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      Frequency of Human papillomavirus in women attending cervical cancer screening program in Chile

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          Abstract

          Background

          Human papillomavirus (HPV) is the etiological factor for cervical cancer and its precursor lesions. The characterization of HPV genotypes in preneoplastic lesions and cervical cancer could establishes the effectiveness of vaccination plan in Chilean population. The aim of this study was to determine HPV frequency in a group of women including in a cervical screening program in the public health care system in Chile.

          Methods

          We analyzed 985 cervical smears samples from women with different histological diagnosis, attending to public health care in Temuco-Chile between 2004 and 2012, to detect HPV genotypes, through PCR followed by reverse line blotting assay.

          Results

          HPV was found present in 80.8% ( n = 796) of samples. Only a 5.6% of 985 samples were infected with a low-risk HPV, considering multiple infections. 10.5% ( n = 8/76) of normal cervical epithelia, 83.5% ( n = 208/249) and 87.6% ( n = 557/636) of low and high grade squamous intraepithelial lesions, respectively, and 95.8% ( n = 23/24) of squamous cervical carcinomas tested positive for HPV. HPV 16 was the most frequent genotype found (Overall 44.9%, n = 442/985; SCC: 62.5%, n = 15/24). A high variability of HPV types was also found in preneoplastic lesions, whereas there was a selection of genotypes in neoplasia. Also, there was a higher risk of infection with HPV 16 in women ≤26 years and 34–41 years old ( p < 0.05), meanwhile infections with HPV 16 or HPV 18 have related with cancer development ( p < 0.01).

          Conclusions

          These data provide further information about the frequency of HPV genotypes in women with cervical lesions in Chile, and the introduction of new targeted vaccines against a wider spectrum of HPV is suggested.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12885-017-3496-x) contains supplementary material, which is available to authorized users.

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          Most cited references29

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          The natural history of cervical HPV infection: unresolved issues.

          The identification of high-risk human papillomavirus (HPV) types as a necessary cause of cervical cancer offers the prospect of effective primary prevention and the possibility of improving the efficiency of cervical screening programmes. However, for these opportunities to be realized, a more complete understanding of the natural history of HPV infection, and its relationship to the development of epithelial abnormalities of the cervix, is required. We discuss areas of uncertainty, and their possible effect on disease prevention strategies.
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            Worldwide distribution of human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: a pooled analysis.

            The proportion of women infected with human papillomavirus (HPV) varies greatly across populations, as might the distribution of HPV types. We aimed to compare HPV-type distribution in representative samples of women from different world regions. Women were randomly selected from the general population of 13 areas from 11 countries (Nigeria, India, Vietnam, Thailand, Korea, Colombia, Argentina, Chile, the Netherlands, Italy, and Spain). A standardised protocol was used for cervical specimen collection. All HPV testing was by GP5+/6+ PCR-based EIA. The proportion of HPV-positive women infected with different HPV types was compared by study area and between pooled regions with age-adjusted odds ratios (ORs) with corresponding 95% floating CIs. 15 613 women aged 15-74 years without cytological abnormalities were included in a pooled analysis. Age-standardised HPV prevalence varied nearly 20 times between populations, from 1.4% (95% CI 0.5-2.2) in Spain to 25.6% (22.4-28.8) in Nigeria. Although both overall HPV prevalence and HPV16 prevalence were highest in sub-Saharan Africa, HPV-positive women in Europe were significantly more likely to be infected with HPV16 than were those in sub-Saharan Africa (OR 2.64, p=0.0002), and were significantly less likely to be infected with high-risk HPV types other than HPV16 (OR 0.57, p=0.004) and/or low-risk HPV types (OR 0.44. p=0.0002). Women from South America had HPV-type distribution in between those from sub-Saharan Africa and Europe. Heterogeneity between areas of Asia was significant. Heterogeneity in HPV type distribution among women from different populations should be taken into account when developing screening tests for the virus and predicting the effect of vaccines on the incidence of infection.
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              Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia.

