RESUMEN
African American women suffer under the burden of cervical cancer as they are first in mortality, diagnosed at later stages, and have a survivorship rate that is lower than the national average. The aim of our review is to evaluate the effectiveness of cervical cancer screening and prevention interventions for African American women living in the United States and to assess their commitment to health equity. A literature search was conducted using PubMed, Embase, CINAHL, and Scopus using MeSH terms related to cervical cancer, human papillomavirus (HPV), screening and prevention, and African Americans. This resulted in 1970 articles. Studies were included if they promoted cervical screening or prevention, sampled African American women aged 18 and over, and evaluated interventions. Among the 23 articles that met inclusion criteria, there were a wide variety of intervention strategies, that is, community health workers, patient navigation, patient reminders, self-sampling collection, and HPV vaccination. Health education interventions, when coupled with patient navigation or community health workers, were effective in promoting screening participation (odds ratio: 2.43, 95% confidence interval: 1.47-4.02). There were mixed results regarding the incorporation of health equity principles. This review supports the importance of incorporating health equity principles and community based methods in screening and prevention interventions. Future research and practice should incorporate African American women's perspectives in intervention development and implementation.
Asunto(s)
Negro o Afroamericano , Detección Precoz del Cáncer , Equidad en Salud , Tamizaje Masivo , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Humanos , Femenino , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/etnología , Negro o Afroamericano/estadística & datos numéricos , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/diagnóstico , Estados Unidos , Tamizaje Masivo/estadística & datos numéricos , Vacunas contra Papillomavirus/administración & dosificación , Adulto , Promoción de la Salud/métodosRESUMEN
Introduction: This study explored the influence of the Theory of Planned Behavior constructs on human papillomavirus (HPV) vaccine (HPVV) intentions and uptake among Hispanic parents in South Florida for their children aged 9-21. Method: A descriptive exploratory analysis was conducted using 39 surveys completed by Hispanic parents. These surveys encompassed demographic data and questions about HPVV uptake, intention, attitudes, subjective norms, knowledge, self-efficacy, and awareness. Results: Most participants were uninsured (77%), unemployed (59%), and had low Americanism acculturation (74%). A little over half were aware of the HPVV (54%), yet most had high positive HPVV attitudes (95%) and self-efficacy (85%). HPVV intentions within the year were also high (82%); however, HPVV uptake (45%) and HPVV knowledge (40%) were low at the time of the study. Most parents reported physicians (72%) and nurses/nurse practitioners (59%) as the most influential individuals in their decision-making. A statistically significant relationship between HPVV intention and HPVV attitude (X_Wald^2 (1) = 5.71, p = 0.02., OR = 5.11) and between HPVV uptake and HPVV awareness (X_Wald^2 (1) = 4.63, p = 0.03., OR = 12) were observed. Conclusion: This study recommends further research and targeted interventions to improve HPVV awareness among Hispanic communities. The participants' highly positive attitudes and self-efficacy provide a hopeful outlook for future vaccination efforts within this demographic.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos , Intención , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Padres , Autoeficacia , Humanos , Hispánicos o Latinos/psicología , Vacunas contra Papillomavirus/administración & dosificación , Femenino , Masculino , Estudios Transversales , Padres/psicología , Adulto , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/etnología , Florida , Adolescente , Niño , Adulto Joven , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Encuestas y Cuestionarios , Vacunación/psicologíaRESUMEN
BACKGROUND: Latina women experience disproportionately higher rates of HPV infection, persistence, and progression to cervical dysplasia and cancer compared to other racial-ethnic groups. This systematic review explores the relationship between the cervicovaginal microbiome and human papillomavirus infection, cervical dysplasia, and cervical cancer in Latinas. METHODS: The review abides by the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, EMBASE, and Scopus databases were searched from January 2000 through November 11, 2022. The review included observational studies reporting on the cervicovaginal microbiota in premenopausal Latina women with human papillomavirus infection, cervical dysplasia, and cervical cancer. RESULTS: Twenty-five articles were eligible for final inclusion (N = 131,183). Forty-two unique bacteria were reported in the cervicovaginal microbiome of Latinas. Seven bacteria: Lactobacillus crispatus, Lactobacillus iners, Chlamydia trachomatis, Prevotella spp., Prevotella amnii, Fusobacterium spp. and Sneathia spp. were enriched across multiple stages of cervical carcinogenesis in Latinas. Therefore, the total number of reported bacteria includes four bacteria associated with the healthy state, 16 bacteria enriched in human papillomavirus outcomes, 24 unique bacteria associated with abnormal cytology/dysplasia, and five bacteria associated with cervical cancer. Furthermore, three studies reported significantly higher alpha and beta diversity in Latinas with cervical dysplasia and cancer compared to controls. Lactobacillus depletion and an increased abundance of L. iners in Latinas compared to non-Latinas, regardless of human papillomavirus status or lesions, were observed. CONCLUSIONS: The identification of 42 unique bacteria and their enrichment in cervical carcinogenesis can guide future cervicovaginal microbiome research to better inform cervical cancer prevention strategies in Latinas.
