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Human Papillomavirus Infection in relation to the Development of Precancerous Cervical Lesions across Age Groups in Hong Kong Andre Ma1, Stephanie Yu1, Corey Nelson2, Hebe Law2, Cassandra Lee11The University of Hong Kong, 2The Chinese University of Hong Kong

Asian Medical Students Association Hong KongSOutlineIntroductionStudy Design and MethodsResults and DiscussionLimitationsRole of Medical StudentsFuture DirectionsOutlineIntroductionStudy Design and MethodsResults and DiscussionLimitationsRole of Medical StudentsFuture DirectionsIntroductionCervical Cancer: 8th most common cancer-related death in HK womenSexually transmitted HPV infection is necessary and preventable causeStudy of HPV in Hong Kong valuable for guidelines on screening and vaccination

Cervical cancer: serious health problem worldwide, especially in Hong KongUnique necessary, preventable cause,Vaccine for most common, high-risk genotypes, 16 and 184Intro: Cervical Cytology

Progression of HPVs effects on cervical epithelial cells measurableCervical cytology detects abnormal cells, graded by severity22% of HSIL converts to carcinoma, acts as good substitute measure of cancer development5Intro (contd)Previous literature in HK: first large-scale surveys of lesion developmentData from 1988-1999Our aim: update and expand previous trendsData from 2005-2011Develop timeline of HPV progression

Previous studies in HK, particularly Chen 2003/2004 gave first large-scale survey of lesion development trends in asian populations-Develop timeline of progression of HPV effects on lesion developments, among different age groups6OutlineIntroductionMethodologyResults and DiscussionLimitationsRole of Medical StudentsFuture DirectionsDiagnosed with ASC-US (17,748)Tested for HPV (8,710)Followed up after 2 years (5,269)Total LBC samples (453,460)Normal cytology (435,712) Undetermined HPV status (9,038)Failed to follow up (3441)MethodologyParticipants Excluded8MethodologyLesion development across age groupsCorrelation of HPV status and age with lesion developmentThe follow-up data was analyzed for correlations between age at diagnosis of ASC-US cases and subsequent detection of LSIL or HSIL. They were also examined for any statistical link between HPV positivity and the likelihood of developing SIL. This data was evaluated with Pearson's chi-squared tests or Fishers exact test for statistical significance with a 95% confidence rate. An odds ratio analysis was also used to examine the relative risks between different age groups.

9OutlineIntroductionStudy Design and MethodsResults and DiscussionLimitationsRole of Medical StudentsFuture DirectionsSignificant chi-squared result for all age groupsResults and Discussion

11Results and DiscussionHPV and LSIL prevalence are highest in 21-25 y.o. groupPeakHPV prevalence highest in women under 3012HPV and LSIL prevalence are highest in 21-25 y.o. groupHSIL prevalence is highest in 31-35 y.o. groupResults and DiscussionHPV and LSIL prevalence are highest in 21-25 y.o. groupHSIL prevalence is highest in 31-35 y.o. groupCervical cancer incidence peaks in 41-55 y.o. groupResults and DiscussionHPV and LSIL prevalence are highest in 21-25 y.o. groupHSIL prevalence is highest in 31-35 y.o. groupCervical cancer incidence peaks in 41-55 y.o. groupHPV infectionLSILHSILCervical cancer< 5 years~7-9years~10years(Moscicki et al. 2001)(Schlecht et al. 2003,Khan et al. 2005)(Holowaty et al. 1999,Schiffman and Rodriguez 2008)Results and Discussion

The relative odds of developing HSIL in HPV positive patients31-40 y.o. age group has a significantly higher odd of HPV-related HSIL developmentResults and DiscussionResults and DiscussionDevelopment of HSIL:Overall confirmed risk of HSIL from HPV infectionIncreased likelihood across all age groupsRecommendations based on results:Education programs:HPV prevention, targeted at young individualsHPV screening, targeted at women under 30Results and DiscussionGuidelines:Begin HPV screening as early as 20More aggressive screening 31-40Colposcopy and followup, 31-40Results and DiscussionSubsidize Vaccination as Early as PossibleOutlineIntroductionStudy Design and MethodsResults and DiscussionLimitationsRole of Medical StudentsFuture DirectionsLimitationsSample sizeWomen 60Limited genotype testingPrevents individual subtype trend analysisOther risk factorsSexual activity patterns, smoking

OutlineIntroductionStudy Design and MethodsResults and DiscussionsLimitationsRole of Medical StudentsFuture DirectionsProtocols for infections, screening & vaccinationHealth CampaignsEducational EventsMass Media CampaignsAccurate public knowledge about HPV infectionsRole of Medical StudentsReduce burden on Hong Kongs medical costsMedical students have the role of an intermediary between governments and the general populationDue to their accessibility to the grass roots level, students can assist the government to raise awareness about HPV and increase acceptability of the currently available vaccines among members of our community.

This can be performed in numerous ways, such as the rectification of common misconceptions through health exhibitions and campaigns in partnership with NGOs to educate the publicMedical students can also work to create protocols to prevent and manage HPV infections, including the identifying ways to make vaccinations and screenings more accessible to women

Additionally, medical students may also be more relatable to adolescents at high risk of acquiring HPV infections, Making use of this position, this allows for the possibility of medical students to collaborate with primary and secondary schools to host educational events on HPV prevention and on the importance of obtaining appropriate gynecological care after the initiation of sexual activity.

Lastly, mass media campaigns can be developed, such as websites, videos, or interactive games to raise awareness about the consequences of HPV infection in both genders.

ULTIMATELY, extensive and accurate public knowledge about HPV infections, existing vaccines and cervical cancer can help reduce the burden of the disease on Hong Kongs medical costs.

23OutlineIntroductionStudy Design and MethodsResults and DiscussionsLimitationsRole of Medical StudentsFuture Directions24Future DirectionsIdentify Hong Kong-specific HPV types that are high riskInvestigate consequences of HPV infections in malesEfficacy of providing HPV vaccines to both gendersTaking heed of the limitations of this research as outlined above, there are a number of further areas that need to be investigated.

Firstly, further research is needed to identify HK-specific high risk HPV subtypes, as subtype distributions have been found to vary greatly between populations

Secondly, further investigation should be conducted on the consequences of HPV infections on the malegender

And finally, the efficacy of providing the HPV vaccine to both men and women to reduce the burden of HPV-related cancers needs to be investigated. 25Thank you!SSupplementary material

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