Mentor: Gelila Goba, MD
Cervical Cancer and High-Risk HPV Strains in Chicago: the importance of the “Other”
The National Health and Nutrition Examination Survey indicates that 20.4% of adult women have High-Risk Human Papilloma Virus (hrHPV). Strains 16 and 18 of the virus are most commonly associated with cervical cancer, but HPV strains 31, 33, 35, 39, 45, 51, 52, 56, 58, 66, and 68 have also been identified as high-risk for cervical cancer development. These strains are pooled together and labeled as “Other” for testing and epidemiological purposes.
As part of a larger study seeking to correlate the effects of structural violence on the prevalence of hrHPV and higher rates of cervical cancer among African American and Hispanic populations, our team identified 13,466 patients residing in 24 Chicago neighborhood areas serviced by the University of Illinois Health Network seen over a five-year period (January 2014 to December 2018). A retrospective chart review was conducted, and any female patient 21 years or older with at least one Pap test and subtyped hrHPV testing (Roche Cobas test) was included. The final cohort consisted of 4,616 patients.
The overall prevalence in adult women within the UI Health Network is 21.4%. Of the hrHPV positive strains, 16 and 18 accounted for 7.4% and 3.5% of hrHPV infections, respectively. The pooled “Other” hrHPV subtypes accounted for 82.8% of infections. The “Other” hrHPV subtypes were most likely to be associated with cervical pathology. Nearly 80% of ASCUS (atypical squamous cell of undetermined significance) pathology were associated with hrHPV “Other” subtypes, as were 81.3% of LSIL (low-grade squamous intraepithelial lesion), 69.4% of HSIL (high-grade squamous intraepithelial lesion) and 37.5% of squamous cell carcinoma.
The once dismissed “Other” subtypes of hrHPV can no longer be ignored. The “Other” subtypes contribute to the majority of overall hrHPV infections, as well as to the majority of pathological changes such as ASCUS, LSIL, and HSIL. By further studying the prevalence and role of the “Other” hrHPV subtypes, Sayegh and her colleagues aim to improve care across the city and lower the rate of hrHPV and cervical cancer incidence and mortality in specific geospatial locations.