Asunto(s)
Hispánicos o Latinos , Microbiota , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Vagina , Humanos , Femenino , Infecciones por Papillomavirus/etnología , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/microbiología , Hispánicos o Latinos/estadística & datos numéricos , Vagina/microbiología , Displasia del Cuello del Útero/microbiología , Displasia del Cuello del Útero/virología , Displasia del Cuello del Útero/etnología , CarcinogénesisRESUMEN
Safe and effective vaccines have been developed that protect against high-risk strains of HPV, but uptake is relatively low. We previously identified factors such as sexual attitudes and HPV knowledge that impact the intent of Christian parents to vaccinate their children against HPV. We hypothesized that culturally specific interventions in the form of short videos would be effective at improving HPV vaccine intentions and attitudes. We made three short educational videos, one with a Christian focus, one informational about HPV, and one control. Videos were distributed electronically with accompanying surveys, and responses were measured before and after watching a randomly selected video. The religious-focused and educational interventions significantly (p < 0.0001, p = 0.0015) improved intentions towards HPV vaccination. The religiously-focused video also significantly diminished the belief that the HPV vaccine is unnecessary because of a family's values (p = 0.014). Parents significantly credited both interventions with improving their intent to vaccinate their children against HPV (p < 0.001 for both). These results suggest that culturally focused educational interventions are effective at influencing vaccine intentions and attitudes, even when those are based on religious or cultural feelings. Highly specific interventions are likely to be necessary for optimal improvement in vaccine hesitancy.
Asunto(s)
Cristianismo , Conocimientos, Actitudes y Práctica en Salud , Intención , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Vacunas contra Papillomavirus/administración & dosificación , Femenino , Masculino , Adulto , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/etnología , Adolescente , Estados Unidos , Padres/psicología , Persona de Mediana Edad , Adulto Joven , Grabación en Video , Educación en Salud/métodos , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicologíaRESUMEN
BACKGROUND: The incidence of cervical cancer in Uyghur women ranks first among those in Han and other ethnic minority groups. We aimed to understand the natural history of HPV in Uyghur women. METHODS: A longitudinal cohort study on the natural history of HPV infection in rural Uyghur women in China was conducted between May 2013 and May 2014. A total of 11000 women from South Xinjiang underwent HPV screening by careHPV and liquid-based cytology. Ultimately, a total of 298 women with positive HPV and normal biopsy results or CIN1 were enrolled to participate in a study including follow-up HPV testing for two years. RESULTS: The HPV infection rate in Uyghur women was 9.15%. Among the participants, the careHPV test showed that 298 women were HPV-positive, and histology showed CIN1 or normal results for these women at baseline. Among these patients, after 24 months of initial recruitment, 92 (30.87%) patients had persistent HPV infections, and 206 (69.13%) had cleared HPV infection. Univariate analysis showed that persistent HPV infection was associated with age and shower frequency (P < 0.001 and P = 0.047, respectively). CONCLUSIONS: Our results suggest that women over the age of 50 years who have been infected with HR-HPV for more than 1 year should be regularly screened and monitored for HPV. In addition, education should be strengthened to improve poor health habits in these women.
Asunto(s)
Infecciones por Papillomavirus , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Femenino , Humanos , Persona de Mediana Edad , China/epidemiología , Etnicidad , Estudios Longitudinales , Grupos Minoritarios , Papillomaviridae , Infecciones por Papillomavirus/etnología , Prevalencia , Factores de Riesgo , Displasia del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/etnología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/etnologíaRESUMEN
BACKGROUND: Despite the disparate human papillomavirus (HPV) infection rates among sexually active Black young adults, HPV vaccine uptake remains low among this population. This study aimed to explore HPV beliefs, attitudes, and knowledge among Black young adults and provide recommendations on ways to improve vaccine uptake. METHODS: We used a mixed-method, convergent design to conduct five focus groups and administered a 40-item electronic survey that was developed with health belief model (HBM) constructs. We assessed HPV and vaccine knowledge, barriers, and attitudes toward vaccination. We analyzed quantitative data using descriptive statistics and bivariate methods. Focus group transcripts were analyzed using content analysis. Results were integrated to obtain a better understanding of the topic. RESULTS: Forty individuals participated in the study. The mean age was 22.2 ± 4.5 years and 55% identified as African immigrants. Integrated data revealed themes mapped to relevant HBM constructs. Almost one third (32.5%) of participants were unaware of their susceptibility to HPV infection and its severity. From focus group discussions, the majority (75%) believed that vaccines are beneficial. Major cues to action include promoting HPV vaccine uptake via community wide informational sessions, provider recommendation, and social and mass media campaigns. CONCLUSION: Barriers to vaccine uptake, limited HPV knowledge, and lack of vaccine recommendation are important factors contributing to low vaccine uptake among Black young adults. Interventions to decrease barriers to HPV vaccination, increase HPV knowledge, address misconceptions, and unfavorable beliefs are needed to promote HPV vaccine uptake.
