Journal Article•
Prevención primaria del cáncer cervicouterino
TL;DR: La infección por el VPH de los tipos 6, 11, 16 and 18 puede ocasionar resultados anormales en la citología vaginal y lesiones displásicas de grado leve (NIC 1, NIV 1 and NIVa 1) para que aparezcan el cáncer cervicouterino.
Abstract: A ctualmente podemos prevenir el cáncer de cuello uterino con tres estrategias: la primera es abstinencia sexual; retrasar la vida sexual después de los 20 años, monogamia y el uso de condón; la segunda, a través de la prevención primaria (antes de la adquisición del virus del papiloma humano, vacunas profilácticas), en la etapa presexual y; la tercera, basada en la citología vaginal con tinción de Papanicolaou y pruebas de ADN. Para fines prácticos, la primera opción sólo la practica la minoría de la población, por lo tanto, carece de impacto significativo en la prevención del cáncer cervicouterino. A pesar de que la citología vaginal reduce tanto la tasa de incidencia y mortalidad del cáncer cervicouterino (70%), para alcanzar estos resultados debe repetirse con frecuencia, ya que su baja sensibilidad, entre 30 a 57%, y su elevada tasa de falsos negativos hace que esta estrategia sea menos costo-efectiva. El cáncer cervicouterino es causado por una infección por el virus del papiloma humano (VPH). Es necesaria la infección por VPH para que aparezcan el cáncer cervicouterino de células escamosas (y su lesión precursora, la neoplasia intraepitelial cervical o NIC de grados 1 y 2/3) y el adenocarcinoma cervicouterino (y su lesión precursora, el adenocarcinoma in situ [AIS]). El VPH también causa un subgrupo de cánceres vulvares y vaginales, así como sus lesiones precursoras, la neoplasia intraepitelial vulvar (NIV) y la neoplasia intraepitelial vaginal (NIVa). La infección por el VPH es muy común. A falta de vacunación, más de 50% de los adultos sexualmente activos se infectarán con el VPH a lo largo de la vida. La mayoría de las infecciones por VPH desaparecen sin secuelas, pero algunas avanzan hasta desembocar en cáncer cervicouterino. La infección por el VPH de los tipos 6, 11, 16 y 18 puede ocasionar resultados anormales en la citología vaginal y lesiones displásicas de grado leve (NIC 1, NIV 1 y NIVa 1). Las lesiones por el VPH de los tipos 6 y 11 tienen pocas probabilidades de progresar hasta el cáncer, pero son clínicamente indistinguibles de las lesiones premalignas causadas por el VPH de los tipos 16 y 18. Los VPH de los tipos 16 y 18 causan 70% de los cánceres de ano y de pene relacionados, así como sus lesiones precursoras. La infección por el VPH de los tipos 6 y 11 también causa verrugas genitales (condilomas acuminados), excrecencias que aparecen en la mucosa cervicovaginal, vulvar y perianal y en los genitales externos, que rara vez progresan hasta el cáncer. Se ha calculado que el riesgo de por vida de contraer verrugas genitales es superior al 10%. La incidencia de estas lesiones, por lo general, es comparable entre hombres y mujeres. El VPH de los tipos 6 y 11 también causa la papilomatosis respiratoria recurrente (PRR), una enfermedad de los lactantes y los adultos. La papilomatosis respiratoria recurrente se caracteriza por la aparición repetida de verrugas en las vías respiratorias. En Estados Unidos, cada año se diagnostican 5,900 casos, y el tratamiento requiere intervenciones quirúrgicas repetidas.
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TL;DR: Primary cervical cancer screening with citology decrease incidence by more than 50% and the test of the human papilloma virus high risk, is effective and safe because of its excellent sensitivity, negative predictive value and optimal reproducibility.
Abstract: Primary cervical cancer screening Abstract Cervicouterine cancer screening with citology decrease incidence by more than 50%. The cause of this cancer is the human papilloma virus high risk, and requires a sensitive test to provide sufficient sensitivity and specificity for early detection and greater interval period when the results are negative. The test of the human papilloma virus high risk, is effective and safe because of its excellent sensitivity, negative predictive value and optimal reproducibility, especially when combined with liquid-based cytology or biomarkers with viral load, with higher
11 citations
Cites background from "Prevención primaria del cáncer cerv..."
...2012;120(5):294--307; (b) Carozzi F, Gillio-Tos A, Confortini M, Del Mistro A, Sani C, De Marco L, et al....
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17 Aug 2017
TL;DR: Cervical cancer is the leading cause of morbidity and mortality among gynecological cancers worldwide and is the main cancer found in developing countries.
Abstract: Cervical cancer is the leading cause of morbidity and mortality among gynecological cancers worldwide. Cervical cancer is the main cancer found in developing countries. There are risk factors for cervical cancer worldwide,
3 citations
Cites background from "Prevención primaria del cáncer cerv..."
...To reduce the high rates of mortality from cervical cancer is necessary to institute measures of innovation and equity; create sex education campaigns, increase screening coverage and provided women with geographical, cultural or economic barriers; free universal application of the HPV vaccine and the full treatment for all women’s [26]....
