Essay On My Pico Question

Essay on My Pico Question
My Pico question:
P: Women between 18–69 years presenting for cervical cytology screening.
I: HPV DNA testing
C: Cytology Screening
O: Sensitivity for detecting cervical precancerous lesions.
Article 1:
Int J Cancer. 2014 Jul 1;135(1):166–77. doi: 10.1002/ijc.28640. Epub 2014 Jan 24.
Is HPV DNA testing specificity comparable to that of cytological testing in primary cervical cancer
screening? Results of a meta–analysis of randomized controlled trials.
Pileggi C1, Flotta D, Bianco A, Nobile CG, Pavia M.
Author information
Abstract
Human–papillomavirus (HPV) DNA testing has been proposed as an alternative to primary cervical
cancer screening using cytological testing. Review of the evidence shows that available data are
conflicting for ... Show more content on Helpwriting.net ...
SEARCH METHODS:
We made a comprehensive literature search that included the Cochrane Register of Diagnostic Test
Accuracy Studies; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane
Library), MEDLINE (through PubMed), and EMBASE (last search 6 January 2011). Selected
journals likely to contain relevant papers were handsearched from 1992 to 2010 (December). We also
searched CERVIX, the bibliographic database of the Unit of Cancer Epidemiology at the Scientific
Institute of Public Health (Brussels, Belgium) which contains more than 20,000 references on
cervical cancer.More recent searches, up to December 2012, targeted reports on the accuracy of triage
of ASCUS or LSIL with other HPV DNA assays, or HPV RNA assays and other molecular markers.
These searches will be used for new Cochrane reviews as well as for updates of the current review.
SELECTION CRITERIA:
Studies eligible for inclusion in the review had to include: women presenting with a cervical cytology
result of ASCUS or LSIL, who had undergone both HC2 testing and repeat cytology, or HC2 testing
alone, and were subsequently subjected to
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HPV Case Study
HPV and its associated diseases affect men and women of all races and ethnicities. In the United
States, Caucasian females have a lower incidence of cervical cancer and a higher incidence of vulvar
cancer, while vaginal cancers associated with HPV occur more frequently in black females CITE
JEMAL 2013 HPV linked oropharyngeal cancers are increasing in both sexes across all ethnicities
with the exception of blacks, and hpv associated anal cancers have increased in both males and
females of all races and ethnicities CITE JEMAL 2013 In the state of Florida, between 1981 and
2009, there was a higher incidence of cervical, vaginal, and penile cancer in the black population, a
higher incidence of anal cancer in the Hispanic population, and a ... Show more content on
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In their 2015 study Alves Ribeiro et al. found that women who began having sexual intercourse prior
to age of 16 were more than four times as likely to have a HPV infection (OR 4.41; 95%CI:1.20–
19.33), and nearly five times as likely for that infection to involve serotypes 16 and 18 (OR 4.68;
95% CI: 1.20–21.32). Moreover, women with a sexual debut prior to age 16 were twice as likely to
have a diagnosis of cervical intraepithelial neoplasia (CIN)1 or greater (OR 2.2; 95% CI: 0.94–5.08
CITE 2. The same study also demonstrated a statistically significant association between CIN 1 and
HPV infection, especially infection with HPV serotypes 16 and 18 (OR 2.76; 95% CI: 1.05–7.19) and
(OR 3.53; 95% CI: 1.17–10.67) respectively (Alves Riberio et al., 2015). Over 90% of females in the
United States are sexually active by age 24; correspondingly, the prevalence of high–risk HPV peaks
at over 43% in the 20–24 age group (Vegunta, Kransdorf, & Mayer, 2014). By age 30, the prevalence
of high–risk HPV decreases to 30.4%, and continues to decrease as age increases. It is thought that
this age related decrease in prevalence can be attributed to a combination of factors, including,
decreased exposure, resistance to reinfections, and HPV's self–limiting nature (Alves Ribeiro et al.,
2015; Vegunta et al., 2014). Cumulatively, the prevention and treatment of HPV and its associated
diseases are responsible for a staggering approximately 8 billion in

Hepatitis B And Its Effects
Hepatitis B is a genuine liver disease created by the hepatitis B virus (HBV). For some individuals,
hepatitis B contamination gets to be incessant, which means it keeps going over six months. Having
unending hepatitis B builds your danger of creating liver disappointment, liver disease or cirrhosis
which is a condition that causes lasting scarring of the liver. A great number of people contaminated
with hepatitis B as grown–ups recuperate completely, regardless of the possibility that their signs and
side effects are extreme. Babies and youngsters will probably build up a ceaseless hepatitis B
contamination (MayoClinic).
Hepatitis C contamination additionally expands the danger of creating liver disease just like hepatitis
B. Until the 1980 's, hepatitis C virus (HCV) was known as non–A non–B hepatitis. The underlying
disease may have side effects, yet a critical number of individuals don 't have side effects. Not at all
like hepatitis B, in which the ailment does not frequently get to be constant, have around 80% of
individuals with hepatitis C built up an endless disease. As the invulnerable framework keeps on
assaulting the infection after some time, fibrosis grows, in the end prompting cirrhosis. This unending
aggravation can likewise prompt liver growth. This infection is spread through tainted blood, for
example, with transfusions and IV drug misuse, however numerous individuals don 't have evident
danger components for the sickness. It is currently suggested that

A Link Between Cervical Cancer And Hpv
Introduction Did you know there is more of a link between cervical cancer and HPV than smoking
and lung cancer? Cervical cancer is currently the fourth most common cancer in women and the
second leading cause of death from cancer in women. Along with those statistics, human
papillomavirus is the most common sexually transmitted viral disease amongst men and women
worldwide. The prevalence of women having a strain of HPV that ultimately leads to or increases the
chance of cervical cancer is highly relatable. What is pathophysiology, signs, symptoms, prevention,
and treatments of this ailment? You might ask will be covered in the next few pages of this paper.
Pathophysiology
There are several strains of the human papillomavirus the ... Show more content on Helpwriting.net ...
Human papilloma virus will cause almost all cases of cervical cancer, and therefore is the highest risk
factor. There are many factors that will determine if HPV will lead to cervical cancer, HPV directly
affects and transforms either or both the deepest layer of the mucous epithelial cells and more
superficial layers. Targeting the receptors found in the layers of the stratified squamous epithelium.
This is where the virus will proliferate into more differentiated cells to spawn offspring virus. The
virus replication is what causes the skin characteristics of a wart. With the help of a pap smear, we are
able to investigate if cervical epithelial cells are healthy and normal or determine which point in
dysplasia they are at in transforming to cancerous cells. The HPV virus does not need a host to
survive, and can survive in low and high temperatures. The different stages of the squamous
intraepithelial lesion can include low– grade, high–grade risk types of HPV, at this point HPV can
spontaneously go away on its own and shows no signs of concern to the patient. If a biopsy is done
and is showing dysplasia the physician can then rate the Cervical intraepithelial neoplasm is common
among young women and can be divided and graded

Persuasive Speech On Human Papilloma Virus
Human Papilloma Virus HPV Specific purpose: To persuade my audience why they should give their
pre–teen the Human Papilloma Virus (HPV) vaccine. Central ideal: People should get vaccinated to
prevent contracting the Human Papilloma Virus (HPV) which can lead to cervical cancer that can
develop through HPV. Introduction I. How would you feel if one day, you went to your OBGYN for a
routine checkup and a pap–smear. Afterwards, a few days later your doctor calls you to inform you
that your pap–smear is abnormal. After a biopsy is performed, you find out that you have HPV. II.
People should get vaccinated to prevent contracting the Human Papilloma Virus (HPV). So, what is
HPV? III. How the HPV vaccine can prevent you from getting the virus which has an extremely high
rate that can lead to cervical cancer. An example of how HPV can affect individuals is the experience
that my cousin, Darlene went through after receiving an abnormal pap–smear. IV. Controversy on
why people refuse to get vaccinated? Transition Main point I: First, I will begin by discussing what
HPV is Human Papilloma Virus (HPV) remains the most commonly sexually transmitted infection in
both males and females. (Giuliano et al., 1999). A. Subpoint 1: According to the CDC (2008), HPV is
the most common sexually transmitted disease. Approximately 20 million people are currently
infected with the virus in the United States (Myers et al., 2000). About 6.2 million Americans get a
new genital HPV infection each year

