Cancer in Young Adults Disproportionately Affects Women

MedicalResearch.com Interview with:

Dr Miranda M Fidler, PhD Section of Cancer Surveillance International Agency for Research on Cancer Lyon, France 

Dr. Fidler

Dr Miranda M Fidler, PhD
Section of Cancer Surveillance
International Agency for Research on Cancer
Lyon, France 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The burden of cancer among young adults has been rarely studied in depth. To our knowledge, we describe for the first time the scale and profile of cancer incidence and mortality worldwide among 20-39 year-olds, highlighting major patterns by age, sex, development level, and geographic region.

Although cancer is less frequent than that observed at older ages, its impact remains considerable because these individuals have a large proportion of their expected lifespans remaining, contribute substantially to the economy, and play a major role in caring for their families. Worldwide, almost 1 million new cases of cancer and 400 000 cancer-related deaths occurred among young adults aged 20–39 years in 2012.

Overall, the most common cancer types in terms of new cases were female breast cancer, cervical cancer, thyroid cancer, leukemia, and colorectal cancer, and the most common types of cancer-related deaths were those due to female breast cancer, liver cancer, leukemia, and cervical cancer. The burden was disproportionately greater among women, with an estimated 633 000 new cancer cases (65% of all new cancer cases in that age group) and 194 000 cancer-related deaths (54% of all cancer-related deaths in that age group) in 2012.

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Oropharyngeal Cancer Rising In Incidence and Costs to Over $140,000

MedicalResearch.com Interview with:

David R. Lairson, PhD Professor of Health Economics Division of Management Policy and Community Health Co-Director, Center for Health Services Research School of Public Health The University of Texas Health Science Center at Houston (UTHealth)

Dr. Lairson

David R. Lairson, PhD
Professor of health economics
Department of Management, Policy, and Community Health
The University of Texas Health Science Center at Houston (UTHealth) School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The study of oropharyngeal cancer treatment cost was initiated by the Head and Neck Cancer Surgery Department at the University of Texas MD Anderson Cancer Center as part of a larger study of the economic and health consequences of human papillomavirus (HPV) related conditions in Texas.  State specific information is required for policy-makers to consider future investments in cancer prevention based on HPV immunization and cancer screening.  The cost estimates at $140,000 per case for the first two years of treatment are substantially higher than previous estimates.  They indicate the potential savings associated with cancer prevention and partially justify increased investment in immunization efforts.

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Increase in HPV+ Oropharyngeal Cancers Suggests Both Sexes Should Be Vaccinated

MedicalResearch.com Interview with:

Steven Habbous MSc, PhD candidate Ontario Cancer Institute Scarborough, Ontario, Canada

Steven Habbous

Steven Habbous MSc, PhD candidate
Ontario Cancer Institute
Scarborough, Ontario, Canada

MedicalResearch.com: What is the background for this study?

Response: Human papillomavirus (HPV) is a strong risk factor for oropharyngeal cancers (a subset of head and neck cancers). Because HPV-related oropharyngeal cancers generally respond well to treatment and may be prevented through HPV vaccination, it is critical to be able to accurately estimate the incidence and prevalence of this disease. Only recently, however, has testing for HPV become routine at most cancer centres across Canada.  As a result, attempts to estimate the growth of HPV-related oropharyngeal cancer over time may be inaccurate.

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How Does HPV Virus Lead To Skin Cancer?

MedicalResearch.com Interview with:
Prof. Dr. med. Sigrun Smola
Institute of Virology, Saarland University
Homburg/Saar, Germany

MedicalResearch.com: What is the background for this study?

Response: Non-melanoma skin cancer (NMSC), the most common cancer in humans, is caused by UV-irradiation. The potential co-factor role of cutaneous genus beta-human papillomaviruses (beta-HPV) in skin carcinogenesis, particularly in immunosuppressed patients, has become a major field of interest. However, the underlying mechanisms were unclear.

The skin has natural mechanisms providing protection against UV-induced damage. One important factor suppressing UV-induced skin carcinogenesis is the transcription factor C/EBPα belonging to the CCAAT/enhancer binding protein family. C/EBPα can induce cellular differentiation and is regarded as a tumor suppressor in various tissues. When C/EBPα expression is blocked in these tissues, tumorigenesis is enhanced.

Another important factor is the microRNA-203. It has been shown to control “stemness” in normal skin by suppressing a factor called p63. In many tumors miR-203 expression is shut off releasing this “brake”.

In our study we demonstrate that cutaneous beta-HPV interferes with both protective factors providing an explanation how cutaneous beta-HPV enhances the susceptibility to UV-induced carcinogenesis. Moreover, we provide evidence that these viruses regulate miR-203 via C/EBPα.

We have investigated this mechanism in Epidermodysplasia verruciformis (EV) patients that serve as a human model disease for studying the biology of genus beta-HPVs. They are highly susceptible to persistent genus beta-HPV infection, such as HPV8, and have an increased risk to develop non-melanoma skin cancer at sun-exposed sites.

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Quadrivalent HPV Vaccination and the Risk of Adverse Pregnancy Outcomes

MedicalResearch.com Interview with:
Anders Hviid

Senior Investigator, M.Sc.,Dr.Med.Sci.
Department of Epidemiology Research
Division of National Health Surveillance & Research

MedicalResearch.com: What is the background for this study?

Response: HPV vaccination targeting girls and young women has been introduced in many countries throughout the world. HPV vaccines are not recommended for use in pregnancy, but given the target group, inadvertent exposure will occur in early unrecognized pregnancies. However, data on the safety of HPV vaccination in pregnancy is lacking.
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Pubic Hair Grooming Linked To Increased Risk of STDs

MedicalResearch.com Interview with:

E. Charles Osterberg, M.D. Assistant Professor of Surgery Genitourinary Reconstruction and Trauma University of Texas- Dell Medical School Dell-Seton Medical Center / University Hospital

Dr. Osterberg

E. Charles Osterberg, M.D.
Assistant Professor of Surgery
Genitourinary Reconstruction and Trauma
University of Texas- Dell Medical School
Dell-Seton Medical Center / University Hospital

MedicalResearch.com: What is the background for this study?

Response: Pubic hair grooming has become an increasingly common practice among men and women. Perceptions of genital normalcy have changed as modern society’s definition of attractiveness and feelings of femininity and masculinity have changed. Pubic hair grooming has been shown to increase morbidity such as genital injuries, however little is known about the relationship between grooming practices and sexually transmitted infections.