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...In Australia the vaccination program nationwide recombinant quadrivalent HPV vaccine is offered to adolescents 12 to 18 years old, to women under 26 years, with a coverage rate [18,24-27], of 65-75%....
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...4 million doses have been given since the vaccination program started and from 2009 for adolescents 18 years of age or younger; scheme with 3 injections over 6 months, mainly applied in high schools and 80% coverage in adolescents 12 to 13 years, a reduction of 63% of cervical cancer, 51% reduction of CIN-3 is projected and 27% reduction of abnormal smears before 30 years of age [25-28]....
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23 Jan 2020
TL;DR: The treatment of malignant neoplasms of the vulva, in general, surgery is the primary treatment.
Abstract: Vulvar cancer is rare, occupies the fourth most common type of gynecological cancer mainly affects postmenopausal, there are no screening tests or effective strategies to reduce its incidence, only the timely treatment of preneoplastic lesions; It is initially asymptomatic, chronic pruritus or vulvar pain is reported, or the presence of tumor or ulcer; alone, the biopsy confirms the diagnosis and histopathological type. Surgical staging involves the removal of the primary lesion and locoregional lymph node evaluation. In current practice, surgical management is conservatively substituted for radical vulvectomy and depends mainly on the histopathological type and staging, mainly the nodal state. Conclusion: The treatment of malignant neoplasms of the vulva, in general, surgery is the primary treatment.
2 citations
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TL;DR: The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer, and the rationale for HPV testing in addition to, or even instead of, cervical cytology in routine cervical screening.
Abstract: A recent report that 93 per cent of invasive cervical cancers worldwide contain human papillomavirus (HPV) may be an underestimate, due to sample inadequacy or integration events affecting the HPV L1 gene, which is the target of the polymerase chain reaction (PCR)-based test which was used. The formerly HPV-negative cases from this study have therefore been reanalyzed for HPV serum antibodies and HPV DNA. Serology for HPV 16 VLPs, E6, and E7 antibodies was performed on 49 of the 66 cases which were HPV-negative and a sample of 48 of the 866 cases which were HPV-positive in the original study. Moreover, 55 of the 66 formerly HPV-negative biopsies were also reanalyzed by a sandwich procedure in which the outer sections in a series of sections are used for histological review, while the inner sections are assayed by three different HPV PCR assays targeting different open reading frames (ORFs). No significant difference was found in serology for HPV 16 proteins between the cases that were originally HPV PCR-negative and -positive. Type-specific E7 PCR for 14 high-risk HPV types detected HPV DNA in 38 (69 per cent) of the 55 originally HPV-negative and amplifiable specimens. The HPV types detected were 16, 18, 31, 33, 39, 45, 52, and 58. Two (4 per cent) additional cases were only HPV DNA-positive by E1 and/or L1 consensus PCR. Histological analysis of the 55 specimens revealed that 21 were qualitatively inadequate. Only two of the 34 adequate samples were HPV-negative on all PCR tests, as against 13 of the 21 that were inadequate ( p< 0.001). Combining the data from this and the previous study and excluding inadequate specimens, the worldwide HPV prevalence in cervical carcinomas is 99.7 per cent. The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer. The extreme rarity of HPV-negative cancers reinforces the rationale for HPV testing in addition to, or even instead of, cervical cytology in routine cervical screening.
8,407 citations
"Prevención primaria del cáncer cerv..." refers background in this paper
...La neoplasia intraepitelial vulvar y la neoplasia intraepitelial vaginal de grados 2 y 3 son las precursoras de los cánceres vulvares y vaginales relacionados con el VPH.(4,5)...
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...La neoplasia intraepitelial vulvar y la neoplasia intraepitelial vaginal de grados 2 y 3 son las precursoras de los cánceres vulvares y vaginales relacionados con el VPH.4,5...
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...Así pues, los precursores inmediatos, tales como la NIC 2 (displasia cervicouterina de grado moderado), la NIC 3 (displasia cervicouterina de grado alto, que incluye el carcinoma in situ), y el adenocarcinoma in situ son los puntos finales más apropiados para demostrar la prevención del cáncer cervicouterino mediante las vacunas contra el VPH. La neoplasia intraepitelial cervical 3 y el adenocarcinoma in situ se clasifican como cánceres cervicouterinos de grado 0, según la FIGO (Federación Internacional de Ginecología y Obstetricia)....
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TL;DR: Variation in the incidence of cervical cancer is also present within countries, where rural and poor areas have the highest rates.
Abstract: In 1985, 7.6 million cases of cancer were diagnosed in 24 different regions all over the world (1). Globally, cervical cancer is the fifth most frequent malignancy and second among women, with an annual estimate of 471,000 new cases and 213,000 deaths. The age-adjusted incidence rates for developed countries are 7.6 to 11.8 per 105 and for developing countries, 17.6 to 46.8 per 105 (1,2). This variation in the incidence of cervical cancer is also present within countries, where rural and poor areas have the highest rates.