Hpv Research Paper
Jaydann McCorkle
Mrs. Retherford
AP/Ivy Tech English 111
7 May 2018
Human Papillomavirus Vaccine Education
Human Papillomavirus is a broad term used to describe over one hundred and fifty related viruses.
The Human Papillomavirus, better known as HPV is named for the warts (papillomas) that become
present on the skin of an HPV victim. HPV is transmitted via intamainte skin–to–skin contact. Each
year a small number of cases of HPV go unknown because no symptoms are present or the body
fights away the virus. Other cases that do not go away commonly are expressed in genital warts and
cancers. Some cancers commonly developed from HPV are cervical, vaginal, anus, back of the throat,
tonsil and tongue cancers (What). In recent years researchers, ... Show more content on
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A study of college–age women showed that approximately 70% of women with HPV infections
became HPV negative within 1 year and as many as 91% of them became HPV negative within 2
years, with a median duration of infection of 8 months. Certain HPV types, such as HPV 16, are
associated with increased rates of persistence; however, in the previously mentioned study, the 24–
month clearance of HPV 16 was 72%. Thus, the majority of these infections clear. Other factors
associated with persistent HPV infection include age higher than 30, parity, infection with multiple
HPV subtypes, immunosuppression, smoking, and oral contraceptive use.
Cervical intraepithelial neoplasia caused by HPV can clear without treatment, but the rate of
clearance varies according to the severity of the lesion; high–grade lesions have a greater rate of
progression to cervical cancer (Blackman). Sixty percent of CIN 1 lesions are likely to regress
spontaneously, 10% are likely to progress to CIN 3, and only 1% is likely to progress to invasive
cancer. For CIN 3, these numbers are quite different: approximately one third of these lesions are
likely to regress, and the rate of progression to cervical cancer is greater than 12% if left

Gardasil Research Paper
Summary
The research questions are why is Gardasil such a controversial topic and why can't the debate on if
Gardasil is safe, on what age it should be given, and how successful it would be when administered
be settled? The research was conducted to answer these questions because Merck, the maker of
Gardasil, presented this vaccine as the first vaccine to prevent HPV and cervical cancer in girls but
there was no real solid proof that the vaccine was successful since Merck and the FDA (Food and
Drug Administration) approved the vaccine a year before the results/data on the vaccine's safety and
efficacy became available. Likewise, researchers were trying to learn if Merck's claims of "one less"
life being affected by cervical cancer with their ... Show more content on Helpwriting.net ...
I feel like the article should have talked about both sides of the debate because, despite people's
personal beliefs/feelings on Gardasil, the vaccine does work, just not on everything that the company
is advertising that it does. It does not prevent cervical cancer mainly because with the way the lesions
of cervical cancer are (CIN 1–3) the lesions hardly ever develop into the other two lesions known as
CIN 2 and CIN 3. This article was completely against the vaccine but it provided plenty of proof and
detail to back up why Gardasil should not be required, especially because research has proven that a
pap smear can do more for women when it comes to cervical cancer than Gardasil can. I like the
article overall, and it helped me understand a little more of what Gardasil can or cannot do. However,
I feel like the article could've been "dumbed down" some just because I never even heard of CIN
lesions before and so I felt like they should've explained a little easier and in simpler terms of what
these cells are, otherwise those without any medical background/schooling would not follow too well
with the

Ceervical Cancer Case Study
Good Evening Dr. Anttila and Class, Based on Shelby's age, smoking, and medical history, she should
be screened for cervical cancer. Women age 30–65 should have a Pap (Papanicolaous) smear done
every three years or Pap smear in combination with human papillomavirus (HPV) testing every 5
years (American Cancer Society [ACS], 2016). HPV is the leading cause of cervical cancer. Smoking
doubles a woman's risk of developing cervical cancer and it also weakens the body's immune system
to fight the HPV virus (ACS, 2017). Cervical cancer is the 4th most commonly diagnosed cancer
among women worldwide and the 14th in the U.S. (Kessler, 2017). This year the cervical cancer
prevalence was estimated to be 256,078 and incidence was 12,820 in the ... Show more content on
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The study was done by performing a Pap smear, followed by a visual inspection with acetic acid, and
a colposcopy on all the subjects. Biopsies were done to those who had an abnormal result. A
"histopathological diagnosis was used as gold standard for women for whom biopsies were taken"
(Saleh, 2014). A larger study involving 256,648 women in multiple clinical practices in the U.S.
comparing Pap test alone vs co–testing with HPV and HPV test alone showed that a positive co–test
result has a better sensitivity (98.8%; 4040 of 4090 co–tests) for diagnosing CIN3 than either a
positive HPV only test (94%; 3845 of 4090 HPV only tests) or a positive Pap only test (91.3%; 3734
of 4090 Pap only tests; P<.0001). A high sensitivity means that the test is capable of detecting those
who have the disease. A positive Pap only result had a slightly better specificity (26.3%; 66,145 of
251,715 Pap only tests) for diagnosing CIN3 than a positive HPV only test (25.6%; 64,625 of
252,556 HPV only tests) or a positive co–test (10.9%; 27,578 of 252,558 co–tests; P<.0001) (Blatt,
Kennedy, Luff, Austin, & Rabin, 2015). When performing a test simultaneously like a co–test, the
specificity usually decreases because both tests have to show negative results for the individual to be
considered negative and the sensitivity increases because an individual will be considered positive
when either of the tests show positive. The results of the three tests are very similar. This shows

Global Burden Of Disease : Cervical Cancer
Anthony Sleiman
Dr. Baker and Dr. Story
International Health
3 November 2016
Global Burden of Disease – Cervical Cancer On a global scale, cancer is now responsible for double
the amount of annual deaths than malaria, tuberculosis, and AIDS combined, according to the Center
for Disease Control (CDC, 2016). With cancer rates now increasing rapidly in developing countries,
the World Health Organization has predicted that the amount of cancer deaths worldwide will
increase by 80% by 2030 (WHO, 2012). Most of these new cases will emerge in the developing
regions of the world, regions that lack efficient healthcare access and proper screening procedures to
catch the disease early on. Cervical cancer is one of the most prevalent cancer types among humans
today, ranking as the 7th most prevalent cancer overall, and 4th most prevalent among women.
Furthermore, almost 9 out of 10 (87%) of cancer deaths occur in developing regions of the world
(Globocan, 2012). Clearly, the global burden of cervical cancer is not evenly distributed. Already, it
can be seen that gender and socioeconomic status, among other determinants, play a role in
susceptibility to the disease. This paper explores the various factors that account for the unequal
global burden of cervical cancer, and presents an intervention strategy that targets the root causes of
discrepancy for the disease. In 2012, there were 528,000 global cases of cervical cancer, of which
266,000 affected cases were fatal. However, only