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Epidemic of HPV Associated Throat Cancer in Men

MedicalResearch.com Interview with:

Eric M Genden, MD, FACS Isidore Friesner Professor and Chairman Department of Otolaryngology-Head and Neck Surgery The Icahn School of Medicine at Mount Sinai

Dr. Eric Genden

Eric M Genden, MD, FACS
Isidore Friesner Professor and Chairman
Department of Otolaryngology-Head and Neck Surgery
The Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this report? How has the clinical picture of HPV infections of oral and throat cancers changed over the past two decades?

Response: There has been no change however there has been a epidemic of viral induced throat cancer in men. The HPV virus has been established a the causative agent in cervical cancer in women. It has now been identified as a major causative agent in tonsillar and base of tongue cancer.

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Cell Biomarkers To Distinguish Deadly From Less Aggressive HPV Oral Cancers

MedicalResearch.com Interview with:

Elizabeth Franzmann, M.D. Scientific Founder and Chief Scientific Officer Vigilant Biosciences

Dr. Elizabeth Franzmann

Elizabeth Franzmann, M.D.
Scientific Founder and Chief Scientific Officer
Vigilant Biosciences

MedicalResearch.com: What is the background for this study?

Response: Head and neck cancer involves cancers of the oral cavity, oropharynx and larynx. It is difficult to treat. Part of the challenge is that it is distinguishing the patients with tumors that are going to behave aggressively from those with less aggressive disease. As a result, many patients undergo treatment that may be more intensive and morbid than they need while others need more aggressive treatment. Tissue markers associated with prognosis may be able to help clinicians differentiate patients who need more aggressive treatment from those whose treatment can be less intensive. CD44 is a cell surface glycoprotein and tumor-initiating marker. CD44 and another surface protein, EGFR, are involved in tumor extension and are associated with poor prognosis. Certain forms of Human Papillomavirus (HPV) are known to cause oropharyngeal cancer and are associated with a good prognosis. P16 is a surrogate marker for the kind of HPV that causes cancer. Understanding the relationships between how these markers are expressed in cancer tissue may direct patient treatment in the future.

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HPV-Related Cancers Continue to Risk, Most Preventable With Vaccine

MedicalResearch.com Interview with:
Laura J. Viens, MD
Division of cancer prevention and control
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We analyzed the most recent available data from 2008–2012 from CDC’s National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program for HPV-associated cancers.

  • These data cover 99% of the US population.
  • These data represent the official federal statistics on cancer incidence (new cases).
  • Every year between 2008 and 2012, about 39,000 men and women were diagnosed with cancers associated with HPV, an overall increase when compared with the 33,000 cancers associated with HPV between 2004 and 2008.
  • 23,000 (13.5 per 100,000 population) among females and 15,793 (9.7 per 100,000 population) among males.

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Kidney Transplant Patients May Not Be Protected From HPV Strains in Vaccines

MedicalResearch.com Interview with:

Dr. Delphine Robotham MD Division of Pediatric Nephrology Johns Hopkins University School of Medicine Baltimore, Maryland

Dr. Robotham

Dr. Delphine Robotham MD
Division of Pediatric Nephrology
Johns Hopkins University School of Medicine
Baltimore, Maryland

Medical Research: What is the background for this study? What are the main findings?

Response: Cervical cancer is the second most common cancer in women worldwide and is almost entirely caused by high risk HPV genotypes.  Vaccines to high risk HPV genotypes have shown great success in protecting healthy women from the sequelae of infection, including cervical cancer and genital warts. Young women with a kidney transplant as well as those with chronic kidney disease have abnormal immune systems and as a result have a significantly increased burden of HPV-related disease making the potential health benefits of the HPV vaccine substantial in this particularly vulnerable population.  This study examined the immune response to the HPV vaccine among girls and young women with kidney disease.

The goal of this research was to determine if girls and young women with chronic kidney disease (abnormal kidney function, on dialysis, or post kidney transplant) showed evidence of immune response to the quadrivalent HPV vaccine.  Immune response was determined by measuring the amount of antibody made by the patients against each of the 4 HPV genotypes included in the vaccine.  There are established thresholds of antibody above which patients are believed to have protection from infection.  We found that study participants with chronic kidney disease and those on dialysis had antibody levels above the threshold, indicating the vaccine should be effective in protecting them from HPV related disease.  A significant proportion of patients with kidney transplants showed evidence of inadequate antibody response.  This is important information as it means patients with a kidney transplant, whom we know are at increased risk of developing cervical cancer from HPV infection, may not be protected from HPV infections from the HPV genotypes included in the vaccine.
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Hepatitis C Raises Risk of HPV Head and Neck Cancers

MedicalResearch.com Interview with:

Harrys A. Torres, MD, FACP, FIDSA Associate Professor Director of Hepatitis C Clinic Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer Center Houston TX 77030

Dr. Harrys Torres

Harrys A. Torres, MD, FACP, FIDSA
Associate Professor
Director of Hepatitis C Clinic
Department of Infectious Diseases, Infection Control and Employee Health
The University of Texas MD Anderson Cancer Center
Houston TX 77030

Medical Research: What is the background for this study? What are the main findings?

Dr. Torres: Hepatitis C virus (HCV) is an oncogenic virus and is associated with an increased risk of liver cancer and certain types of non-Hodgkin lymphomas. In 2009, at MD Anderson Cancer Center, we set up the first clinic in the United States, and probably in the world, specifically devoted to managing HCV infection in cancer patients. In the clinic, we expected to see a number of patients with liver cancers and non-Hodgkin’s lymphoma, as these have documented associations with HCV. Unexpectedly, we saw a high number of HCV-infected patients with head and neck cancers, and wondered whether there was an undiscovered association between having the infection and head and neck cancers. To explore this, we conducted a case-control study using 409 head and neck cancer subjects (164 oropharyngeal, 245 non-oropharyngeal [oral cavity, nasopharynx, larynx] cancers) and 694 control subjects with other smoking-associated cancers (378 lung, 168 esophagus, and 148 urinary bladder cancers), and compared the prevalence of HCV infection in the two groups. We observed a high prevalence of HCV infection in oropharyngeal (14%) and non-oropharyngeal (20%) cancer patients when compared to control subjects (6.5%). After adjusting for confounders such as smoking, alcohol intake, and socioeconomic status, HCV-infected individuals were 2.04 times more likely to have oropharyngeal cancers and 2.85 times more likely to have non-oropharyngeal cancers. Of note, HCV was associated only with patients with oropharyngeal cancers that tested positive for human papilloma virus, which is one of the main virus linked with increased risk of oropharyngeal cancers.

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Vaginal Ultrasound Probes Should Be Covered With Condom To Reduce HPV Infection Risk

MedicalResearch.com Interview with:
Andrew Combs MD
Alan Fishman MD

Obstetrix Medical Group
San Jose, California

MedicalResearch.com: What is the background for this study?