Asunto(s)
Población Negra , Emigrantes e Inmigrantes , Conocimientos, Actitudes y Práctica en Salud , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Aceptación de la Atención de Salud , Adolescente , Adulto , Humanos , Adulto Joven , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud/etnología , Virus del Papiloma Humano , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/psicología , Vacunas contra Papillomavirus/uso terapéutico , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Vacunación/psicología , África/etnología , Población Negra/psicología , Población Negra/estadística & datos numéricosRESUMEN
BACKGROUND: Asian Americans and Native Hawaiians and other Pacific Islanders have suboptimal human papillomavirus (HPV) vaccination and cancer screening rates. Asian Americans and NHPIs are often aggregated, masking disparities characterized by varying colonization and immigration patterns and cultural and religious beliefs between populations and ethnicities. We examined the incidence of HPV-associated cancers across disaggregated Asian American and NHPI ethnicities. METHODS: Using the Surveillance, Epidemiology, and End Results Detailed Asian/Pacific Islander database, we calculated 1990 to 2014 sex-specific, age-standardized HPV-associated cancer incidence of cervical carcinoma, oropharyngeal squamous cell carcinoma (SCC), vulvar SCC, vaginal SCC, anal SCC, and penile SCC by ethnicity: Asian Indian and Pakistani, Chinese, Filipino, Japanese, Kampuchean, Korean, Laotian, Native Hawaiian, other Pacific Islander, and Vietnamese. Trends by calendar period (1990 to 1996, 1997 to 2002, 2003 to 2008, 2009 to 2014) were estimated using Joinpoint regression. RESULTS: The most common HPV-associated cancer was cervical carcinoma in women and oropharyngeal SCC in men. During 1990 to 2014, cervical carcinoma incidence per 100â000 ranged from 4.5 (Asian Indian and Pakistani) to 20.7 (Laotian). Cervical carcinoma incidence only statistically significantly declined for Asian Indian and Pakistani, Filipino, Korean, Laotian, and Vietnamese women (range = 19.9% to 44.1% decline per period). Among men, oropharyngeal SCC incidence per 100â000 ranged from 1.1 (Chinese) to 5.1 (Native Hawaiian). Oropharyngeal SCC incidence only statistically significantly increased (31.0% increase per period) for Japanese men. Heterogeneity across ethnicities were observed for other cancer sites. CONCLUSIONS: HPV-associated cancer incidence varied widely between Asian Americans and NHPIs and by ethnicity, underscoring the need for improved data capture of ethnic groups in research and more tailored interventions to better address health disparities between Asian American and NHPI populations.
Asunto(s)
Carcinoma de Células Escamosas , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , Femenino , Humanos , Masculino , Asiático , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/etnología , Etnicidad , Virus del Papiloma Humano , Incidencia , Nativos de Hawái y Otras Islas del Pacífico , Pueblos Isleños del Pacífico , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/etnología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/etnología , Neoplasias del Cuello Uterino/virologíaRESUMEN
Latinx populations have unique barriers to HPV vaccination. In the current study, we assessed the effectiveness of an online intervention to increase HPV vaccination intentions among patients of clinics that principally serve a Latinx population (n = 85%) as part of a randomized control trial (RCT). Participants viewed on an iPad either an individually tailored educational website (CHiCOS) or untailored information derived from the Vaccine Information Sheet (VIS) for HPV. Vaccination intention and related covariates were assessed via survey items administered before (pre-test) and after (post-test) viewing the material. No statistically significant differences were seen in changes of intention to vaccinate between groups (N = 1294). However, 16% of all (tailored and untailored combined) participants increased in their intention to vaccinate, while 7% decreased in intention. Overall 72% of participants had high intentions to vaccinate, yet far fewer actually received a vaccine dose. The current study explores implications of the demonstrated intention-behavior gap. As such, it presents opportunities to improve future interventions-specifically those that employ tailored messaging.
Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Promoción de la Salud , Hispánicos o Latinos , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Vacunación , Humanos , Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos/psicología , Intención , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Aceptación de la Atención de Salud , Vacunación/psicología , Internet , Promoción de la Salud/métodos , Asistencia Sanitaria Culturalmente Competente/métodosRESUMEN
Low HPV vaccination rates among Latina young adults perpetuate HPV-associated cancer disparities. Using qualitative methods, this study explored individual, interpersonal, and community factors that influence HPV vaccine delay and refusal among Mexican- and U.S.-born Mexican American young adult women. Participants (N = 30) between 18 and 26 years old were purposively sampled from two federally qualified health centers in Orange County, California. The National Institute on Minority Health and Health Disparities research framework and narrative engagement theory guided semi-structured phone interviews coded inductively and deductively. Participants primarily attributed vaccine status to individual and interpersonal reasons. Emerging themes included low HPV vaccine knowledge, insufficient provider communication, negative perceptions about HPV and the vaccine, motherhood responsibilities, mother's communication about HPV, cultural family norms, health care access, and misinformation. Compared to U.S.-born Latinas, Mexican-born participants more frequently expressed avoiding health care discussions with family. HPV vaccine recommendations for young Mexican American women should include socioculturally tailored messages that may improve HPV vaccination acceptance and uptake.