Cervical Smoking Research Papers
Women are also targeted when it comes to cigarettes. According to some, "Many girls and women are
more concerned about looking good than about the long–term health effects" (Sasman 23). Strong
evidence points to the connection between smoking and cervical intraepithelial neoplasia; which is
the abnormal growth of squamous cells on the cervix. CIN is curable; however, cervical cancer is a
consequence from it if left untreated. According to Saules study, "Cervical Cancer is now well–
established as a smoking related illness" (207), claiming 5,000 lives annually. In the Journal of
College health, the rate of cervical intraepithelial neoplasia and cervical cancer is elevated in
smokers. Quitting or reducing smoking reduces the likelihood of a ... Show more content on
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Brief leaflets on the connection of smoking and cervical cancer have shown to be effective; however,
in efforts to make more and younger women mindful, a study was designed to research the
possibilities. According to Saules, increasing this awareness may help with the cessation efforts
caused by cervical cancer" (208). The 135 female students who participated were in between the ages
of 18 and 24 with various smoking status. The procedures were approved by the Eastern Michigan
University Human subjects review board with the average age of about 20 years old and completed
about 2 years of college, 78% Caucasian and 17% African–American. First, participants were asked
to rate their risk of developing heart disease, lung disease and cervical cancer. According to this
study, participants were asked to indicate which of the following they believed would increase the
risk of developing cervical cancer by answering yes or no to each: HPV, oral contraceptive use,
changing sexual partners, smoking, alcohol use, not using a condom, low–fiber diet, cervical
dysplasia, and having an abortion. Participants were also asked to determine whether they considered
themselves as a smoker, ex–smoker or non–smoker. Past–month smokers sought themselves likely in
the average and above average category for heart disease and lung disease. Also, past–month smokers

Human Papillomavirus ( HPV ) And Cancer Of The Ceervix
Causal Association of Human Papillomavirus (HPV) and Cancer of the Cervix
It is important to have a clear understanding of how the etiology of cancer of the cervix was
established which eventually enabled the development of HPV vaccines, one of the major
breakthroughs in the history of cervical cancer. For decades, the etiology of cancer of the cervix
remained unknown and there were several attempts by past scientists to establish the cause of cervical
cancer without much success. However, the earliest breakthroughs came in the 1930s while Dr.
Richard Shope of the Rockefeller University was working on wild rabbits that had developed "horn",
which upon further analysis, was caused by a virus that could be transmitted. This discovery played ...
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Evidently, in the 1990s the relationship between HPV and cervical neoplasia was confirmed.54
According to Bosch et al., the 1990s produced the key results of case–control and cohort studies, and
witnessed an increasing number of results on the clinical uses of HPV–DNA testing in screening and
triage,55 and, as Liaw et al. (1995) noted in their case control studies, it was also becoming apparent
that those with multiple HPV infections have a higher risk of developing cancer of the cervix.53
With the changing dimension of research studies having confirmed that HPV was a necessary cause
of cervical cancer, epidemiological studies advanced to associating different strains of HPV to
different anogenital pathologies, categorizing different histological forms of cervical cancer in
relation to HPV strains and highlighting other risk factors that may play a prominent role or catalyze
the carcinogesis process. For instance, Ngelangel et al. in their hospital–based case control studying
the Philippines detected HPV–DNA in 93.8% case subjects with squamous cell carcinoma, 90.9% in
case subjects with adenocarcinoma/adenosquamous carcinoma as opposed to just 9.2% of control
subjects.56
They observed the presence of 6 HPV types in adenocarcinoma, and 15 HPV types in squamous cell
carcinoma while noting that, apart from HPV 16 and HPV 18, HPV45 had the strongest association
with squamous cell carcinoma. The same year saw the publication of the

Crvical Cancer Essay
With more than 500,000 new cases being detected each year, cervical cancer is one of the leading
causes of cancer affecting women worldwide.1, 2 A very high burden of cervical cancer mortality is
found in developing countries, where nearly 9 out of 10 cases result in cervical cancer–related
mortality among women.3, 4 These healthcare disparities can be largely explained by the lack of
access to effective cervical cancer screening programs in low–resource settings, such as Sub–Saharan
Africa (SSA), that allow for early detection and treatment.5 African women have an extremely high
incidence of cervical cancer, with approximately 420,000 new cases, half of which die per year.6
Kenya has the second highest incidence of invasive cervical cancer (ICC) in Africa.6,7 The ... Show
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However, after controlling for risk behavior, HPV incidence is higher among women with HIV.17–19
Squamous intraepithelial lesions (SIL) or cervical intraepithelial neoplasia (CIN), the HPV–mediated
cytological and histological precursors of cervical cancer, are more prevalent in HIV–infected
women.20, 21 HIV leads to an increased prevalence of HPV and incidence of CIN in HIV–infected
women. This maybe due to immune–suppression seen with HIV.22 Moreover, cervical lesions are
twice as likely to progress to high–grade cervical intra–epithelial neoplasia (HGCIN) in HIV–infected
women as compared to HIV negative women.23 This could be due to the inability of the immune
system to clear HPV in advanced precancerous and cancerous lesions.21, 24, 25 However, studies
have found that the rates of invasive cervical cancer (ICC) do not increase with decreasing CD4+
counts.26 Researchers attribute this finding to the long latency period prior to the development of
invasive cervical disease, during which, HIV–infected women end up dying of other complications of
their HIV before ICC affects

The For Healthy Border 2010 Essay
The "Healthy Border 2010" consisted of 11 focus areas with 21 objectives regarding public health
problems that the inhabitants of the US– Mexico border were facing. Some of the objectives were
met and some were not. To meet the unmet objectives of health promotion and disease prevention, the
framework of "Healthy Border 2020" was constructed. This framework is composed of 5 focus areas,
which are chronic and degenerative diseases; infectious diseases; maternal and child health; substance
abuse and mental health conditions; and injuries. Cancer is the second leading cause of death world–
wide and cervical cancer is the third most common cancer (9%) in women as well as seventh (4%)
among all cancer deaths. (Chabra 2016). One of the objectives of "Healthy Border 2010" was to
reduce cervical cancer death by 30%in the United States and 20% in Mexico. This objective was not
completely but about to meet in Mexico by the year 2010 however, the cervical cancer death rate in
the United States has not met its target by the deadline. Therefore, the area of cervical cancer is an
important area of concern in the US–Mexico border. New objectives for cervical carcinoma has been
set in the "Healthy Border 2020". The new objectives include decreasing the mortality in women of
25 years or older by 20%; maintaining screening for women between 25 to 64 years at 80%; screen
for women at 21 years and older; maintaining the coverage of HPV vaccinations for girls 9–11 years
at 90%. Current screening

The Human Papillomavirus ( Hpv ) Essay
The Human Papillomavirus (HPV) is the most common sexually transmitted disease in the United
States among teens and young adults (Centers for Disease Control and Prevention, 2015). HPV is
known to attack epithelial cells and as many as 75% to 80% of males and females can become
infected in their lifetime (Merck Sharp & Dohme Corp., 2012). There are many different strains–
some of which cause no symptoms and others that can cause genital warts, as well as various types of
oropharyngeal and/or anogenital cancers. There are currently three vaccines licensed by the FDA
since 2006–Cervarix, Gardasil, and Gardasil 9. These vaccines are a 3–dose series recommended for
routine use among girls and boys at ages 11 and 12, and ages 13–26 for those who have not
previously been infected. Although these vaccines do not protect against all HPV strains, they do
protect against the two most common high–risk (cancer–causing) strains–types 16 and 18. In addition
to preventing types 16 and 18, the Gardasil vaccine protects against the two most common low–risk
(genital warts–causing) strains and the Gardasil 9 vaccine protects against five additional cancer–
causing strains, as well as the other strains previously mentioned. (Centers for Disease Control and
Prevention, 2015)The purpose of the Bauldur–Felskov et al (2014) study was to assess the efficacy of
the HPV vaccine against cervical lesions by comparing the incidence trends before and after the
vaccination program was first implemented.

