Open Journal Systems

Received: October 26^th 2014

Accepted: March 6^th 2015

EDITORIALS

Human papillomavirus and cervical cancer in México: a constant struggle

Kirvis Torres-Poveda,^a Vicente Madrid-Marina^b

^aCátedra CONACyT/Instituto Nacional de Salud Pública

^bPresidencia de la Sociedad Mexicana del Virus del Papiloma/Instituto Nacional de Salud Pública

Distrito Federal, México

Communication with: Vicente Madrid-Marina

Telephone: (777) 329 3056

Email: vmarina@insp.mx

Given that human papillomavirus and cervical cancer are a health problem in México, since they affect women of reproductive age and have a negative impact on our society, it is crucial to prevent those diseases and to raise awareness among physicians who deal with their clinical and therapeutic management. That is the reason why we show three Original contributions and 13 Current themes in this supplement of the Revista Médica del Instituto Mexicano del Seguro Social.

Keywords: History of medicine, Health policy, Planning and management, Mexico

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The Revista Médica del Instituto Mexicano del Seguro Social is characterized by publishing research results and reviews on topics of clinical and public health importance, prepared by expert professionals from the Instituto Mexicano del Seguro Social (IMSS) and other health institutions that make information and recommendations accessible to the medical community for handling a particular problem. Such is the case of this supplement, which shows current topics on infection by the human papillomavirus (HPV) and cervical cancer (CC) in Mexico, a public health problem that is still relevant for our country, despite being the female cancer with the highest potential for secondary prevention.   

Cervical cancer is caused by persistent infection with high-risk HPV. Studies on the prevalence of oncogenic HPV have reported a consistent pattern of HPV prevalence with lesser age, viral elimination, and reduction of exposure to new types of HPV.¹ Viral prevalence is the product of incidence (acquisition of new infections) and duration (persistence). Possible mechanisms that favor a higher prevalence of HPV include age, male or female sexual behavior, increased detection of HPV infection, cervical and vaginal epithelium changes due to age or associated with menopause and immune senescence related to age, leading to an increase in reactivation of latent infection and thus to an increase in the detection of new cases of infection.¹ The prevalence and estimated attribution of different HPV genotypes in the development of premalignant lesions in the cervix and CC has recently been determined.^2,3

Given that CC remains a health problem in our community affecting women of reproductive age and impacting Mexican society, it is of great importance to face the challenge of preventing this disease and raising awareness of the role of treating physicians in its clinical and therapeutic management. That's why this special issue of the Revista Médica del Instituto Mexicano del Seguro Social, consisting of three original articles and twelve revisions, takes on greater relevance if one takes into account the broad audience of health professionals reached by the journal.

The three original articles present the prevalence of HPV genotypes in Mexico and worldwide, the frequency of cervical epithelial lesions reported in the Laboratorio Regional de Citología Exfoliativa of Jalisco, and the detection of cellular microRNA seed sequences in the HPV genome. In Mexico, cervical cancer is the second most fatal malignancy for women (10.4%); so, with an estimated 2012 population of 60 million women, 6240 women die of this disease yearly.⁴ CC is a preventable cancer, either by primary prevention through prophylactic vaccines, or secondary prevention by cytology and HPV detection testing. The ideal screening test for CC should, in addition to high sensitivity, have a high positive predictive value, and should select exclusively for women with significant disease (high-grade lesion or cancer) or potential for progression. However, both cytology and HPV testing detect excess women with positive or inconclusive HPV, with no significant lesions or those that resolve spontaneously. This creates an overload of care for diagnosis or treatment.⁵ Thus, the information presented in this supplement could be of great help to the development of new technologies to help solve the problem of accumulation of patients with positive HPV diagnosis, and to identify which women will develop cervical cancer. The knowledge gained from these three items will update health professionals and encourage the generation of new strategies for early prevention of CC.

Cervical cancer afflicts women with social, economic, and cultural detriment. Consequently, it is much more common in developing countries, where 85% of cases occur. In contrast, the incidence of cervical cancer in developed countries is 3.6%.⁴ In this supplement, the article "Cervical cancer and human papillomavirus. A glance from a family medical viewpoint" addresses CC as a social and family medical issue and analyzes the role of the family physician, who by definition is the specialist on primary health care, as they are responsible for monitoring and resolving the most common health problems. The contribution of this article will give health professionals a more holistic view of the problem and lead to better monitoring of patients suffering from this disease.

Also, twelve articles present different approaches to the pathophysiology of cervical cancer, including the mechanisms of carcinogenesis, and the HPV host itself. Regarding HPV, three articles describe the properties of this virus, ranging from general aspects of the structure, classification, and replication of HPV, to the role of the E7 oncoprotein of this virus and its role in cell transformation, as well as the detection of cellular microRNA seed sequences within the genome of HPV. On the other hand, three articles address the cellular and molecular aspects of the host related to genes associated with cancer, with the role of development genes like HOX in CC, and the Wnt signaling pathway and its association with cervical cancer. The article "Study of chromosomal instability in the progression of cervical cancer by DBD-FISH technique" examines the role of alterations undergone by guest molecules, which affect the development of CC. Finally, there are two articles dealing with altered aspects of the innate immune response and how the process of apoptosis is involved in the development of cervical cancer, "Escape mechanisms to the innate immune response in HPV-associated cervical cancer" and "Apoptosis modulation by human papillomavirus."

The material gathered here is the product of the Programa de Redes de Investigación Institucional of the Coordinación de Investigación en Salud of the Instituto Mexicano del Seguro Social, specifically the collaborative effort of researchers from different areas, who are linked through the Red de Investigación del Virus del Papiloma Humano, a pioneering group in multidisciplinary research for the benefit of the population.

Such efforts are remarkable considering that many of the results published in this supplement can be used to improve health policies. In addition to the information shared here, a recent consensus made in Mexico established guidelines for prevention, diagnosis, and treatment, based on national and international evidence to unify criteria at national and inter-institutional levels to reduce the incidence and mortality of this disease.⁶ Both efforts provide products that are useful for the continuing education of health professionals responsible for making decisions, either clinical or in health policy.

References

1. Siegel R, Jiemin Ma, Zou Zhaochui, Jemal A. Cancer statistics. CA Cancer J Clin. 2014;64:9-29.
2. Lazcano-Ponce E. Nuevas alternativas de prevención secundaria de cáncer cervical. Salud Publica Mex. 2007;49:32-4.
3. Castle PE, Schiffman M, Herrero R, Hildesheim A, Rodriguez AC, Bratti MC, et al. J Infect Dis. 2005;191(11):1808-16.
4. Insinga RP, Liaw KL, Johnson LG, Madeleine MM. A systematic review of the prevalence and attribution of human papillomavirus types among cervical, vaginal, and vulvar precancers and cancers in the United States. Cancer Epidemiol Biomarkers Prev. 2008;17:1611-22.
5. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, et al. Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. Int J Cancer. 2007;121:621-32.
6. Primer consenso nacional de prevención, diagnóstico y tratamiento del cáncer cervicouterino. Gaceta Mexicana de Oncología. 2014;13, Supl 4.

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