Human papillomavirus (HPV) is a sexually transmitted infection that represents a serious health issue that can lead to significant morbidity and mortality. Although FDA-approved vaccines for the prevention against the majority of strains responsible for cervical cancer and genital warts have been available for many years, immunization rates remain low. This study will consider cervical cancer as the main consequence of HPV and thus will investigate parents of daughters. This is of particular relevance to Arizona, given the large Hispanic population and the racial and ethnic disparities that exist in the incidence, mortality and survival of cervical cancer when compared to the national average. Administration of the three-dose series is recommended for girls and boys beginning at 12 years of age. The target population of this study was parents as the HPV vaccine necessitates parental consent and immunization rates remain low. This study specifically aimed to explore the knowledge, attitudes and beliefs of Hispanic parents in Maricopa County toward the HPV vaccine in efforts to identify barriers to immunization and create future implications for practice. Findings were consistent with previous literature: Hispanic parents exhibited suboptimal knowledge regarding HPV and HPV vaccination. Specific opportunities for education include the etiology, transmission and health consequences of HPV. Despite many areas for education, the majority of Hispanic parents indicated they would follow their health providers' recommendation on vaccination.

Os carcinomas de cabeça e pescoço, causados principalmente pelo tabaco e pela infecção por HPV, além da predisposição genética, figuram como a sexta maior causa de câncer no mundo. Este tipo de neoplasia maligna acomete cerca de 600 mil novas pessoas por ano e é caracterizada por apresentar baixas taxas de sobrevida. Essas baixas taxas se devem, principalmente, a (i) ausência de biomarcadores; (ii) diagnóstico tardio; e (iii) inespecificidade de tratamento. Não somente as altas taxas de mortalidade acompanham a doença, mas também de morbidade, devido ao fato de áreas nobres do organismo serem danificadas em consequência do tratamento cirúrgico agressivo utilizado e que, em combinação com a radioterapia, interferem em processos fisiológicos de grande importância como a fala e a deglutição. Ainda, o comportamento tumoral, mais ou menos agressivo, é resultado do desequilíbrio na expressão de diversos genes e proteínas. Neste cenário, muitas serino proteases, em conjunto com seus inibidores e substratos, estão alteradas durante o processo de carcinogênese. Destacamos a via da matriptase, uma serino protease transmembrana que ativa vias relacionadas à proliferação e sobrevivência celulares, e que se encontra superexpressa em diferentes casos de câncer. A interação entre a protease e seu inibidor cognato HAI-1 tem grande importância no prognóstico e evolução de diferentes carcinomas. Além disso, sabe-se que a superexpressão de HAI-1 tem efeito protetivo sobre lesões causadas pelo aumento nos níveis de matriptase, além de estar imunohistologicamente aumentado em carcinomas cervicais, cuja etiologia envolve a infecção por HPV em mais de 90% dos casos. Neste contexto, e considerando o potencial tumorigênico do HPV para os carcinomas de cabeça e pescoço, utilizamos, neste trabalho, camundongos transgênicos que expressam HAI-1 sob o promotor da queratina 5 (K5-HAI-1) e camundongos que expressam as oncoproteínas E6 e E7 do HPV16 sob o promotor da queratina 14 (K14- HPV), para avaliar o possível efeito modulador de HAI-1 sobre o fenótipo causado pelos oncogenes do HPV16. Para tanto, observamos os efeitos da co-expressão dos transgenes no desenvolvimento dos animais e analisamos quantitativamente a evolução das lesões espontâneas causadas pelos oncogenes virais, na presença ou ausência do transgene de HAI-1. Os resultados indicam que os diferentes animais transgênicos se desenvolvem de maneira semelhante, e que a expressão de HAI-1 em células tronco epiteliais parece não interferir no surgimento e na progressão de lesões epiteliais, características da expressão de E6 e E7 nas mesmas células precursoras do epitélio. / Head and neck carcinomas, which are mainly caused by tobacco use and HPV infection are also favoured by the individual genetic predisposition, and are considered the sixth leading cause of cancer worldwide. This type of malignant neoplasm affects about 600,000 new people per year and is also characterised by presenting low survival rates. These low rates are mostly due to (i) the absence of biomarkers; (ii) late diagnosis; and (iii) inespecificity of treatment. High mortality and morbidity rates go along with the disease due to the fact that noble areas of the organism are damaged as a consequence of the aggressive surgical treatment used which, in combination with the radiotherapy, interferes in physiological processes of great importance such as speech and swallowing. Moreover, the more or less aggressive tumour behaviour is a result of the imbalance in the expression of several genes and proteins. In this scenario, many serine proteases, their inhibitors and substrates are altered during the process of carcinogenesis. Matriptase, a transmembrane serine protease that activates pathways related to cell proliferation and survival, has gathered attention for being overexpressed in different cases of cancer. The interaction between this protease and its cognate inhibitor, HAI-1, is of great importance in the prognosis and evolution of different carcinomas. In addition, it is known that HAI-1 overexpression is closely related to a protective effect on lesions caused by increased levels of matriptase. In addition, the same inhibitor is immunohistologically enhanced in cervical carcinomas, a type of cancer caused by HPV infection in more than 90% of cases. In this context and considering the tumorigenic potential of HPV for head and neck carcinomas, transgenic mice that express HAI-1 under the keratin 5 promoter (K5-HAI-1), and mice expressing the E6 oncoproteins and E7 from HPV16 under the keratin 14 promoter (K14-HPV) were used in order to evaluate the possible HAI-1 modulating effect on the phenotype caused by the HPV16 oncogenes. In order to do so, the effects of co-expression of both transgenes on the development of animals were properly observed and the evolution of spontaneous lesions caused by viral oncogenes were quantitatively analysed in the presence or absence of the HAI- 1 transgene. The results indicate that different transgenic animals have a similar development, and finally that HAI-1 expression in epithelial stem cells does not appear to interfere with the appearance and progression of epithelial lesions, which is a characteristic of E6 and E7 expression in the same precursor epithelial cells.

