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No Evidence for Human Papillomavirus in the Etiology of Colorectal Polyps

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No Evidence for Human Papillomavirus in the Etiology of Colorectal Polyps Published OnlineFirst August 4, 2011; DOI: 10.1158/1055-9965.EPI-11-0450 Cancer Epidemiology, Research Article Biomarkers & Prevention No Evidence for Human Papillomavirus in the Etiology of Colorectal Polyps Andrea N. Burnett-Hartman1,2, Polly A. Newcomb1,2, Margaret T. Mandelson1, Denise A. Galloway1,2, Margaret M. Madeleine1,2, Michelle A. Wurscher1, Joseph J. Carter1, Karen W. Makar1, John D. Potter1,2, and Stephen M. Schwartz1,2 Abstract Background: While some studies have reported detection of oncogenic human papillomavirus (HPV) in colorectal tumors, others have not. Methods: We examined the association between oncogenic HPV infection and colorectal polyps in a case– control study of individuals with colorectal adenomas (n ¼ 167), hyperplastic polyps (n ¼ 87), and polyp-free controls (n ¼ 250). We carried out real-time PCR for HPV-16 and -18 DNA, and SPF PCR covering 43 HPV types, on lesional and normal colorectal tissue samples. Plasma antibodies for oncogenic HPV types were assessed via a bead-based multiplex Luminex assay. Results: HPV DNA was not found in any of the 609 successfully assayed colorectal tissue samples from adenomas, hyperplastic polyps, normal biopsies adjacent to polyps, or normal biopsies of the rectum of disease-free controls. Also, there was no association between HPV seropositivity for all oncogenic HPV types combined, for either polyp type, and for men or women. When analyses were restricted to participants without a history of polyps, among men [adenomas (n ¼ 31), hyperplastic polyps (n ¼ 28), and controls (n ¼ 68)], there was an association between seropositivity and hyperplastic polyps when all oncogenic HPV types were combined (OR ¼ 3.0; 95% CI: 1.1–7.9). Conclusions: Overall, our findings do not support an etiologic relationship between HPV and colorectal adenomas or hyperplastic polyps; however, our finding suggesting an association between HPV seropos- itivity and hyperplastic polyps in men may warrant further investigations. Impact: After stringent controls for contamination and three methods to assess HPV infection, we report no evidence for HPV in the etiology of colorectal neoplasia for either men or women. Cancer Epidemiol Biomarkers Prev; 20(10) 2288–97. Ó2011 AACR. Introduction Although 100% of cervical cancer is attributable to HPV, the proportion of other anogenital cancers that Oncogenic human papillomavirus (HPV) infection is a are etiologically connected to HPV varies (2). In those necessary cause of cervical cancer and is strongly asso- cancers showing associations with HPV, but with less ciated with other epithelial malignancies such as oropha- than 100% attributable to HPV, there are most likely ryngeal, penile, vaginal, vulvar, and anal cancers (1–3). multiple pathways leading to cancer, one (or more) of HPV DNA 16 and other oncogenic types are present in which involves HPV infection. precursor lesions of HPV-related cancers as well as the Because colorectal cancer originates in epithelial cells carcinomas themselves (4). In all of the known HPV- and the anal canal, a site known to be associated with HPV- related carcinomas, the most common types detected related malignancies (1), leads to the rectum and colon, are types HPV-16 and -18, which cause more than 70% more than a dozen studies have considered whether of HPV-related carcinomas (5–8). colorectal neoplastic tissue contains HPV DNA (9–22). Results from these studies have been inconsistent, with some studies reporting 14% to 84% of colorectal neoplasia positive for HPV DNA (9–17) and others detecting no HPV Authors' Affiliations: 1Fred Hutchinson Cancer Research Center; and 2 DNA in colorectal cancers (18–22) or adenomatous polyps Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington (19, 22). Therefore, the association between HPV and Corresponding Author: Andrea N. Burnett-Hartman, 1100 Fairview Ave. colorectal neoplasia is unclear. N, M4-B402, Seattle, WA 98109. Phone: 206-667-2126; Fax: 206-667- Colorectal cancer is a heterogeneous, multifactorial 5977; E-mail: [email protected] disease with several distinct causal pathways (23). Also, doi: 10.1158/1055-9965.EPI-11-0450 recent evidence supports the hypothesis that specific Ó2011 American Association for Cancer Research. precursor lesions are associated with different pathways 2288 Cancer Epidemiol Biomarkers Prev; 20(10) October 2011 Downloaded from cebp.aacrjournals.org on September 25, 2021. © 2011 American Association for Cancer Research. Published OnlineFirst August 4, 2011; DOI: 10.1158/1055-9965.EPI-11-0450 Human Papillomavirus and Colorectal Polyps (24). Colorectal adenomatous polyps (adenomas) are tional Review Boards