Prevalence and risk factors of sexually transmitted infections and cervical neoplasia in women from a rural area of southern mozambique

There is limited information on the prevalence of sexually transmitted infections and the prevalence of cervical neoplasia in rural sub-Saharan Africa. This study describes the prevalence and the etiology of STIs and the prevalence of cervical neoplasia among women in southern Mozambique. An age-stratified cross-sectional study was performed where 262 women aged 14 to 61 years were recruited at the antenatal clinic (59%), the family-planning clinic (7%), and from the community (34%). At least one active STI was diagnosed in 79% of women. Trichomonas vaginalis was present in 31% of all study participants. The prevalence of Neisseria gonorrhea and Chlamydia trachomatis were 14% and 8%, respectively, and Syphilis was diagnosed in 12% of women. HPV DNA was detected in 40% of women and cervical neoplasia was diagnosed in 12% of all women. Risk factors associated with the presence of some of the STIs were being divorced or widowed, having more than one sexual partner and having the partner living in another area. A higher prevalence was observed in the reproductive age group and some of the STIs were more frequently diagnosed in pregnant women. STI control programs are a priority to reduce the STIs burden, including HIV and cervical neoplasia.

Vacuna frente al virus del papiloma humano. Eficacia y seguridad / Human papillomavirus vaccine. Efficacy and safety

Las vacunas profilácticas frente al virus del papiloma humano (VPH) se consideran la intervención más efectiva para el control de la carga de enfermedad relacionada con el VPH. Este artículo revisa los principales ensayos clínicos de fase ii/iii realizados con la vacuna bivalente (VPH 16/18), tetravalente (VPH 6/11/16/18) y la recientemente aprobada vacuna nonavalente (VPH 6/11/16/18/31/33/45/52/58).Los ensayos clínicos de fase ii y iii con las vacunas bivalente y tetravalente demuestran la seguridad, inmunogenicidad y eficacia de ambas vacunas en la prevención de infecciones por VPH y lesiones precancerosas, especialmente si se administran en adolescentes antes de la exposición al virus. Los ensayos clínicos con la vacuna nonavalente también muestran su seguridad, inmunogenicidad y eficacia en la prevención de infección y enfermedad asociada con los tipos vacunales, y sugieren el potencial de la vacuna para reducir la carga de enfermedad asociada al VPH. Informes poscomercialización en países con programas de vacunación sistemática y altas coberturas sugieren una efectividad muy alta a nivel poblacional, con descensos en la prevalencia de los VPH relacionados con la vacuna, y en la incidencia de verrugas genitales y lesiones cervicales de alto grado

Human papillomavirus (HPV) related disease remains a major cause of morbidity and mortality worldwide. Prophylactic vaccines have been recognized as the most effective intervention to control for HPV-related diseases. This article reviews the major phase ii/iii trials of the bivalent (HPVs 16/18), quadrivalent (HPVs 6/11/16/18), and the recently approved 9-valent vaccine (HPVs 6/11/16/18/31/33/45/52/58).Large trials have been conducted showing the safety, immunogenicity and high efficacy of the bivalent and quadrivalent vaccines in the prevention of pre-invasive lesions and infection, especially when administered at young ages before exposure to HPV. Trials of the 9-valent vaccine have also demonstrated the safety, immunogenicity and efficacy of the vaccine in the prevention of infection and disease associated with the vaccine types, and its potential to substantially increase the overall prevention of HPV-related diseases. Post-licensure country reports have shown the recent and early impact of these vaccines at population level after the implementation of established HPV vaccination programs, including decreases in the prevalence of vaccine HPV types, the incidence of genital warts, and the incidence of high-grade cervical abnormalities. If widely implemented, current HPV vaccines may drastically reduce the incidence of cervical cancer and other HPV-related cancers and diseases

Determinantes de las conductas sexuales de riesgo en jóvenes de Cataluña / Factors associated with sexual risk behaviour among Young people in Catalonia

