Leveraging National Cancer Institute Programmatic Collaboration for Uterine Cervix Cancer Patient Accrual in Puerto Rico

Kunos, Charles; Massett, Holly A.; Galassi, Annette; Walker, Joan L.; Good, Marge; Díaz, Luis Báez; McCaskill‐Stevens, Worta

doi:10.3389/fonc.2018.00102

Cited by 4 publications

(10 citation statements)

References 8 publications

(9 reference statements)

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“…Puerto Rican women have a higher age-adjusted incidence for cervical cancer compared to the U.S. mainland ( PAN American Health Organization, 2013 ). Puerto Ricans also have substantial economic and access barriers to treatments, including poor insurance coverage and even fewer credentialed radiotherapy machines island-wide ( Kunos et al, 2018 ). Puerto Rico also has the lowest cervical cancer screening rates in the US, and higher HPV prevalence than on the mainland (34 vs. 27%; Dunne et al, 2007 ; Ortiz et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Cervicovaginal Fungi and Bacteria Associated With Cervical Intraepithelial Neoplasia and High-Risk Human Papillomavirus Infections in a Hispanic Population

et al. 2018

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The human cervicovaginal microbiota resides at an interface between the host and the environment and may affect susceptibility to disease. Puerto Rican women have high human papillomavirus (HPV) infection and cervical cancer rates. We hypothesized that the population structure of the cervicovaginal bacterial and fungal biota changed with cervical squamous intraepithelial lesions and HPV infections. DNA was extracted from cervix, introitus, and anal sites of 62 patients attending high-risk San Juan clinics. The 16S rRNA V4 region and ITS-2 fungal regions were amplified and sequenced using Illumina technology. HPV genotyping was determined by reverse hybridization with the HPV SPF10-LiPA25 kit. HPV prevalence was 84% of which ∼44% subjects were infected with high-risk HPV, ∼35% were co-infected with as many as 9 HPV types and ∼5% were infected with exclusively low-risk HPV types. HPV diversity did not change with cervical dysplasia. Cervical bacteria were more diverse in patients with CIN3 pre-cancerous lesions. We found enrichment of Atopobium vaginae and Gardnerella vaginalis in patients with CIN3 lesions. We found no significant bacterial biomarkers associated with HPV infections. Fungal diversity was significantly higher in cervical samples with high-risk HPV and introitus samples of patients with Atypical Squamous Cells of Undetermined Significance (ASCUS). Fungal biomarker signatures for vagina and cervix include Sporidiobolaceae and Sacharomyces for ASCUS, and Malassezia for high-risk HPV infections. Our combined data suggests that specific cervicovaginal bacterial and fungal populations are related to the host epithelial microenvironment, and could play roles in cervical dysplasia.

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Section: Introductionmentioning

confidence: 99%

Cervicovaginal Fungi and Bacteria Associated With Cervical Intraepithelial Neoplasia and High-Risk Human Papillomavirus Infections in a Hispanic Population

et al. 2018

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“…The high-risk HPV types (oncogenic) includes genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, and 58 that are associated with cervical, vulvar, vaginal, and anal cancer progression, while low-risk types such as 6, 11, 40, 42, 43, 44, 53, 54 and 74 are associated with warts and low-grade anal lesions [5]. Puerto Rico is the region with the lowest cervical cancer screening rates in the US, which has also substantial economic and access barriers to preventive strategies and treatments [6], and a higher prevalence of HPV than compared to those in the US (34% vs 27%) [7, 8].…”

Section: Introductionmentioning

confidence: 99%

“…This test has shown to reduce the incidence of mortality from cervical cancer [10]. However, the test has many barriers that include embarrassment in the screening method that can also contribute to low screening rates in certain cultures such as in Puerto Rico, where screening is significantly low [6]. Therefore, there is a definite need for alternative and supplementary HPV-related infections early detection tests that some authors have discussed before [11].…”