According to the Centers for Disease Control and Prevention (CDC), there are approximately 14 million new cases of HPV diagnosed each year (men and women combined). The rate of vaccine administration among adolescent males is much less than it is among females. As a result, the CDC has urged health care providers to work with state and local health care providers to improve the utilization of the HPV vaccine. The purpose of this scholarly project was to develop an educational toolkit, one guided by Ajzen and Fishbein's theory of reasoned action, regarding the value of the HPV vaccine. The toolkit was offered through both online and hard copy formats and provided parents of adolescent males with information regarding HPV, the HPV vaccine, helpful websites, and references. The toolkit's efficacy will be determined by a comparison of annual vaccination rates. This project fills a significant knowledge gap in the scholarly literature, as there were only 8 articles that met the inclusion criteria in the review of literature. It also provides a guide for other outpatient clinics that may want to implement a comparable toolkit.

Bakgrund: Humant papillomvirus (HPV) är ett sexuellt överförbart vårtvirus, som kan orsaka cellförändringar och livmoderhalscancer. Tidigare forskning har visat att kunskap om HPV och HPV-vaccin generellt är låg och att vaccinationstäckningen bland unga kvinnor i många länder varit suboptimal. Syfte: Syftet med föreliggande studie var att kartlägga gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin, samt undersöka om det föreligger skillnader mellan elever på praktiska och teoretiska gymnasieprogram. Metod: Studien var en deskriptiv komparativ tvärsnittsstudie med kvantitativ ansats. Orems egenvårdsteori användes som teoretisk referensram. De 230 deltagarna från fyra gymnasieskolor i Uppsala besvarade ett enkätformulär. Resultat: Majoriteten av eleverna hade generellt låg kunskap om HPV och HPV-vaccinet, hade låg tilltro till vaccinet och var osäkra på huruvida de i framtiden ville vaccineras, dock hade elever på teoretiska program bättre kunskap och mer positiv inställning än elever på praktiska program. Flickor hade bättre kunskap och om HPV och HPV-vaccin än pojkar. De flesta hade inte hört talas om vaccin mot HPV, men de allra flesta hade kännedom om vaccin mot livmoderhalscancer. Slutsats: Den låga kunskapen om HPV och HPV-vaccin kan påverka elevernas inställning samt deras intentioner att i framtiden vaccineras. Resultatet indikerar på ett behov av mer information om HPV och HPV-vaccin. Skolsköterskans hälsosamtal med gymnasieelever bör inkludera information och diskussion om HPV och HPV-vaccin anpassad för ungdomar, för att ge dem möjlighet att förstå sambandet mellan kondylom, HPV och livmoderhalscancer, och därmed lättare kunna ta ställning till vaccination.