Fundamentos: la conducta sexual en jóvenes se ve influida por factores externos que pueden favorecer una disminución del control de la situación y mayor desprotección. Objetivo: describir y comparar según sexo la conducta sexual y otros indicadores de salud sexual y reproductiva en jóvenes (16-24 años) en Cataluña e identificar factores asociados a las conductas sexuales de riesgo. Métodos: estudio transversal realizado en 2012 mediante encuesta en línea a partir de un panel de población (n=800). Se identificaron factores asociados al no uso del preservativo (no UP) en la última relación sexual con penetración (RS) mediante modelos de regresión logística multivariantes. Resultados: el 76,1% de los chicos y el 83,3% de las chicas declararon RS alguna vez (p=0,012). El 39,7% de los chicos y el 22,5% de las chicas tuvieron parejas ocasionales, siendo el uso de Internet para contactar parejas del 31,4% y 10,3%, respectivamente. Entre los factores asociados al no UP durante la última RS destacó no haber usado preservativo en la primera RS (OR=2,50 en chicos y OR=3,18 en chicas). Haber contactado parejas sexuales por Internet se mostró asociado en chicos (OR=2,29) y haber usado la anticoncepción de emergencia ≥3 veces en chicas (OR=3,38). Conclusiones: se observan diferencias en la conducta sexual de los jóvenes según sexo, siendo el uso del preservativo en la primera relación sexual un buen predictor de su uso en la última. Los chicos presentan mayor número de parejas ocasionales que las chicas y utilizan más las nuevas tecnologías de la información para contactar estas parejas (AU)

Background: sexual behavior in young people is influenced by external factors that may increase their vulnerability. Objective: to describe sexual behavior and other indicators of sexual and reproductive health among young people (16 to 24 years) in Catalonia and to identify factors associated with sexual risk behaviors. Methods: cross-sectional study in 2012 carried out by an online survey from a panel of population (n=800). Factors associated with not using a condom at last sexual intercourse were evaluated using multivariate logistic regression models. Results: 76.1% of boys and 83.3% of girls reported having had complete sexual intercourse (p=0.012). The proportion of boys and girls who reported casual partners was 39.7% and 22.5%, respectively. 31.4% of boys and 10.3% of girls reported having contacted partners through Internet. Not using a condom at first sexual intercourse showed significant association with reporting not using a condom in the last sexual intercourse, for both, boys (OR= 2.50) and girls (OR= 3.18). Having contacted partners through the Internet (OR=2.29) was associated with this risky sexual behavior in boys, and having used the emergency contraception 3 or more times (OR=3.38) was associated in girls. Conclusions: there are differences in the sexual behavior of young people by sex, being condom use at first sexual relationship a good predictor of condom use at last sexual intercourse. Boys show a higher number of casual partners than girls, as well as a higher use of the Internet to contact sexual partners (AU)

Maté drinking and esophageal squamous cell carcinoma in South America: pooled results from two large multicenter case-control studies

BACKGROUND: Maté tea is a nonalcoholic infusion widely consumed in southern South America, and may increase risk of esophageal squamous cell carcinoma (ESCC) and other cancers due to polycyclic aromatic hydrocarbons (PAH) and/or thermal injury.METHODS:We pooled two case-control studies: a 1988 to 2005 Uruguay study and a 1986 to 1992 multinational study in Argentina, Brazil, Paraguay, and Uruguay, including 1,400 cases and 3,229 controls. We computed ORs and fitted a linear excess OR (EOR) model for cumulative maté consumption in liters/day-year (LPDY).RESULTS:The adjusted OR for ESCC with 95% confidence interval (CI) by ever compared with never use of maté was 1.60 (1.2-2.2). ORs increased linearly with LPDY (test of nonlinearity; P = 0.69). The estimate of slope (EOR/LPDY) was 0.009 (0.005-0.014) and did not vary with daily intake, indicating maté intensity did not influence the strength of association. EOR/LPDY estimates for consumption at warm, hot, and very hot beverage temperatures were 0.004 (-0.002-0.013), 0.007 (0.003-0.013), and 0.016 (0.009-0.027), respectively, and differed significantly (P < 0.01). EOR/LPDY estimates were increased in younger (<65) individuals and never alcohol drinkers, but these evaluations were post hoc, and were homogeneous by sex.CONCLUSIONS:ORs for ESCC increased linearly with cumulative maté consumption and were unrelated to intensity, so greater daily consumption for shorter duration or lesser daily consumption for longer duration resulted in comparable ORs. The strength of association increased with higher maté temperatures.IMPACT:Increased understanding of cancer risks with maté consumption enhances the understanding of the public health consequences given its purported health benefits(AU)