Asunto(s)
Americanos Mexicanos , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Vacilación a la Vacunación , Vacunación , Adolescente , Adulto , Femenino , Humanos , Adulto Joven , Conocimientos, Actitudes y Práctica en Salud , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/psicología , Vacunas contra Papillomavirus/uso terapéutico , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Vacunación/psicología , Vacilación a la Vacunación/etnología , Vacilación a la Vacunación/psicología , Competencia CulturalRESUMEN
BACKGROUND: Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. METHODS: We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. RESULTS: Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53-3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2-1 children (ORadj = 1.25, 95% CI = 1.07-1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24-1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15-1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41-1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44-1.77, PAF = 4.4%). CONCLUNSION: This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.
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Alcoholismo/epidemiología , Carcinoma de Células Escamosas/epidemiología , Infecciones por Papillomavirus/epidemiología , Fumar/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Adulto , Alcoholismo/complicaciones , Alcoholismo/etnología , Carcinoma de Células Escamosas/etnología , Carcinoma de Células Escamosas/virología , Estudios de Casos y Controles , Femenino , Hospitales de Enseñanza , Humanos , Estilo de Vida , Modelos Logísticos , Persona de Mediana Edad , Infecciones por Papillomavirus/etnología , Paridad , Embarazo , Prevalencia , Fumar/efectos adversos , Sudáfrica/epidemiología , Neoplasias del Cuello Uterino/etnología , Neoplasias del Cuello Uterino/virologíaRESUMEN
BACKGROUND: Mississippi (MS) has among the highest rates of cervical cancer incidence and mortality in the United States, with disproportionately higher rates among Blacks compared to Whites. Here, we evaluate the prevalence of high-risk human papillomavirus (HPV) and abnormal cytology in a representative baseline sample from a diverse statewide cohort of individuals attending cervical screening in MS from the STRIDES Study (STudying Risk to Improve DisparitiES in cervical cancer). METHODS: We included individuals aged 21-65 years undergoing screening at the University of Mississippi Medical Center (UMMC) and the Mississippi State Department of Health (MSDH) from May to November 2018. We calculated age-specific HPV prevalence, overall and by partial HPV16/18 genotyping, and abnormal cytology by race. RESULTS: A total of 6871 individuals (mean age 35.7 years) were included. HPV prevalence was 25.6% and higher in Blacks (28.0%) compared to Whites (22.4%). HPV prevalence was significantly higher in Blacks aged 21-24 years (50.2%) and 30-34 years (30.2%) compared to Whites in the same age groups (32.1% and 20.7%; p < 0.0001, respectively). The prevalence of high-grade cytologic abnormalities, a cytologic sign of cervical precancer, peaked earlier in Blacks (ages 25-29) compared to Whites (35-39). For comparison, we also analyzed HPV prevalence data from the National Health and Nutrition Examination Survey (NHANES, 2013-2016) and observed similar racial differences in HPV prevalence among women aged 21-24 years. CONCLUSIONS: Our findings suggest that Blacks undergoing cervical cancer screening in MS have higher prevalence of other high-risk 12 HPV types at younger ages and experience an earlier peak of high-grade cytologic abnormalities compared to Whites.