Os carcinomas de cabeça e pescoço, causados principalmente pelo tabaco e pela infecção por HPV, além da predisposição genética, figuram como a sexta maior causa de câncer no mundo. Este tipo de neoplasia maligna acomete cerca de 600 mil novas pessoas por ano e é caracterizada por apresentar baixas taxas de sobrevida. Essas baixas taxas se devem, principalmente, a (i) ausência de biomarcadores; (ii) diagnóstico tardio; e (iii) inespecificidade de tratamento. Não somente as altas taxas de mortalidade acompanham a doença, mas também de morbidade, devido ao fato de áreas nobres do organismo serem danificadas em consequência do tratamento cirúrgico agressivo utilizado e que, em combinação com a radioterapia, interferem em processos fisiológicos de grande importância como a fala e a deglutição. Ainda, o comportamento tumoral, mais ou menos agressivo, é resultado do desequilíbrio na expressão de diversos genes e proteínas. Neste cenário, muitas serino proteases, em conjunto com seus inibidores e substratos, estão alteradas durante o processo de carcinogênese. Destacamos a via da matriptase, uma serino protease transmembrana que ativa vias relacionadas à proliferação e sobrevivência celulares, e que se encontra superexpressa em diferentes casos de câncer. A interação entre a protease e seu inibidor cognato HAI-1 tem grande importância no prognóstico e evolução de diferentes carcinomas. Além disso, sabe-se que a superexpressão de HAI-1 tem efeito protetivo sobre lesões causadas pelo aumento nos níveis de matriptase, além de estar imunohistologicamente aumentado em carcinomas cervicais, cuja etiologia envolve a infecção por HPV em mais de 90% dos casos. Neste contexto, e considerando o potencial tumorigênico do HPV para os carcinomas de cabeça e pescoço, utilizamos, neste trabalho, camundongos transgênicos que expressam HAI-1 sob o promotor da queratina 5 (K5-HAI-1) e camundongos que expressam as oncoproteínas E6 e E7 do HPV16 sob o promotor da queratina 14 (K14- HPV), para avaliar o possível efeito modulador de HAI-1 sobre o fenótipo causado pelos oncogenes do HPV16. Para tanto, observamos os efeitos da co-expressão dos transgenes no desenvolvimento dos animais e analisamos quantitativamente a evolução das lesões espontâneas causadas pelos oncogenes virais, na presença ou ausência do transgene de HAI-1. Os resultados indicam que os diferentes animais transgênicos se desenvolvem de maneira semelhante, e que a expressão de HAI-1 em células tronco epiteliais parece não interferir no surgimento e na progressão de lesões epiteliais, características da expressão de E6 e E7 nas mesmas células precursoras do epitélio. / Head and neck carcinomas, which are mainly caused by tobacco use and HPV infection are also favoured by the individual genetic predisposition, and are considered the sixth leading cause of cancer worldwide. This type of malignant neoplasm affects about 600,000 new people per year and is also characterised by presenting low survival rates. These low rates are mostly due to (i) the absence of biomarkers; (ii) late diagnosis; and (iii) inespecificity of treatment. High mortality and morbidity rates go along with the disease due to the fact that noble areas of the organism are damaged as a consequence of the aggressive surgical treatment used which, in combination with the radiotherapy, interferes in physiological processes of great importance such as speech and swallowing. Moreover, the more or less aggressive tumour behaviour is a result of the imbalance in the expression of several genes and proteins. In this scenario, many serine proteases, their inhibitors and substrates are altered during the process of carcinogenesis. Matriptase, a transmembrane serine protease that activates pathways related to cell proliferation and survival, has gathered attention for being overexpressed in different cases of cancer. The interaction between this protease and its cognate inhibitor, HAI-1, is of great importance in the prognosis and evolution of different carcinomas. In addition, it is known that HAI-1 overexpression is closely related to a protective effect on lesions caused by increased levels of matriptase. In addition, the same inhibitor is immunohistologically enhanced in cervical carcinomas, a type of cancer caused by HPV infection in more than 90% of cases. In this context and considering the tumorigenic potential of HPV for head and neck carcinomas, transgenic mice that express HAI-1 under the keratin 5 promoter (K5-HAI-1), and mice expressing the E6 oncoproteins and E7 from HPV16 under the keratin 14 promoter (K14-HPV) were used in order to evaluate the possible HAI-1 modulating effect on the phenotype caused by the HPV16 oncogenes. In order to do so, the effects of co-expression of both transgenes on the development of animals were properly observed and the evolution of spontaneous lesions caused by viral oncogenes were quantitatively analysed in the presence or absence of the HAI- 1 transgene. The results indicate that different transgenic animals have a similar development, and finally that HAI-1 expression in epithelial stem cells does not appear to interfere with the appearance and progression of epithelial lesions, which is a characteristic of E6 and E7 expression in the same precursor epithelial cells.

