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Investigating a cluster of vulvar cancer in young women: a cross-sectional study of genital human papillomavirus prevalence

Rumbold, Alice R., Tan, Sarah E., Condon, John R., Taylor-Thomson, Debbie M., Nickels, Maria, Tabrizi, Sepehr N., Davy, Margaret L. J., O'Brien, Margaret M., Connors, Christine M., Zardawi, Ibrahim, Stankovich, Jim and Garland, Suzanne M. (2012). Investigating a cluster of vulvar cancer in young women: a cross-sectional study of genital human papillomavirus prevalence. BMC Infectious Diseases,12(243):1-8.

Document type: Journal Article
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IRMA ID bsmithxPUB144
NHMRC Grant No. 436013
Title Investigating a cluster of vulvar cancer in young women: a cross-sectional study of genital human papillomavirus prevalence
Author Rumbold, Alice R.
Tan, Sarah E.
Condon, John R.
Taylor-Thomson, Debbie M.
Nickels, Maria
Tabrizi, Sepehr N.
Davy, Margaret L. J.
O'Brien, Margaret M.
Connors, Christine M.
Zardawi, Ibrahim
Stankovich, Jim
Garland, Suzanne M.
Journal Name BMC Infectious Diseases
Publication Date 2012
Volume Number 12
Issue Number 243
ISSN 1471-2334   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84867032763
Start Page 1
End Page 8
Total Pages 8
Place of Publication United Kingdom
Publisher BioMed Central
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Vulvar cancer is a relatively rare malignancy, which occurs most often in postmenopausal women. We have previously identified a geographic cluster of vulvar cancer in young Indigenous women living in remote communities in the Arnhem Land region of Australia. In this population, we investigated the prevalence of oncogenic human papillomavirus (HPV) infection in anogenital samples (vulvar/vaginal/perianal area and cervix) and compared the overall, type-specific and multiple infection prevalence between sites.

Methods
A cross-sectional survey of 551 Indigenous women aged 18–60 years was undertaken in 9 Arnhem Land communities. Women were consented for HPV detection and genotyping collected by a combined vulvar/vaginal/perianal (VVP) sweep swab and a separate PreservCyt endocervical sample collected during Pap cytology screening. HPV DNA testing was undertaken using PCR with broad spectrum L1 consensus PGMY09/11 primers with genotyping of positive samples by Roche Linear Array. The primary outcomes were the prevalence of cervical and VVP high-risk (HR) HPV.

Results
The prevalence of VVP HR-HPV was 39%, which was significantly higher than the cervical HR-HPV prevalence (26%, p<0.0001). HPV-16 was the most common genotype detected in both sites (VVP 11%, cervical 6%). HPV-16 infection peaked in women aged <20 years; however, there was a marked decline in cervical HPV-16 prevalence with age (p=0.007), whereas following an initial decline, the prevalence of VVP HPV-16 remained constant in subsequent age-groups (p=0.835).

Conclusions
In this population experiencing a cluster of vulvar cancer, the prevalence of cervical oncogenic HPV infection was similar to that reported by studies of other Australian women; however there was a significantly higher prevalence of vulvar/vaginal/perianal infection to cervical. The large discrepancy in HPV prevalence between anogenital sites in this population may represent more persistent infection at the vulva. This needs further investigation, including the presence of possible environmental and/or genetic factors that may impair host immunity.
Keywords Human papillomavirus
Population prevalence
Vulvar neoplasms
Young women
Indigenous women
DOI http://dx.doi.org/10.1186/1471-2334-12-243   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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