HPV Clearance Tied to Cervical Cancer Disparity
Additionally, women in the two groups had similar rates of infection with high-risk strains of HPV, 28.4% of specimens from African Americans and 25% of specimens from European Americans.
Analysis of HPV status by clinic visit showed that African-American women tested positive 46.7% of the time compared with 37.8% among European-American women (P<0.0001).
African Americans also had significantly more positive tests for high-risk HPV strains (45.2% versus 35.9%, P<0.001) and for low-risk strains (12.6% versus 8.6%, P<0.009).
HPV infection, including infection with high-risk strains, resolves within 12 months in most cases. Among study participants who tested positive for high-risk HPV strains, the median duration of infection was 12 months in European-American women and 18 months in African Americans.
SOCIOECONOMIC AND ETHNIC FACTORS
Although the rate of cervical cancer has declined among both Caucasian and African-American women over the past decades, it remains much more prevalent in African-Americans - whose death rates are twice as high as Caucasian women. Hispanic American women have more than twice the risk of invasive cervical cancer as Caucasian women, also due to a lower rate of screening.
These differences, however, are almost certainly due to social and economic differences. Numerous studies report that high poverty levels are linked with low screening rates. In addition, lack of health insurance, limited transportation, and language difficulties hinder a poor woman’s access to screening services.
HIGH SEXUAL ACTIVITY
Human papilloma virus (HPV) is the main risk factor for cervical cancer. In adults, the most important risk factor for HPV is sexual activity with an infected person. Women most at risk for cervical cancer are those with a history of multiple sexual partners, sexual intercourse at age 17 years or younger, or both. A woman who has never been sexually active has a very low risk for developing cervical cancer.
Sexual activity with multiple partners increases the likelihood of many other sexually transmitted infections (chlamydia, gonorrhea, syphilis).Studies have found an association between chlamydia and cervical cancer risk, including the possibility that chlamydia may prolong HPV infection.
At 24 months after diagnosis, high-risk HPV strains persisted in 56% of African Americans versus 24% of European Americans (P<0.01).
African-American women were significantly more likely to have abnormal Pap tests, including low-grade squamous intraepithelial lesions (9.0% versus 5.8%) and high-grade squamous intraepithelial lesions (1.9% versus 0.4%).
After combining the two categories, investigators found that African Americans had a 1.7-fold greater likelihood of abnormal Pap tests (P<0.005).
The findings support the public health message that "HPV vaccines and routine Pap-test screening remain the best practices for the prevention of Cervical dysplasia and cervical cancer," said Creek.
Creek had no relevant disclosures.
Primary source: American Association for Cancer Research
Source reference: Messersmith AR, et al “Increased risk of persistent human papillomavirus infetion and abnormal Pap tests in African-Americancompared to European-American women in a college-age cohort” AACR 2012; Abstract 550.
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