure recency, we used weighted cumulative exposure (WCE) modeling. Among 1064 KTR, 108 (10.2%) developed PMN over median follow-up of 73 months (interquartile range: 32-120). Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of 0.96 (0.64-1.43), 1.34 (0.96-1.86), and 1.06 (0.88-1.29) were estimated for cumulative daily doses of prednisone (5 mg), mycophenolate (1000 mg), and tacrolimus (2 mg) administered continuously over the past 10 years, respectively. PMN risk associated with cumulative tacrolimus exposure was modified by age (interaction p = .035) and was more pronounced in 15-year and 30-year-old KTR (aHRs of 1.57 [1.08-2.28] and 1.31 [1.03-1.66], respectively) in comparison to older KTR. PMN risk increase associated with higher cumulative mycophenolate dose was more pronounced in females (aHR = 1.86 [1.15-3.00]) than in males (aHR = 1.16 [0.74-1.81]; interaction p = .131). WCE analyses suggested increased PMN risk the higher the mycophenolate doses taken 5-10 years ago. A trend toward increased PMN risk with long-term mycophenolate exposure, particularly in females, and more pronounced risk with long-term tacrolimus exposure in younger KTR, identify opportunities for tailored immunosuppression to mitigate cancer risk.
Assuntos
Transplante de Rim , Neoplasias , Masculino , Feminino , Humanos , Adolescente , Tacrolimo/efeitos adversos , Estudos Retrospectivos , Prednisona/efeitos adversos , Transplante de Rim/efeitos adversos , Ácido Micofenólico/efeitos adversos , Rejeição de Enxerto/epidemiologia , Imunossupressores/efeitos adversos , Terapia de Imunossupressão/efeitos adversos , Inibidores Enzimáticos , Neoplasias/induzido quimicamente , Neoplasias/epidemiologia , TransplantadosRESUMO
BACKGROUND: The knowledge on vertical human papillomavirus (HPV) transmission is limited. We aimed to determine whether HPV transmission from parents to their offspring occurs before or during birth. METHODS: Altogether, 321 mothers, 134 fathers, and their 321 newborn offspring from the Finnish Family HPV study cohort were included. Parents' genital and oral brush samples and semen samples were collected for HPV testing at baseline (36 weeks of pregnancy). Oral, genital, and umbilical samples from the newborn and placenta samples were collected for HPV testing immediately after delivery. HPV risk for the newborn was calculated from the mother's and father's HPV status by using logistic regression analyses. RESULTS: Concordances between mothers' and their newborns' HPV genotype at any site were statistically significant with HPV-6, -16, -18, -31, and -56; odds ratios (ORs) ranged from 3.41 (95% confidence interval [CI], 1.80-6.48) for HPV-16 to 634 (95% CI, 28.5-14 087) for HPV-31. Father-newborn HPV concordance was statistically significant with HPV-6 and HPV-31 (ORs, 4.89 [95% CI, 1.09-21.9] and 65.0 [95% CI, 2.92-1448], respectively). CONCLUSIONS: The genotype-specific HPV concordance between parents and their newborn is suggestive for vertical HPV transmission. However, transmission from the father to the newborn remains more uncertain.
Assuntos
Infecções por Papillomavirus , Complicações Infecciosas na Gravidez , Gravidez , Feminino , Humanos , Recém-Nascido , Papillomavirus Humano , Finlândia , Papillomaviridae/genética , Pais , Papillomavirus Humano 31RESUMO
BACKGROUND: Colorectal cancer (CRC) is a major cause of cancer deaths worldwide. Accumulating evidence suggests a potentially important role of colorectal infection with Fusobacterium nucleatum (F. nucleatum) in colorectal carcinogenesis. We conducted a systematic review, including both a qualitative synthesis and a meta-analysis, to synthesize the evidence from the epidemiological literature on the association between F. nucleatum detection in the colon/rectum and CRC. METHODS: A systematic literature search of Ovid MEDLINE(R), Embase, Web of Science Core Collection, EBM Reviews-Cochrane Database of Systematic Reviews, and CINAHL Plus with Full Text was conducted using earliest inclusive dates up to 4 October 2020. Eligible studies were original, comparative observational studies that reported results on colorectal F. nucleatum detection and CRC. Two independent reviewers extracted the relevant information. Odds ratio (OR) estimates were pooled across studies using the random effects model. Newcastle-Ottawa scale was used to critically appraise study quality. RESULTS: Twenty-four studies were included in the systematic review, of which 12 were included in the meta-analysis. Studies investigated F. nucleatum in feces, colorectal tissue samples, or both. In most studies included in the systematic review, the load of F. nucleatum was higher, on average, in specimens from CRC patients than in those from CRC-free controls. Meta-analysis showed a positive association between F. nucleatum detection in colorectal specimens and CRC (OR = 8.3; 95% confidence interval (95% CI) 5.2 to 13.0). CONCLUSIONS: The results of this systematic review suggest that F. nucleatum in the colon/rectum is associated with CRC. SYSTEMATIC REVIEW REGISTRATION: This systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) on July 10, 2018 (registration number CRD42018095866).
