Paul, Proma
(2016)
Comprehensive cervical cancer prevention and control: Potential strategies at different stages of cervical cancer progression.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
This is the latest version of this item.
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: |
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| ETD Committee: |
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| 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: |
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: |
01 Sep 2021 05:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/29045 |
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Comprehensive cervical cancer prevention and control: Potential strategies at different stages of cervical cancer progression. (deposited 12 Sep 2016 16:38)
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