Asunto(s)
Infecciones por Papillomavirus/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Adulto , Factores de Edad , Anciano , Femenino , Genotipo , Humanos , Persona de Mediana Edad , Mississippi/epidemiología , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/virología , Prevalencia , Estudios Prospectivos , Neoplasias del Cuello Uterino/etnologíaRESUMEN
BACKGROUND: Parents in the Arab population of Israel are known to be "pro-vaccination" and vaccinate their children at higher rates than the Jewish population, specifically against human papilloma virus (HPV) and seasonal influenza. OBJECTIVES: This study seeks to identify and compare variables associated with mothers' uptake of two vaccinations, influenza and HPV, among different subgroups in Arab and Jewish society in Israel. METHODS: A cross-sectional study of the entire spectrum of the Israeli population was conducted using a stratified sample of Jewish mothers (n = 159) and Arab mothers (n = 534) from different subgroups: Muslim, Christian, Druse and Northern Bedouins. From March 30, 2019 through October 20, 2019, questionnaires were distributed manually to eighth grade pupils (13-14 years old) who had younger siblings in second (7-8 years old) or third (8-9 years old) grades. RESULTS: Arab mothers exhibited a higher rate of uptake for both vaccinations (p < .0001, HPV - 90%; influenza - 62%) than Jewish mothers (p = 0.0014, HPV - 46%; influenza - 34%). Furthermore, results showed that HPV vaccination uptake is significantly higher than seasonal influenza vaccination uptake in both populations. Examination of the different ethnic subgroups revealed differences in vaccination uptake. For both vaccinations, the Northern Bedouins exhibited the highest uptake rate of all the Arab subgroups (74%), followed by the Druse (74%) and Muslim groups (60%). The Christian Arab group exhibited the lowest uptake rate (46%). Moreover, the uptake rate among secular Jewish mothers was lower than in any of the Arab groups (38%), though higher than among religious/traditional Jewish mothers, who exhibited the lowest uptake rate (26%). A comparison of the variables associated with mothers' vaccination uptake revealed differences between the ethnic subgroups. Moreover, the findings of the multiple logistic regression revealed the following to be the most significant factors in Arab mothers' intake of both vaccinations: school-located vaccination and mothers' perceived risk and perceived trust in the system and in the family physician. These variables are manifested differently in the different ethnic groups. CONCLUSIONS: This research shows that all Arabs cannot be lumped together as one monolithic group in that they exhibit major differences according to religion, education and access to information. Ranking of variables associated with uptake of the two vaccines can provide decision-makers an empirical basis for tailoring appropriate and specific interventions to each subgroup to achieve the highest vaccine uptake rate possible. Media campaigns targeting the Arab population should be segmented to appeal to the various sub-groups according to their viewpoints, needs and health literacy.
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Árabes , Vacunas contra la Influenza , Judíos , Madres , Vacunas contra Papillomavirus , Vacunación , Adolescente , Árabes/psicología , Árabes/estadística & datos numéricos , Niño , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/etnología , Gripe Humana/prevención & control , Israel , Judíos/psicología , Judíos/estadística & datos numéricos , Masculino , Madres/psicología , Madres/estadística & datos numéricos , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Estaciones del Año , Vacunación/estadística & datos numéricosRESUMEN
BACKGROUND/OBJECTIVE: Cervical Cancer is the 6th most common and 3rd most deadly cancer among women. Despite the fact that the majority of the countries in Asia and Africa have a similar economy and low life expectancy, the mean age-standardized incidence rate (ASIR) of cervical cancer is substantially higher in Africa than in Asia. This study identified the correlates of the higher ASIR rates in Africa relative to Asia against two timelines; 2004-2009 and 2010-2017. METHODS: Peer-reviewed articles published between 2004 and 2017 were selected using the PRISMA standard. Sources of articles included Google Scholar, Scopus, PubMed Central, and EMBASE. Search keywords included: HPV genotypes, cervical cancer, HPV vaccine, and multiple infections in Africa and Asia. RESULT: Twenty-nine and seventeen full-length articles were selected from Africa and Asia, respectively. The pooled prevalence of HPV infection up to 2017 was higher in Africa (41.8%; 95% CI: 35.9, 47.7) than in Asia (24.2%; 95% CI: 16.22, 32.2) at p< 0.001. Between 2004-2009 and 2010-2017 timelines, the pooled prevalence of HPV infection decreased from 49.1% to 36.7% (OR': 1.66, 95% CI: 1.51-1.80) in Africa and increased from 16.9% to 20.5% (OR': 0.79, 95% CI: 0.71-0.86) in Asia. However, the pooled prevalence of multiple HPV infections and non-vaccine high-risk HPV infections were higher among African women diagnosed with cancer (30.9% and 5.2%) than their Asian counterparts (21.0% and 2.0%, respectively) at p< 0.001. Additionally, the pooled prevalence of the five most prevalent high-risk HPV types in Africa were HPV16 (35.3%), HPV52 (14.2%), HPV35 (12.4%), HPV18 (10.4%), and HPV58 (10.0%), while that of Asia were HPV16 (37.3%), HPV52 (16.2%), HPV58 (14.7%), HPV33 (7.4%) and HPV18 (7.2%). CONCLUSION: This study suggests that the higher prevalence of HPV, multiple HPV and non-vaccine HPV infections could be responsible for the higher ASIR in Africa than in Asia.