Response: Vaginal ultrasound is a common procedure in gynecology and obstetrics. To perform vaginal ultrasound, an ultrasound probe is placed in the vagina in order to get a close-up view of a woman’s pelvic organs. In non-pregnant women, this is the preferred method for ultrasound of the uterus and ovaries. In early pregnancy, vaginal ultrasound often yields better images of the developing embryo than abdominal ultrasound. In later pregnancy, vaginal ultrasound gives more accurate pictures of the cervix and placenta than abdominal ultrasound.

In order to prevent transmission of disease from patient to patient, it is mandatory to clean and disinfect the probe after each vaginal exam. The FDA has a list of “high level” disinfectants that neutralize or kill a variety of bacteria and viruses. Several manufacturers make disinfectant systems that are approved for disinfection of ultrasound probes.

It is also mandatory to cover the probe with a barrier during each exam. Various companies manufacture ultrasound probe covers intended to be barriers against infection. 

MedicalResearch.com: What are the main findings?

Response: Recent studies found that two widely-used disinfectants (glutaraldehyde and ortho-ophthalaldehyde) do not neutralize human papilloma virus (HPV) even though they are on the FDA list of high level disinfectants. HPV is the most common sexually transmitted infection in the USA, affecting over 8 million women of reproductive age. HPV is responsible for 60% of cervical cancer worldwide. Clearly, it is critical to neutralize this virus on vaginal ultrasound probes. A different high-level disinfectant system, sonicated hydrogen peroxide, was found to be highly effective at neutralizing HPV.

Other studies show that commercial ultrasound probe covers have a high rate of leakage, 8-81%. Condoms are safer probe covers, with leakage rates of 0.9 to 2%.

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Dual and Concordant Vaginal and Oral HPV Infections in Women

MedicalResearch.com Interview with:

Ryan K. Orosco, MD Division of Head and Neck Surgery Department of Surgery University of California, San Diego

Dr. Ryan Orosco

Ryan K. Orosco, MD
Division of Head and Neck Surgery
Department of Surgery
University of California, San Diego

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Orosco: Our group at UC San Diego is interested in HPV as it relates to diseases of the head and neck.  HPV is a well-publicized cause of cervical cancer, and awareness about its link to throat (oropharynx) cancer is rapidly increasing.

Less well-known, is the relationship between HPV and benign (non-cancerous) diseases such as genital warts and papilloma of the throat.  As we strive to understand how to best care for patients with HPV-related disorders, it is important to understand the entire process of disease progression, which begins with HPV infection. Our group wanted to explore the relationship between HPV infection in the two most commonly infected body sites: oral and vaginal.

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HPV Strains Raise Risk of Head and Neck Squamous Cell Cancer

Ilir Agalliu, M.D., Sc.D. Assistant Professor, Department of Epidemiology & Population Health and Department of Urology Albert Einstein College of Medicine Jack and Pearl Resnick Campus Bronx, NY

Dr. Ilir Agalliu

More on HPV on MedicalResearch.com 

MedicalResearch.com Interview with:
Ilir Agalliu, M.D., Sc.D.
Assistant Professor, Department of Epidemiology & Population Health and Department of Urology
Albert Einstein College of Medicine
Jack and Pearl Resnick Campus
Bronx, NY


Medical Research: What is the background for this study?

Dr. Burk: We performed this study since we had previously detected an unusually high prevalence of HPV types found on the skin and skin cancers in the oral cavity in addition to HPV16 and other high-risk (HR) types (as defined by their association with cervix cancer) (see Journal of Infectious Diseases 204:787, 2011). We wished to determine if these types were associated with risk of head and neck cancers (HNSCCs). In addition, we wished to determine if HPV detection preceded the diagnosis of HNSCCs and might serve as a biomarker. Currently there are no good screening tests for HNSCC.

Dr. AgalliuTo-date, there have been no prospective studies examining the temporal relationship between oral HPV detection and risk of head and neck squamous cell carcinoma (HNSCC). In this manuscript we examined prospectively associations between detection of a wide spectrum of oral HPVs (alpha, beta and gamma) with incident HNSCC in a nested case-control study among ~100,000 participants who provided mouthwash samples in the American Cancer Society-CPS II cohort and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

Dr. Agalliu: Oral HPV16 detection, which preceded cancer development on average for 4 years, was associated with a 22-fold increased risk for incident oropharyngeal cancer.

Detection of other oral HPVs (beta1 HPV5, and gamma11 and 12 species) were associated with a 3.3 to 5.5-fold higher risk of  head and neck squamous cell carcinoma after adjustment for smoking, alcohol and HPV16. Associations of beta and gamma HPVs, which have been identified in the skin, with risk of HNSCC suggest a broader role for HPVs in HNSCC etiology.

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HPV Vaccination Rate Low for Girls Under Both Commercial and Medicaid Plans

Shannon Stokley, MPH Epidemiologist in the CDC Immunization Services Division

Shannon Stokley MPH

MedicalResearch.com Interview with:
Shannon Stokley, MPH

Epidemiologist in the
CDC Immunization Services Division

Medical Research: What is the background for this study? What are the main findings?

Response: To determine whether the recommended HPV vaccination series is currently being administered to adolescents with health insurance, CDC and the National Committee for Quality Assurance (NCQA) assessed 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS HPV Vaccine for Female Adolescents performance measure evaluates the proportion of female adolescent members in commercial and Medicaid health plans who complete the recommended HPV vaccination series by age 13 years. In 2013, in the United States, the median HPV vaccination coverage level for female adolescents among commercial and Medicaid plans was 12% and 19%, respectively (ranges = 0%–34% for commercial plans, 5%–52% for Medicaid plans). The results of this study indicate that there are significant opportunities for improvement as HPV vaccination coverage among female adolescents was low for both commercial and Medicaid plans.

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Women Who Don’t Get HPV Vaccine May Also Not Get PAP Tests

MedicalResearch.com Interview with:
Ann Goding Sauer
Epidemiologist, American Cancer Society, Inc.
Atlanta, GA 30303

MedicalResearch: What is the background for this study?

Response: Among US women, a positive association between Pap test uptake and HPV vaccination has been shown, though potential variation of the association by race/ethnicity had not been explored previously. The prevalence of some HPV types varies across different racial/ethnic groups so it is important to explore the association between Pap test uptake and HPV vaccination in detail.

MedicalResearch: What are the main findings?

Response: Pap test uptake was significantly lower among those who had not initiated HPV vaccination (81.0%) compared to women who had initiated vaccination (90.5%) (adjusted prevalence ratio = 0.93, 95% CI: 0.90–0.96). This result was seen across most of the sociodemographic factors examined, though not statistically significant for non-Hispanic blacks, Hispanics, those with lower levels of education, or those with higher levels of income.