Human Papilloma Virus And The Prevalence Of Cervical Cancer
Human Papilloma Virus and the Prevalence of Cervical Cancer
Introduction
Did you know there is more of a link between cervical cancer and HPV than smoking and lung
cancer? Cervical cancer is currently the fourth most common cancer in women and the second
leading cause of death from cancer in women. Along with those statistics, human papillomavirus is
the most common sexually transmitted viral disease amongst men and women worldwide. The
prevalence of women having a strain of HPV that ultimately leads to or increases the chance of
cervical cancer is highly relatable. What is pathophysiology, signs, symptoms, prevention, and
treatments of this ailment? You might ask will be covered in the next few pages of this paper.
Pathophysiology
There are several strains of the human papillomavirus the highest risk strains for cervical cancer are
HPV 16 and 18 those strains cause 70 percent of cervical cancer along with a few other high–risk
strains. There are low–risk strains that cause things such as common warts, which are seen on the
skin, or genital warts seen on the mucous membranes. For the purpose of this paper, we will only be
covering strains that can lead to cervical cancer. Transmission of HPV is fairly easy which may be
why it is so prominent in our society today. HPV is transmitted primarily by sexual activity but can
also occur due to prolonged exposure to things like skin–to–skin interaction, or wear of clothing that
has been chronically exposed to the virus. It is

Hpv Cause For Disease
Damir Sarajlic
Professor Dianne Fair
MCB3020C
13 November 2017
HPV: A Cause for Concern
1. Introduction
Human papillomavirus or HPV is one of the most common viruses that are transmitted through
sexual activity. A virus is sometimes referred to an obligate intracellular parasite, which cannot
multiply outside of a living cell. Transmission can occur through hand to hand contact, exposure to
contaminated blood, and shared objects. Typical exposure is achieved through skin–to–skin contact
during intercourse. HPV can pass from person to person with no signs or symptoms. Development of
symptoms can occur years after initial infection. Many cases of HPV can clear up on their own. If a
reoccurring case of HPV is left untreated, then a papilloma ... Show more content on Helpwriting.net
...
Detections methods have improved over the years for identification with the use of swabs from
cutaneous epithelium or plucked hairs. These methods primarily identify beta and gamma types of
viruses. Most infected individuals eliminate the virus without developing clinical manifestations.
Closely related types of virus can show distinct pathologies in HPV. While their genetic sequences
can be similar, their pathologies and virulence can be different. HPV six and eleven share 85%
sequence identity. HPV six is found in anogenital warts while HPV eleven is primarily responsible
for laryngeal papillomas. HPV thirteen shares a 78% likeness with both HPV six and eleven but
doesn't cause the same pathologies. HPV seven and forty have an 87% resemblance in sequence and
both cause "butchers" warts.
3. Structure and Function
HPV is a non–enveloped virus with double–stranded DNA that is protected by an icosahedral capsid.
An icosahedral is a polyhedral with twenty faces. The genome consists of double–stranded circles
with approximately eight–thousand base pairs containing eight or nine open reading frames. Gene
expression involves multiple promoters and complex patterns of splicing. The HPV genome separates
into three regions; the long control region, early region, and a late region. The early region contains
no coding for structural proteins in

Human Papolloma Viruse Type 16 and Type 18
Human Papilloma Virus Type 16 and Type 18 Human Papilloma Virus (HPV) is a double stranded
DNA virus. There are many genotypes HPV and some of them are oncogenic. They have envelope
proteins E6 and E7 on their cell wall which are associated to initiate cancer. Anogenital lesions
associated to HPV are divided into 'low–risk' types (6, 11, 34, 40, 42, and 43) and 'high risk' types
(16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 73, and 82). Most of the low risk HPV
infections are asymptomatic and are not fatal, however infection to high risk HPV such as type 16
and 18 may cause cervical, anal, vaginal, vulvar and penile cancer (Centre of Disease Control, 2012).
Low risk HPV generally cause warts on the skin surface which rarely develop into malignancy. Type
16 and 18 both were originally isolated from cervical carcinomas of human body. More than 70% of
human cervical is due to the infection of either HPV 16 or 18. According to CDC, in 2008 it was
estimated 11,070 cases of cervical cancer in United States and about 3,870 deaths due to cervical
cancer. Higher percentage of HPV persistent infection occurs by HPV–16 and the risk of getting
cervical cancer due the progression of disease is higher for HPV 16 and 18 and 45 (Tino F. Schwarz,
2008). Antigen involved The antigens involved on human cervical cancer from HPV 16 or 18 are E6
and E7. Expression of protein E6 and E7 on the epithelial surface is the cause of cervical cancer.
These proteins are also known as viral

The HPV Vaccine and Its Effect on Cancer Screening and...
The HPV vaccine and its effect on cancer screening and prevention
Introduction
Human Papillomavirus(HPV) is the most common sexually transmitted infection in the United States,
according to Centers for Disease Control and Prevention(CDC) around 20 million people are infected
with HPV and additional 6.2 million people are newly infected every year. According to National
Health and Nutrition Examination Survey in 2003–2004 among sexually active women (57% of 14 to
19 years and 97% of 20 to 59 years) HPV was highest prevalent in youngest age group (40% of 14–
19 years and 50% of 20–24 years). Infection rates decrease after age of 24 years. There are more than
100 types of HPV viruses out of which 40 cause genital infections. Out of ... Show more content on
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In US cervical cancer is ranked 13th most common cancer in women and 4th among women between
15 to 44 years.
HPV vaccine HPV vaccine was introduced in the U.S. in June 2006. It is a quadrivalent vaccine
containing high risk HPV type 16 and 18 and low risk types 6 and 11.CDC recommended use of the
vaccine in females of ages through 11 to 12 and catch up immunization in ages 13 through 26 years.
This vaccine comprises of three doses given within 6 months. This vaccine prevents infections with
HPV type 16 and 18 which are responsible for 70% of cervical cancers. Castle and colleagues did a
study to determine the appropriate age for HPV vaccination. They stated that in the United States
cervical cancer screening program has achieved 75% reduction in incidence of the cervical cancer
and HPV vaccine will only reduce additional cancer cases and other HPV related sequelae such as
carcinoma intraepithelial neoplasia (CIN) 2 and CIN 3. These are the precancerous lesions. The
vaccine will be effective only for those who are never exposed to HPV infection. It will have no use
for those who are already infected or exposed.. According to the study the median age for CIN 2/3
lesion was between the ages 25 to 30. If the time since acquiring infection and development of CIN
2/3 is on average 5 to 10 years, HPV vaccine will prevent CIN 2/3 only if given to women before age
of 26 years with best results if given before 18 years of age (Castle, et

Cervical Cancer Case Study
For the given assignment, I chose Cervical Cancer as the health outcome and the screening tests
recommended by the USPSTF for the age group of 30 to 65. Cervical cancer is a type of cancer
arising from the cervix. In more than 90% of the cases HPV infection is involved in the development
of the disease. The current annual incidence rate for the disease is 6.6 cases per 100,000 women, and
the age–adjusted mortality rate is 2.4 deaths per 100,000 (for 2003 to 2007). Five–year survival rates
in the United States are 68%. Worldwide, it is the fourth–most common cause of death from cancer in
women. The risk factors associated with cervical cancer include smoking, HIV infection, using birth
control pills for long time etc.
Benefits and Harms of screening test:
According to a study, screening of population for cervical cancer has reduced cervical cancer rates by
60% to 90% within 3 years of its implementation, thus reducing mortality and morbidity associated
with the disease.
For women belonging to the age group of 30 to 65 years, USPSTF recommends screening tests to be
done by combination of cytology and pap smear once every 5 years. It is beneficial for women to
undergo co–testing of cytology with Pap smear test because it would increase the screening interval.
Also, pap smear has high sensitivity but low specificity, thereby increasing the chances of ... Show
CIN is not cancer and consists of three stages. Progression to invasive cancer occurs in approximately
1% of CIN1, 5% in CIN2 and at least 12% in CIN3. Another important research gap is lack of long–
term cumulative data from screening trials on cervical cancer. Much of the data to date are limited to
detection of CIN grade 3. Although CIN3 is considered an acceptable substitute for cancer, more
evidence is required to determine benefits and

