Exploring the Intricacies of Cervical Intraepithelial Neoplasia and Its Connection with HPV: A Narrative Review
Abstract
Cervical Intraepithelial Neoplasia grade III (CIN III) represents a critical precursor to invasive cervical cancer, necessitating a comprehensive understanding of its etiology, progression, diagnosis, and preventive strategies. This review integrates an approach to synthesize current literature, conducted through a meticulous search of databases (Scopus, Web of Science, and Google Scholar) for relevant articles discussing CIN III and its association with Human Papillomavirus (HPV). The review delineates the multifaceted landscape of CIN III, elucidating the pathogenesis involving high-risk HPV types, demographic factors (age and sexual behavior), behavioral determinants (smoking and contraceptive use), and environmental influences impacting disease epidemiology. Diagnostic modalities, including Pap smears, HPV testing, and colposcopy, were assessed for their role in early detection and intervention. The results highlight the significance of HPV vaccination, screening programs, and robust public health policies in mitigating the burden of CIN III. Effective interventions, particularly excisional procedures, demonstrate efficacy in reducing the risk of progression to invasive cancer, emphasizing the importance of vigilant follow-up. A comprehensive approach integrating vaccination initiatives, early detection through screening, and equitable healthcare policies stands pivotal in combating CIN III. The review underscores the imperative of evidence-based interventions for disease prevention, reducing disparities, and enhancing public health outcomes for individuals affected by or at risk of CIN III.
2. Pina-Sanchez P (2022). Human Papillomavirus: Challenges and opportunities for the control of cervical cancer. Arch Med Res, 53 (8):753-769.
3. Carrero YN, Callejas DE, Mosquera JA (2021). In situ immunopathological events in human cervical intraepithelial neoplasia and cervical cancer. Transl Oncol, 14 (5):101058.
4. Daponte A, Michail G, Daponte A-I, et al (2021). Urine hpv in the context of genital and cervical cancer screening-an update of current literature. Cancers (Basel), 13 (7):1640.
5. Stumbar SE, Stevens M, Feld Z (2019). Cervical cancer and its precursors: a preventative approach to screening, diagnosis, and management. Prim Care, 46 (1):117-134.
6. Gupta S, Nagtode N, Chandra V, Gomase K (2023). From Diagnosis to Treatment: Exploring the Latest Management Trends in Cervical Intraepithelial Neoplasia. Cureus, 15 (12):e50291.
7. Moscicki A-B, Schiffman M, Franceschi S (2020). The natural history of human papillomavirus infection in relation to cervical cancer. In: Human papillomavirus. Ed(s): Elsevier, pp. 149-160.
8. Kaliterna V, Barisic Z (2018). Genital human papillomavirus infections. Front Biosci (Landmark Ed), 23 (9):1587-1611.
9. Doorbar J, Zheng K, Aiyenuro A, et al (2021). Principles of epithelial homeostasis control during persistent human papillomavirus infection and its deregulation at the cervical transformation zone. Curr Opin Virol, 51:96-105.
10. Estêvão D, Costa NR, da Costa RMG, Medeiros R (2019). Hallmarks of HPV carcinogenesis: The role of E6, E7 and E5 oncoproteins in cellular malignancy. Biochim Biophys Acta Gene Regul Mech, 1862 (2):153-162.
11. Karimian A, Ahmadi Y, Yousefi B (2016). Multiple functions of p21 in cell cycle, apoptosis and transcriptional regulation after DNA damage. DNA Repair (Amst), 42:63-71.
12. Choi P-W, Liu TL, Wong CW, et al (2022). The Dysregulation of MicroRNAs in the Development of Cervical Pre-Cancer—An Update. Int J Mol Sci, 23 (13):7126.
13. Bodelon C, Vinokurova S, Sampson JN, et al (2016). Chromosomal copy number alterations and HPV integration in cervical precancer and invasive cancer. Carcinogenesis, 37 (2):188-196.
14. Gardella B, Pasquali MF, La Verde M, et al (2022). The complex interplay between vaginal microbiota, HPV infection, and immunological microenvironment in cervical intraepithelial neoplasia: a literature review. Int J Mol Sci, 23 (13):7174.