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Study Tests Two Dose Schedule of HPV Vaccination Against Genital Warts In Girls

Maria Blomberg Virus, Lifestyle & Genes Danish Cancer Society Research Centre Copenhagen, DenmarkMedicalResearch.com Interview with:
Maria Blomberg
Virus, Lifestyle & Genes
Danish Cancer Society Research Centre
Copenhagen, Denmark

Medical Research: What is the background for this study? What are the main findings?

Response: Two vaccines against human papillomavirus (HPV) were licensed almost one decade ago. Since then multiple countries have implemented HPV vaccination programs, but many struggle with low coverage rates.  An important barrier to vaccination is the cost of the vaccines and less developed countries also face considerable logistical challenges. Both vaccines were administered as three dose schedules, but in early 2014 the WHO’s Strategic Advisory Group of Experts and the European Medicines Agency reviewed the evidence of reduced dose schedules of HPV vaccination, and subsequently recommended a two dose schedule for young girls. A reduction of the number of doses has obvious advantages; it would lower the costs, ease implementation of vaccination schedules and potentially increase coverage rates. Based on these recommendations, countries around the world have reduced the dosing schedule in their HPV vaccination programs for young girls to two doses. However, the current evidence is based primarily on immunological studies, and because the immune correlate of protection is not known, studies with disease endpoints are very important.

Using the biologically relevant endpoint of genital warts, this study aimed to assess the clinical effectiveness of a two dose schedule of quadrivalent HPV vaccine compared with the standard three-dose regimen administered at month 0, 2 and 6. We found that with the standard vaccination schedule, completion of the three dose regimen is important to gain maximal protection. However, the effectiveness of two doses increased significantly with increasing time between the doses, and with an interval of approximately 6 months between dose one and two, no differences could be found between two and three doses.

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HPV Vaccination of Boys Can Yield Substantial Health Benefits

MedicalResearch.com Interview with:
Dr. Johannes Berkhof
Department of Epidemiology and Biostatistics, VU University Medical Centre
Amsterdam
Centre for Infectious Disease Control,
National Institute for Public Health and the Environment, Bilthoven, Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: Vaccination against the sexually transmitted human papillomavirus (HPV) is offered free-of-charge to 12-year-old girls in the Netherlands.
There is strong evidence that HPV also causes cancer in men: the virus is associated with cancers of the penis, anus, and oropharynx, and possibly with a small proportion of oral cancers. A number of these cancers will be prevented because vaccination of girls leads to a decrease of  HPV in the general population and thus provides indirect protection to heterosexual men.

However, vaccine uptake among girls is only about 60 percent in the Netherlands. Moreover, men who have sex with men are at increased risk of HPV-related cancer and will not be protected by vaccination of girls.

On the basis of data from several epidemiological studies and a dynamic model for virus transmission, we calculated that, if the vaccine uptake is low, about 200 girls need to be vaccinated to prevent one case of cervical cancer and 470 boys need to be vaccinated to prevent one case of cancer in men.

An increase in vaccine uptake in girls will decrease the HPV infection risk in heterosexual men and if the uptake in girls is 60 percent, around 800 boys need to be vaccinated to prevent one additional case of cancer in men.

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HPV Vaccine Still Valuable For Women Who Were Not Fully Vaccinated As Children

Jacqueline Hirth, PhD, MPH Assistant Professor andMedicalResearch.com Interview with:
Jacqueline Hirth, PhD, MPH
Assistant Professor and
Dr. Abbey B. Berenson MD, MMS, PhD Center for Interdisciplinary Research in Women's Health Obstetrics and Gynecology The University of Texas Medical Branch at Galveston TexasDr. Abbey B. Berenson MD, MMS, PhD
Center for Interdisciplinary Research in Women’s Health
Obstetrics and Gynecology
The University of Texas Medical Branch at Galveston Texas

Medical Research: What is the background for this study? What are the main findings?

Response: In this sample of young women, vaccination was effective at reducing prevalence of vaccine-type HPV (6,11,16,18) compared to women who were unvaccinated. We also found a dose response, with young women who received at least 2 doses of the 3 dose vaccine series having a lower rate of vaccine-type HPV compared to those who only received one dose (8.6% compared to 16.9%, respectively).

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HPV Vaccine Provides Protection at Multiple Sites

Daniel C. Beachler, PhD, Postdoctoral fellow Infections and Immunoepidemiology Branch of the National Cancer Institute (NCI) MedicalResearch.com Interview with:
Daniel C. Beachler, PhD
Postdoctoral fellow
Infections and Immunoepidemiology Branch of the
National Cancer Institute (NCI)

Medical Research: What is the background for this study? What are the main findings?

Dr. Beachler: HPV is a common sexually transmitted infection. Individuals can acquire HPV infections in the epithelium of their cervical, anal and oral sites, and occasionally these infections lead to cancer. There are three prophylactic HPV vaccines on the market that can protect against HPV at these sites among those not been previously exposed to HPV.
This study examined the effect of HPV vaccination of 18-25 year old women at all three anatomic sites. The combined multi-site HPV vaccine efficacy has not been reported previously. It was unknown whether the vaccine may protect non-infected sites against HPV infection or re-infection in women exposed to HPV prior to vaccination.
We observed that the HPV vaccine provides the strongest protection at all three sites among women unexposed to HPV before vaccination. Additionally, we observed some protection at the non-infected sites in women who were previously infected with HPV.

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New Antiviral Medication For HPV Infection Shows Promise

MedicalResearch.com Interview with:
Luis Squiquera, MD

Tamir Biotechnology

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Squiquera: Ranpirnase is a small peptide that has a characteristic enzymatic activity against double stranded RNA (dsRNA). As a drug it has been extensively tested intravenously in high concentration for oncology in over 1000 patients with different types of malignancy, especially mesothelioma, with minimal side effects and mainly a transient increase of serum creatinine level observed.

In the last year we started a comprehensive antiviral program and obtained encouraging results in several RNA and DNA virus families. Several research groups have already studied the anti HIV activity. HPV was one of many viruses that showed a high selectivity index in our antiviral screening (the relationship between efficacy and cytotoxicity). We were encouraged by the low concentrations (nanomolar range) needed to stop virus reproduction in cell cultures. We performed in vitro analysis of two of the main HPV types that cause human disease (HPV 11 and 16). HPV 11 was highly sensitive to ranpirnase; and since this is one of the main virus type responsible for inducing genital warts, we decided to focus our efforts in bringing the drug to a new route of administration.