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Disparidades en el Estado de Salud , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/virología , Grupos Raciales/estadística & datos numéricos , África/epidemiología , Asia/epidemiología , Femenino , Humanos , Papillomaviridae/genética , Vacunas contra Papillomavirus , Prevalencia , Neoplasias del Cuello Uterino/etnologíaRESUMEN
OBJECTIVES: High-risk human papillomavirus (HR-HPV) is an important risk factor for esophageal cancer. Macrophages constitute a crucial immune medium for regulating HPV-related tumors; however, the specific regulatory mechanisms remain unknown. Therefore, the purpose of our current study was to investigate the mechanism by which HPV16E6 regulates macrophages to promote the invasion and metastasis of esophageal cancer. METHODS: HPV16E6 infection was detected by polymerase chain reaction. Immunohistochemistry was used to verify the distribution of tumor-associated macrophages (TAMs) and MMP-9 expression in esophageal squamous cell carcinoma tissues (ESCCs), and cancer adjacent normal tissues (CANs) from Kazakh patients. ESCC cells were transfected with a plasmid over-expressing HPV16E6 and non-contact cocultured with macrophages. RESULTS: The infection rate of HPV16E6 in Kazakh ESCCs was clearly higher than that in CANs (P < 0.05). The density of CD163-positive TAMs was significantly positively correlated with HPV16E6 infection in ESCCs (P < 0.05). After coculturing macrophages and EC9706 cells transfected with the HPV16E6 plasmid, the phenotype of macrophages transformed into M2 macrophages. The migration and invasion ability of ESCC cells were higher in the HPV16E6-transfected and coculture group than in the HPV16E6 empty vector-transfected and non-cocultured HPV16E6-transfected groups (all P < 0.05). The density of M2-like TAMs in ESCCs was positively correlated with the level of MMP-9 expression. MMP-9 expression in the HPV16E6-ESCC coculture macrophages group was substantially higher than that in controls (all P < 0.05). CONCLUSIONS: HPV16 infection mediates tumor-associated macrophages to promote ESCC invasion and migration.
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Neoplasias Esofágicas/patología , Carcinoma de Células Escamosas de Esófago/patología , Papillomavirus Humano 16 , Proteínas Oncogénicas Virales/metabolismo , Infecciones por Papillomavirus/complicaciones , Proteínas Represoras/metabolismo , Macrófagos Asociados a Tumores/patología , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/metabolismo , Diferenciación Celular , China/etnología , Técnicas de Cocultivo , Neoplasias Esofágicas/etnología , Neoplasias Esofágicas/virología , Carcinoma de Células Escamosas de Esófago/etnología , Carcinoma de Células Escamosas de Esófago/virología , Humanos , Metaloproteinasa 9 de la Matriz/metabolismo , Invasividad Neoplásica , Proteínas Oncogénicas Virales/genética , Infecciones por Papillomavirus/etnología , Fenotipo , Receptores de Superficie Celular/metabolismo , Proteínas Represoras/genética , Microambiente Tumoral , Macrófagos Asociados a Tumores/metabolismo , Macrófagos Asociados a Tumores/virologíaRESUMEN
Native Hawaiian and Pacific Islander (NHPI) adults bear a disproportionate burden of certain human papillomavirus (HPV)-associated cancers. In 2015, data from the National Health Interview Survey (NHIS) showed vaccination coverage among adults by racial and ethnic groups; however, coverage data for NHPI adults were unavailable. In this study, we estimated the initiation and completion of HPV vaccination and assessed the factors associated with vaccination among NHPI adults aged 18 to 26 years in the United States. We analyzed public data files from the 2014 NHPI NHIS (n = 1204). We specified sampling design parameters and fitted weighted logistic regression models to calculate the odds of HPV vaccine initiation. We developed a directed acyclic graph to identify a minimally sufficient set for adjustment and adjusted for insurance coverage (for education and ethnicity) and doctor visit (for insurance coverage, earnings, ethnicity, and sex). Overall, 24.9% and 11.5% of NHPI adults had initiated and completed the HPV vaccination series, respectively. Weighted logistic regression models elucidated that the odds of HPV vaccine initiation were higher for females (weighted odds ratio = 5.4; 95% confidence interval = 2.8-10.4) compared with males. Low vaccination coverage found among NHPI adults provides an opportunity for targeted programs to reduce the burden of HPV-associated cancers.
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Nativos de Hawái y Otras Islas del Pacífico , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Cobertura de Vacunación , Adolescente , Adulto , Femenino , Humanos , Masculino , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Neoplasias/etnología , Neoplasias/virología , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Estados Unidos , Cobertura de Vacunación/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: The high-risk human papillomavirus (HR-HPV) infection is the main cause of cervical cancer development, and the most common types were included in the last approved nonavalent vaccine (9vHPV). Geographical, socioeconomic and ethnic barriers in developing countries challenge primary and secondary prevention measures of cervical cancer. We aimed to determine the prevalence of HPV infection and the viral load of HR-HPV 9vHPV-related types black women resident in rural semi-isolated communities. METHODS: A descriptive study was conducted with 273 cervical samples of women from rural communities of Southeastern Brazil. Viral DNA was amplified by PCR, the genotype was identified by Reverse Line Blot (RLB) and Restriction Fragment Length Polymorphism (RFLP), and real-time PCR was applied to determine the viral load. RESULTS: HPV frequency was 11.4% (31/273), associated with the presence of cytological abnormalities (32.3%; p < 0.001). Thirty-one distinct genotypes were detected; HR-HPV occurred in 64.5% (20/31) of the samples and the most prevalent type were HPV52 > 58, 59. Multiple infections occurred with up to nine different genotypes. The viral load of HR-HPV 9vHPV-related types was higher in lesions than in normal cytology cases (p = 0.04); "high" and "very high" viral load occurred in HSIL and LSIL, respectively (p = 0.04). CONCLUSIONS: We highlight that despite the low HPV frequency in the black rural women population, the frequency of HR-HPV was high, particularly by the HR-HPV52 and 58 types. Moreover, the HR-HPV viral load increased according to the progression from normal to lesion, being a potential biomarker to identify those women at higher risk of developing cervical lesions in this population.
