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Comprehensive cervical cancer prevention and control: Potential strategies at different stages of cervical cancer progression

Paul, Proma (2016) Comprehensive cervical cancer prevention and control: Potential strategies at different stages of cervical cancer progression. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Advancements in the continuum of cervical cancer care, including risk factor assessment, human papillomavirus (HPV) vaccines, and screening programs, have reduced the cervical cancer burden. However, cervical cancer remains an important public health issue, particularly in developing countries. This research investigated three potential prevention opportunities along the cervical cancer continuum, including: factors associated with HPV natural history in middle-aged women which may influence current vaccination and screening recommendations; testing for carcinogenic HPV serotypes to assess the feasibility of ‘catchup’ HPV vaccination in populations who missed the conventional adolescent vaccination window; and protective dietary patterns. First, we measured the incidence and clearance of HPV, and associated risk factors, in the HIP (HPV in Perimenopause) Study, a U.S. clinic-based cohort of women aged 35-60 years old. Next, we measured the quadrivalent vaccine-specific HPV seroprevalence in a population-based, cross-sectional analysis of young, married, postpartum, rural Indian women. Lastly, we evaluated the associations of soy and tea consumption on risk of cervical cancer in a large Singapore population of women aged 45-74. Each of these studies yielded findings of public health significance. First, the majority of new HPV detections in U.S. older women occurred during periods of sexual abstinence or monogamy, lifetime number of sexual partners modified incident HPV risk, and the majority of incident HPV cleared within 18 months. Our findings suggest that although HPV vaccination may provide some protection the overall benefit may be limited and considering a risk-based approach to cervical cancer screening may be valuable. Second, we found that seroprevalence of HPV-6, HPV-11, HPV-16, and HPV-18 was relatively low in the postpartum Indian women, 6.6%, 10.1%, 10.1%, and 3.9%, respectively, suggesting that ‘catchup’ HPV vaccination in this population may be effective in preventing cervical cancer. Third, we found that high soy intake was associated with a decrease cervical cancer risk among Chinese green tea drinkers, but not among non-drinkers of green tea. Developing nutritional interventions utilizing soy and tea components may disrupt cervical carcinogenesis. Further research is needed to continue to develop and implement effective cervical cancer interventions at various points on the cancer continuum.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Paul, Promaprp25@pitt.eduPRP25
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBunker, Clareann H.bunkerc@pitt.eduBUNKERC
Committee MemberButler, Lesley M.butlerl3@upmc.edu
Committee MemberYouk, Ada O.ayouk@pitt.eduAYOUK
Committee MemberRussell, Joanne L.joanner@pitt.eduJOANNER
Date: 12 September 2016
Date Type: Publication
Defense Date: 13 July 2016
Approval Date: 12 September 2016
Submission Date: 14 July 2016
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 145
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: DrPH - Doctor of Public Health
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: cervical cancer, HPV
Date Deposited: 12 Sep 2016 16:38
Last Modified: 15 Nov 2016 14:35
URI: http://d-scholarship.pitt.edu/id/eprint/29045

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