Investigating a cluster of vulvar cancer in young women: a cross-sectional study of genital human papillomavirus prevalence

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• 作者：Alice R Rumbold (1) (2)
  Sarah E Tan (3) (4)
  John R Condon (2)
  Debbie Taylor-Thomson (2)
  Maria Nickels (5)
  Sepehr N Tabrizi (3) (4) (6)
  Margaret LJ Davy (7)
  Margaret M O’Brien (8)
  Christine M Connors (6)
  Ibrahim Zardawi (9)
  Jim Stankovich (10)
  Suzanne M Garland (3) (4) (6)
  
• 关键词：Human papillomavirus ; Population prevalence ; Vulvar neoplasms ; Young women ; Indigenous women
• 刊名：BMC Infectious Diseases
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：12
• 期：1
• 全文大小：210KB
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  33. The pre-publication history for this paper can be accessed here:ntral.com/1471-2334/12/243/prepub" class="a-plus-plus">http://www.biomedcentral.com/1471-2334/12/243/prepub
  
• 作者单位：Alice R Rumbold (1) (2)
  Sarah E Tan (3) (4)
  John R Condon (2)
  Debbie Taylor-Thomson (2)
  Maria Nickels (5)
  Sepehr N Tabrizi (3) (4) (6)
  Margaret LJ Davy (7)
  Margaret M O’Brien (8)
  Christine M Connors (6)
  Ibrahim Zardawi (9)
  Jim Stankovich (10)
  Suzanne M Garland (3) (4) (6)
  
  1. Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, SA, 5005, Australia
  2. Epidemiology and Health Systems Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia
  3. Clinical Microbiology and Infectious Diseases, Royal Women’s Hospital, and Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Cnr of Flemington Road and Grattan Street, Parkville, VIC, 3052, Australia
  4. WHO HPV LabNet Regional Reference Laboratory - Western Pacific Region, Melbourne, VIC, Australia
  5. Health Services Division, Northern Territory Department of Health, PO Box 40596, Casuarina, NT, 0811, Australia
  6. Infectious Diseases and Microbiology Group, Murdoch Children’s Research Institute, Bio 21 Institute, Level 1 Building 404, 30 Flemington Rd, Parkville, Victoria, 3052, Australia
  7. Surgical and Specialties Service, Royal Adelaide Hospital, North Tce, Adelaide, SA, 5000, Australia
  8. Department of Obstetrics and Gynaecology, Cairns Base Hospital, The Esplanade, Cairns, QLD, 4870, Australia
  9. Discipline of Anatomical Pathology, University of Newcastle, Manning Health Campus, PO Box 649, Taree, NSW, 2430, Australia
  10. Biostatistics Group, Menzies Research Institute Tasmania, University of Tasmania, Medical Sciences Building 1, 17 Liverpool Street, Private Bag 23, Hobart, TAS, 7000, Australia
  

文摘

Background Vulvar cancer is a relatively rare malignancy, which occurs most often in postmenopausal women. We have previously identified a geographic cluster of vulvar cancer in young Indigenous women living in remote communities in the Arnhem Land region of Australia. In this population, we investigated the prevalence of oncogenic human papillomavirus (HPV) infection in anogenital samples (vulvar/vaginal/perianal area and cervix) and compared the overall, type-specific and multiple infection prevalence between sites. Methods A cross-sectional survey of 551 Indigenous women aged 18-0 years was undertaken in 9 Arnhem Land communities. Women were consented for HPV detection and genotyping collected by a combined vulvar/vaginal/perianal (VVP) sweep swab and a separate PreservCyt endocervical sample collected during Pap cytology screening. HPV DNA testing was undertaken using PCR with broad spectrum L1 consensus PGMY09/11 primers with genotyping of positive samples by Roche Linear Array. The primary outcomes were the prevalence of cervical and VVP high-risk (HR) HPV. Results The prevalence of VVP HR-HPV was 39%, which was significantly higher than the cervical HR-HPV prevalence (26%, p<0.0001). HPV-16 was the most common genotype detected in both sites (VVP 11%, cervical 6%). HPV-16 infection peaked in women aged <20 years; however, there was a marked decline in cervical HPV-16 prevalence with age (p=0.007), whereas following an initial decline, the prevalence of VVP HPV-16 remained constant in subsequent age-groups (p=0.835). Conclusions In this population experiencing a cluster of vulvar cancer, the prevalence of cervical oncogenic HPV infection was similar to that reported by studies of other Australian women; however there was a significantly higher prevalence of vulvar/vaginal/perianal infection to cervical. The large discrepancy in HPV prevalence between anogenital sites in this population may represent more persistent infection at the vulva. This needs further investigation, including the presence of possible environmental and/or genetic factors that may impair host immunity.