Vacunas frente al virus del papiloma humano, para la prevención del cáncer de cuello uterino / Vaccines against human papilloma virus for the prevention of uterine cervical cancer

Mediante el uso de sistemas de expresión celulares o microbianos se ha sintetizado partículas similares a virus a partir de proteinas L1 auto-ensambladas. Las vacunas profilácticas basadas en dichas partículas previenen en forma eficaz las infecciones y lesiones causadas por los tipos de VPH incluidos en sus preparados. Ensayos clínicos con tres prototipos de vacunas (una con VPH 16, otra con VPH 16 / 18 y otra con VPH 6/11/16/18) han demostrado que son seguras, inmunogénicas y altamente eficaces para prevenir NIC 2/3, precursores inmediatos del carcinoma de cuello uterino. La implementación de programas de vacunación con cobertura aceptable, tendría el potencial de reducir sustancialmente la morbilidad y mortalidad por cáncer de cérvix. Este artículo enfoca los resultados de los ensayos clínicos de las vacunas.

Virus-like particles have been sinthetized from a self-assembling L1 protein, using celular and bacterial expresion systems. Human papillomavirus (HPV) virus-like particle prophylactic vaccines are effective in preventing infection and lesions caused by the targeted HPV type. Clinical trials with 3 vaccine prototypes (HPV16, other with HPV 16/18 and other with 6/11/16/18) have demonstrated their safety, immunogenicity and efficacy to prevent CIN 2/3, immediate precursors of invasive cervical carcinoma. Vaccination programs with adequate coverage would have the potential to substantially reduce morbidity and mortality related to cervical cancer. This paper presents data from clinical trials of the above mentioned vaccines.

Impacto sanitario y económico de la vacunación frente al cáncer de cérvix y lesiones precursoras en España / Healthcare and economic impact of vaccination against cervical cancer and precursor lesions in Spain

Objetivo. Analizar el impacto sanitario y económico de la vacunación frente al cáncer de cérvix en España con la vacuna VPH 16/18 adyuvada AS04 (Cervarix®) desde la perspectiva del Sistema Nacional de Salud. Material y métodos. Adaptación al entorno español de un modelo farmacoeconómico que simula el impacto que podría esperarse de los actuales programas de vacunación infantil sobre la carga de las lesiones precursoras y cáncer de cérvix. El modelo emplea datos epidemiológicos nacionales y la eficacia demostrada por la vacuna en ensayos clínicos. Resultados. Considerando la cobertura vacunal media en España, el modelo estima que actualmente la vacunación con Cervarix® podría evitar anualmente 45.060 ASCUS, 35.166 lesiones CIN1, 29.549 lesiones CIN2/3 y 1.053 casos de cáncer de cérvix, lo que supondría evitar unos costes sanitarios totales de 89.271.085 euros. Conclusiones. La vacunación con Cervarix® en España disminuiría los casos de cáncer de cérvix y lesiones precursoras y los consecuentes costes sanitarios asociados a su tratamiento (AU)