Hpv Associated Anal And Oral Cancers
HPV–associated anal and oral cancers are increasing. The reason is still unclear although sexual
behavior changes in the general population are postulated as one of the factors. The incidence is
drastically higher in specific risk groups, such as men who have sex with men, and HIV–1 infected
individuals. Interestingly, anal cancer is predominant in women while a higher incidence of oral
cancer is found in men. This review gives a brief summary of epidemic, risk factors, mechanisms,
diagnosis, and treatment of these two HPV–associated cancers.
Most sexually active individuals will have detectable human papillomavirus (HPV) at least once in
their lifetime. 14 million people are infected annually, and 79 million people have the prevalent
infection. Approximate 5% of the cancers globally are HPV–associated anogenital or oral cancers (1).
HPV is transmitted frequently between partners; more frequent transmission has been reported from
females to males than from males to females (2). The incidence of anal and oral cancers related to
HPV is increasing in the general population and is growing even faster among individuals who are
immunocompromised because of human immunodeficiency virus (HIV) infection (3, 4). Two
prophylactic vaccines (Gardasil and Cervarix) have been approved for a decade. Recently, the
nonavalent vaccine including additional high–risk HPV types is promised to provide more coverage
against cervical cancers (5). The HPV vaccine is recommended

Essay On P16ink4a Overexpression
p16INK4a overexpression in HPV–infected human cancers and their prognostic values
The RB protein is inactivated by interaction with the high–risk HPV oncoprotein E7 (Refs. 131, 132),
and oncoprotein E6 induces degradation of the tumor suppressor p53. RB inactivation releases
p16INK4a from its negative feedback control, causing a paradoxical increase in the levels of this
protein, which attempts to inhibit uncontrolled cellular replication. As a consequence, p16INK4a is
overexpressed in HPV–expressing tumors such as cervical cancer and head and neck tumors (Refs.
133–135; Table 1).
Previous reports suggested that p16INK4a immunostaining allows precise identification of even
small cervical intraepithelial neoplasia (CIN) or cervical ... Show more content on Helpwriting.net ...
It is generally accepted that p16INK4a expression is frequently associated with HPV infection and
better prognostic factor in HNSCC (Refs. 136, 137) since they respond to chemo/radiotherapy.
p16INK4a overexpression in malignant tumors without HPV infection
Aberrant expression of p16INK4a, either high or low, is found frequently in human cancers (Table 1).
In colon cancer, two different patterns of p16INK4a overexpression have been reported. The ﬁrst
pattern is related to senescence in serrated adenomas, which have malignant transformation
associated with p16INK4a downregulation (Refs. 138, 139). The second pattern is characterized by a
very low p16INK4a immunostaining in normal mucosa, with a progressively higher expression in
aberrant crypt foci, non–serrated adenomas, primary carcinomas and metastatic tumors (Ref. 87). A
similar pattern was observed in skin cancer where p16INK4a expression increases from relatively
low levels in pre–malignant lesions to high levels in in situ and inﬁltrating carcinomas (Ref. 140). In
breast cancer, p16INK4a was negative or low in normal ductal epithelium, but a progressive increase
was found in benign lesions and carcinoma (Refs. 88, 89). Increased nuclear p16INK4a protein
expression compared with normal epithelium has been reported in pre–neoplastic and tumor tissues
of the gallbladder (Ref. 141). Therefore, inactivation of

Dual P16 / Ki67 Staining
Dual P16/Ki67 staining may help identify women with low grade cytology who are likely to progress
to cervical cancer.
Amber Joyner BSc (Hons) LIBMS
The Royal Sussex County Hospital, Brighton in collaboration with Roche Tissue Diagnostics,
Burgess Hill.
Supervisor: Gary Robinson
This dissertation is submitted in partial fulfilment of the project requirements for the M.S.c:
Clinical Sciences
May 2015
Abstract: words Number of tables:
Main Text: words Number of figures:
Student Declaration:
I declare that all the work presented in this dissertation is my own, except where otherwise stated.
Signature: ...................................................................................
Date:.....................................................................................
Dual P16/Ki67 staining may help identify women with low grade ... Show more content on
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It is widely accepted that HPV subtypes 16 and 18 are responsible for around 70% of cases of
cervical cancer (2, 3), however, with the advent of the current quadrivalent vaccine it is expected that
the number of HPV 16 and 18 infections will reduce in the coming years.
The high numbers of patients testing positive for oHPV has been noted at this centre, resulting in
large numbers of colposcopy referrals. The gov.uk website publishes the National Schedule of
Reference Costs every year which lists the number of patients who attend for procedures, the unit
costs for these procedures and the total cost for these procedures for that year. In 2013–2014 a total of
230, 038 women attended diagnostic colposcopies across all NHS Trusts and Foundation Trusts
costing a total of £28,179,422(4).
This study aimed to determine if it is possible to more accurately identify women who are most likely
to develop high grade dyskaryosis or invasive cervical cancer, and send only those for treatment, thus
streamlining the current protocol by using immunostaining during the screening process.
P16 and Ki67

Cell cycle control in mammalian cells is a complex mechanism and is regulated by cyclin–dependent
kinases (CDKs) and their activating co–enzyme cyclins (A, B, D, and E).
P16INK4a (P16) is a tumour suppressor protein and

Active Antiretroviral Therapy ( Haart )
Since the advent of highly active antiretroviral therapy (HAART) there has been a significant
decrease in the impact of HIV associated comorbidities. The HIV status of patients can present with
numerous oral manifestations, and their implications make it an essential field of study for the general
dentist. However, while the decline of these comorbidities is well documented, the continued
prevalence of Human Papilloma Virus (HPV) is of notable concern. The primary manifestation of
HPV in the oral cavity presents as the Squamous Papilloma, commonly referred to as the oral wart.
Our preconception of the lesion usually consists of a cauliflower shaped mass projecting from the
buccal mucosa. But it is the possibilities of malignancy associated ... Show more content on
Helpwriting.net ...
It represents 2.5% of all oral lesions and is the most frequently observed papillary lesion in the oral
cavity (2). The majority of these lesions are associated with varying HPV subtypes and considerable
research has been conducted to identify them. It should be noted that not all squamous papillomas
have a viral etiology; however, this discussion will focus on those that do. Epidemiologically, HPV is
a significant health burden worldwide as well as to the U.S population. Currently, the U.S estimated
incidence of genital HPV is 5.5 million, and the prevalence of current infection is estimated at 20
million (3). Assessment of HPV infection is accomplished by HPV DNA detection tests through PCR
technique. Data on infection in women is more numerous, due to the availability of standardized
methods of mucosal sampling. Detection is essential in infected patients as the majority of cases can
appear asymptomatic, (especially in men) with no means of detection physically or cytologically.
HPV is a double stranded DNA virus of the papovavirus family containing a single molecule (2). The
various subtypes are antigenically distinct yet still retain common antigenic determinants.
Proliferation of the virus is dependent on the host cell's DNA and occurs in the nuclei of the host's
epithelial cells. Expression of the viral genome comes about due to the host DNA

Does Hpv Vaccination Within Msm Significantly Prevent...
Clinical Question: Does HPV vaccination in MSM significantly prevent anogenital neoplasia
occurrence and recurrence compared to not being vaccinated? Introduction Anogenital cancer (rectal,
anal, anal canal, anorectum, penis and other genital) rates are on the rise with 27,660 estimated new
male cases and 710 estimated male deaths in the United States last year alone.1 Currently, the Center
for Disease Control (CDC) recommends vaccination in the men who have sex with men (MSM)
population up to age 26 if they had not received it when they were younger.2 There are no current
recommendations for this population who are greater than age 26 who have not previously received
the vaccine. As age of an individual and number of lifetime sexual partners increases, the risk of
developing anal cancer also increases. Men who have had >15 sexual partners during their lifetime
show an increase in risk of developing anal cancer (OR=5.3; 95% CI, 2.4–12.0). Additionally, men
who practice receptive anal intercourse is independently related to an increased risk of developing
anal cancer (OR=6.8; 95% CI 1.4–33.8).3 These findings suggest that the MSM population,
especially the aging MSM population, is a high–risk group that could benefit from vaccination
protecting against the strains of Human Papiloma Virus (HPV) that are associated with cancer
development. This growing need is addressed through extensive research of relevant literature
answering the question "Does HPV vaccination in MSM

