Human papillomavirus status and cervical abnormalities in women from public and private health care in Rio de Janeiro State, Brazil

Abstract

This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4% presented HPV and nearly 90% of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3%. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3%), and invasive cervical carcinoma (16.3%). HPV infection was found in 93.1% and 94.4% of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p<0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions. These data provides baseline support for the role of social inequalities linked to high risk HPV infection leading to cervical cancer. Broadly screening programs and the development of safe and effective vaccines against HPV would diminish the toll of this disease that affect mainly poor women.

Correlates of HPV: a cross-sectional study in women with normal cytology in north-central Morocco

“…Those abnormalities were reported to occasionally progress from low-grade dysplasia to cervical cancer [1]. HPV can be grouped to high-risk (such as HPV-16, -18, -31, and -45) and low-risk HPV types (such as 6,11,42,43, and 44) [4]. Highrisk HPV types are present in most cervical cancer tissues and high-grade cervical intraepithelial neoplasia.…”

“…In many countries, 20% to 40% of sexually active young women have detectable latent HPV infection [4,5]. The frequency of high-risk types may vary according to geographic regions [5][6][7] and to demographic and clinical/pathological factors [8][9][10].…”

Prevalence of micronuclei in exfoliated uterine cervical cells from patients with risk factors for cervical cancer

“…8 Extensive screening programs and the development of safe and effective vaccines against HPV would diminish mortality and morbidity from this disease, which has been reported to affect poor women disproportionately. 8,9 Behavioral risk factors such as smoking indirectly infl uence the manifestation of cervical cancer and thereby accelerate the tumor progression induced by HPV. Smoking may contribute towards the development of cervical cancer through direct exposure of the DNA of epithelial cells to nicotine and cotinine, or through reactions with the metabolic products from the smoke, such as aromatic polycyclic hydrocarbons and aromatic amines.…”

Examining the association between socioeconomic status and potential human papillomavirus-associated cancers

“…14 The body of research that links SES to potentially human papillomavirus (HPV)-associated cancers is sparse and has primarily focused on the HPV to cervical cancer relation. 9,[15][16][17][18][19][20][21][22][23][24][25] In a sample of women living in Brazil, poverty and access to care inequities were found to be predictive of oncogenic-type HPV and, ultimately, of cervical cancer. 21 A meta-analysis based upon 57 studies found that there was a 2-fold increased risk of invasive cervical cancer among individuals of low social status compared with individuals of high social status.…”