Objective. To evaluate the healthcare and economic impact of vaccination against cervical cancer with the HPV 16/18 AS04-adjuvanted vaccine (Cervarix®) in Spain from the perspective of the national health system. Material and methods. A health economics model was adapted to the Spanish environment. The model simulated the impact of current vaccination programs on the burden of precancerous lesions and cervical cancer. National epidemiological data and the vaccine efficacy shown in clinical trials were used. Results. Considering the average vaccination coverage in Spain, the model estimated that vaccination with Cervarix® would prevent 45,060 cases of atypical squamous cells of undetermined significance (ASCUS), 35,166 cases of low-grade squamous intraepithelial lesions (LSIL), 29,549 cases of high-grade squamous intraepithelial lesions (HSIL) and 1,053 cases of cervical cancer. Thus, vaccination would save 89,271,085 € in direct medical costs. Conclusions. Vaccination with Cervarix® in Spain would significantly reduce the number of cases of cervical cancer and precancerous lesions and the associated medical costs (AU)

Patología del tracto genital inferior asociada al virus del papiloma humano en mujeres españolas / Lower genital tract lesions associated with human papillomavirus in Spanish women

Objetivo. Evaluar la frecuencia de lesiones del tracto genital inferior asociadas a virus del papiloma humano (VPH) en mujeres españolas atendidas en la práctica clínica diaria. Material y métodos. Estudio observacional, retrospectivo, de corte transversal y multicéntrico en el que ginecólogos recogieron información sobre mujeres atendidas en los 6 meses previos con diagnóstico de neoplasias intraepiteliales de cérvix (CIN), vagina (VaIN), vulva (VIN), adenocarcinomas in situ (AIS) y/o verrugas genitales. Resultados. La población de estudio fue de 5.665 mujeres (mediana de edad 32 años) atendidas por 385 ginecólogos, con un total de 6.200 diagnósticos (de novo 82,5%). La mayoría de los casos presentó un diagnóstico de CIN (71,6%), seguido de verrugas genitales (20,8%), AIS (3,6%), VIN (2,0%) y VaIN (1,9%). Las lesiones de grado 1 fueron las más frecuentes entre los casos de CIN y VaIN. La mayoría de las pacientes con CIN, independientemente del grado, tenían entre 30 y 44 años (90% era < 45 años). La mayoría de mujeres con VaIN 1 (71%), AIS (77,2%) y verrugas genitales (96%) eran también < 45 años. Por el contrario, la mayoría de los diagnósticos de VaIN 2/3 se efectuaron en pacientes > 45 años (63,6%). No hubo diferencias respecto a la edad en las mujeres con diagnóstico de VIN. Conclusiones. CIN y verrugas genitales constituyen los diagnósticos más frecuentemente realizados por ginecólogos españoles dentro de la patología del tracto genital inferior asociada a VPH (aproximadamente, el 70 y el 20%, respectivamente, del total). La mayor carga de enfermedad se encuentra en mujeres de 30-44 años (CIN cualquier grado, AIS y VaIN 1). La mayoría de los condilomas se diagnostican antes de los 30 años, mientras que las lesiones de VIN y VaIN 2/3 se presentan con más frecuencia en mujeres > 60 años (AU)

Objective. To assess the frequency of lower genital tract lesions associated with human papillomavirus (HPV) infection in Spanish women attended in routine gynecology practice. Material y methods. We performed an observational, retrospective, cross-sectional, multicenter study in which participating gynecologists collected information on women attended in the previous 6 months with a diagnosis of intraepithelial neoplasia of the cervix (CIN), vagina (VaIN), vulva (VIN), adenocarcinoma in situ (AIS) and/or genital warts. Results. The study population consisted of 5,665 women (median age 32 years) attended by 385 gynecologists, with a total of 6,200 diagnoses (de novo 82.5%).The majority of diagnoses were CIN (71.6%), followed by genital warts (20.8%), AIS (3.6%), VIN (2.0%) and VaIN (1.9%). In patients with CIN and VaIN, the most frequently diagnosed lesions were grade 1. Independently of the grade of the lesion, most patients with a diagnosis of CIN were aged 30 to 44 years (90% were under 45 years). Most of the women with VaIN grade 1 (71%), AIS (77.2%) or genital warts (96%) were also younger than 45 years. In contrast, most of the diagnoses of VaIN grades 2 and 3 corresponded to women older than 45 years. There were no differences in the frequency of diagnosis of VIN among age groups. Conclusions. Among lower genital tract lesions associated with HPV infection, the most frequent diagnoses made by Spanish gynecologists were CIN and genital warts (representing approximately 70% and 20% of all cases, respectively). Most of the burden of disease was found among women aged between 30 and 44 years (CIN, any grade, AIS and VaIN grade 1). Genital warts mainly occurred in women younger than 30 years, while VIN and VaIN grade 2 and 3 lesions were more frequently diagnosed in women older than 60 years of age (AU)