Assuntos
Neoplasias Colorretais , Fezes , Fusobacterium nucleatum , Humanos , Mucosa , Fatores de RiscoRESUMO
Most women positive for human papillomavirus (HPV) are cytology normal. The optimal screen-management of these women is unclear given their risk of developing precancer. We performed a systematic review and meta-analysis of progression rates to precancer and cancer for HPV-positive, cytology normal women. We searched MEDLINE, EMBASE and Scopus for prospective studies measuring the cumulative incidence of precancer and cervical cancer in HPV-positive, cytology/histology normal women. Record screening was performed independently by two reviewers. We modeled the cumulative incidence over time using a multilevel random-effects meta-regression model. We used the model to predict HPV type-specific risks of precancer and cancer over follow-up. Data from 162 unique records were used in our analysis. The average incidence rate of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) in high-risk HPV positive but cytology/histology normal women was 1.0 per 100 women-years (95% CI: 1.0-1.1). This corresponds to an average cumulative risk at 1, 3 and 5 years of 2.1% (95% prediction interval 0.0-9.5), 4.3% (95% prediction interval 0.0-11.5) and 6.4% (95% prediction interval 0.0-13.5). HPV type was a strong predictor of the risk of oncogenic progression. There was substantial heterogeneity in the background precancer risk across studies (P-value < .0001). Our HPV type-specific progression risk estimates can help inform risk-based cervical cancer screening guidelines for HPV-positive women. However, precancer and cervical cancer risks are highly variable and may not be generalizable between populations.
Assuntos
Alphapapillomavirus/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Alphapapillomavirus/genética , DNA Viral/genética , Feminino , Humanos , Gradação de Tumores , Estudos Observacionais como Assunto , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/virologiaRESUMO
OBJECTIVE: To perform a systematic review of the literature to estimate the prevalence and outcomes of occult tubal carcinoma in BRCA mutation carriers and high-risk patients undergoing risk-reducing salpingo-oophorectomy. DATA SOURCE: A search was done using OVID MEDLINE, EMBASE, and ClinicalTrials.gov between 1946 and March 2019 with keywords and MeSH terms selected by an expert medical librarian and coauthors. METHODS OF STUDY SELECTION: Two independent reviewers performed study selection with an initial screen on abstracts and a second on full articles. Articles were rejected if they were irrelevant to the study question, pertained to a different population or did not report occult tubal neoplasia. Quality was assessed using methodologic index for nonrandomized studies criteria. TABULATION, INTEGRATION, AND RESULTS: Data were extracted and recorded in an Excel database. Forest plots for the prevalence of occult carcinoma were done using STATA. Among 2,402 studies assessed, 27 met the inclusion criteria for qualitative and quantitative analysis. A total of 6,283 patients underwent risk-reducing salpingo-oophorectomy between 2002 and 2019: 2,894 cases were BRCA1, 1,579 BRCA2, and 1,810 high-risk based on family history. Among these, 75 patients were diagnosed with occult tubal carcinoma at the time of surgery. The pooled prevalence was 1.2% (I=7.1%, P=.363) occurring at a median age of 53.2 years (range 42.4-67). In a subanalysis of 18 studies reporting follow-up data, 10 recurrences (18.7%, 95% CI 7.5-53%) and 24 cases of post-risk-reducing salpingo-oophorectomy peritoneal cancer (0.54%, 95% CI 0.4-1.9%) were reported after a median follow-up of 52.5 months. BRCA1, older age, and previous breast cancer were more often associated with occult malignancy. CONCLUSION: Occult tubal carcinomas found at risk-reducing salpingo-oophorectomy in high-risk patients and BRCA mutation carriers have significant potential for recurrence despite the frequent administration of postoperative chemotherapy.