              Worldwide human papillomavirus (HPV) prevalence in women with normal cytology at any given point in time is approximately 10% indicating that HPV is one of the most common sexually transmitted infections. HPV-16 is consistently the most common type and HPV-18 the second with some minor regional differences. Furthermore, across the spectrum of cervical lesions, HPV-16 is consistently the most common HPV type contributing to 50-55% of invasive cervical cancer cases strongly suggesting that this viral type has a biological advantage for transmission, persistency and transformation. The same phenomenon is observed albeit at a lower level for HPV-18 and HPV-45. Sexual behavioral patterns across age groups and populations are central to the description of the HPV circulation and of the risk of infection. The concept of group sexual behavior (in addition to individual sexual behavior) is important in exploring HPV transmission and has implications for defining and monitoring HPV and cancer prevention strategies. In natural history studies, the pattern of HPV DNA prevalence by age groups is similar to the patterns of HPV incidence. Rates of exposure in young women are high and often include multiple types. There is a spontaneous and rapid decrease of the HPV DNA detection rates in the middle-age groups followed by a second rise in the post-menopausal years. This article reviews: 1) the evidence in relation to the burden of HPV infections in the world and the contributions of each HPV type to the spectrum of cervical cellular changes spanning from normal cytology to invasive cervical cancer; 2) the critical role of the patterns of sexual behavior in the populations; and 3) selected aspects of the technical and methodological complexity of natural history studies of HPV and cervical neoplasia.
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                Author and article information

                Contributors
                brebimieville@gmail.com
                carmengloriaili@gmail.com
                alejandra.andana@ufrontera.cl
                doris.menzel@ufrontera.cl
                jaime.lopez@ufrontera.cl
                pabloguzman1969@gmail.com
                angelica.melo@ufrontera.cl
                k.buchegger@gmail.com
                +56223541061 , jcroas@gmail.com
                Journal
                BMC Cancer
                BMC Cancer
                BMC Cancer
                BioMed Central (London )
                1471-2407
                3 August 2017
                3 August 2017
                2017
                : 17
                : 518
                Affiliations
                [1 ]ISNI 0000 0001 2287 9552, GRID grid.412163.3, Laboratorio de Patología Molecular, Departamento Anatomía Patológica, , Facultad de Medicina, Universidad de La Frontera, ; Casilla 54-D, Temuco, Chile
                [2 ]ISNI 0000 0001 2287 9552, GRID grid.412163.3, Centro de Excelencia en Medicina Traslacional-Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), , Universidad de La Frontera, ; Casilla 54-D, Temuco, Chile
                [3 ]ISNI 0000 0001 2157 0406, GRID grid.7870.8, Department of Pathology, , School of Medicine, Pontificia Universidad Católica de Chile, ; Marcoleta 377, 7TH Floor, Santiago, Chile
                [4 ]Advanced Center for Chronic Diseases (ACCDiS); Millennium Institute on Immunology and Immunotherapy P09-016-F, Santiago, Chile
                Article
                3496
                10.1186/s12885-017-3496-x
                5543533
                28774281
                6b76d04c-6861-43cb-ae98-77bbff8f8ef4
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 29 April 2016
                : 23 July 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100009465, Corporación de Fomento de la Producción;
                Award ID: 07CN13PBT-222
                Award ID: 09CN14-5960
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100009465, Corporación de Fomento de la Producción;
                Award ID: 12IDL-18157
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100002850, Fondo Nacional de Desarrollo Científico y Tecnológico;
                Award ID: 11150802
                Award ID: 11150622
                Award Recipient :
                Funded by: Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias (Fondap)
                Award ID: P09-016
                Funded by: Millennium Institute on Immunology and Immunotherapy
                Award ID: P09- 016-F
                Funded by: CONICYT FONDAP
                Award ID: 15130011
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Oncology & Radiotherapy
                human papillomavirus,cervical intraepithelial neoplasia,cervical cancer,polymerase chain reaction,reverse line blotting assay

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