We set out to obtain and did obtain a formulation that was extremely stable, even at high temperatures. Before using it in patients, we performed testing for irritation using standardized Draize animal models. Even though we ran these tests in high concentrations (1 mg/ml) the final product was not irritant and was deemed safe to use in a clinical setting.

With these safety data on hand – plus extensive experience in IV dosing and non-irritation in animal models – we decided to make the formulation available as a compassionate use for patients with genital warts.

As we reported in our presentation in San Francisco, all cases that completed an 8-week treatment showed clearance of the lesions. Some of the cases were cleared in as soon as two weeks and the average time for clearance was 33 days. One of the patients had to be discontinued due to an eczematous skin reaction. We will be studying the characteristic of this effect in our trials. Continue reading

Random Stem Cell Divisions May Play Role in Persistent HPV Infections

Marc Ryser PhD Visiting Assistant Professor Department of Mathematics Duke University Durham, North CarolinaMedicalResearch.com Interview with:
Marc Ryser PhD
Visiting Assistant Professor Department of Mathematics
Duke University Durham, North Carolina

Medical Research: What is the background for this study

Dr. Ryser: Infection with the human papillomavirus (HPV) is responsible for approximately 5% of all cancers worldwide. In addition to cervical cancers, HPV is associated with various other female and male cancers, including cancers of the anus and oropharynx. Despite expansive screening and vaccination programs, HPV-related cancers remain a serious public health concern in the US and abroad. To further improve public health interventions against HPV, a thorough understanding of the underlying biology is critical.

The lifetime risk of getting infected with HPV is as high as 80%, yet most individuals remain asymptomatic and clear the virus after 1-2 years.  However, if an infection with a high-risk type of HPV persists, the virus can interfere with the replication mechanism of the host cells, and initiate tumor growth. Even though our understanding is incomplete to date, clearance of HPV infections is primarily attributed to an effective immune response.

Interestingly, recent studies about the stem cell dynamics in epithelial tissues – the types of tissues that are affected by HPV –  have shown that the fate of these stem cells is random: most of the time, a stem cell divides into a new stem cell and a differentiating daughter cell; however, every now and then, a stem cell divides either into two stem cells, or into two differentiating daughter cells. These dynamics have not been acknowledged by the HPV community, and our goal was to develop mathematical models to examine whether the random division patterns of stem cells could play a role in the clearance of HPV infections.
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Strong Evidence HPV Vaccination Highly Effective Outside Trial Settings

MedicalResearch.com Interview with: Marc Brisson Canada Research Chair in Mathematical Modeling and Health Economics of Infectious Disease Associate Professor, Université LavalMedicalResearch.com Interview with:
Marc Brisson

Canada Research Chair in Mathematical Modeling and Health Economics of Infectious Disease
Associate Professor, Université Laval

Medical Research: What is the background for this study? What are the main findings?

Response: Since 2007, 52 countries have implemented human papillomavirus vaccination (HPV) programmes. Two HPV vaccines are currently available worldwide: the bivalent vaccine, which targets HPV types 16 and 18, causing 70-80% of cervical cancer, and the quadrivalent vaccine, which also targets HPV types 6 and 11, associated with 85-95% of anogenital wart cases. Large international randomised controlled clinical trials have shown both vaccines to be safe, well tolerated and highly efficacious against vaccine-type persistent infections and precancerous cervical lesions.  Furthermore, both vaccines have shown some level of cross-protection against 3 HPV types (HPV 31, 33 and 45) not included in the vaccine and associated with a supplementary 10-15% of cervical cancers worldwide. Now that 7 years have elapsed since the implementation of the first HPV vaccination program, we verified whether the promising results from clinical trials are materialising at the population level. We conducted a meta-analysis to examine the population-level impact in countries that have introduced HPV vaccination programs.

In countries with high female vaccination coverage (<50%), our main findings indicate:

  • sharp declines in HPV-related outcomes among females targeted for vaccination (e.g., HPV-16/18 infection and anogenital warts declined by more than 60% in females younger than 20 years), and
  • evidence of cross-protection with significant reductions in HPV-31/33/45 infection among females younger than 20 years
  • evidence of herd effects (indirect benefit of vaccination among unvaccinated individuals) with significant reductions in anogenital warts among males and older females.

In countries with low coverage (<50%), we report:

  • significant reductions in HPV-16/18 infection and anogenital warts among young females, with no indication of herd effects or cross-protection. Continue reading

HPV-16/18 Vaccine Provides Some Cross Protection To Other Cancer-Causing Subtypes

MedicalResearch.com Interview Invitation
Frank Struyf MD PhD
Director, Lead Clinical Development HPV vaccines at GlaxoSmithKline Biologicals GlaxoSmithKline Vaccines,
Rixensart, Belgium

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Struyf: Cervical cancer is the fourth most common cancer among women, with estimates from 2012 indicating that there are 528,000 new cases and 266,000 deaths each year worldwide, the majority of cases occurring in developing countries (reference: Globocan 2012 at http://globocan.iarc.fr/old/FactSheets/cancers/cervix-new.asp). Persistent infection with oncogenic human papillomavirus (HPV) is a necessary condition for the development of invasive cervical cancer. HPV type 16 (HPV-16) and HPV-18 are found in approximately 70% of cases. We conducted the Papilloma Trial Against Cancer in Young Adults (PATRICIA), a multinational clinical trial in 14 countries in Europe, the Asia-Pacific region, North America, and Latin America and enrolled over 18,000 women. The trial showed that the HPV-16/18 AS04-adjuvanted vaccine not only prevented persistent infections and high-grade cervical lesions associated with HPV types 16 and/or 18 included in the vaccine, but also protected against some common related oncogenic HPV types not included in the vaccine. However, during the analysis of this trial, we also noticed that for some rare nonvaccine oncogenic HPV types, the vaccine efficacy against infections did not seem to match the efficacy against lesions associated with the same HPV type. To investigate this, we re-analyzed the samples from the trial using a different PCR method and found that the HPV PCR methodology used per protocol may have underestimated the efficacy for non-vaccine HPV types in cases of multiple infections. While these results do not replace the results generated according to the study protocol and included in the product label, they are reassuring, as they confirm the cross-protective efficacy of the HPV-16/18 vaccine against some HPV types related to those included in the vaccine.
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New Ninevalent HPV Vaccine Gives Greater Protection Against Cervical Cancer and Genital Warts

Elmar A. Joura, M.D Gynecologist University of ViennaMedicalResearch.com Interview with:
Elmar A. Joura, M.D
Gynecologist
University of Vienna

MedicalResearch: What are the main findings of this study?