BACKGROUND: Cervical cancer is one of the most common forms of gynecologic malignancies worldwide with increased incidence in lower income countries. Bolivia, a lower-income country, experiences high rates of morbidity and mortality related to cervical cancer. The increased incidence is a multifactorial issue that includes low cervical cancer literacy, barriers to healthcare access, and poor follow-up rates. LITERATURE REVIEW FINDINGS: The current research finds that Bolivia's fragmented healthcare system has significantly influenced the country’s high cervical cancer burden. Women often receive inadequate sexual and reproductive health services that has led to a higher incidence of preventable morbidity and mortality. Previous research, however, has shown that the implementation of HPV self-screening and use of point of care testing are effective interventions in rural areas of Bolivia to increase screening. In addition, studies have shown that vaccination of school aged children utilizing a school-based model is another promising intervention in hopes of lowering the country’s burden of disease. Lack of cervical health knowledge in rural areas of Bolivia is another finding. Previous research has proposed that community education and optimization of cervical cancer knowledge can have a great impact on screening. METHODS: The study proposes to conduct an interventional study. The study will initially seek to implement an education intervention to improve the knowledge and understanding of cervical health for school aged and adult women in a single school district of rural Cochabamba, Bolivia. Phase I and II of the study will then aim to implement a vaccination campaign and an HPV self-screening program with point of care testing in the same school district. CONCLUSION: This study will seek to implement an HPV- self screening program and a vaccination campaign in rural Cochabamba, Bolivia through a multidisciplinary approach which involves vaccination, screening, and community education. Limitations of the proposed study includes lack of generalizability, time constraints, and financial constraints. SIGNIFICANCE: Cervical cancer is highly preventable through adequate screening and prophylaxis with vaccination. The goals of the study will seek to implement affordable and easily accessible screening methods and vaccination for a population in rural Bolivia to ultimately improve screening rates and follow up care. Efforts to increase screening in this population can lead to decreased rates of mortality and morbidity from cervical cancer in vulnerable, resource limited countries.

No description available.

Background: In 2007, the Canadian federal budget provided $300 million over three years to the provinces and territories to implement publicly-funded HPV immunization programs. Current estimates indicate that HPV vaccine uptake varies significantly across Canada and is reported to be lowest in Ontario at 53%. There is a paucity of literature on the determinants of HPV vaccine uptake in the Canadian context, therefore further research is needed. Objectives: To describe the patterns of HPV vaccine non-uptake across health units in Ontario, and identify the individual- and health unit (ecologic)-level factors that influenced HPV immunization decision-making between 2007 and 2011. Methods: The study linked administrative health and immunization databases to identify a retrospective population-based cohort of 144,047 girls eligible for Ontario's school-based HPV immunization program between 2007 and 2011. In this study a girl was considered vaccinated if she received at least 1 dose, otherwise she was considered unvaccinated. Ecologic or health unit-level factors that may have influenced HPV vaccine decision-making were assessed, as well as individual-level predictors including clinical characteristics and sociodemographics. A population-average model based on generalized estimating equations was used to identify determinants associated with non-uptake. Results: In all, 49.3% of girls from 21 public health units refused HPV immunization between 2007 and 2011. Non-uptake varied across health units, from 41.82% to 60.30%. In multivariate analyses, non-uptake was strongly associated with a history of autism (OR=1.60; 95% CI 1.34, 1.90) and Down's syndrome (OR=1.37; 95% CI 1.16, 1.63), refusal of mandatory and optional vaccines (OR=2.23; 95% CI 2.07, 2.4, and OR=3.96; 95% CI 3.87, 4.05, respectively), and infrequent physician visits (OR=1.45; 95% CI 1.35, 1.55). Contextual or health unit-level characteristics appeared to have a weak influence on vaccine decision-making. Conclusions: HPV immunization could lead to a lower risk of developing and dying from HPV-related cancers; however, non-uptake of this vaccine is high. Concerted efforts are needed to reduce missed opportunities during medical consultations, to refine communication strategies and activities to address the information needs of special groups, as well as to develop cross-sectoral collaborations to support the delivery of publicly-funded HPV immunization to schools across Canada. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-02-01 19:49:17.262