Epidemiología de las lesiones precancerosas y verrugas genitales asociadas a infección por virus del papiloma humano en España / Epidemiology of precancer lesions and genital warts associated with Human papilloma virus infection in Spain

Objetivo El objetivo del estudio fue estimar el número de citologías y diagnósticos de neoplasia intraepitelial cervical (CIN) y verrugas genitales realizados anualmente en España. Material y métodos Se realizaron dos estudios transversales retrospectivos a partir de datos suministrados por una muestra de ginecólogos, dermatólogos y urólogos en 6 Comunidades Autónomas consideradas representativas de la población española. Los datos se extrapolaron a la población general teniendo en cuenta la distribución de edad y sexo de la población española. Resultados A partir de los resultados del estudio se estima que el número de casos de verrugas genitales que ocurren anualmente en España sería de 56.400. Además, en España se realizarían un total de 7,6 millones de citologías anuales y se diagnosticarían cada año 40.530, 26.243 y 28.423 casos de CIN 1, CIN 2 y CIN 3, respectivamente. Conclusiones Las lesiones asociadas a la infección por virus del papiloma humano (VPH) suponen una considerable morbilidad en España (AU)

Objective The objective of this study was to estimate the number of cytologies and diagnoses of cervical intraepithelial neoplasia (CIN) and genital warts performed annually in Spain. Material and methods Two cross-sectional studies based on retrospective data were conducted among a sample of gynaecologists, urologists and dermatologists in 6 Autonomous Regions considered to be representative of the Spanish population. Study data were extrapolated to the general population, taking into account the age and sex distribution of the Spanish population. Results Based on the study results, the estimated number of cases of genital warts that occur annually in Spain was 56,400. It was, also, estimated that 7.6 million cytologies were performed annually in Spain and that 40,530, 26,243 and 28,423 women are annually diagnosed with CIN 1, CIN 2 and CIN 3, respectively. Conclusions Lesions related to human papilloma virus (HPV) infection cause substancial morbidity burden in Spain (AU)

The male role in cervical cancer

Evidencia experimental, clínica y epidemiológica demuestra que los papilomavirus humanos (VPH) genitales son predominantemente de transmisión sexual. Estudios experimentales en mujeres vírgenes y en mujeres VPH-negativas indican de forma clara que el coito es virtualmente un paso necesario para adquirir el VPH. Como ocurre con cualquier otra infección de transmisión sexual (ITS) los varones están implicados en la cadena epidemiológica de la infección. Los VPH en el pene son predominantemente adquiridos a través de contactos sexuales. Los contactos sexuales con mujeres que ejercen el sexo comercial juegan un papel importante en la transmisión de los VPH y en algunas poblaciones estas mujeres pueden convertirse en un importante reservorio de VPH de alto riesgo. Actuando ambos como "portadores" y "vectores" de los VPH oncogénicos los hombres pueden aumentar de forma substancial el riesgo de propiciar cáncer de cérvix en sus parejas. En ausencia de programas de detección precoz, el riesgo de cáncer de cérvix en una mujer puede depender menos de su conducta sexual que de la de su marido u otras parejas sexuales. Aunque más raramente que en las mujeres, los hombres pueden también convertirse en "víctimas" de sus propias infecciones por el VPH, pues una fracción de hombres infectados tiene un riesgo aumentado de desarrollar cáncer de pene y de ano. Se ha mostrado que la circuncisión masculina puede reducir el riesgo no sólo de adquisición y transmisión del VPH genital, sino también de cáncer cervical en las parejas de hombres circuncisos. Se requieren más estudios científicos para entender mejor la historia natural y la epidemiología de las infecciones por el VPH en el hombre.