Dr. Joura: This study demonstrates that the new ninevalent HPV vaccine induces a good immunogenicity against HPV 6/11/16/18 and gives a 97% protection against disease caused by HPV 31/33/45/52/58. This has a potential of a 90% reduction of cervical cancer and other HPV related cancers and a similar protection against genital warts. The full benefit is seen in persons without current HPV infection, this reinforces early vaccination against HPV. The safety profile was favourable.
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No Link Between HPV Vaccine and Multiple Sclerosis

Anders Hviid, M.Sc., Dr.Med.Sci. Senior Investigator, Statens Serum InstitutMedicalResearch.com Interview with:
Anders Hviid, M.Sc., Dr.Med.Sci.

Senior Investigator, Statens Serum Institut

Medical Research: What is the background for this study?

Response: After the widespread introduction of HPV vaccination of adolescent girls, a number of safety concerns have emerged. In this case, demyelinating diseases, including multiple sclerosis, occurring after HPV vaccination has been reported in social media, news media and medical journals.

Medical Research: What are the main findings?

Response: In a study of almost 4 million Danish and Swedish women, we found no support for an increased risk of multiple sclerosis or other demyelinating diseases following HPV vaccination. Continue reading

MSM May Need Greater HPV Vaccine Protection

MedicalResearch.com Interview with:
Huachun Zou PhD on behalf of all authors.

Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC,
Melbourne School of Population and Global Health
University of Melbourne, Melbourne, VIC, Australia

Medical Research: What is the background for this study? What are the main findings?

Response: Anogenital human papillomavirus (HPV) infection and anal cancer are common among men who have sex with men (MSM) and preventable with the HPV vaccine. However, the optimal strategy for vaccinating MSM against HPV requires an accurate understanding of the age specific incidence of early HPV infection. In addition to understanding the optimal age at which to vaccinate young MSM, policy makers also need to know the vaccine coverage required in MSM. In this paper we aimed to provide estimates for the site specific incidence of HPV and to use this to estimate the probability of transmission per partner in a cohort of very young MSM aged 16 to 20 years. These data will assist governments in deciding what HPV vaccination strategy is likely to be the most effective in MSM.

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No Adverse Effects From Inadvertent HPV Vaccine During Pregancy

dr-pedro-moroMedicalResearch.com Interview with:
Pedro Moro MD MPH
Immunization Safety Office, Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Medical Research: What is the background for this study? What are the main findings?

Dr. Moro: Gardasil® is a human papillomavirus (HPV) vaccine recommended for all girls and boys at age 11 or 12, and teens and young adults who did not get the vaccine when they were younger. Because there is limited safety data available on use of the vaccine during pregnancy, it is not currently recommended for pregnant women. However, some pregnant women will inadvertently receive Gardasil® because they do not yet know that they are pregnant at the time of vaccination.

The study reviewed non-manufacturer reports to the Vaccine Adverse Event Reporting System (VAERS) about pregnant women who received Gardasil®. VAERS is a national vaccine safety surveillance program co-administered by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). VAERS accepts reports of health problems that occur after any US-licensed vaccine (these are called adverse events). VAERS may also accept reports not describing any health problem but vaccination errors (for example, administration of a vaccine not recommended to a particular group of people like pregnant women). VAERS is an early-warning system and cannot generally assess if a vaccine caused an adverse event.

After reviewing all non-manufacturer reports of Gardasil vaccination during pregnancy, this study found no unexpected patterns of safety issues for pregnant woman who received Gardasil®, or for their babies. This finding is reassuring and reconfirms the safety of this vaccine for pregnant women, as was previously reported by the pregnancy registry maintained by Gardasil®’s manufacturer.

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HPV Vaccine Not Linked To Increased Risky Sexual Behavior

Leah M. Smith PhD Department of Epidemiology, Biostatistics, and Occupational Health (Smith, Kaufman, Strumpf) McGill University, Montréal, QuebecMedicalResearch.com Interview with:
Leah M. Smith PhD
Department of Epidemiology, Biostatistics, and Occupational Health  (Smith, Kaufman, Strumpf)
McGill University, Montréal, Quebec

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Smith: The human papillomavirus (HPV) vaccine protects against types of HPV that cause cervical cancer and anogenital warts. The vaccine first became available in 2006. Since then, it has faced a great deal of controversy surrounding, in part, some of the unanswered questions about the real-world effects of the vaccine, especially on the young girls targeted for immunization. One issue that has received a great deal of public attention has been the concern that HPV vaccination might give girls a false sense of protection against all sexually transmitted infections that might lead them to be more sexually active than they would otherwise. As a result, some parents have been reluctant to have their daughters vaccinated. It is also reason why some religious groups have spoken out against the vaccine. This question is further important from a public health perspective because increases in risky sexual behaviour would inevitably also lead to increases in teen pregnancy and sexually transmitted infections (excluding anogenital warts), which would of course undermine the potential health benefits of the vaccine. 

In this study, we directly addressed the question of whether HPV vaccination has led to increases in pregnancy and non-HPV-related sexually transmitted infections (both of which are proxies for risky sexual behaviour) among adolescent girls.

In our study of over 260,000 girls, we did not find any evidence that the HPV vaccine had a negative impact on these outcomes.

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HPV Vaccination Rates Leaves Room For Improvement

Dr. Raquel Qualls-Hampton MD, MS Assistant Professor University of North Texas Health Science CenterMedicalResearch.com Interview with:
Dr. Raquel Qualls-Hampton MD, MS
Assistant Professor
University of North Texas Health Science Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Qualls-Hampton: There are currently two vaccines approved by the Food and Drug Administration (FDA)—Gardasil for males and Gardasil and Cervix for females – that protect against the human papilloma virus (HPV). These vaccines are recommended by the ACIP for females ages 9 to 26 years and males ages 9 to 21 years. Both vaccines protect males and females against some of the most common types of HPV.  HPV vaccines are administered in three doses over six months and are considered safe and effective. However, the promise of these vaccines is going unfulfilled as initiation and completion rates for the three doses are suboptimal among females and males.

Nationally, although HPV vaccination initiation coverage is increasing, overall vaccine completion rates are at suboptimal levels and below the U.S. Department of Health and Human Services’ Healthy People 2020 initiative target of 80%. Thus, many states are turning to legislative interventions in efforts to increase initiation and completion rates. This study examines HPV vaccination legislative initiatives and their impact, specifically in estimating state legislation’s effects on HPV vaccine initiation, completion and patient care provider recommendations by gender.

