Human papillomavirus and cervical neoplasia: A case‐control study in Taiwan

Abstract

Multiple sexual partners and early age at first intercourse have been identified as major risk factors for cervical cancer in earlier epidemiologic studies (Brinton, 1992), implying that sexually transmitted agents might be involved in its etiology. Over the last decade, mounting evidence from laboratory (zur Hausen, 1994) and epidemiologic (Muiioz et al., 1992; Peng et aZ., 1991) studies has shown that sexually transmitted infection with genital types of human papillomavirus (HPV) may be the primary causal agent for cervical cancer worldwide (Bosch et al., 1995). However, the relationship between HPV and cervical intraepithelial neoplasia (CIN) is less well established. Among epidemiologic studies investigating this relationship, few (Schiffman et al., 1993;Bosch et al., 1993;Morrison et al., 1991) have been able to use HPV DNA testing methods with high sensitivity and broad type range (Schiffman, 1992a;Burmer et al., 1990). In particular, epidemiologic studies investigating the relationship of HPV with CIN have been quite limited in Asia, even though cervical cancer is the most common cancer among women in this region (Parkin et al., 1992).Cervical cancer is the leading cancer among women in Taiwan (31% of all incident cancers in women) with an annual age-adjusted incidence rate of 33.5 per 100,000 (Cancer Registry Annual Report in Taiwan Area, 1986), which is about 4 times higher than that in the United States (8.7 per 100,000) (Miller et al., 1993). Reasons for the high risk in Taiwan are unclear, since the reported prevalence of known epidemiologic risk factors for cervical cancer, in particular multiple sexual partners, is quite low compared with Western women (Schiffman et al., 1993;Bosch et al., 1993;Morrison et al., 1991;Shen et al., 1993). However, approximately 90% of the women in Taiwan have never had a Papanicolaou (Pap) smear (Health Annual Report in Taiwan Area, 1993), which might be related to the high risk.As reported in Western countries (Bosch et al., 1995), a clinical report from China and Taiwan has shown that HPV could be detected in over 70% of cervical cancer patients (Pa0 et al., 1993), suggesting that HPV may be an important risk factor for cervical cancer in this monogamous female population. To investigate the role of HPV and other possible etiologic factors in the full spectrum of cervical neoplasia in Taiwan, we conducted a case-control study as part of a community-based cervical neoplasia screening study, using a sensitive HPV testing method that detects a broad range of HPV types (Manos et al., 1989). METHODS Study population (screened women)In 1991, a community-based cervical neoplasia screening study was conducted among women aged 30-64 in 4 rural townships in Taiwan with high cancer mortality rates. Women who had never been married or who had a history of cervical neoplasia or a hysterectomy were ineligible for the screening. As of June, 1992, 5,286 women had been recruited into the screening study. Briefly, at screening, Pap smears and cervigrams, magnified photographic imag...

Unique variants of human papillomavirus genotypes 52 and 58 and risk of cervical neoplasia

“…1,2 The unusually high prevalence of HPV 52 and 58 has been reported in Chinese populations living in China 3,4 and Taiwan. [5][6][7][8] In a previous report of our study, the prevalence of high-grade squamous intraepithelial lesion (HSIL) or worse lesions among participants with single-type infection of HPV 16, HPV 58 and HPV 52 at study entry was 31.9, 35.7 and 13.3%, respectively. 9 The participants infected with HPV 16, HPV 58 or HPV 52 had an increased prevalence of cervical cancer and carcinoma in situ (CIS).…”

“…In several previous studies, the high prevalence of HPV 52 and HPV 58 has been reported in Chinese populations. [3][4][5]7,8,29 Our study was the first comprehensive study on the genetic variations of E6-E7-LCR of HPV 52 and 58 and their association with cervical neoplasia in Taiwan.…”

Type‐specific human papillomavirus oncogene messenger RNA levels correlate with the severity of cervical neoplasia

“…[8][9][10][11][12][13][14][15]36,37 The overall presence of HPV 16, 18, 52, 58, 31 and 33 E6 mRNA transcripts (68.7%) in the 6 types of HPV DNA-positive cases in CIN lesions is higher than that in a previous study (46%). 21 The presence of these 6 types mRNA transcripts with HPV DNA positive is 80% for CIN 3 but only 13% for normal cytology.…”

“…1 In addition, HPV 52 and 58 are more prevalent in patients with preinvasive and cervical cancer in Taiwan and other Asian countries. [8][9][10][11][12][13][14][15] On the other hand, the occurrence of infection with HPV types 52 or 58 is relatively uncommon in cervical cancer in the Americas, Europe, Africa and …”

Prevalence of Human Papillomavirus in Women from Saudi Arabia

“…This was synthesized with multiple nucleotides in each primer and mixed with 25 primers including HMB01M, which detect a large spectrum of HPV types? This has been used in North and South America as well as in Asia (Wheeler et al, 1993;Hildesheim et al, 1994;Ley et al, 1994;Liaw et al, 1995;Lazcano et al, 2001;Thomas et al, 2004).…”