15. Chambuso RS (2019). Human Immunodeficiency Virus/Human Papillomavirus co-infection and host molecular genetics of cervical carcinoma. https://hdl.handle.net/11427/31668
16. Mejía L, Munoz D, Trueba G, et al (2016). Prevalence of human papillomavirus types in cervical cancerous and precancerous lesions of Ecuadorian women. J Med Virol, 88 (1):144-152.
17. Heydari N, Oskouee MA, Vaezi T, et al (2018). Type‐specific human papillomavirus prevalence in cervical intraepithelial neoplasia and cancer in Iran. J Med Virol, 90 (1):172-176.
18. Sand FL, Munk C, Frederiksen K, et al (2019). Risk of CIN3 or worse with persistence of 13 individual oncogenic HPV types. Int J Cancer, 144 (8):1975-1982.
19. Abbas M, de Jonge J, Bettendorf O (2023). Prevalence of High-Risk HPV Subtypes and Efficacy of the HPV Vaccine in Preventing Cervical Epithelial Lesions: Survey and Insights from a German Study. Life (Basel), 13 (8):1637.
20. Arbyn M, Xu L, Verdoodt F, et al (2017). Genotyping for human papillomavirus types 16 and 18 in women with minor cervical lesions: a systematic review and meta-analysis. Ann Intern Med, 166 (2):118-127.
21. Boda D, Docea AO, Calina D, et al (2018). Human papilloma virus: Apprehending the link with carcinogenesis and unveiling new research avenues. Int J Oncol, 52 (3):637-655.
22. Zhou H-L, Zhang W, Zhang C-J, et al (2018). Prevalence and distribution of human papillomavirus genotypes in Chinese women between 1991 and 2016: A systematic review. J Infect, 76 (6):522-528.
23. Rader JS, Tsaih SW, Fullin D, et al (2019). Genetic variations in human papillomavirus and cervical cancer outcomes. Int J Cancer, 144 (9):2206-2214.
24. Rizzo AE, Feldman S (2018). Update on primary HPV screening for cervical cancer prevention. Curr Probl Cancer, 42 (5):507-520.
25. Sabiha Nikhat N (2022) Evaluation of Human Papilloma Virus as a Risk Factor for Cervical Cancer in Human Immunodeficiency Virus Positive Women. Madras Medical College, Chennai.
26. Gravitt PE, Winer RL (2017). Natural history of HPV infection across the lifespan: role of viral latency. Viruses, 9 (10):267.
27. Syrjänen S (2018). Oral manifestations of human papillomavirus infections. Eur J Oral Sci, 126 Suppl 1(Suppl Suppl 1):49-66.
28. Taku O, Businge CB, Mdaka ML, et al (2020). Human papillomavirus prevalence and risk factors among HIV-negative and HIV-positive women residing in rural Eastern Cape, South Africa. Int J Infect Dis, 95:176-182.
29. Gursahaney PR, Cordes S, Ofotokun I, et al (2019). Factors associated with condom use among HIV-positive women living in Atlanta, Georgia. PLoS One, 14 (12):e0225406.
30. Vidrine JI, Fennell BS, Simmons VN, et al (2023). Enhancing long-term smoking abstinence among individuals with a history of cervical intraepithelial neoplasia or cervical cancer (Project ACCESS): protocol for a randomized clinical trial. BMC Public Health, 23 (1):1284.
31. Szymonowicz KA, Chen J (2020). Biological and clinical aspects of HPV-related cancers. Cancer Biol Med, 17 (4):864-878.
32. Venkatas J, Singh M (2020). Cervical cancer: A meta-analysis, therapy and future of nanomedicine. Ecancermedicalscience, 14:1111.
33. Adhikari I (2022). Association of Sexual Behaviour and Oral Contraceptive Use with Cervical Neoplasia. Facultyof Social Sciences, Tampere University, Finland.
