Investigator
University Of North Carolina At Chapel Hill
Human papillomavirus vaccination and cervical cancer risk
ABSTRACT Persistent human papillomavirus infection is the central cause of cervical cancer, the leading cause of cancer death among women worldwide. Clear evidence from both randomized trials and population based studies shows that vaccination against human papillomavirus reduces the incidence of cervical pre-cancer. These data suggest that the vaccine reduces the incidence of cervical cancer. However, human papillomavirus vaccine coverage is inadequate in all countries, especially in low and middle income countries where disease burden is highest. Supply side strategies to improve coverage include increasing the availability of low cost vaccines, school located delivery, single dose vaccine schedules, and development of vaccines that do not need refrigeration. Demand side strategies include enhancing provider recommendations, correcting misinformation, and public awareness campaigns. The near elimination of cervical cancer is achievable through increased uptake of human papillomavirus vaccination and efforts to increase screening for cervical cancer, especially when enacted to reduce disparities in across the world.
Eliminating cervical cancer as a global public health problem requires equitable action
Feasibility of 5‐fluorouracil and imiquimod for the topical treatment of cervical intraepithelial neoplasias (CIN) 2/3
AbstractObjectivesTo determine the feasibility (as measured by tolerability and safety) and efficacy of topical 5‐fluorouracil (5‐FU) and imiquimod for the treatment of cervical intraepithelial neoplasia (CIN) 2/3.MethodsThis pilot prospective study was conducted in women aged 18–45 years with p16+ CIN 2/3. Participants underwent an 8‐week alternating regimen of self‐applied 5% 5‐FU on weeks 1, 3, 5, and 7 and physician‐applied imiquimod on weeks 2, 4, 6, and 8. Adverse events (AEs) were collected by symptom diary and clinical exam. Feasibility was measured by tolerability and safety (AEs) of the study intervention. Tolerability was assessed as the number of participants able to apply 50% or more of the treatment doses. The safety outcome was calculated as the number of participants who experienced “specified AEs” defined as possibly, probably, or definitely related grade 2 or worse AE or grade 1 genital AEs (blisters, ulcerations, or pustules) lasting more than 5 days. The efficacy of the intervention was determined by histology and high‐risk human papillomavirus (hrHPV) testing was done after treatment.ResultsThe median age of the 13 participants was 27 ± 2.9 years. Eleven (84.61%) participants applied 50% or more of the treatment. All participants reported grade 1 AEs; 6 (46.15%) reported grade 2 AEs; and 0 reported grade 3/4 AEs. Three (23.08%) participants had specified AEs. Histologic regression to normal or CIN 1 among those completing 50% or more of the treatment doses was observed in 10 (90.91%) participants, and 7 (63.63%) tested negative for hr‐HPV at the end of the study.ConclusionsTopical treatment for CIN 2/3 with 5‐FU/imiquimod is feasible, with preliminary evidence of efficacy. Topical therapies need further investigation as adjuncts or alternatives to surgical therapy for CIN 2/3.
