HPV INFECTIONS IN OLDER WOMEN

老年女性的 HPV 感染

• 批准号: 6235386
• 负责人: KEERTI V SHAH
• 金额: $ 24.87万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-07-01 至 1998-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6235386
• 关键词: African American; biopsy; capsid; cervical /vaginal smear; cervix neoplasms; communicable disease transmission; cooperative study; diagnosis design /evaluation; diagnosis quality /standard; disease /disorder proneness /risk; female; female reproductive system disorder diagnosis; histology; human middle age (35-64); human papillomavirus; human subject; longitudinal human study; neoplasm /cancer diagnosis; polymerase chain reaction; serology /serodiagnosis; urban poverty area; virus DNA; viruslike particle

Although Pap smears are properly credited for the marked reduction of cervical cancer mortality in the USA over the past 40 years, a single Pap Smear often fails to detect co-existing cervical neoplasia. This low sensitivity of Pap smear for detection of disease may be especially harmful for older women who are at an increased risk of cancer and for women who are not screened regularly. The aim of the project is to evaluate if diagnosis of HPV DNA in the genital tract is a useful adjunct to Pap smears in a cervical cancer screening program in economically disadvantaged older women. About thirty-five hundred women 40-70 years old in East Baltimore communities will be recruited through community organization, church fairs, door-to-door or leafletting and advertisement in newspapers. They will undergo screening for cervical cancer and cervical cancer precursor lesions by three tests: Pap Smear, HPV DNA detection by PCR and cervicography. Women found to be abnormal in any of the screens will be referred to colposcopy. Cervical biopsy will be obtained if abnormal areas are seen by colposcopy. With biopsy-proven disease as the reference, it is anticipated that HPV DNA detection and cervicography will increase the sensitivity of disease detection, from 0.7 for cytology alone to 0.95 for the three tests. Data will be examined to determined how the specificity of disease detection can also be maintained at a high level. Steps which might conceivably be useful in this regard are: (i) limiting analysis to cancer-associated HPVs; (ii) taking into account the quantity of viral DNA in the sample; and (iii) confining analysis to post-menopausal women, sexually inactive women and women with a smoking history. In a prospective component of the study, normal women (negative in all screens) and "at-risk" women (women with abnormal screens but without biopsy-proven disease) will be monitored annually for two years to compare cervical neoplasia incidence rates in the two groups. The data will be analyzed to identify factors which are predictive of cervical neoplasia. The results of this project will help determine if HPV DNA detection, as an adjunct to Pap smear examination, has any role in detection of cervical neoplasia in older women.

尽管子宫颈抹片检查被认为可以显着减少 过去 40 年来美国宫颈癌死亡率 涂片常常无法检测出共存的宫颈肿瘤。这个低 巴氏涂片检查疾病的敏感性可能特别高 对患癌症风险增加的老年妇女有害 未定期检查的女性。该项目的目的是 评估生殖道 HPV DNA 的诊断是否是有用的辅助手段 子宫颈抹片检查在宫颈癌筛查项目中的经济价值 处于不利地位的老年妇女。大约 3500 名 40-70 岁女性 东巴尔的摩社区的老年人将通过社区招募 组织、教堂集市、挨家挨户或发传单和广告 在报纸上。他们将接受宫颈癌筛查 宫颈癌前兆病变通过三种测试：巴氏涂片、HPV DNA 通过PCR和宫颈造影检测。女性被发现有任何异常 这些屏幕将被转至阴道镜检查。宫颈活检将 如果通过阴道镜检查发现异常区域，则获得。经活检证实 以疾病为参考，预计HPV DNA检测和 宫颈造影将提高疾病检测的敏感性 单独细胞学检查为 0.7，三项检查为 0.95。数据将被审查 确定如何也可以实现疾病检测的特异性 维持在较高水平。可能有用的步骤 这方面是：(i) 限制对癌症相关 HPV 的分析； (二) 考虑样本中病毒 DNA 的数量； (三) 分析仅限于绝经后妇女、性生活不活跃的妇女和 有吸烟史的女性。在该研究的前瞻性部分中， 正常女性（所有筛查均为阴性）和“高危”女性（患有 异常筛查但没有活检证明的疾病）将受到监测 两年内每年一次比较宫颈肿瘤的发病率 两组。将分析数据以确定哪些因素 宫颈肿瘤的预测。该项目的结果将有助于 确定 HPV DNA 检测是否作为巴氏涂片检查的辅助手段， 对检测老年妇女宫颈肿瘤有一定作用。