34. Jabbour J, Robey T, Cunningham MJ (2018). Healthcare disparities in pediatric otolaryngology: a systematic review. Laryngoscope, 128 (7):1699-1713.
35. Gupta S, Palmer C, Bik EM, et al (2018). Self-sampling for human papillomavirus testing: increased cervical cancer screening participation and incorporation in international screening programs. Front Public Health, 6:77.
36. Benard VB, Castle PE, Jenison SA, et al (2017). Population-based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era. JAMA Oncol, 3 (6):833-837.
37. Watson M, Soman A, Flagg EW, et al (2017). Surveillance of high-grade cervical cancer precursors (CIN III/AIS) in four population-based cancer registries, United States, 2009–2012. Prev Med, 103:60-65.
38. Karuri AR, Kashyap VK, Yallapu MM, et al (2017). Disparity in rates of HPV infection and cervical cancer in underserved US populations. Front Biosci (Schol Ed), 9(2):254-269.
39. Roger VL, Sidney S, Fairchild AL, et al (2020). Recommendations for cardiovascular health and disease surveillance for 2030 and beyond: a policy statement from the American Heart Association. Circulation, 141 (9):e104-e119.
40. de Sanjosé S, Diaz M, Castellsagué X, et al (2007). Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis, 7 (7):453-9.
41. Liu J, Ma S, Qin C, et al (2020). Prevalence and genotype distribution of human papillomavirus in Zhengzhou, China, in 2016. Arch Virol, 165 (3):731-736.
42. Rahmat F, Kuan JY, Hajiman Z, et al (2021). Human Papillomavirus (HPV) Prevalence and Type Distribution in Urban Areas of Malaysia. Asian Pac J Cancer Prev, 22 (9):2969-2976.
43. Bosnjak Z, Perić M, Krizan IR, et al (2013). Prevalence and genotype distribution of high-risk human papillomavirus (HR HPV) in male genital samples of Osijek-Baranja County. Coll Antropol, 37 (4):1203-8.
44. Walczak L, Dutkiewicz S, Marszałek A (2013). Incidence and prevalence of multiple types of genital human papillomavirus (HPV) infection in men: a study in Poland. Ginekol Pol, 84 (2):112-5.
45. Parada R, Morales R, Giuliano AR, et al (2010). Prevalence, concordance and determinants of human papillomavirus infection among heterosexual partners in a rural region in central Mexico. BMC Infect Dis, 10:223.
46. Jeršovienė V, Gudlevičienė Ž, Rimienė J, et al (2019). Human Papillomavirus and Infertility. Medicina (Kaunas), 55 (7): 377.
47. Salehi-Vaziri M, Sadeghi F, Bokharaei-Salim F, et al (2015). The Prevalence and Genotype Distribution of Human Papillomavirus in the Genital Tract of Males in Iran. Jundishapur J Microbiol, 8 (12):e21912.
48. Bruni L, Albero G, Rowley J, et al (2023). Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis. Lancet Glob Health, 11 (9):e1345-e1362.
49. Luyten A, Buttmann-Schweiger N, Luyten K, et al (2014). Early detection of CIN3 and cervical cancer during long-term follow-up using HPV/Pap smear co-testing and risk-adapted follow-up in a locally organised screening programme. Int J Cancer, 135 (6):1408-16.
50. Shiraz A, Crawford R, Egawa N, et al (2020). The early detection of cervical cancer. The current and changing landscape of cervical disease detection. Cytopathology, 31 (4):258-270.
51. Mitteldorf CAT (2016). Cervical cancer screening: from Pap smear to future strategies. J Bras Patol Med Lab, 52:238-245.
52. Reynolds SH (2020) HPV Primary Screening Pilot Study: molecular testing of potential triage strategies for HPV-positive women. https://secure.key4events.com/key4register/AbstractList.aspx?e=612&preview=1&aig=-1&ai=15475
53. Gandi SR, Vishwekar PS (2017). A study on correlation of Pap smear, colposcopy and colposcopic directed biopsy in women with unhealthy cervix. J Evolution Med Dent Sci, 6 (7):515-518.