Section: Introductionmentioning

confidence: 99%

Discriminating high-risk cervical Human Papilloma Virus infections with urinary biomarkers via non-targeted GC-MS-based metabolomics

et al. 2018

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Genital human papillomavirus (HPV) is the world’s most commonly diagnosed sexually transmitted infection, and high-risk HPV types are strongly linked to cervical dysplasia and carcinoma. Puerto Ricans are among the US citizens with higher HPV prevalence and lower screening rates and access to treatment. This bleak statistic was as a motivation to detect biomarkers for early diagnosis of HPV in this population. We collected both urine and cervical swabs from 43 patients attending San Juan Clinics. Cervical swabs were used for genomic DNA extractions and HPV genotyping with the HPV SPF10-LiPA25 kit, and gas chromatography-mass spectrometry (GC-MS) was employed on the urine-derived products for metabolomics analyses. We aimed at discriminating between patients with different HPV categories: HPV negative (HPV-), HPV positive with simultaneous low and high-risk infections (HPV+B) and HPV positive exclusively high-risk (HPV+H). We found that the metabolome of HPV+B is closer to HPV- than to HPV+H supporting evidence that suggests HPV co-infections may be antagonistic due to viral interference leading to a lower propensity for cervical cancer development. In contrast, metabolites of patients with HPV+H were significantly different from those that were HPV-. We identified three urinary metabolites 5-Oxoprolinate, Erythronic acid and N-Acetylaspartic acid that discriminate HPV+H cases from negative controls. These metabolites are known to be involved in a variety of biochemical processes related to energy and metabolism and may likely be biomarkers for HPV high-risk cervical infection. However, further validation should follow using a larger patient cohort and diverse populations to confirm our finding.

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Section: Introductionmentioning

confidence: 99%

“…The NCI conducts trials in Puerto Rico supported by a Minority/Underserved NCI Community Oncology Research Program (PRNCORP) newly based at the Centro Comprensive de Cancer–Universidad de Puerto Rico (CCCUPR) Research Hospital, which opened in San Juan in June 2018 (4). The PRNCORP navigates women with advanced stage uterine cervix cancer undergoing radiochemotherapy through one of three San Juan-centric gynecologic brachytherapy centers, with only an estimated 30 percent of women undergoing the requisite brachytherapy (4). Pre-hurricane, the NCI provided resources to the PRNCORP to hire a gynecologic research nurse that would help steer uterine cervix cancer patients through treatment, inclusive of their brachytherapy, with a particular emphasis to meet requirements of NCI-sponsored uterine cervix cancer trials (like NRG Oncology GY006 that randomly allocates untreated women with advanced-stage uterine cervix cancer to triapine-cisplatin-radiotherapy vs. cisplatin-radiotherapy [NCT02595879]).…”

Section: Introductionmentioning

confidence: 99%

Leveraging National Cancer Institute Programmatic Collaboration for Uterine Cervix Cancer Brachytherapy in Puerto Rico After Hurricane Maria

Kunos

Ivy

2019

Front. Oncol.

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Evaluating the impact of natural disasters on cancer patients is vital to the recovery of cancer treatment services and infrastructure. In September 2017, Hurricane Maria demolished the gynecologic cancer service in the United States territory of Puerto Rico and its outreach to the territory of the Virgin Islands of the United States. Patient access to brachytherapy for uterine cervix cancer patients can be difficult to measure in the aftermath of a hurricane. The United States National Cancer Institute (NCI) surveyed gynecologic radiation medicine providers on the island to generate an independent perspective on gynecologic brachytherapy service recovery after the hurricane. Providers were asked about patient displacement, infrastructure loss, and reestablishment of cancer treatment. Here, the NCI provides its perspective on recovery of these services as it relates to its pre-hurricane investment for staff in the NCI Community Oncology Research Program.

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Leveraging National Cancer Institute Programmatic Collaboration for Uterine Cervix Cancer Patient Accrual in Puerto Rico

Cited by 4 publications

References 8 publications

Cervicovaginal Fungi and Bacteria Associated With Cervical Intraepithelial Neoplasia and High-Risk Human Papillomavirus Infections in a Hispanic Population

Cervicovaginal Fungi and Bacteria Associated With Cervical Intraepithelial Neoplasia and High-Risk Human Papillomavirus Infections in a Hispanic Population

Discriminating high-risk cervical Human Papilloma Virus infections with urinary biomarkers via non-targeted GC-MS-based metabolomics

Leveraging National Cancer Institute Programmatic Collaboration for Uterine Cervix Cancer Brachytherapy in Puerto Rico After Hurricane Maria

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