Assuntos
Carcinoma/epidemiologia , Neoplasias das Tubas Uterinas/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Procedimentos Cirúrgicos Profiláticos , Feminino , HumanosRESUMO
BACKGROUND: This study aimed to estimate the extent to which oral sex behavior is associated with an increased risk of oropharyngeal cancers (OPCs), and how much of the association is mediated by oral human papillomavirus (HPV) infection. METHODS: We used data from a hospital-based case-control study conducted in Montreal, Canada. Information on oral sex behaviors was collected. Oral rinse and oral brush specimens were analyzed for HPV positivity and genotyping. Logistic regression estimated the odds ratios (OR) and 95% confidence intervals (CI) for the association between oral sex behaviors and OPC. RESULTS: Onset of oral sex practice at age 16 years or younger had an increased risk of OPCs relative to those with onset after age 30 years (OR = 2.98; 95% CI 1.37-6.47). This association decreased (OR = 1.09; 95% CI 0.25-4.71) when restricted to those positive for HPV. CONCLUSIONS: Our results suggest that the association between oral sex and OPC seems mediated by oral HPV infection.
Assuntos
Carcinoma de Células Escamosas/virologia , Neoplasias Orofaríngeas/epidemiologia , Neoplasias Orofaríngeas/virologia , Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Comportamento Sexual , Idoso , Canadá , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Neoplasias Orofaríngeas/psicologia , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/psicologia , Fatores de RiscoRESUMO
Solid organ transplant recipients have an increased risk of lip cancer, but the reasons are uncertain. Using data from the Transplant Cancer Match Study, we describe the epidemiology of lip cancer among 261 500 transplant recipients in the United States. Two hundred thirty-one lip cancers were identified, corresponding to elevated risks for both invasive and in situ lip cancers (standardized incidence ratios of 15.3 and 26.2, respectively). Invasive lip cancer incidence was associated with male sex (adjusted incidence rate ratio [aIRR] 2.01, 95% CI 1.44-2.82), transplanted organ (0.33, 0.20-0.57, for liver transplants and 3.07, 1.96-4.81, for lung transplants, compared with kidney transplants), and racial/ethnic groups other than non-Hispanic whites (0.09, 0.04-0.2). In addition, incidence increased with age and during the first 3 years following transplant, and was higher in recipients prescribed cyclosporine/azathioprine maintenance therapy (aIRR 1.79, 95% CI 1.09-2.93, compared with use of tacrolimus/mycophenolate mofetil) and following a diagnosis of cutaneous squamous cell carcinoma (4.21, 2.69-0.94). The elevation in lip cancer incidence is consistent with an effect of immunosuppression. Notably, the very strong associations with white race and history of prior skin cancer point to an important role for ultraviolet radiation exposure, and cyclosporine and azathioprine may contribute as photosensitizing or DNA damaging agents.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Labiais/diagnóstico , Transplante de Órgãos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Transplantados , Adolescente , Adulto , Idoso , Azatioprina/efeitos adversos , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/etnologia , Criança , Pré-Escolar , Ciclosporina/efeitos adversos , Dano ao DNA , Etnicidade , Feminino , Humanos , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Incidência , Lactente , Recém-Nascido , Neoplasias Labiais/epidemiologia , Neoplasias Labiais/etnologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos , Adulto JovemRESUMO
PURPOSE: We evaluated whether an increased body-mass index (BMI) and decreased physical activity increase the risk of locally advanced or high-risk prostate cancer (PCa) at radical prostatectomy (RP), and treatment failure after surgery. METHODS: Data were collected from the PROCURE Biobank, a prospective cohort of patients with localized PCa undergoing RP in four academic centers in Québec between 2006 and 2013. Treatment failure was defined as biochemical recurrence and/or initiation of secondary, non-adjuvant therapy, and analyzed using the Kaplan-Meier method, log-rank tests, and Cox proportional-hazards models. Uni- and multivariate (ordered) logistic regression was used for time-independent variables. RESULTS: 1813 patients were included. Median follow-up time was 69 months. Patients who reported a lower BMI were generally older, of Asian descent, and physically more active (p < 0.05). Younger, black, and overweight/obese patients reported less physical activity (p < 0.05). In multivariate analyses, a higher BMI increased the risk for locally advanced, high-risk PCa (defined as a pT3, N1 and/or Gleason 8-10 tumor; odds ratio 1.33, p < 0.001), but increased physical activity did not predict high-risk disease (odds ratio 0.84, p = 0.39). Patients with a higher BMI also had a larger prostate at surgery (odds ratio 1.13, p = 0.03). BMI and physical activity were not associated with positive surgical margins or time to treatment failure (p > 0.05). CONCLUSIONS: BMI was an independent predictor for locally advanced, high-risk disease in this cohort of PCa patients undergoing RP, but was unrelated to treatment failure. Physical activity was not related to locally advanced, high-risk PCa or treatment failure.
