School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi.
National Cancer Institute, Rockville, Maryland.
Cancer Cytopathol. 2020 Aug;128(8):528-534. doi: 10.1002/cncy.22267. Epub 2020 Apr 3.
Understanding racial influences on human papillomavirus (HPV) distribution in women with atypical squamous cells of undetermined significance (ASCUS) cytology via partial genotyping in a statewide population can inform HPV-based prevention efforts.
Women aged 21 to 65 years with any cytology result and partial HPV genotyping for ASCUS triage between January 1, 2014, and December 31, 2017, were included. All women attended a Mississippi State Department of Health clinic. Age, race, cytopathologic, and HPV data were extracted from the electronic health record and analyzed. Cytologic specimens were processed with ThinPrep and HPV testing with the Cobas 4800 assay. HPV genotypes were evaluated in hierarchical categories. Chi-square tests and multinomial logistic regression models evaluated associations between race and type prevalence.
There were 43,106 women who underwent cervical cancer screening with cytology and ASCUS triage. Of these, 34,363 (80.2%) had normal cytology, 4672 (10.9%) had ASCUS, 2683 (6.3%) had a low-grade squamous intraepithelial lesion, and 633 (1.5%) had a high-grade squamous intraepithelial lesion. Blacks represented 69.3% of the sample and had a higher proportion of HPV-positive ASCUS (6.5%) in comparison with whites (5.6%). Blacks had significantly decreased odds of HPV-16 (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.6-0.9; P = .002) and significantly increased odds for 12 other types (OR, 1.37; 95% CI, 1.2-1.5; P < .0001) in comparison with whites.
In a diverse population, significant differences in HPV genotypes are shown by race. Importantly, blacks with ASCUS are less likely to be positive for HPV-16 in comparison with whites. Ongoing work is evaluating the individual genotype prevalence and genotype-specific risk of precancer by race.
通过对全州范围内具有非典型意义的不典型鳞状细胞（ASCUS）细胞学的妇女进行部分基因分型，了解种族对人乳头瘤病毒（HPV）分布的影响，可为 HPV 为基础的预防措施提供信息。
本研究纳入了 2014 年 1 月 1 日至 2017 年 12 月 31 日期间，年龄在 21 至 65 岁之间，接受任何细胞学检查结果和 ASCUS 分流的部分 HPV 基因分型的妇女。所有妇女均在密西西比州立卫生部诊所就诊。从电子病历中提取年龄、种族、细胞病理学和 HPV 数据并进行分析。细胞学标本采用 ThinPrep 处理，HPV 检测采用 Cobas 4800 检测。按照层次类别评估 HPV 基因型。卡方检验和多项逻辑回归模型评估了种族与类型流行率之间的关联。
共有 43106 名妇女接受了宫颈癌筛查和 ASCUS 分流的细胞学检查。其中，34363 名（80.2%）细胞学正常，4672 名（10.9%）为 ASCUS，2683 名（6.3%）为低度鳞状上皮内病变，633 名（1.5%）为高度鳞状上皮内病变。黑人占样本的 69.3%，HPV 阳性 ASCUS 的比例（6.5%）高于白人（5.6%）。与白人相比，黑人 HPV-16 的可能性显著降低（比值比[OR]，0.66；95%置信区间[CI]，0.6-0.9；P=0.002），12 种其他类型的可能性显著增加（OR，1.37；95%CI，1.2-1.5；P<.0001）。
在一个多样化的人群中，种族之间显示出 HPV 基因型的显著差异。重要的是，与白人相比，黑人的 ASCUS 中 HPV-16 的阳性率较低。目前正在评估按种族划分的个别基因型流行率和特定基因型的癌前风险。