54. Perkins RB, Guido RS, Castle PE, et al (2020). 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis, 24 (2):102-131.
55. Han L, Zhang B (2023). Can prophylactic HPV vaccination reduce the recurrence of cervical lesions after surgery? Review and prospect. Infect Agent Cancer, 18 (1):66.
56. Xu L, Jiang Y, Zhao R (2023). Advances in ablative treatment for human papillomavirus related cervical pre-cancer lesions. Gynecology and Obstetrics Clinical Medicine, 3 (4):213-219.
57. Loopik DL, Bentley HA, Eijgenraam MN, et al (2021). The natural history of cervical intraepithelial neoplasia grades 1, 2, and 3: a systematic review and meta-analysis. J Low Genit Tract Dis, 25 (3):221-231.
58. Kelly H (2017) The epidemiology of Human Papillomavirus (HPV) infection and epigenetic factors associated with the development of cervical cancer precursor lesions in women living with HIV in Africa. London School of Hygiene & Tropical Medicine.
59. Desravines N, Miele K, Carlson R, et al (2020). Topical therapies for the treatment of cervical intraepithelial neoplasia (CIN) 2–3: A narrative review. Gynecol Oncol Rep, 33:100608.
60. Hoffman SR, Le T, Lockhart A, et al (2017). Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review. Int J Cancer, 141 (1):8-23.
61. Zarankiewicz N, Zielinska M, Kosz K, et al (2020). High-risk HPV test in cervical cancer prevention-present and future. J Pre Clin Clin Res, 14 (3):80-84.
62. White MD (2014). Pros, cons, and ethics of HPV vaccine in teens-Why such controversy? Transl Androl Urol, 3 (4):429-34.
63. Toh ZQ, Kosasih J, Russell FM, et al (2019). Recombinant human papillomavirus nonavalent vaccine in the prevention of cancers caused by human papillomavirus. Infect Drug Resist, 12:1951-1967.
64. de Sanjose S, Quint WG, Alemany L, et al (2010). Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol, 11 (11):1048-56.
65. Smalley Rumfield C, Roller N, Pellom ST, et al (2020). Therapeutic Vaccines for HPV-Associated Malignancies. Immunotargets Ther, 9:167-200.
66. Harper DM, Nieminen P, Donders G, et al (2019). The efficacy and safety of Tipapkinogen Sovacivec therapeutic HPV vaccine in cervical intraepithelial neoplasia grades 2 and 3: Randomized controlled phase II trial with 2.5 years of follow-up. Gynecol Oncol, 153 (3):521-529.
67. Choi YJ, Hur SY, Kim TJ, et al (2020). A Phase II, Prospective, Randomized, Multicenter, Open-Label Study of GX-188E, an HPV DNA Vaccine, in Patients with Cervical Intraepithelial Neoplasia 3. Clin Cancer Res, 26 (7):1616-1623.
68. Park YC, Ouh YT, Sung MH, et al (2019). A phase 1/2a, dose-escalation, safety and preliminary efficacy study of oral therapeutic vaccine in subjects with cervical intraepithelial neoplasia 3. J Gynecol Oncol, 30 (6):e88.
69. García-Hernández E, González-Sánchez JL, Andrade-Manzano A, et al (2006). Regression of papilloma high-grade lesions (CIN 2 and CIN 3) is stimulated by therapeutic vaccination with MVA E2 recombinant vaccine. Cancer Gene Ther, 13 (6):592-7.
70. Felix JC, Lacey MJ, Miller JD, et al (2016). The Clinical and Economic Benefits of Co-Testing Versus Primary HPV Testing for Cervical Cancer Screening: A Modeling Analysis. J Womens Health (Larchmt), 25 (6):606-16.
71. Cartmell KB, Young-Pierce J, McGue S, et al (2018). Barriers, facilitators, and potential strategies for increasing HPV vaccination: a statewide assessment to inform action. Papillomavirus Res, 5:21-31.
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Issue | Vol 53 No 12 (2024) | |
Section | Review Article(s) | |
Keywords | ||
Cervical intraepithelial neoplasia Human papillomavirus Health policies |
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