TY - JOUR
T1 - Investigating a cluster of vulvar cancer in young women
T2 - a cross-sectional study of genital human papillomavirus prevalence
AU - Rumbold, Alice R.
AU - Tan, Sarah E.
AU - Condon, John R.
AU - Taylor-Thomson, Debbie
AU - Nickels, Maria
AU - Tabrizi, Sepehr N.
AU - Davy, Margaret L.J.
AU - O'Brien, Margaret M.
AU - Connors, Christine M.
AU - Zardawi, Ibrahim
AU - Stankovich, Jim
AU - Garland, Suzanne M.
N1 - Funding Information:
This work was supported by the National Health and Medical Research Council (NHMRC) in Australia, Grant ID: 436013. The views expressed in this publication are those of the authors and do not reflect the views of NHMRC. Alice Rumbold is supported by the Jean B Reid Fellowship from the University of Adelaide Medical Endowment Funds. Sarah Tan is supported by the Royal Women’s Hospital Post Graduate Degree Scholarship from the Royal Women’s Hospital, Melbourne Australia.
Funding Information:
SMG has received advisory board fees and grant support from CSL and GSK; lecture fees from Merck, GSK and Sanofi Pasteur; funding (through her employing institution) to conduct HPV vaccine studies for MSD and GSK; and is a member of the Merck Global Advisory Board and the Merck Scientific Advisory Committee for HPV. SET is the recipient of a GlaxoSmithKline Australian Postgraduate Support Grant for work outside of this submitted manuscript. CSL Biotherapies have provided funding to the authorship group to support a workshop on genetic susceptibility to vulvar cancer.
PY - 2012/10/5
Y1 - 2012/10/5
N2 - 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 18-60 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.
AB - 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 18-60 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.
KW - Human papillomavirus
KW - Indigenous women
KW - Population prevalence
KW - Vulvar neoplasms
KW - Young women
UR - http://www.scopus.com/inward/record.url?scp=84867032763&partnerID=8YFLogxK
U2 - 10.1186/1471-2334-12-243
DO - 10.1186/1471-2334-12-243
M3 - Article
C2 - 23040203
AN - SCOPUS:84867032763
VL - 12
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
SN - 1471-2334
M1 - 243
ER -