Assuntos
Exercício Físico , Obesidade/epidemiologia , Prostatectomia , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Humanos , Modelos Logísticos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Prospectivos , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Falha de Tratamento , Resultado do TratamentoAssuntos
Humanos , Comportamento Sexual , Comportamento , Neoplasias , Sexo , Infecções Sexualmente Transmissíveis , HIVRESUMO
BACKGROUND: Adults with congenital heart disease (CHD) are exposed to increasing amounts of low-dose ionizing radiation (LDIR) from cardiac procedures. Cancer prevalence in this population is higher than in the general population. This study estimates the association between LDIR exposure from cardiac procedures and incident cancer in adult patients with CHD. METHODS: The study population derived from the Quebec Congenital Heart Disease Database. We measured cumulative numbers of LDIR-related cardiac procedures for each patient until 1 year before the time of cancer diagnosis or administrative censoring. To assess the association between LDIR exposure and cancer risk, we conducted a nested case-control study and matched cancer cases with controls on sex, CHD severity, birth year, and age. RESULTS: The study included 24 833 adult patients with CHD aged 18 to 64 years from 1995 to 2009. In >250 791 person-years of follow-up, 602 cancer cases were observed (median age, 55.4 years). The cumulative incidence of cancer estimated up to 64 years of age was 15.3% (95% confidence interval [CI], 14.2-16.5). Cases had more LDIR-related cardiac procedures than controls (1410 versus 921 per 1000 adult patients with CHD, P<0.0001). Cumulative LDIR exposure was independently associated with cancer (odds ratio [OR], 1.08 per procedure; 95% CI, 1.04-1.13). Similar results were obtained by using dose estimates for LDIR exposure (OR, 1.10 per 10 mSv; 95% CI, 1.05-1.15) with a possible dose-related response. The effect measure was in the same direction, and the association was persistent for exposure from ≥6 procedures in all sensitivity analyses: after excluding most smoking-related cancer cases (OR, 1.10 per procedure; 95% CI, 1.05-1.16 and OR when exposure from ≥6 procedures, 3.08; 95% CI, 1.77-5.37), and after applying a 3-year lag period (OR, 1.09 per procedure; 95% CI, 1.03-1.14 and OR when exposure from ≥6 procedures: 2.58; 95% CI, 1.43-4.69). CONCLUSIONS: To our knowledge, this is the first large population-based study to analyze and document the association between LDIR-related cardiac procedures and incident cancer in the population of adults with CHD. Confirmations of these findings by prospective studies are needed to reinforce policy recommendations for radiation surveillance in patients with CHD where no regulation currently exists. Physicians ordering and performing cardiac imaging should ensure that exposure is as low as reasonably achievable without sacrificing quality of care.
Assuntos
Cardiopatias Congênitas/diagnóstico por imagem , Neoplasias Induzidas por Radiação/diagnóstico , Radiação Ionizante , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos , Bases de Dados Factuais , Feminino , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/etiologia , Razão de Chances , Quebeque/epidemiologia , Doses de Radiação , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Despite the growing appreciation of the importance of sex and gender considerations in transplantation research, there is currently no framework or good practice guidelines for the appropriate handling of sex and gender issues in human allotransplantation research. METHODS: We will conduct a scoping review to synthesize the evidence on how matters of sex and gender have been handled in human allotransplantation research. We will survey the literature discussing sex and gender in relation to transplantation, including adult and pediatric patients, hematopoietic and solid organ transplant recipients as well as organ donors. We will search MEDLINE and Embase for literature discussing sex and gender in relation to transplantation. Two reviewers will independently evaluate the eligibility of all identified titles and abstracts for inclusion in the full text review, as well as data extraction. Descriptive data and information on how sex and gender have been considered in human transplantation research will be reported. DISCUSSION: This scoping review will be an important stepping stone towards the development of good practice guidelines on study design and analysis considerations when handling sex and gender issues in human transplantation research. This scoping review can also help identify methodological issues that restrict the translation of transplantation research findings into clinical practice related to underestimation of sex/gender differences. This review will ultimately identify major gaps, inform donor-recipient selection, guide personalized interventions, and prioritize research recommendations in human transplantation research.