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Población Negra/estadística & datos numéricos , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/epidemiología , Neoplasias del Cuello Uterino/virología , Carga Viral , Adolescente , Adulto , Anciano , Brasil/epidemiología , ADN Viral/análisis , Femenino , Genotipo , Humanos , Persona de Mediana Edad , Papillomaviridae/clasificación , Papillomaviridae/genética , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/virología , Polimorfismo de Longitud del Fragmento de Restricción , Prevalencia , Reacción en Cadena en Tiempo Real de la Polimerasa , Factores de Riesgo , Población Rural/estadística & datos numéricos , Carga Viral/genética , Adulto JovenRESUMEN
OBJECTIVE: To investigate differences in epidemiology of oropharyngeal squamous cell carcinoma (OPSCC) with regards to human papillomavirus (HPV), race, and socioeconomic status (SES) using the National Cancer Database (NCDB). STUDY DESIGN: Population-based cohort study. SETTING: Racial and socioeconomic disparities in survival of OPSCC have been previously acknowledged. However, the distribution of HPV-related cancers and its influence on survival in conjunction with race and SES remain unclear. SUBJECTS AND METHODS: All patients with OPSCC in the NCDB with known HPV status from 2010 to 2016 were included. Differences in presentation, HPV status, treatment, and outcomes were compared along racial and socioeconomic lines. Univariable and multivariable Cox regression survival analyses were performed. RESULTS: In total, 45,940 patients met criteria. Most were male (38,038, 82.8%), older than 60 years (23,456, 51.5%), and white (40,156, 87.4%), and lived in higher median income areas (>$48,000, 28,587, 62.2%). Two-thirds were HPV positive (31,007, 67.5%). HPV-negative disease was significantly more common in lower SES (<$38,000, 2937, 41.5%, P < .001) and among blacks (1784, 55.3%, P < .001). Median follow-up was 33 months. Five-year overall survival was 81.3% (95% CI, 80.5%-82.1%) and 59.6% (95% CI, 58.2%-61.0%) in HPV-positive and HPV-negative groups, respectively. In univariable and multivariable analyses controlling for HPV status, age, stage, and treatment, black race (hazard ratio [HR], 1.22; 95% CI, 1.11-1.34; P < .001) and low SES (HR, 1.58; 95% CI, 1.45-1.72; P < .001) were associated with worse survival. CONCLUSION: Significant differences in HPV status exist between socioeconomic and racial groups, with HPV-negative disease more common among blacks and lower SES. When controlling for HPV status, race and SES still influence outcomes in oropharyngeal cancers.
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Carcinoma de Células Escamosas/virología , Neoplasias Orofaríngeas/virología , Infecciones por Papillomavirus/virología , Adulto , Anciano , Carcinoma de Células Escamosas/etnología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/terapia , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias Orofaríngeas/etnología , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/terapia , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/mortalidad , Infecciones por Papillomavirus/terapia , Sistema de Registros , Factores Socioeconómicos , Tasa de SupervivenciaRESUMEN
BACKGROUND: The US American Society of Colposcopy and Cervical Pathology guidelines for cervical cancer screening have been largely adopted worldwide. Pooled high-risk human papillomavirus (hrHPV) testing has been routinely used to risk-stratify women who have atypical squamous cells of undetermined significance (ASC-US) cytology. However, it has been reported that there are distinguished differences in the distribution of hrHPV genotypes between the Chinese and American populations. METHODS: The objective of this study was to analyze the age-stratified reporting rates, hrHPV-positive rates, and genotyping by different cytology preparation methods and hrHPV testing assays, along with the immediate histopathologic correlation of ASC-US cytology, in the Chinese population. RESULTS: The ASC-US reporting rate of 1,597,136 Papanicolaou (Pap) tests was 4.2%, and the overall hrHPV-positive rate was 48.7% in the ASC-US cases. In total, 25,338 women with ASC-US Pap tests had immediate histologic follow-up, and the detection rate for cervical intraepithelial neoplasia 2 and higher lesions (CIN2+) was 7.1%, including 0.6% carcinomas. Among the women who underwent hrHPV testing, CIN2+ lesions were identified in 657 of 6154 (10.7%) who had hrHPV-positive results and in only 1.5% those who had hrHPV-negative results. Further genotyping analysis revealed that HPV types 16 and/or 18 were commonly identified genotypes among the Chinese women who had ASC-US cytology. CONCLUSIONS: This large-scale study demonstrated that the hrHPV-positive rate, the CIN2+ detection rate, and the distribution of hrHPV genotypes in Chinese women with ASC-US cytology were essentially consistent with those from the American population, further supporting that the current and newly released 2019 American Society of Colposcopy and Cervical Pathology guidelines should be applicable to the Chinese population.