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The role of viruses in most common cancers is undoubtedly important, yet highly underestimated. Human Papilloma Virus (HPV) has been implicated with 99.7% of cervical cancers and its oncogenic mechanism has been clearly identified. The association of cervical cancer with 90% of triple negative breast cancer (TNBC) cases in African countries creates an intriguing possibility of HPV being a candidate oncovirus for breast cancer. In fact, numerous recent tissue studies conducted throughout the world detected HPV DNA in breast cancer tissues of patients with cervical cancer, while high‐risk HPV types (16, 18, 33) were present in invasive ductal carcinomas. 5,6 Prevalence of HPV varied from 4% in Mexican to 86% in American women. The virus was noted to be present in tumor tissue only, with the exception of one study, which identified lower concentration of HPV in normal tissue. 7 Although substantial evidence exists supporting involvement of HPV in breast cancer, no clinical studies have been conducted to elucidate this relationship. The goal of our retrospective chart review was to examine the association of breast cancer and HPV‐related cervical dysplasia in a cohort of women in urban setting. 15% (39/260) had abnormal Pap‐smear, while 8% (16/198) were HPVpositive. No statistically significant difference of Pap‐smear abnormality or of HPV positivity were detected among the groups in all categories. However, we noticed that non‐luminal breast cancers, double negative and triple negative (DN and TN), have higher rate of HPV positivity: 13.3% non‐luminal vs. 6.3% of luminal breast cancers, 12.5% DN breast cancers and 11.5% of TN vs. 6.4% of luminal A and 6.3% of luminal B. This creates an intriguing possibility that HPV might be associated with more than 50% increase of incidence rates of non‐luminal breast cancers, suggesting a need for larger scale studies to confirm this association.

INTRODUCTION: Head and neck cancer is one of the most common malignancy in the world. While it has been associated with several factors like alcohol consumption and smoking, there is approximately 25% of head and neck cancer that can be attributed to Human Papillomavirus (HPV) especially HPV 16. HPV associated cancer has been associated with a better prognosis as compared to HPV negative cancers. It has also been shown in previous studies that HPV-negative African Americans have a higher mortality rate as compared to HPV associated cancers in European Americans and HPV-negative European Americans patients. The three states of HPV associated cancers have been compared, which included HPV active, HPV inactive and HPV negative. AIM: The study aims include: 1) Compare the differences in the gene expression profiles of HPV negative HNSCC in AA from EA patients, and determine the differences in their biological make up. 2) Explore and compare the genetic expression profiles of HPV-active, HPV-inactive and HPV-negative head and neck cancer patients. METHODS: A secondary data analysis was conducted on 36 oropharyngeal cancer tissues samples with different HPV status (HPV-active, HPV-inactive and HPV- negative). ANOVA was conducted in R to compare all the three groups from each other and identify the genes that were differentially expressed. Bayes Moderated paired t-test was used to compare two groups of HPV-negative European Americans with HPV-negative African Americans. RESULTS: Our analysis revealed that the genes that were differentially expressed in HPV- active and HPV-negative analysis were different from HPV-active and HPV-inactive analysis. Our analysis also identified genes that were differentially expressed in African Americans as compared to European Americans. DISCUSSION: This study provides the genetic expression profiles in different groups (European Americans and African Americans) based on different HPV stages. Despite the small sample size of our data, we were able to identify the genes that were differentially expressed amongst different conditions in patients who had oropharyngeal carcinoma. We were also able to identify the genes involved in HPV-negative oral cancer comparing the African Americans to the European Americans.