249 citations
"Prevención primaria del cáncer cerv..." refers background in this paper
...A pesar de que la citología vaginal reduce tanto la tasa de incidencia y mortalidad del cáncer cervicouterino (70%), para alcanzar estos resultados debe repetirse con frecuencia, ya que su baja sensibilidad, entre 30 a 57%, y su elevada tasa de falsos negativos hace que esta estrategia sea menos costo-efectiva.(1,2) El cáncer cervicouterino es causado por una infección por el virus del papiloma humano (VPH)....
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TL;DR: The available evidence indicates that the HPV-cervical cancer association satisfies all relevant causal criteria for public health action and is the first instance in which a necessary cause has been demonstrated in cancer epidemiology--a realization that has obvious implications for primary and secondary prevention of this neoplastic disease.
Abstract: Cervical cancer is one of the most common neoplastic diseases affecting women, with a combined worldwide incidence of almost half a million new cases annually, second only to breast cancer. Basic and epidemiologic research conducted during the past 15-20 years have provided overwhelming evidence for an etiologic role for infection with certain types of sexually-transmitted human papillomavirus (HPV) as the primary cause of cervical cancer. The relative risks of cervical cancer following HPV infection as ascertained in case-control and cohort studies are among the highest in cancer epidemiology. The available evidence indicates that the HPV-cervical cancer association satisfies all relevant causal criteria for public health action. Other cervical cancer risk factors, such as smoking, parity, use of oral contraceptives, diet, other infections, and host susceptibility traits must be understood in the context of mediation of acquisition of HPV infection or in influencing events of the natural history of cervical neoplasia that occur following the establishment of a persistent HPV infection. Virtually all cervical carcinoma specimens contain HPV DNA, which suggests that HPV infection is a necessary cause of cervical neoplasia. This is the first instance in which a necessary cause has been demonstrated in cancer epidemiology--a realization that has obvious implications for primary and secondary prevention of this neoplastic disease.
213 citations
TL;DR: At this stage of development, regulatory agencies are requested to evaluate the scientific evidence and weigh its implications in relation to costs, public health investments and policy.
Abstract: Epidemiological studies supported by molecular technology have provided sufficient evidence on the causal role of some Human Papillomavirus (HPV) infections in the development of cervical cancer. This association has been evaluated under all proposed sets of causality criteria and endorsed by the scientific community and major review institutes. HPV has been proposed as the first-ever identified, necessary cause of a human cancer. In practical terms, the concept of a necessary cause implies that cervical cancer does not and will not develop in the absence of the persistent presence of HPV-deoxyribonucleic acid (DNA). This important advancement has two practical implications in prevention. Firstly, screening programs can be enhanced if HPV testing is judiciously incorporated into solving the fraction of ambiguous cytology readings. In some populations HPV screening as a primary test may prove to be the strategy of choice. Secondly, like in the hepatitis B disease model, intense efforts are currently being put into the development and testing of vaccines that may prevent the relevant HPV infections, and presumably, cervical cancer. At this stage of development, regulatory agencies are requested to evaluate the scientific evidence and weigh its implications in relation to costs, public health investments and policy. This is a subjective evaluation that could be guided by a careful description of the most relevant studies and findings.
200 citations
"Prevención primaria del cáncer cerv..." refers background in this paper
...Las lesiones por el VPH de los tipos 6 y 11 tienen pocas probabilidades de progresar hasta el cáncer, pero son clínicamente indistinguibles de las lesiones premalignas causadas por el VPH de los tipos 16 y 18.(3) Los VPH de los tipos 16 y 18 causan 70% de los cánceres de ano y de pene relacionados, así como sus lesiones precursoras....
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TL;DR: Although sensitivity and specificity of the available diagnostic techniques are suboptimal, screening for persistent HPV infection is effective in reducing the incidence of cervical cancer.
Abstract: Cervical cancer is caused by infection with a range of high risk oncogenic human papillomavirus (HPV) types, and it is now accepted that >99% of cervical cancer is initiated by HPV infection. The estimated lifetime risk of cervical cancer is nevertheless relatively low (less than I in 20 for most community based studies). Although sensitivity and specificity of the available diagnostic techniques are suboptimal, Screening for persistent HPV infection is effective in reducing the incidence of cervical cancer. Infection can be detected by molecular techniques or by cytological examination of exfoliated cervical cells. Persistent infection is the single best predictor of risk of cervical cancer.(1) The latest findings of HPV and cervical cancer research need to be widely disseminated to the scientific and medical societies that are updating screening and management protocols, public health professionals, and to women and clinicians. This report reviews current evidence, clinical implications and directions for further research in the prevention, control and management of cervical cancer. We report the conclusions of the Experts' Meeting at the EUROGIN 2003 conference. (C) 2003 Wiley-Liss, Inc.
136 citations
"Prevención primaria del cáncer cerv..." refers background in this paper
...A pesar de que la citología vaginal reduce tanto la tasa de incidencia y mortalidad del cáncer cervicouterino (70%), para alcanzar estos resultados debe repetirse con frecuencia, ya que su baja sensibilidad, entre 30 a 57%, y su elevada tasa de falsos negativos hace que esta estrategia sea menos costo-efectiva.(1,2) El cáncer cervicouterino es causado por una infección por el virus del papiloma humano (VPH)....
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