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Factores de Edad , Alphapapillomavirus/aislamiento & purificación , Pueblo Asiatico , Células Escamosas Atípicas del Cuello del Útero/patología , Neoplasias del Cuello Uterino/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Células Escamosas Atípicas del Cuello del Útero/virología , China , Femenino , Humanos , Persona de Mediana Edad , Prueba de Papanicolaou , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/virología , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Neoplasias del Cuello Uterino/etnología , Neoplasias del Cuello Uterino/virología , Adulto JovenRESUMEN
Objective: To investigate the prevalence and genotype distribution of high-risk human papillomavirus (HR-HPV) and the correlation between cervical lesions and analyze the risk factors for HR-HPV infection. Methods: In June 2018, a population-based study for cervical cancer screening in Tuoli county of Xinjiang Uygur Autonomous Region was conducted. A total of 2 000 Kazak women aged 25-64 years were included in the study. Three cervical exfoliated cells samples were collected from them for careHPV, PCR HPV, p16(INK4a), and liquid-based cytology (LBC) tests. Women with any positive test were referred for colposcopy with biopsies taken at abnormal sites. Histo-pathological diagnoses were used as the gold standard. Results: The overall prevalence of HPV was 14.55%, among which the infection rate of HR-HPV was 12.90%, which was even higher in the 50-54 years age group. The most prevalent genotypes of HR-HPV were HPV16 (2.80%), HPV51(2.35%), HPV52 (1.70%), HPV56 (1.50%), and HPV39 (1.20%). The most common HPV infection was a single infection (71.48%). In the age group of 50-54 years, the multiple infection rates were higher, with the majority of double infection (69.88%), and HPV42 and 56 were the most common co-infection types. HPV16 (31.82%), HPV51 (27.27%) and HPV18 (13.64%) were higher in cervical intraepithelial neplasia grade 1, HPV16 (57.14%) was higher in cervical intraepithelial neplasia grade 2, and HPV16 (55.56%) and HPV18 (33.33%) were higher in cervical intraepithelial neplasia grade 3 or worse. Results from the multivariate logistic regression analysis showed that higher education, menopause, and syphilis infection increased the HPV infection. Conclusions: The most common prevalence genotypes of HR-HPV among Kazak women were HPV16, HPV51, and HPV52. The infection rate of HR-HPV among Kazak women was correlated with education level, menopausal status, and syphilis infection. Measures should be taken targeting high-risk factors. This result suggests that STD patients and women aged 50 and above should be encouraged for screening.
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Etnicidad , Papillomaviridae , Infecciones por Papillomavirus , Adulto , China/epidemiología , Etnicidad/genética , Etnicidad/psicología , Etnicidad/estadística & datos numéricos , Femenino , Genotipo , Humanos , Persona de Mediana Edad , Papillomaviridae/genética , Infecciones por Papillomavirus/etnología , Infecciones por Papillomavirus/genética , Factores de RiesgoRESUMEN
Human papillomavirus (HPV) causes most cervical cancers and some cancers of the penis, vulva, vagina, oropharynx, and anus. Cervical precancers can be detected through screening. HPV vaccination with the 9-valent HPV vaccine (9vHPV) can prevent approximately 92% of HPV-attributable cancers (1).* Previous studies have shown lower incidence of HPV-associated cancers in non-Hispanic American Indian and Alaska Native (AI/AN) populations compared with other racial subgroups (2); however, these rates might have been underestimated as a result of racial misclassification. Previous studies have shown that cancer registry data corrected for racial misclassification resulted in more accurate cancer incidence estimates for AI/AN populations (3,4). In addition, regional variations in cancer incidence among AI/AN populations suggest that nationally aggregated data might not adequately describe cancer outcomes within these populations (5). These variations might, in part, result from geographic disparities in the use of health services, such as cancer screening or vaccination (6). CDC analyzed data for 2013-2017 from central cancer registries linked with the Indian Health Service (IHS) patient registration database to assess the incidence of HPV-associated cancers and to estimate the number of cancers caused by HPV among AI/AN populations overall and by region. During 2013-2017, an estimated 1,030 HPV-associated cancers were reported in AI/AN populations. Of these cancers, 740 (72%) were determined to be attributable to HPV types targeted by 9vHPV; the majority were cervical cancers in females and oropharyngeal cancers in males. These data can help identify regions where AI/AN populations have disproportionately high rates of HPV-associated cancers and inform targeted regional vaccination and screening programs in AI/AN communities.