Causes And Treatment Of Cervical Cancer
INTRODUCTION
Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix or
cervix uteri. Cervical cancer is the third most commonly diagnosed cancer and the fourth leading
cause of cancer death in females worldwide with over 527,000 new cases 1,2 and perhaps the second
most common cancer among women in the third world countries 3–5 It accounts for 9% of the total
new cancer cases and 8% (more than 265,000) of the total cancer deaths among females.1,2 More
than 80% of these cases and deaths occur in developing countries.1–4
Although cancer of the cervix is known to be a preventable cancer, it still remains one of the major
causes of cancer deaths in females under 60 years old.1,2 In developed regions, ... Show more content
on Helpwriting.net ...
BACKGROUND
The cervix is the lower part or neck of the uterus (womb) connecting the body of the uterus to the
vagina (birth canal). It is a cylindrical structure, which lies below the internal os.11–13 The upper
third of the cervix is made up of columnar/glandular cells (similar to the rest of uterus). The lower
two–thirds of the cervix is made up of squamous cells (similar to the vagina) see figure 1. The normal
squamocolumnar junction (transformation zone or T–zone) is located in the ectocervix and can be
exposed to carcinogens, resulting in cervical intraepithelial neoplasia (CIN), an abnormal
proliferation or overgrowth of the basal cell layer.11,12 The T–zone is the most common site for
cervical dysplasia which is a premalignant condition to cervical cancer that results from an abnormal
proliferation of cells characterized by changes in cell size, shape, and loss of cellular
organization.11,12
Approximately 90% of cervical cancers are squamous cell carcinomas.11,12,,14 Another 10% of
cervical cancers are of the adenocarcinoma type.11,12,14 Occasionally, the cancer may have
characteristics of both types and is called adenosquamous carcinoma or mixed carcinoma.11,12,14
Figure 1: Adapted from http://www.bing.com/images/search?
q=anatomy+of+cervix&id=4B21A47DFDF1FD4269F79CD47453E03D15FE3FA7&FORM=IQFRBA
Cause/Risks of Cancer of Cervix
The etiological role of

Types And Types Of Hpv Vaccine
Most sexually active individuals will have detectable human papillomavirus (HPV) at least once in
their lifetime. 14 million people are infected annually, and 79 million people have the prevalent
infection. Approximate 5% of the cancers globally are HPV–associated anogenital or oral cancers (1).
HPV is transmitted frequently between partners; more frequent transmission has been reported from
females to males than from males to females (2). The incidence of anal and oral cancers related to
HPV is increasing in the general population and is growing even faster among individuals who are
immunocompromised because of human immunodeficiency virus (HIV) infection (3, 4). Two
prophylactic vaccines (Gardasil and Cervarix) have been approved for a decade. Recently, the
nonavalent vaccine including additional high–risk HPV types is promised to provide more coverage
against cervical cancers (5). The HPV vaccine is recommended routinely for 11– or 12–year–olds, as
well as for young men through age 21 years and young women through age 26 years who have not
previously been vaccinated. HPV vaccine is also recommended for men who have sex with men
(MSM), people living with HIV/AIDS, and immunocompromised persons through age 26 years.
However, the high–risk HPV types included in the nonavalent vaccine contribute little to anal,
oropharyngeal, penile, vulvar and vaginal cancer (5, 6).
HPV infection is mostly asymptomatic, but may also have many diverse clinical signs encompassing
benign

Cervical Cancer : The Commonest Causes Of Death Worldwide
Cervical cancer is one of the commonest causes of death worldwide. (Chabra 2016). This is the third
most common cancer (9%) in women and seventh (4%) among all cancer deaths. (Chabra 2016).
Cervical carcinoma is mostly preventable as screening is available for early diagnosis and there is
existence of highly efficacious treatment regimens for early stage disease. (Marcus, Crane, 1998).
That's why death from cervical carcinoma is categorized as "avoidable mortality", even though, it is
killing many women every year worldwide. Though, the incidence, and mortality of cervical cancer is
decreasing by 40% in the developed country since early 1970, the developing countries are not
following this decreasing trend and about 88% of the cervical cancer cases are occurring in the
developing countries. (Quinn, Babb, Jones, Allen, 2011); (Chabra 2016). To maintain this decreasing
trend in developed country and prevent the new onset of this cancer in the developing country,
attention and emphasis should be given on screening procedures for early diagnosis of any cervical
pathology.
Cervical cancer is caused by persistent infection with Human Papilloma Virus (HPV) and it is the
most common sexually transmitted infection in the United States. (Insinga, Glass, and Rush, 2004).
This infection is prevalent among female ages 14–24 years (Roland, Benard, Soman, Breen, Kepka,
Saraiya, 2013) and may occur within few years of first sexual intercourse but it may take many years
to progress to

Essay On Cervical Cancer
Introduction
The cells in our bodies all have certain jobs to do. Normal cells divide in an orderly way. They die
when they are damaged, and new cells take their place. Cancer is when the cells start to growth out of
control, meanly know as malignancy. The cancer cells keep on growing and making new cells. They
crowd out normal cells. This causes problems in the part of the body where the cancer started. Cancer
is not just one disease. There are many types of cancer. Cancer can start in the lungs, the breast, the
colon, or even in the blood. Cancers are alike in some ways, but they are different in the ways they
grow and spread. The most common types of cancer in the U.S are; Bladder cancer, Breast cancer,
Cervical cancer, ... Show more content on Helpwriting.net ...
Start a sexual active life at an early age, and have sex with different sexual partners follows as a risk
factor. HIV, multiple pregnancy, and the birth control pills, are others risk factors associated to the
cervical cancer. Smoking is an important risk factor, nicotine has been found in the cervical mucus; it
increases the possibilities to develop cervical cancer by weakening the immune system and the person
is more susceptible to be infected by HPV (American Society for Colposcopy and Cervical
Pathology, 2010). In thinking about risk factors, it helps to focus on those you can change or avoid
(like smoking or human papilloma virus infection), rather than those you cannot (such as your age
and family history). However, it is still important to know about risk factors that cannot be changed,
because it's even more important for women who have these factors to get regular Pap tests to detect
cervical cancer early.
The NHS (National Health Service) Cervical Screening Program began in 1988, the rate of women
diagnosed with cervical cancer in the United Kingdom has halved from 16 per 100,000 in 1988 to 8
per 100,000. (See image 1A, page

Cervical Cancer: The Best Form of Prevention Is To Be...
Cervical cancer is the second most common cancer among women and the leading cause of death
among women in underdeveloped countries. In fact, 500,000 cases are diagnosed each year
worldwide. This particular cancer is found mainly in middle–aged to older women; it is very rare to
find it in women age fifteen and younger. The average age of women with cervical cancer is age 50–
55; however, the cancer begins to appear in women in their twenties (2). It is also found in women of
lower–class areas, as they are not able to see a gynecologist to be screened. African American,
Hispanic, and Native American women are more prone to developing cervical cancer as well (1).
The cervix is an organ in the female reproductive system; it is the entrance ... Show more content on
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Also, Human Immunodeficiency Virus (HIV) increases the likelihood of the precancerous cells
developing into cancer. This occurs because HIV weakens the immune system, and a woman with
HIV is unable to fight off HPV and precancerous abnormalities (2). Scientists have also found that
smokers are possibly twice as likely to develop cervical cancer. Cigarettes release many chemicals
that cause cancer (1). When a woman smokes a cigarette, these chemicals enter her bloodstream, and
they are carried to all parts of the body. These chemicals are also believed to damage the DNA in
cervical cells (2). Scientists are also examining the effects of Oral Contraceptives. No direct links
have been found, but there is some statistical evidence showing that women that have taken Oral
Contraceptives for over five years have a low risk of developing the cancer (2).
Often there are no symptoms while developing the cancer. For this reason, it is extremely important
for a woman to have an annual Pap smear test, as this is the only way to detect any kind of
abnormalities. The Pap smear evaluates the cells of the cervix under a microscope. It looks for three
signs: (a) inflammation of the cells, (b) the amount of estrogen in the cells and (c) the presence of
precancerous cells. The test is 90–95% accurate in finding an abnormality

