Showing papers by "Mona Saraiya published in 2012"

EUROGIN 2011 roadmap on prevention and treatment of HPV-related disease

Abstract: The EUROGIN 2011 roadmap reviews the current burden of human papillomavirus (HPV)-related morbidity, as well as the evidence and potential practice recommendations regarding primary and secondary prevention and treatment of cancers and other disease associated with HPV infection. HPV infection causes ~600,000 cases of cancer of the cervix, vulva, vagina, anus and oropharynx annually, as well as benign diseases such as genital warts and recurrent respiratory papillomatosis. Whereas the incidence of cervical cancer has been decreasing over recent decades, the incidence of anal and oropharyngeal carcinoma, for which there are no effective screening programs, has been rising over the last couple of decades. Randomized trials have demonstrated improved efficacy of HPV-based compared to cytology-based cervical cancer screening. Defining the best algorithms to triage HPV-positive women, age ranges and screening intervals are priorities for pooled analyses and further research, whereas feasibility questions can be addressed through screening programs. HPV vaccination will reduce the burden of cervical precancer and probably also of invasive cervical and other HPV-related disease in women. Recent trials demonstrated that prophylactic vaccination also protects against anogenital HPV infection, anogenital intraepithelial lesions and warts associated with vaccine types, in males; and anal HPV infection and anal intraepithelial neoplasia in MSM. HPV-related oropharyngeal cancer could be treated less aggressively because of better survival compared to cancers of the oropharynx unrelated to HPV. Key findings in the field of cervical cancer prevention should now be translated in cost-effective strategies, following an organized approach integrating primary and secondary prevention, according to scientific evidence but adapted to the local situation with particular attention to regions with the highest burden of disease.

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.

Cancers That U.S. Physicians Believe the HPV Vaccine Prevents: Findings from a Physician Survey, 2009

Abstract: Background: There is strong scientific evidence that human papillomavirus (HPV) vaccines, which protect against two oncogenic HPV types (16 and 18), can prevent cervical, vaginal, and vulvar cancers in women. In addition, recent research has established that the HPV vaccine can prevent anal cancer and has implied that it may also prevent oropharyngeal cancers. Methods: A 2009 web-based survey of 1500 physicians from four specialties (pediatricians, family practitioners, internists, and obstetrician-gynecologists) explored knowledge about which female cancers the HPV vaccine was effective in preventing. Physician characteristics associated with the belief that the HPV vaccine prevents cervical, vaginal, vulvar, anal, and other cancers were examined using logistic regression models. Results: Nearly all respondents (97.8%) identified cervical cancer as being prevented by the HPV vaccine; however, lower awareness that the vaccine prevents vaginal (23.8%), vulvar (27.8%), and anal cancer (28.4%) was f...

Human papillomavirus vaccination practices among providers in Indian health service, tribal and urban Indian healthcare facilities.

Abstract: Purpose: The human papillomavirus (HPV) vaccine is of particular importance in American Indian/Alaska Native women because of the higher rate of cervical cancer incidence compared to non-Hispanic white women. To better understand HPV vaccine knowledge, attitudes, and practices among providers working with American Indian/Alaska Native populations, we conducted a provider survey in Indian Health Service, Tribal and Urban Indian (I/T/U) facilities. Methods: During December 2009 and January 2010, we distributed an on-line survey to providers working in I/T/U facilities. We also conducted semistructured interviews with a subset of providers. Results: There were 268 surveys and 51 provider interviews completed. Providers were more likely to administer vaccine to 13–18-year-olds (96%) than to other recommended age groups (89% to 11–12-year-olds and 64% to 19–26-year-olds). Perceived barriers to HPV vaccination for 9–18-year-olds included parental safety and moral/religious concerns. Funding was the mai...

Human papillomavirus vaccine practices in the USA: do primary care providers use sexual history and cervical cancer screening results to make HPV vaccine recommendations?

Abstract: Objectives Guidelines recommend against the use of Papanicolaou (Pap) or human papillomavirus (HPV) testing when determining eligibility for the HPV vaccine. Optimally, the HPV vaccine should be administered before sexual initiation. Guidelines recommend that age-eligible women with past exposure to HPV should still be vaccinated. Little is known about how primary care providers (PCPs) use sexual history and HPV and Pap tests in their HPV vaccine recommendations. Methods Data from the 2007 Cervical Cancer Screening Supplement (CCSS) administered with the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess HPV vaccination recommendations. The CCSS investigates cervical cancer screening practices, HPV testing and HPV vaccine recommendations among PCPs. A summary measure of compliance with guidelines was defined as rarely or never using the number of sexual partners and HPV tests and Pap tests to determine vaccine receipt. A total of 421 PCPs completed the CCSS in 2007. Results Among NAMCS and NHAMCS providers who recommend the HPV vaccine, only 53% (95% CI 42% to 63%) reported making guideline-consistent recommendations. The majority reported sometimes to always recommending the HPV vaccine to women with a history of an abnormal Pap result (85%; 95% CI 75% to 91%) and a positive HPV test (79%; 95% CI 70% to 86%). Conclusions A large proportion of providers report practices that are inconsistent with guidelines. Providers may also be recommending the vaccine to women who may receive little benefit from the vaccine. Provider and system-level efforts to improve guideline-consistent practices are needed.

Recency of Pap Testing and Future Testing Plans Among Women Aged 18–64: Analysis of the 2007 Health Information National Trends Survey

Abstract: Background: Cervical cancer incidence has declined as a result of Papanicolaou (Pap) test use. Current guidelines recommend increasing screening intervals for women of average risk. The objective of this study is to examine current screening intervals, factors associated with recency of Pap testing, and future testing plans. Methods: We analyzed data from 2915 female respondents, aged 18–64, using the 2007 Health Information National Trends Survey (HINTS), a biennial national survey of access and use of cancer information in the United States. We divided time since last Pap test into ≤1 year (n=1960), >1 to ≤3 years (n=512), >3 years/never had Pap test (n=443). We performed univariate analyses and multivariate logistic regression, using proportional odds model with cumulative logit link. Results: Sixty-five percent of women had their most recent Pap test within 1 year. Most expected to be screened again within 1 year (81%). This expectation was highest among women who were tested within the previ...

Bolivian Health Providers' Attitudes Toward Alternative Technologies for Cervical Cancer Prevention: A Focus on Visual Inspection with Acetic Acid and Cryotherapy

Abstract: Background: Little is known about health providers' attitudes toward visual inspection with acetic acid (VIA) and cryotherapy in the prevention of cervical cancer, as most research in Latin America and the Caribbean (LAC) has examined attitudes of the general population. This study describes attitudes of Bolivian health professionals toward new technologies for cervical cancer prevention, focusing on VIA and cryotherapy. Methods: Between February 2011 and March 2012, we surveyed 7 nurses and 35 physicians who participated in 5-day workshops on VIA and cryotherapy conducted in Bolivia. Multiple choice and open-ended questions were used to assess participants' acceptability of these procedures and the feasibility of their implementation in the context of perceived barriers for the early detection of cervical cancer in this country. Results: Most believed that cultural factors represent the main barrier for the early detection of cervical cancer (70%), although all stated that VIA and cryotherapy wo...

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