Independent and joint effects of tobacco smoking and alcohol drinking on the risk of esophageal cancer in men and women

To estimate the independent and joint effects of tobacco smoking and alcohol drinking, we analyzed data from a series of 5 hospital-based case-control studies of squamous-cell carcinoma of the esophagus conducted in high-risk areas in South America. A total of 830 case subjects and 1779 control subjects were included in the pooled analysis. All exposure characteristics of amount, duration, cessation and type of alcohol and tobacco consumed were strongly related to esophageal.cancer risk in both sexes. Women had the same esposure profile as men, but the magnitudes of the associations were lower than were those among men. Black-tobacco smoking was associated with a 2-fold increased risk as compared with the smoking of blond o mixed tobacco. Quitting either of the 2 habits significantly reduced esophageal-cancer risk. Alcohol and tobacco alone were strongly related to the risk of esophageal cancer, even in the absence of the other exposure. A history of simultaneous exposure to cigarette smoking and alcohol drinking had a strong multiplicative effect on risk. Concomitant exposure to heavy alcohol drinking and black-tobacco smoking identified the group with the highest risk for developing esophageal cancer (odds ratio = 107). A synergistic interaction was found between the 2 habits, particularly in women and in moderately exposed men. Moderate cigarette smoking without drinking and moderate alcohol drinking without smoking had a negligible effect on wsophageal-cancer risk. However, simultaneous exposure to the same moderate amounts increased the risk 12 -to 19-fold in men and in women respectively. The overall public-health implication of these findings are obvious for a tumor that depends on preventive strategies for its control

Impacto de la vacuna tetravalente frente al virus del papiloma humano (VPH) tipos 6, 11, 16 y 18 en las enfermedades asociadas al VPH en España / Impact of the human papilloma virus (HPV) quadrivalent (types 6/11/16/18) vaccine in HPV-associated diseases in Spain

Objetivo: Evaluar el potencial impacto epidemiológico, sanitario y económico de la introducción de una vacuna tetravalente en la carga de enfermedades asociadas a los tipos de virus del papiloma humano (VPH) 6, 11, 16 y 18 en España. Métodos: Se ha realizado una simulación a partir de un modelo matemático dinámico desarrollado para el Reino Unido, utilizando datos epidemiológicos y económicos específicos para España obtenidos de la literatura científica, de bases de datos y de estudios epidemiológicos previos. Se ha asumido que cualquier estrategia de vacunación se implementaría en combinación con los actuales programas de cribado y tratamiento de la enfermedad por el VPH. Se ha analizado la estrategia de vacunación sistemática de una cohorte de niñas de 11 años de edad, sola o en combinación con una vacunación no sistemática de adolescentes y mujeres de 12 a 24 años. Resultados: A largo plazo, la vacunación reduciría un 86, un 85, un 79 y un 81% los casos de cáncer de cuello de útero, las lesiones precancerosas CIN (neoplasia intraepitelial cervical) II/III, CIN I y las verrugas genitales asociados al VPH 6, 11, 16 y 18%, respectivamente. Globalmente, la vacunación disminuiría un 83,5% los costes totales asociados a las enfermedades por el VPH 6, 11, 16 y 18 a largo plazo. La vacunación no sistemática en mujeres de 12 a 24 años de edad sería la causa del 77% de los costes evitados en los primeros 10 años del programa de vacunación. A corto plazo, la mayoría de los casos y los costes evitados serían atribuibles a la prevención de los casos de lesiones asociadas a la infección por el VPH 6 y 11. Conclusiones: La introducción de una vacuna tetravalente frente al VPH, en combinación con los actuales programas de cribado, reduciría significativamente el número de casos de cáncer de cuello de útero, de lesiones precancerosas y de verrugas genitales en España. La vacunación de las niñas y mujeres de 12 a 24 años no incluidas en los programas de vacunación sistemática permitiría una reducción mayor y a más corto plazo del número de casos de enfermedades asociadas al VPH