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Oral Sex Can Lead To Oral HPV Infection

Eduardo L. Franco DrPH, FRSC, FCAHS James McGill Professor Departments of Oncology and Epidemiology & Biostatistics, Director, Division of Cancer Epidemiology Minda de Gunzburg Chair, Department of Oncology, Division of Cancer Epidemiology Department of Oncology McGill University Montreal, Quebec, CanadaMedicalResearch.com Interview with;
Eduardo L. Franco DrPH, FRSC, FCAHS
James McGill Professor Departments of Oncology and Epidemiology & Biostatistics, Director, Division of Cancer Epidemiology, Minda de Gunzburg Chair, Department of Oncology, Division of Cancer Epidemiology Department of Oncology
McGill University, Montreal, Quebec, Canada

Medical Research: What should clinicians and patients take away from your report?

Dr. Franco: Our findings of oral transmission of human papillomavirus (HPV) infection in men are part of a larger molecular epidemiologic study called ‘HPV Infection and Transmission among Couples through Heterosexual Activity’ (HITCH) cohort study. The focus of the HITCH study is to understand how HPV is transmitted within couples via sexual contact and other behaviors. We measure the presence of this virus using highly-sensitive molecular assays for HPV DNA in the genital surfaces (vagina and penis), oral cavity, and hands. We also take a blood sample to look for the presence of antibodies against HPV. We take multiple samples over a period of two years at pre-scheduled visits. We have previously published results focused exclusively on genital transmission. The present report is the first in the HITCH study to look at what happens in terms of characteristics that place male participants to be at risk of oral HPV infection.

To our knowledge, this is the first study to show a high risk of oral HPV infection among men whose female partners had a genital or oral HPV infection, suggesting that transmission may occur through oral or genital routes. We looked at transmission for 36 individual HPV genotypes, which improved our ability to study risk determinants. Risk was also significantly higher among men who had ever smoked, had a high number of lifetime sex partners, or were in non-monogamous relationships. Our results are largely consistent with previous studies that have found male sex practices and smoking to be the most significant risk factors for oral HPV infection.
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Increased Alcohol Use Linked To Greater Risk of HPV Infection

Matthew B. Schabath, Ph.D Assistant Member, Department of Cancer Epidemiology  Moffitt Cancer Center Tampa, Florida
MedicalResearch.com: Interview with:

Matthew B. Schabath, Ph.D
Assistant Member, Department of Cancer Epidemiology
Moffitt Cancer Center Tampa, Florida

 

Medical Research: What are the main findings of the study?

Dr. Schabath: Overall, the results from these analyses demonstrated that men who consumed the highest amounts of alcohol were associated with an increased risk for genital human papillomavirus (HPV) infections.

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New HPV Vaccine Has Potential To Prevent Nearly All Cervical Pre-Cancers

Elmar A. Joura, MD Department of Gynaecology and Obstetrics Medical University of Vienna, Comprehensive Cancer Center Vienna, AustriaMedicalResearch.com Interview with:
Elmar A. Joura, MD
Department of Gynaecology and Obstetrics
Medical University of Vienna, Comprehensive Cancer Center
Vienna, Austria

Medical Research: What are the main findings of the study?

Dr. Joura: The upcoming ninevalent vaccine has the potential to prevent 85% of the cervical precancers and surgeries such as LEEP (conization)
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Study Finds No Link Between HPV Vaccine and Blood Clots

MedicalResearch.com Interview with:
Nikolai Madrid Scheller
Department of Epidemiology Research
Statens Serum Institut, Copenhagen

Medical Research: What are the main findings of the study?

Answer: In a large and comprehensive study of more than 1.5 million women including more than 500,000 HPV vaccinated there was no association between HPV vaccination and blood clots.
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Treating Metastatic Cervical Cancer With HPV-Targeted TILs

Dr. Christian S Hinrichs MD Assistant Clinical Investigator Center for Cancer Research National Cancer Institute Bethesda, MD 20814MedicalResearch.com Interview with:
Dr. Christian S Hinrichs MD
Assistant Clinical Investigator
Center for Cancer Research
National Cancer Institute
Bethesda, MD 20814

MedicalResearch: What are the main findings of the study?

Dr. Hinrichs: Objective tumor regression occurred in 3/9 patients with metastatic cervical cancer. Two responses were complete and are ongoing 22 and 15 months after treatment with a single infusion of T cells targeting the HPV oncoproteins.
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Higher Risk Young Women May Be Less Likely to be Offered, Accept HPV Vaccine

MedicalResearch.com Interview with:
Dr Rachel J Sacks
Jefferiss Wing,  St Mary’s Hospital
Imperial College Healthcare NHS Trust,
London UK

MedicalResearch.com: What is the background of this study?

Dr. Sacks: 2247 anonymous questionnaires were completed by young women, aged 13-19 years old, attending sexual health services across England, looking at their HPV vaccination outcomes and prevalence of risk factors associated with HPV acquisition and cervical cancer development, and comparing the survey results with national data where available. Known HPV acquisition and cervical cancer development risk factors include cigarette smoking, early age at first intercourse, increasing number of lifetime partners, co-infection with other sexually transmitted infections.

MedicalResearch.com: What are the main findings of the study

Dr. Sacks:

  •          Young women, aged 13  to 19 years old attending sexual health services across England had higher prevalence of known risk factors associated with HPV acquisition and cervical cancer development, compared with national data.
  •          Survey respondents had lower HPV vaccination offer and lower HPV vaccination completion rates than nationally.
  •          Subgroups within the survey respondents were identified as having a significantly lower offer and significantly lower completion rate of the HPV vaccination. These subgroups included respondents from London, those of non-white ethnicities, 17 to 19 year olds, smokers and those not in education, employment or training (NEETs).
  •          The highest risk individuals, in terms of HPV related risk factors, were the least likely to be offered and additional the least likely to complete the HPV vaccination course.
  •          Currently sexual health services in England are not involved in the delivery of the HPV vaccination programme and this is felt to be a huge missed opportunity for the primary prevention of HPV acquisition and its potential sequelae. Sexual health services should be included as a supplementary HPV vaccination delivery site in order to target these particularly vulnerable young women and to increase the success of the HPV vaccination programme in England.

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HPV Vaccination and Prevention of Cervical Abnormalities

MedicalResearch.com Interview with:
Dr Julia Brotherton
Victorian Cytology Service, Melbourne, Victoria, Australia

Dr Elizabeth Crowe
The University of Queensland, School of Population Health, Brisbane, Australia
NHS Borders, Department of Public Health, Melrose, Scotland, UK

Prof. David Whiteman
Group Leader / Department Coordinator
QIMR Berghofer Medical Research Institute
Royal Brisbane Hospital, QLD 4029

MedicalResearch.com: What are the main findings of the study?

1.       We conducted a case-control study in which we retrieved the HPV vaccination histories of young Australian women who were notified to the Pap smear registry with high-grade cervical lesions or with other types of cervical lesions, and compared them with the vaccination histories of women whose Pap smears showed only normal cytology.

