Oncogenic types of human papilloma viruses (HPVs) have been established to be the causative agents for cervical cancers and high-grade squamous intraepithelial lesions (HSILs). The clinical application of molecular tests for HPV detection for screening purposes has been of considerable interest. DNA amplification methods allow the use of self-collected samples (including urine) from material collected away from the original disease site. For screening of cervical pathology, detection of HPV-DNA in urine would be useful only if it represents cervical HPV infection and/or HPV-related cervical pathology. We conducted a review of the literature in order to ascertain: (1) if urine is an adequate sample for HPV-detection; (2) whether sensitive techniques are available for HPV-detection in urine and (3) if detection of HPV in urine truly represents cervical infection/pathology. The review process consisted of assembling facts and analysing the published literature on the following facts: anatomical considerations of the lower genital and the lower urinary tract, biological behaviour of HPV and its shedding behaviour, technical issues regarding sample collection, processing and HPV-DNA assay systems, concordance rates of HPV-DNA detection and their type specificity in the paired samples (urine and cervical scrapes) obtained in different clinico-epidemiological settings and comparative detection rates of HSILs in the paired samples.
Background. The role of male behavior in the genesis of cervical cancer was examined. In India, where the incidence of cervical cancer is among the highest in the world, promiscuity among women is virtually unknown. In this study, the authors investigated the role of male behavior in cervical carcinogenesis among Indian women who had one lifetime sexual partner.
Methods. A case‐control study was used.
Results. Premarital sexual relationships (relative risk [RR], 1.9; confidence interval, 1.2–3.2) and extramarital sexual relationships (RR, 2.7; confidence interval, 1.5–4.9) of husbands were risk factors. When husbands had sexual relationships both before and during the marriage, their wives' risk of getting cervical cancer increased by 6.9 (CI, 2.3–20.7). Risk also increased with husbands having three or more extramarital sexual partners (RR, 3.05; CI, 1.25–12.6). Sexual contact with prostitutes before or after marriage, however, did not increase the risk. History of sexually transmitted disease before marriage (RR, 2.9) or after marriage (RR, 5.9) was an important risk factor, which persisted after controlling for other factors. Sexual abstinence for 40 or more days after a wife's giving birth or having an abortion provided protection. Sex with uncircumcised men or men circumcised after age 1 year increased the risk of cervical cancer (RR, 4.1).
Bidi smoking (bidi is a cheap smoking stick of 4–8 cm, consisting of a rolled piece of dried temburni leaf [Diospyres melanoxylon] containing 0.15–0.25 g of coarsely ground tobacco) for more than 20 years was a significant risk factor (RR = 2.4), whereas cigarette smoking was not a risk factor.
Conclusions. Male sexual partners play a role in cervical carcinogenesis.
With the change in the life styles and demographic profiles of developing countries, noncommunicable diseases are emerging to be important health problems that demand appropriate control program before they assume epidemic proportion. One of these is the problem of cancer. In India, cervical cancer is a significant problem in terms of incidence, mortality and morbidity. Cervical cancer is a disease that can be prevented through both primary prevention and early detection using screening techniques. Several screening modalities are now available for early detection of cervical cancer and its precursor lesions. They all differ with regard to their test characteristics, feasibility and economic considerations. This communication reviews different aspects of these screening modalities and provides different options considering mass application.
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