The Relationship Between Hpv And Cervical Neoplasia
Evidently, in the 1990s the relationship between HPV and cervical neoplasia was confirmed.[7]
According to Bosch et al., the 1990s produced the key results of case–control and cohort studies, and
witnessed an increasing number of results on the clinical uses of HPV–DNA testing in screening and
triage, [24] and, as Liaw et al. (1995) noted in their case control studies, it was also becoming
apparent that those with multiple HPV infections have a higher risk of developing cancer of the
cervix. [26]
With the changing dimension of research studies having confirmed that HPV was a necessary cause
of cervical cancer, epidemiological studies advanced to associating different strains of HPV to
different anogenital pathologies, categorizing different histological forms of cervical cancer in
relation to HPV strains and highlighting other risk factors that may play a prominent role or catalyze
the carcinogesis process. For instance, Ngelangel et al. (1998) in their hospital–based case control
studying the Philippines detected HPV–DNA in 93.8% case subjects with squamous cell carcinoma,
90.9% in case subjects with adenocarcinoma/adenosquamous carcinoma as opposed to just 9.2% of
control subjects.[27] They observed the presence of fifteen different HPV types in squamous cell
carcinoma, and six different HPV types in adenocarcinoma/adenosquamous carcinoma while noting
that, apart from HPV 16 and HPV 18, HPV45 had the strongest association with squamous cell
carcinoma. [27] The same year

Historical Epidemiological Study Trends On The Causal...
SYSTEMATIC REVIEW OF HISTORICAL EPIDEMIOLOGICAL STUDY TRENDS IN
ESTABLISHING THE CAUSAL RELATIONSHIP BETWEEN HPV AND CERVICAL CANCER:
For centuries, the etiology of cancer of the cervix remained unknown and there were several attempts
by past scientists to establish the cause of cervical cancer without much success. However, the
earliest breakthroughs came in the 1930s while Dr Richard Shope of the Rockefeller University was
working on wild rabbits that had developed "horn", which upon further analysis, was caused by a
virus that could be transmitted. This discovery played a crucial part in the subsequent studies by Dr
Zur Hausen (Cummings 2011).
According to Moghissi and Mack (1968), one of the earliest epidemiological studies to probe into the
relationship between sexual intercourse and cervical cancer involved prostitutes in a prison in the U.S
whose exceptional social peculiarities bordered on sexual intercourse with multiple partners. This
epidemiological study concluded by identifying early exposure to coitus and multiple sexual partners
as the primary etiologic bases for the development of cancer of the cervix.
In the classic research by Gagnon involving the study of 13,000 Canadian Nuns, he found no single
case of cervical cancer (cited in Fenoglio 1982). This was a significant finding in that it concretized
the association between sexual exposure and cancer of the cervix thereby paving the way for further
descriptive studies to investigate the relationship.

Prevention Of Cancer Of Uterus / Cervical Cancer With The...
Florence F. Odekunle
BINF 5130 Term Paper
Fall Semester 2015
Prevention of Cancer of Cervix/ Cervical Cancer with the
Human Papilloma Virus (HPV)–16/18 L1 Virus–like Particle Vaccine
Introduction
In this paper, I would like to critically review the article titled "Sustained efficacy up to 4.5 years of a
bivalent L1 virus–like particle vaccine against human papillomavirus types 16 and18: follow–up from
a randomized control trial" that was written by Harper, Franco, Wheeler, Moscicki, Romanowski,
Roteli–Martin, Jenkins,Schuind, Clemens and Dubin and published in 2006. Additionally, few other
studies are examined to provide background information on the topic. ... Show more content on
Helpwriting.net ...
One type of adenocarcinoma is clear cell carcinoma, which is correlated with in utero
diethylstilbesterol (DES) exposure. Very rarely a sarcoma or lymphoma of the cervix is found (Bosch
et al. 2008).
Human papillomavirus (HPV) types 16 and 18 are most commonly implicated in cancer of the cervix,
other subtypes are 31, 33, 35 45,51,52,58 and 59 (Franceschi et al.2003). The association between
HPV and cervical cancer is unique; no other major human cancer has a single necessary cause
(Franceschi et al.2003). The relative risk of cervical cancer after infection with HPV, as indicated by
the results of case control studies, is the strongest causal relation in cancer epidemiology identified to
date (Bosch et al. 2002). The establishment of the link between HPV and cervical cancer has
provided the impetus for research into prophylactic vaccination against the most common HPV types
associated with the disease: HPV 16 and HPV 18. One of such studies was on sustained efficacy up to
four and half years of a bivalent L1 virus–like particle vaccine against human papillomavirus types
16 and18: follow–up from a randomized control trial by Harper et al (2006). The following section
provides the research aims/goals, the specific questions that were asked, the method used to address
the questions, findings from the study, implications of the findings to healthcare practice and delivery
and finally concluding remarks will be presented.

Visual Inspection With Acetic Acid (VIA)
1.9.3. Visual inspection with acetic acid (VIA): Visual inspection with acetic acid (VIA) is a simple,
inexpensive test, with moderate sensitivity and specificity for screening that can be combined with
simple treatment procedures for early cervical lesions (59). Visual inspectionis direct visualization of
the cervix after application of a solution of either acetic acid 3–5% (VIA) or Lugol's iodine (VILI). A
result is obtained immediately and treatment can be performed at the same setting. In visual
inspection with acetic acid (VIA), CIN lesions will turn white for a few minutes after application of
acetic acid. The effect of acetic acid depends on the amount of nuclear proteins, and cytokeratins
present in the cervical epithelium, which increases in CIN. (60) Scaling up and inclusion of VIA–
based ... Show more content on Helpwriting.net ...
1.10.Management of preinvasive disease of the cervix : CIN 1 disappears spontaneously and needs no
treatment; however, treatment is recommended if patients meet the following criteria: poor
compliance, persistent CIN1 for more than one year, and women older than 30 years and positive to
oncogenic HPV or high–risk of cervical cancer.
1.10.1 Treatment: treatment options include local ablative treatment andexcisional treatment (55)
1.10.2. Follow–Up:Because recurrence is possible, especially in the first 2 years after treatment, and
because the false–negative rate of a single cervical cytologic test is 20%, close follow–up after
colposcopy and biopsy is imperative. For CIN II or III, cytologic examination or cytology and
colposcopy should be repeated every 4 to 6 months intervals for up to 2 years. For CIN I, cytology
should be performed at 6 and 12 months or HPV DNA testing can be done at 12 months. If testing is
normal, routine cytologic screening can be resumed (71).
1.10.3. When to

Cytological Screening
The focus of this essay is on the process that takes place in the pathology laboratory, where the
cervical samples are sent for cytological screening. A cervical cell sample that has no abnormal cells
is categorised cytologically as being negative (negative for the presence of HPV or risk of cervical
cancer). Alternatively, samples may be identified as containing borderline abnormal changes, or
having dyskaryosis (Health and Social Care Information Centre, 2013). In some literature the terms
dysplasia or CIN (cervical intraepithelial neoplasia) seem to be used in place of dyskaryosis (Eifel et
al., 2011), but NHS literature seems to make most consistent reference to dyskaryosis. The extent of
dyskaryosis is then classified across a range from ... Show more content on Helpwriting.net ...
The aim of this new method was initially to try to reduce false–negative and false–positive results
(Karnon et al., 2004; Siebers et al., 2009), as well as the number of samples that are 'inadequate' or
'unsatisfactory' for effective screening (Arbyn et al., 2008; Siebers et al., 2009). In the conventional
cytology method, a woman's cervical sample is transferred directly from the collection spatula onto a
microscopic slide (Arbyn et al., 2008; Moss et al., 2003). This transfer process seems to sometimes
lead samples to be 'inadequate' for screening because the transferred cells are too difficult to clearly
discern. This manual process does also, very occasionally, result in false results, even when
conducted by experienced cytologists. The liquid based cytology (LBC) method involves a slightly
different approach to the preparation of the slides. The cell sample is placed into a vial containing a
preservative fluid (Arbyn et al., 2008; Moss et al., 2003). This creates a liquid suspension of the
sample, which can then be poured onto the slide in a very thin, uniform layer. However, debate
remains over whether this method really offers a substantial improvement over conventional
cytology. The main points of contention surround accuracy and cost effectiveness, with other
arguments relating to patient anxiety and opportunities for HPV