2.       We found that women with high grade cervical lesions were significantly less likely than women with normal cytology to have received 3 doses of the quadrivalent HPV vaccine, equivalent to a vaccine effectiveness of 46%.

3.       The vaccine effectiveness among 15-19 year old women was even higher at 57%. We believe this reflects the fact that HPV16 causes an even higher proportion of high grade disease in young women due to its higher oncogenicity and shorter latent period.

4.       The HPV vaccine had 34% effectiveness against other cervical lesions (i.e. those not proven to be high grade lesions on histology).

5.       We also observed that 2 doses of the vaccine were 21% effective in preventing both high grade lesions and other grade lesions.
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HPV Virus Not Killed by Common Sanitizers

Craig Meyers, Ph.D. Distinguished Professor Department of Microbiology and Immunology H107 The Penn State College of Medicine Hershey, PA 17033MedicalResearch.com Interview with:
Craig Meyers, Ph.D.
Distinguished Professor
Department of Microbiology and Immunology H107
The Penn State College of Medicine
Hershey, PA 17033

MedicalResearch.com: What are the main findings of the study?

Dr. Meyers: The human papillomavirus type 16 (HPV16) is the most common HPV type associated with human cancer. It has always been assumed that HPV16 was susceptible to commonly used disinfectants. However, this has never been tested. We developed the only reproducible method to grow authentic HPV in the laboratory. Our studies show that highly resistant virus; more so than other non-enveloped viruses previously tested. Simply stated that any materials in a healthcare facility that rely on disinfectants (those presently used by healthcare facilities) do absolutely nothing to HPV. This suggests the possibility of risk of infection from inanimate objects, particularly those use in healthcare and dental clinics that depend on disinfectant treatment. Additionally it has been reported that at any one time 20% of individuals with anogenital HPV infections have the virus on their fingertips and the common hand sanitizers do nothing to inactivate the virus.
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Genital Warts: Efficacy of Two Doses of HPV Vaccine

Lisen Arnheim Dahlström Associate Professor (Docent) Institutionen för medicinsk epidemiologi och biostatistik Department of Medical Epidemiology and Biostatistics Karolinska Institutet SwedenMedicalResearch.com Interview with:
Lisen Arnheim Dahlström
Associate Professor (Docent)
Institutionen för medicinsk epidemiologi och biostatistik
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet Sweden

MedicalResearch.com: What are the main findings of the study?

Answer: The main finding, when studying HPV vaccine effectiveness against condyloma by dose level is that 3 doses offered the maximum protection, although 2 doses also offered a substantial protection.
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HPV Vaccine: Adverse Events in Adolescent Girls

Lisen Arnheim Dahlström, Associate Professor (Docent) Institutionen för medicinsk epidemiologi och biostatistik Department of Medical Epidemiology and Biostatistics Karolinska Institutet 171 77 Stockholm, SwedenMedicalResearch.com Interview with:
Lisen Arnheim Dahlström, Associate Professor (Docent)
Institutionen för medicinsk epidemiologi och biostatistik
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet
171 77 Stockholm, Sweden

 

MedicalResearch.com: What are the main findings of the study?

Answer: This is a Swedish/Danish population-based study comparing serious disease outcomes in girls immunized with the quadrivalent HPV vaccine against the unvaccinated population.

The main finding of this study was that none of the 53 outcomes included in the study were more common in the vaccinated population compared to the non-vaccinated population.
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HPV Infections: Race May Influence Natural History

MedicalResearch.com interview with: Matthew B. Schabath, Ph.D

Assistant Member, Department of Cancer Epidemiology
H. Lee Moffitt Cancer Center, 12902 Magnolia Drive
MRC-CANCONT, Tampa, Florida

MedicalResearch.com: What are the main findings of the study?

Dr. Schabath: In this study we found that Asian/Pacific Islander men had the lowest incidence of human papillomavirus (HPV) infection and that they exhibited a lower probability of acquiring new HPV infections.   Furthermore, men of multiple and mixed race had the second lowest incidence of HPV infection and however, while they had a lower probability of acquiring HPV, they also had a lower probability of clearing an HPV infection once acquired.
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Study Reveals High Rate of Anal Cancer in HIV-Positive Women

Newswise — NEW YORK CITY (April 12, 2012) — Anal cancer is on the rise among HIV-positive women, according to a Montefiore Medical Center study entitled, “High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-Infected Women Screened for Anal Cancer,” to be published in the Journal of Aids on May 1.

“Anal cancer was widely associated with HIV-infected men who have sex with men,” said Mark H. Einstein, MD, MS, Director of Clinical Research, Division of Gynecologic Oncology at Montefiore Medical Center and Professor at Albert Einstein College of Medicine. “But now, this study reveals anal precancerous disease in a high proportion of women with HIV.”

Out of 715 asymptomatic HIV-infected women studied, 10.5% exhibited some form of anal disease and approximately one third of them were found to be true pre-cancerous disease. The researchers determined that this is likely due to the fact that HIV promotes human papillomavirus (HPV) persistence and consequently, which is known to cause nearly all anal cancers. HIV-infected individuals are also at increased risk for the development of many other HPV-associated neoplasms.

The incidence of anal carcinoma (AC) has been increasing despite the implementation of antiretroviral therapy (ART), which has not been shown to consistently alter the course of HPV–associated anogenital disease.

The women studied were Montefiore patients in the Bronx, which has one of the highest HIV prevalence rates in the United States. Data indicates that 1.8% of the Bronx population is known to be HIV infected, representing 3% of the total number of HIV patients in the entire country. Montefiore is the largest provider of medical services for people with HIV in the Bronx and has adopted routine screening for AC with annual anal cytology in all HIV-infected patients.

As a result of these findings, Dr. Einstein and his colleagues recommend that all HIV+ women who have any abnormal anal cytology be referred for high resolution anoscopy, particularly those with poorly controlled HIV who are significantly at even higher risk for harboring a high-grade AIN than women who are well controlled. Also, all HIV infected men and women should be considered for anal cancer screening. Given the lower high-grade anal disease prevalence in women with well-controlled HIV, other strategies to improve disease ascertainment, such as inclusion of HPV testing might be found to be useful for AC screening. This risk stratification might prove to be different for women than it is for men, where prevalence rates seem to be considerably higher. Given the high rate of high-grade anal precancerous lesions in screened HIV-infected women and an aging population of HIV-infected patients, measures to increase routine AC screening should be strongly considered. Depending on the size of the pre-cancerous legion, it can be removed long before it becomes cancer, thus being able to save lives.