Objective: To assess the potential epidemiologic and economic impact of vaccination with the human papillomavirus (HPV) quadrivalent (types 6/11/16/18) vaccine in Spain. Methods: We used a transmission dynamic model developed for the United Kingdom and applied to Spain by using Spanish-specific epidemiologic and economic data obtained from the literature, databases, and previous epidemiological studies. It was assumed that any vaccination strategy would be implemented in combination with current HPV screening and treatment programs. The strategy of routine vaccination of a cohort of 11-year-old girls was used, alone or in combination with catch-up vaccination in 12-24-year olds. Results: In the long term, vaccination of girls and young women would reduce the incidence of cervical cancer by 86%, precancerous cervical intraepithelial neoplasia (CIN) II/III lesions by 85%, CIN I by 79% and genital warts by 81% related to HPV 6, 11, 16 and 18. Overall, vaccination would reduce the total cost related to HPV 6, 11, 16 and 18 infections by 83.5%. Catch-up vaccination of 12-to 24-year-old females would save 77% of the costs avoided in the first 10 years of the program. In the first few years of vaccination, most of the cases and costs avoided would be attributable to the prevention of HPV-6- and 11-related diseases. Conclusions: Implementation of vaccination programs with the HPV quadrivalent vaccine, combined with current screening programs, would significantly reduce the number of cases of cervical cancer, precancerous lesions and genital warts in Spain. Vaccination of girls and women aged 12 to 24 years not included in routine vaccination programs would result in a greater and earlier reduction in the incidence of diseases related to HPV 6, 11, 16 and 18

Vacunas contra el virus del papiloma humano / Vaccines against the human papillomavirus

La infección persistente por el virus del papiloma humano (VPH) se considera el principal agente causal del cáncer de cuello uterino y de otros cánceres anogenitales. De los más de 30 genotipos capaces de infectar el tracto anogenital se estima que los VPH 16 y 18 causan el 70% de los cánceres de cérvix en todo el mundo, y los VPH 6 y 11 más del 90% de las verrugas genitales. La morbimortalidad y costes sanitarios asociados con el cáncer de cérvix y sus lesiones precursoras han motivado en los últimos años una intensa investigación para conseguir una prevención primaria de dicha patología mediante vacunas profilácticas. En estudios realizados en animales se ha demostrado la capacidad inmunógena de partículas semejantes a virus (virus like particles [VLP]) constituidas por proteínas L1 autoensambladas. En ensayos clínicos realizados con 2 prototipos de vacunas profilácticas se ha demostrado su eficacia en la prevención de infecciones cervicales incidentes transitorias y persistentes causadas por los VPH 16 y 18, así como para las alteraciones citológicas y las lesiones cervicales asociadas a dichos virus. Ante la inminente comercialización de vacunas profilácticas para el VPH, se abre la esperanza de una notable reducción de las tasas de cáncer de cuello uterino y de sus lesiones precursoras entre las poblaciones vacunadas en los próximos años. Al mismo tiempo, se inicia un intenso debate sobre las condiciones de vacunación (edad, aplicabilidad, indicación en varones, composición según el área geográfica, necesidad de revacunación, aceptación), coste-eficacia, modificación de las condiciones de cribado del cáncer de cérvix en los países desarrollados y disponibilidad y accesibilidad a ellas en los países más pobres