Neoplasm Essay
The neoplasm is assumed to have a nonaggressive nature; however, data regarding the course in HIV
immunocompromised persons is scant. A case of orolabial bowenoid papulosis caused by HPV–32is
noted.[63]
Histopathology: reveals features of an intraepithelial carcinoma. Secondary amyloid deposition has
been reported histologically in one case of BP.[64]
Differential diagnosis Lichen planus, common warts, seborrhoeic warts, naevi and condylomata lata.
A biopsy is indicated in instances where the clinical diagnosis is uncertain.
Treatment and follow up Treatment depends on many factors. Circumcision removes a major risk
factor for cancer and provides extensive tissue for histology. Topical 5–fluorouracil as a 5% cream is
a well established conventional option for the treatment of BP,[65–67] but there have not been any
clinical trials. Other treatments include cryosurgery, curettage and electrocautery, excisional surgery,
glans resurfacing, Mohs micrographic surgery, laser and photodynamic therapy.[ 65–69]
Radiotherapy should be avoided. Topical imiquimod may help some patients.[70–72] Patients
presenting with these conditions should be counselled and screened for HPV and other sexually
transmitted diseases, including HIV infection. They should stop smoking. Sexual ... Show more
content on Helpwriting.net ...
Only 25% are extraocular and the majority of these appear on the head and neck. One–half of
periocular tumors arise from Meibomian glands. The neoplasm appears as a firm, skin–colored, or
yellowish papule that slowly grows into a nodule. Metastasis occurs in 14 to 25% of patients. Several
cases reported in HIV–infected patients achieved unusually large sizes and were not present on the

Safety Of The Hpv Vaccine Essay
Safety of the HPV Vaccine There have been concerns about the safety of the HPV vaccines. In Basu's
(2013) article they reviewed the evidence from the phase III trials and national programs for the HPV
vaccine. After reviewing the data though the article showed that all the randomized control trials
reported both their serious and non–serious adverse events that took place during the phase III trials.
"There were 20,000 participants in the trial" (p.4). Pain at the injection site, headache, and fatigue
were the most frequently reported issues. The serious adverse effects were very rare so the vaccine
was considered safe. When reviewing the safety data from the national programs in Australia there
were millions of doses given out and the most adverse side effects there were anaphylactic and
allergic reactions, and these were not seen as any more dangerous than it is for other vaccines. "In the
US about 40 million doses were given out and among the reports that were received by the Vaccine
Adverse Event Reporting System which totaled 20,096 only 8% of these reports were actually were
considered serious"(p.5). All the reports were reviewed and could not find any adverse events that
occurred that could be ascribed to the vaccine. In the UK they reviewed the vaccine two years after it
came out and concluded it to be safe. Reviewing the data from all three counties in the national
programs showed that none of the deaths that occurred could be linked to the vaccine. So both the

Essay On Cervical Dysplasia
CIN (formerly cervical dysplasia) refers to premalignant changes in the cervical epithelium that have
the potential to progress to cervical cancer. The histologic features most commonly associated with
cervical dysplasia include cellular immaturity, cellular disorganization, nuclear abnormalities, and
increased mitotic activity. The severity of CIN is de termined by the portion of epithelium showing
disordered growth and development. The changes start at the basal layer of the epithelium and can
expand to encompass the entire epithelium .Cervical intraepithelial neoplasia (CIN), formerly called
dysplasia, means disordered growth and development of the epithelial lining of the cervix. There are
various degrees of CIN. Mild dysplasia, or CIN I, is defined as disordered growth of the lower third
of the epithelial lining. Abnormal maturation of the lower two–thirds of the lining is called moderate
dysplasia, or ... Show more content on Helpwriting.net ...
Severe dysplasia, CIN III, encompasses more than two–thirds of the epithelial thickness with
carcinoma in situ (CIS) representing full–thickness dysmaturity. While histologically evaluated
lesions are characterized using the CIN nomenclature, cytologic smears are classified according to the
Bethesda system, which was most recently revised in 2001. Briefly, atypical squamous cells are
divided into those of undetermined significance (ASC–US) and those in which a high grade lesion
cannot be excluded (ASC–H). Low–grade squamous intraepithelial lesion (LSIL) encompasses
cytologic changes consistent with koilocytic atypia or CIN I. High–grade squamous intraepithelial
lesion (HSIL) denotes the cytologic findings corresponding to CIN II and CIN III. CIN may be
suspected because of an abnormal cytologic

Bethesda Classification Of Pap Smear Testing And Evaluation
Bethesda Classification of Pap smear testing and evaluation
The Bethesda classification is relied upon in the reports that need to be made on the diagnosis related
to vaginal or cervical cytology. Pap smear screening is used in the detection of processes in the cervix
that are potentially cancerous and pre–cancerous. In the event of abnormal findings during the
process, there could be further tests ran to get more clarity before the final decision is made on the
conditions that is suffered (Rásky, Regitnig, Schenouda, Burkert, & Freidl, 2013). The National
Cancer Institute recommends utilization of "The Bethesda System" for the reporting of cervical /
endocervical / vaginal cytology (Pap smears) specimens. The standardized language of the ... Show
An adequate endocervical / transformation zone component (from a patient with a cervix) (Nayar, &
Wilbur, 2015).
(2) Quality of the Pap smear will still be noted when:
Less than 10 well preserved endocervical or metaplatic cells are seen
Blood or inflammation moderately obscuring the Pap smear (Nayar, & Wilbur, 2015).
(3)"Unsatisfactory for evaluation" designates that the specimen is unreliable for the detection of
cervical epithelial cell abnormalities.this term is used if any of the following apply:
A broken slide that cannot be repaired
Scanty squamous epithelial component (less than 8,000 well preserved and well visualized cells on
conventional slides or less than 5,000 well preserved and well visualized cells on liquid–based
preparations)
Obscuring blood, inflammation, thick areas, poor fixation, air–drying artifact, contaminant, etc. that
precludes interpretation of approximately 75% of the epithelial cells(Nayar, & Wilbur, 2015).
If the pap smear test is abnormal it can be reported by Bestheda system as follows:
2.Descriptive
Normal
Benign
Epithelial cell abnormality (a) Atypical squamous cells of unknown significance (b) Low grade
squamous intraepithelial lesion (c)

Sexually Transmitted Infection
Public Health Problem
Sexually transmitted infections (STIs) has been a persisting public health problem throughout the
world. While some STIs, like gonorrhea, are curable, other STIs like human papillomavirus (HPV),
have no cure and can lead to deadly consequences. Unfortunately, HPV is considered to be the most
common type of sexually transmitted infection. Like all STIs, HPV spread through sexual contact
with an infected person, whether it be vaginal, anal, or oral sex. According to the Centers for Disease
Control and Prevention, there are about 79 million Americans infected with HPV at a time and about
14 million new cases arise every year ("Human Papillomavirus (HPV)"). This means that about one
in four people are infected with some type ... Show more content on Helpwriting.net ...
Between 2007 and 2009, an HPV vaccine program was introduced in Australia. Three years after the
introduction, Brotheron, Fridman, May, Chappell, Saville, and Gertig (2011) examined how these
vaccines affected women's cervical health. It was found that after the vaccine program was
introduced, there was a lower number of reports of women having high–grade cervical abnormalities.
While this was only the first report, it shows great promise that implementing a program for the HPV
vaccine will have a positive effect on women's health. The lower the chances are for people to
contract the HPV virus means that there's a lower chance that people will develop cervical cancer and
other

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