Showing papers by "Meg Watson published in 2012"

Prevalence of human papillomavirus types in invasive vulvar cancers and vulvar intraepithelial neoplasia 3 in the United States before vaccine introduction.

Abstract: OBJECTIVE The study aimed to determine the baseline prevalence of human papillomavirus (HPV) types in invasive vulvar cancer (IVC) and vulvar intraepithelial neoplasia 3 (VIN 3) cases using data from 7 US cancer registries. MATERIALS AND METHODS Registries identified eligible cases diagnosed in 1994 to 2005 and requested pathology laboratories to prepare 1 representative block for HPV testing on those selected. Hematoxylin-eosin-stained sections preceding and following those used for extraction were reviewed to confirm representation. Human papillomavirus was detected using L1 consensus polymerase chain reaction (PCR) with PGMY9/11 primers and type-specific hybridization, with retesting of samples with negative and inadequate results with SPF10 primers. For IVC, the confirmatory hematoxylin-eosin slides were re-evaluated to determine histological type. Descriptive analyses were performed to examine distributions of HPV by histology and other factors. RESULTS Human papillomavirus was detected in 121/176 (68.8%) cases of IVC and 66/68 (97.1%) cases of VIN 3 (p < .0001). Patients with IVC and VIN 3 differed by median age (70 vs 55 y, p = .003). Human papillomavirus 16 was present in 48.6% of IVC cases and 80.9% of VIN 3 cases; other high-risk HPV was present in 19.2% of IVC cases and 13.2% of VIN 3 cases. Prevalence of HPV differed by squamous cell carcinoma histological subtype (p < .0001) as follows: keratinizing, 49.1% (n = 55); nonkeratinizing, 85.7% (n = 14), basaloid, 92.3% (n = 14), warty 78.2% (n = 55), and mixed warty/basaloid, 100% (n = 7). CONCLUSIONS Nearly all cases of VIN 3 and two thirds of IVC cases were positive for high-risk HPV. Prevalence of HPV ranged from 49.1% to 100% across squamous cell carcinoma histological subtypes. Given the high prevalence of HPV in IVC and VIN 3 cases, prophylactic vaccines have the potential to decrease the incidence of vulvar neoplasia.

Cervical cancer screening measures need to evolve to continue to tell the story.

Abstract: According to Chen et al., 1 6% of U.S. adult women reported never having been screened for cervical cancer. These women were young ( < 21 years) or old ( ‡ 70 years), less educated, uninsured, Hispanic, widowed, and never married. Besides the focus on the never screened women, this study offers many insights into the successes, failures, and gaps of cervical cancer screening over the past two decades. Additionally, it gives public health professionals who develop and use survey measures issues to consider in finding the right balance between keeping the survey consistent to allow for interpretation of trends and flexibility to allow measurement of emerging technologies and new practices. One important success not fully appreciated in the article by Chen et al. is that for the first time, in 2012, cervical cancer screening guidelines are consistent among the three national organizations (www.cdc.gov/cancer/cervical/pdf/ guidelines.pdf for table), including consensus that women 70 years of age who have never had a Pap test? Chen et al. could identify only characteristics currently collected, which do not include language spoken, country of birth, in BRFSS, or specific Hispanic subgroups, all characteristics of women who have been reported to be less likely to get screened. Additional measures not addressed include newer technologies, such as human papillomavirus (HPV) testing and HPV vaccination status. HPV and Pap testing together (cotesting) has been an approved option in screening since 2003 according to some organizations. By 2012, all organizations now either strongly recommend or include cotesting as an option for women ‡ 30 years of age. If both tests are negative, women can now extend the screening interval to 5 years, a response option that needs to be incorporated with in surveys that measure current screening behaviors and practices. Questions on HPV vaccination status would address the interpretation of screening behaviors. There is concern that vaccinated girls and women may have a false sense of security and, thus, not follow recommended screening guidelines. Although current guidelines remain the same for vaccinated and nonvaccinated women, it is anticipated that in the future screening fully vaccinated girls can occur later and less often. In the United States, self-reported state and national surveys are heavily relied upon to measure screening prevalence and gaps for cervical cancer screening, largely because a nationwide population-based screening program does not exist. Long-standing national and statebased surveillance systems face a tough challenge in being responsive to changes in communications technology, population diversity, and newer technologies while still allowing measurement of trends. The same issues are salient and relevant to the international setting. The World Health Organization Global Monitoring Framework currently proposes an indicator to measure that women between the ages of 30 to 49 years have been screened for cervical cancer at least once. With international efforts focused on cervical cancer in lowand middle-income countries, we may need to leverage existing surveillance systems that ask standardized core sets of questions for cervical cancer screening, whether the screening method is using the HPV test, Pap test, or visual inspection with acetic acid (VIA). Clearly, cervical