at Group Health and the Fred well-established precursor lesions; however, only a small Hutchinson Cancer Research Center. Eligibility was proportion of these lesions will progress to cancer (25). limited to participants with at least 1 prevalent adeno- The adenoma–carcinoma pathway usually involves APC ma or hyperplastic polyp at the index colonoscopy, and mutation as an early event, followed by an accumulation for comparison, participants with disease-free colons of other mutations and accompanying morphologic and rectums (see "Case–control classification," later); in changes (26). Hyperplastic polyps, generally considered addition, among these, only those with questionnaire innocuous lesions, may in some instances progress to data and a blood sample, a tissue sample, or both cancer along a separate pathway, termed "the serrated available for analyses were included in the present pathway" (27, 28). This pathway is hypothesized to study. Of the 738 participants in the parent study, we involve aberrant methylation and BRAF mutation (29, excluded those who had a self-reported history of 30). Most reported risk factors for hyperplastic polyps, colorectal cancer, ulcerative colitis, Crohn’s disease, such as increased risks for male sex and high alcohol familial adenomatous polyposis (FAP), or other non- consumption and decreased risk for postmenopausal polyp colorectal pathologies (n ¼ 165). Thirty-seven hormone use, calcium intake, and nonsteroidal anti- additional participants were excluded because of miss- inflammatory drug use, are similar to risk factors for ing or incomplete questionnaire data, which precluded adenomas (31, 32). However, hyperplastic polyps the ascertainment of colorectal disease history, and 32 tend to occur at a younger age than adenomas (31) and were excluded because they did not have blood or tissue have a much stronger association with cigarette smoking samples available for analysis. Thus, 504 participants (31, 33, 34). were eligible (Fig. 1). To date, no other studies have examined hyperplastic polyps in relation to oncogenic HPV infection. Also, none Case–control classification of the previous studies used quantitative methods to For polyp cases, standardized pathology reviews were assess the viral copy number in colorectal case and completed and medical records reviewed to ascertain the control tissue samples. Precursor lesions in HPV-related size and anatomic site of each polyp. If a participant anal and cervical cancer have a higher viral copy number had at least one of the following polyps, he or she was than normal adjacent tissue and normal anal or cervical classified an adenoma case: tubular adenoma, tubulovi- tissue from disease-free controls (35, 36). If HPV were llous adenoma, or villous adenoma. Cases with micro- important in the etiology of colorectal neoplasia, one vesicular hyperplastic polyps, goblet cell hyperplastic would expect to observe similarly increased viral copy polyps, serrated polyps, or sessile serrated polyps and number specifically in the disease tissue and not in the no adenomas were classified as hyperplastic polyp cases normal tissue. Finally, most of the previous studies have (41). Controls were participants who had no colorectal not compared HPV seropositivity (a marker of past pathologies identified during the index colonoscopy. The infection) in colorectal neoplasia cases to disease-free eligible study population consisted of 167 adenoma cases, controls. This is important because antibody analyses 87 hyperplastic polyp cases, and 250 controls (Fig. 1). are less susceptible to contamination than DNA analyses. Also, because it takes an average of 8 to 11 months Data collection postinfection for HPV-16 antibodies to develop (37, 38), Study participants completed a self-administered antibody analyses would be better than DNA analyses questionnaire, eliciting the following information: at differentiating between very recent infection (which demographic characteristics,height,weight,historyof would be unlikely to have caused clinically detectable colorectal polyps, cancer history, lifetime alcohol con- levels of cellular proliferation) and HPV infection sumption, smoking history, aspirin use, and, for women occurring further back in time. We conducted a case– only, reproductive history and hormone use. More control study of the association between oncogenic HPV than 95% of participants completed the forms prior to infection and adenomas and hyperplastic polyps by real- colonoscopy, thus minimizing the possibility of recall time PCR for HPV-16 and -18, as well as by an assay for differences by diagnosis. serologic HPV antibodies. Prior to colonoscopy, an EDTA (ethylenediamine tetra- acetic acid) tube of blood was collected, processed within Methods 20 hours, and stored at À80C. During colonoscopy, tissue samples from polyps and Study
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