Assuntos
Identidade de Gênero , Fatores Sexuais , Transplante , Feminino , Humanos , Masculino , Projetos de Pesquisa , Caracteres Sexuais , Doadores de Tecidos , TransplantadosRESUMO
OBJECTIVE: Human papillomaviruses (HPV) are changing dramatically the epidemiologic landscape of head and neck cancers (HNCs). Their role in the aetiology of these cancers varies widely among HNCs subsites, sex and geographical regions worldwide. We describe HPV prevalence and its association with HNCs risk overall and by anatomical subsite in a sample of Canadians. MATERIALS AND METHODS: The HeNCe Life study recruited 460 incident HNCs cases and 458 controls frequency-matched by age and sex from four Montreal hospitals in 2005-2013. We tested oral rinse and oral brush specimens for mucosal HPV genotypes. HPV positivity was categorized hierarchically as either negative, exclusively non-α-9 species types, α-9 types other than HPV16, and HPV16. We estimated odds ratios (OR) and 95% confidence intervals (CI) for the associations between HPV and HNCs using unconditional logistic regression, controlling for confounders. RESULTS: The prevalence of HPV infection among controls and cases was 14.5% and 41.2% in oral rinse and 3.1% and 24.4% in oral brush samples, respectively. HPV16 was the predominant genotype with an oral rinse and oral brush prevalence of 26.3% and 16.2% among cases and 2.4% and 0.2% among controls, respectively. HPV infection was associated with an increased risk of HNCs overall (OR=4.18; 95% CI, 2.94-5.95) and oropharyngeal cancer only (OR=10.3; 95% CI, 6.8-15.7). HNCs and oropharyngeal cancer were strongly associated with HPV16 (OR=18.1; 95% CI, 9.1-35.8, and OR=47.2; 95% CI, 23.1-96.6, respectively). CONCLUSION: HPV infection, particularly HPV16, was associated with an increased HNCs risk, most strongly for oropharyngeal cancers.
Assuntos
Alphapapillomavirus/genética , Carcinoma de Células Escamosas/virologia , Genótipo , Neoplasias de Cabeça e Pescoço/virologia , Idoso , Canadá , Estudos de Casos e Controles , Feminino , Genes Virais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
Some studies suggest that periodontal diseases increase the risk of oral cancer, but contradictory results also exist. Inadequate control of confounders, including life course exposures, may have influenced prior findings. We estimate the extent to which high levels of periodontal diseases, measured by gingival inflammation and recession, are associated with oral cancer risk using a comprehensive subset of potential confounders and applying a stringent adjustment approach. In a hospital-based case-control study, incident oral cancer cases (N = 350) were recruited from two major referral hospitals in Kerala, South India, from 2008 to 2012. Controls (N = 371), frequency-matched by age and sex, were recruited from clinics at the same hospitals. Structured interviews collected information on several domains of exposure via a detailed life course questionnaire. Periodontal diseases, as measured by gingival inflammation and gingival recession, were evaluated visually by qualified dentists following a detailed protocol. The relationship between periodontal diseases and oral cancer risk was assessed by unconditional logistic regression using a stringent empirical selection of potential confounders corresponding to a 1% change-in-estimates. Generalized gingival recession was significantly associated with oral cancer risk (Odds Ratio = 1.83, 95% Confidence Interval: 1.10-3.04). No significant association was observed between gingival inflammation and oral cancer. Our findings support the hypothesis that high levels of periodontal diseases increase the risk of oral cancer.