Persistent infection by human papilloma virus (HPV) is considered to be the main cause of cervical cancer and other ano-genital cancers. Of more than 30 genotypes able to infect the ano-genital tract, it is estimated that, worldwide, HPV 16 and 18 cause 70% of cervical cancers and that HPV 6 and 11 cause more than 90% of genital warts. In the last few years, the morbidity and mortality and health costs associated with cervical cancer and its precursor lesions have stimulated intense research activity to achieve primary prevention of this disease through prophylactic vaccines. Animal tests demonstrated the immunogenic capacity of virus-like particles composed of self-assembled L1 proteins. Clinical trials with 2 prophylactic vaccine prototypes have demonstrated their effectiveness in the prevention of transitory and persistent incident cervical infections caused by HPV 16 and 18, as well as the cytological alterations and cervical lesions associated with these HPV types. With the imminent commercialization of the prophylactic HPV vaccine, there are high hopes for a marked reduction in the rates of cervical cancer and its precursor lesions amongst the vaccinated population within the next few years. At the same time, an intense debate has arisen on the conditions of vaccination (age, applicability, indication in men, composition according to geographic area, need for revaccination, acceptance) and its cost-effectiveness, as well as on the modification of screening conditions for cervical cancer in developed countries and the availability and accessibility of screening in the poorest countries

Influence of mate drinking, hot beverages and diet on esphageal cancer risk in South America

To estimate the effects of consuming hot beverages, including mate (an infusion of the herb Ilex Paraguayensis), tea, coffee and coffee with milk, and other food items on esophageal cancer risk, we analyzed data from 830 cases and 1.779 controls participating in a series of 5 hospital-based case-controls studies of squamous-cell carcinoma of the esophagus conducted in high-risk areas of South America. After adjusting for the strong effects of tobacco and alcohol consumption, both heavy mate drinking (>I I/day) and self-reported very hot mate drinking were significantly associated with esophageal cancer risk in men and women. The magnitude and strenght of the association for mate amount and, to a lesser extent, mate temperature were higher for women than men. The joint effects of mate amount and mate temperature were more than multiplicative, following a statistically significant synergistic interaction (p=0.02) which was particularly evident among heavy drinkers (>1.50 l/day) of very hot mate (odds ratio = 4.14, 95 per cent confidence interval: 2.24-7.67) compared to light drinkers (<0.50 l/day)of cold/warm/hot mate. Consumption of other very hot beverages, such as tea and coffee with milk but not coffee alone, was also significantly associated with an increased risk, in the 2-to4-fold range. Statistically significant protective associations were identified for consumption of vegetables, fruits, cereal and tea. In contrast, frequent consumption of meat, animal fats and salt was associated with a moderately increased risk. This pooled analysis adds evidence for cardinogenic effect of chronic thermal injury in the esophagus induced by the consumption of very hot drinks, including mate. Our study further confirms the protective effect of a dietary pattern characterized by daily consumption of fruits and vegetables and low consumption of meat and animal fats

Smoking and drinking cessation and risk of esophageal cancer (Spain)

Objectives: To explore the effectiveness of alchol drinking and tobacco cessation in reducing esophageal cancer risk, taking into account the key characteristics of each habit and the simultaneous exposure to both habits. Methods: Data from a series of five hospital-based case-control studies of incident squamous-cell carcinoma of the esophagus conducted by the International Agency for Research of Cancer (IARC, Lyon, France) in high risk areas in South America were combined and analyzed by multivariate logistic regression procedures. A total of 2063 men (655 case patients and 1408 control subjects) were included in the pooled analysis. Results: For either habit, the risk of esophageal cancer decreased rapidly, strongly and significantly with longer periods of abstention. The risk reduction was statistically significant regardless of the intensity and duration of each habit and the type of tobacco or alcoholic drink consumed. For subjects exposed to both risk factores, the protective effect of quitting both habits appeared to be synergistic, reaching, after only five to nine year of simultaneous cessation of both exposures, a 70 per cent risk reduction, a reduction that clearly overlapped with the risk intervals of both never-smokers and never-drinkers. The risk benefit of merely quitting alcohol drinking was delayed (>10 years of cessation) unless it was accompanied by a few years of smoking cessation. Conclusions: Our findings solidly demonstrate for the first time the effectiveness of smoking and drinking cessation in reducing esophageal cancer risk. For the large proportion of subjects in the general population exposed to both risk factors, our results further emphasize the importance of smoling cessation to effectively reduce cancer risk