HPV vaccination for the prevention of cervical intraepithelial neoplasia.

Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
New England Journal of Medicine (Impact Factor: 54.42). 08/2009; 361(3):271-8. DOI: 10.1056/NEJMct0806938
Source: PubMed

ABSTRACT A sexually active 18-year-old woman presents to her internist for an annual examina- tion. During the review of her family history, she notes that her mother recently re- ceived a diagnosis of "pre-cervical cancer" and underwent a loop electrosurgical exci- sion procedure. The patient's mother has advised her to get the "cervical-cancer shot." Should this patient receive a human papillomavirus (HPV) vaccine, and how effective would vaccination be in preventing cervical cancer? The Clinical Problem Genital HPV infection is usually acquired through sexual contact and is extremely common. In a nationally representative study of women in the United States, 25% of persons between the ages of 14 and 19 years and 45% of persons between the ages of 20 and 24 years were HPV-positive.1 It is estimated that more than 80% of both men and women in the United States will be infected with HPV at some point in their lives.2 HPV is often acquired within months after the first sexual intercourse: in a study of university women who had recently had sexual intercourse for the first time and reported having only one partner, almost 30% became HPV-positive within 1 year.3 Although HPV infection is usually asymptomatic, anogenital warts or can- cers or other HPV-associated cancers develop in a subgroup of infected women and men. The clinical outcome of greatest significance for public health is cervical cancer. Globally, cervical cancer is the second most frequent cancer among women; each year, approximately 490,000 women receive this diagnosis and 270,000 die from cervical cancer.4 In the United States, the implementation of cytologic screening programs with the Papanicolaou (Pap) test has led to a decrease in rates of cervical cancer, since screening identifies precancerous cervical lesions that can be treated before they prog- ress to cancer. Despite such screening, in 2008, approximately 11,000 women in the United States received a diagnosis of cervical cancer and 3900 died from the disease.5 The direct medical costs associated with the prevention and treatment of HPV- related anogenital warts and cervical disease in the United States are estimated to be $4.0 billion annually,6 and productivity losses due to deaths from cervical can- cer are estimated to be $1.3 billion annually.7

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    ABSTRACT: When the true relationship between a covariate and an outcome is nonlinear, one should use a nonlinear mean structure that can take this pattern into account. In this article, the fractional polynomial modeling framework, which assumes a prespecified set of powers, is extended to a nonlinear fractional polynomial framework (NLFP). Inferences are drawn in a Bayesian fashion. The proposed modeling paradigm is applied to predict the long-term persistence of vaccine-induced anti-HPV antibodies. In addition, the subject-specific posterior probability to be above a threshold value at a given time is calculated. The model is compared with a power-law model using the deviance information criterion (DIC). The newly proposed model is found to fit better than the power-law model. A sensitivity analysis was conducted, from which a relative independence of the results from the prior distribution of the power was observed. Supplementary materials for this article are available online.
    Statistics in Biopharmaceutical Research 08/2014; 6(3):199-212. DOI:10.1080/19466315.2014.911201 · 0.70 Impact Factor
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    ABSTRACT: It is estimated that Haiti has the highest incidence of cervical cancer in the Western Hemisphere. There are currently no sustainable and affordable cervical cancer screening programs in Haiti. The current status of screening services and knowledge of health care professionals was assessed through a Knowledge, Attitudes, and Practices survey on cervical cancer screening and prevention. It was distributed to Project Medishare for Haiti health care workers (n = 27) in the Central Plateau. The majority (22/27) of participants stated pre-cancerous cells could be detected through screening, however, only four had ever performed a pap smear. All of the participants felt a screening program should be started in their area. Our data establishes that knowledge is fairly lacking among healthcare workers and there is an opportunity to train them in simple, cost effective "screen-and-treat" programs that could have a great impact on the overall health of the population.
    International Journal of Environmental Research and Public Health 11/2014; 11(11):11541-52. DOI:10.3390/ijerph111111541 · 1.99 Impact Factor
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    ABSTRACT: Background Human Papilloma Virus (HPV) infection is the major cause of cervical cancer worldwide. With limited data available on HPV prevalence in the Arab countries, this study aimed to identify the prevalence and genotypic distribution of HPV in the State of Qatar.Methods3008 cervical samples, exclusively of women with Arabic origin residing in Qatar were collected from the Women¿s Hospital and Primary Health Care Corporation in Doha, State of Qatar. HPV DNA detection was done using GP5+/6+ primers based real time-polymerase chain reaction (RT-PCR) assay followed by the usage of HPV type specific primers based RT- PCR reactions and Sanger sequencing for genotype identification.ResultsSimilar prevalence rates of HPV infection was identified in both Qatari and non-Qatari women at 6.2% and 5.9% respectively. HPV prevalence rate of 5.8% and 18.4% was identified in women with normal cytology and in women with abnormal cytology respectively. HPV 81, 11 and 16, in decreasing order were the most commonly identified genotypes. HPV 81 was the most frequent low-risk genotype among women with both normal (74.0%) and abnormal (33.3%) cytology. HPV 16 (4.6%) was identified as the predominant high-risk HPV genotype among women with normal cytology and HPV 16, HPV 18, and HPV 56 (22.2% each) were the most common identified high-risk genotypes in women with abnormal cytology.Conclusions The overall HPV prevalence in Arab women in Qatar was identified as 6.1% with an increased HPV prevalence seen in women with abnormal cytology results and no significant trends seen with age. In contrast to Western countries, we report a varied genotypic profile of HPV with a high prevalence of low-risk HPV genotype 81 among the Arab women residing in Qatar.
    Journal of Translational Medicine 11/2014; 12(1):300. DOI:10.1186/s12967-014-0300-4 · 3.99 Impact Factor


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