Assuntos
Retração Gengival/epidemiologia , Gengivite/epidemiologia , Neoplasias Bucais/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Índia/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-IdadeRESUMO
Oral cancer is a major public health issue in India with â¼ 77,000 new cases and 52,000 deaths yearly. Paan chewing, tobacco and alcohol use are strong risk factors for this cancer in India. Human papillomaviruses (HPVs) are also related to a subset of head and neck cancers (HNCs). We examined the association between oral HPV and oral cancer in a sample of Indian subjects participating in a hospital-based case-control study. We recruited incident oral cancer cases (N = 350) and controls frequency-matched by age and sex (N = 371) from two main referral hospitals in Kerala, South India. Sociodemographic and behavioral data were collected by interviews. Epithelial cells were sampled using Oral CDx® brushes from the oral cancer site and the normal mucosa. Detection and genotyping of 36 HPV genotypes were done using a polymerase chain reaction protocol. Data collection procedures were performed by qualified dentists via a detailed protocol with strict quality control, including independent HPV testing in India and Canada. HPV DNA was detected in none of the cases or controls. Associations between oral cancer and risk factors usually associated with HPV infection, such as oral sex and number of lifetime sexual partners, were examined by logistic regression and were not associated with oral cancer. Lack of a role for HPV infection in this study may reflect cultural or religious characteristics specific to this region in India that are not conducive to oral HPV transmission. A nationwide representative prevalence study is needed to investigate HPV prevalence variability among Indian regions.
Assuntos
Carcinoma de Células Escamosas/virologia , Neoplasias Bucais/virologia , Infecções por Papillomavirus/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Papillomaviridae , Reação em Cadeia da PolimeraseRESUMO
STUDY QUESTION: What is the prevalence of human papillomavirus (HPV) in semen? SUMMARY ANSWER: HPV is present in the semen of asymptomatic men, with a pooled prevalence in a random effects meta-analysis of populations seeking fertility evaluation/treatment of 16%, versus 10% in other populations. WHAT IS KNOWN ALREADY: The main risk of donor insemination (DI) is known to be contamination with an infectious agent. HPV is the necessary cause of cervical cancer, and plays an etiologic role in other anogenital cancers. Although it is known to be prevalent and sexually transmitted, donor semen specimens are not tested for the presence of HPV. STUDY DESIGN, SIZE, DURATION: A systematic review and meta-analysis of studies published between January 1980 and June 2013 were performed. Variables collected included characteristics of study populations, method of semen preparation, HPV DNA detection and genotyping, HPV types targeted and proportion of HPV positivity. PARTICIPANTS/MATERIALS, SETTING, METHODS: Two investigators independently assessed the studies for inclusion in the review and abstracted the data, while others reviewed the extracted data in detail. Studies were included if they provided data on HPV DNA prevalence in semen and PCR-based methods were used. For the meta-analysis, reports were separated according to the study populations, creating two distinct subgroups: populations seeking fertility evaluation/treatments, and other populations. Data were analysed using a random effects model for each subpopulation. MAIN RESULTS AND THE ROLE OF CHANCE: The literature search identified 285 studies, and in the 27 studies that were included the HPV DNA prevalence in 4029 semen samples varied from 0 to 100%. The three studies focusing on sperm donors identified HPV DNA in 26.3, 7.5 and 16.0% of semen samples. HPV-16 was the most common type overall. The pooled prevalence in a random effects meta-analysis of seven studies focusing on infertile populations was 16% [95% confidence interval (CI): 10-23%] versus 10% (95% CI: 7-14%) in 11 reports focusing on other populations. LIMITATIONS, REASONS FOR CAUTION: First, despite defining clinically relevant subgroups, substantial heterogeneity remained. Secondly, although we retrieved data from reports in English or French only, after reviewing the five reports in other languages only two more could have been added and, as their prevalence estimates were similar to those of studies included in our review, we do not believe that exclusion of these reports biased our results or conclusions. WIDER IMPLICATIONS OF THE FINDINGS: HPV DNA can be found in donor semen and preliminary studies confirm genome activity. For this reason, and although the exact consequences of insemination with HPV-infected semen (cervical infections/lesions, impact on success rate of DI) remain to be clarified, we believe that HPV-infected sperm should be considered a health risk unless well-designed studies prove otherwise. The development and validation of adequate sperm washing techniques before DI appears to be a promising option. STUDY FUNDING/COMPETING INTEREST(S): C.L. and P.M. have no conflicts of interests relevant to the submitted work. H.T. has served as a consultant and on advisory boards and has received speaker fees and travel assistance from Merck-Frosst Canada, Glaxo SmithKline Pharmaceuticals, Belgium and Gilead Sciences. F.C. has received grants through his institution from Merck and Roche, as well as honoraria from Merck and Roche for lectures on HPV. M.-H.M. has received grants though her institution from Merck and Qiagen and lecture honoraria from Merck and GSK for conferences on HPV and best practices in cervical cancer prevention. TRIAL REGISTRATION NUMBER: N/A.