CERVICAL CANCER SCREENING IN OLDER WOMEN

描述（申请人描述）：乔治F。Sawaya，医学博士是一 妇产科系的全职教员， 生殖科学在加州大学，旧金山弗朗西斯科（UCSF）。 博士Sawaya的主要兴趣是循证医学，特别是 与女性健康有关。 他最近完成了一项为期两年的研究 流行病学生物统计学和研究设计 具体地说， 他对老年妇女的子宫颈癌检查很感兴趣。 他是 致力于女性健康的学术事业。 该提案有四个具体目标：1）确定 子宫颈细胞检验预防妇女浸润性子宫颈癌 > 60，2）确定依从性和疾病特征的差异 > 60岁的妇女与<60岁的妇女之间诊断为浸润性宫颈癌 3）厘定每年子宫颈细胞检验的发病率 绝经后妇女的异常，和4）确定风险因素， 包括使用荷尔蒙替代疗法，以进行子宫颈细胞检验 绝经后妇女的异常。 前两个目标将会实现 通过分析凯萨永久宫颈癌项目的数据。 这 资料库载有649名被诊断患有子宫颈癌的妇女的子宫颈细胞检验资料。 在1988 - 1994年期间，有130名患者患有浸润性宫颈癌，其中年龄在60岁及以上。 使用该数据集的两项研究旨在提供以下信息 依从性、疾病特征和提供的保护方面的差异 在老年妇女和年轻妇女之间进行子宫颈涂片检查。 的 第二和第三个目标将通过分析现有的数据来实现， 心脏雌激素-孕酮研究，一项随机、安慰剂对照试验， 激素替代疗法（HRT）在2763绝经后妇女。 所有妇女 在试验开始时子宫颈涂片检查正常，并每年进行一次筛查。 确定该人群中涂片异常的发生率， 这对筛查方案的成本效益和决策分析至关重要。 确定风险因素将有助于进行更有针对性的筛查， 减少假阳性涂片。 此外，HRT的独立风险将是 评估。 博士萨瓦亚组建了一个多学科的团队， 赞助商对他的研究计划充满热情，并承诺 他成功完成了这个项目。 他们致力于协助 他的目标是成为一名优秀的临床研究员。

DESCRIPTION (Applicant's Description): George F. Sawaya, M.D. is a full-time faculty member in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco (UCSF). Dr. Sawaya's main interest is in evidence-based medicine, especially as it pertains to women's health. He has recently completed a two-year fellowship in epidemiology, biostatistics and research design at UCSF. Specifically, he is interested in cervical cancer screening in older women. He is strongly committed to an academic career in women's health. This proposal has four specific aims: 1) to determine the efficacy of cervical smear screening in preventing invasive cervical cancer in women >60, 2) to determine differences in compliance and disease characteristics between women >60 compared to women <60 diagnosed with invasive cervical cancer, 3) to d e t e r mine the annual incidence of cervical smear abnormalities in postmenopausal women, and 4) to determine risk factors, including use of hormonal replacement therapy, for developing cervical smear abnormalities in postmenopausal women. The first two aims will be achieved by analyzing data from the Kaiser Permanente Cervical Cancer Project. This database contains cervical smear information on 649 women diagnosed with invasive cervical cancer from 1988-1994, 130 of whom are aged 60 and older. The two studies using this dataset are designed to provide information on differences in compliance, disease characteristics and protection afforded by cervical smear screening between older women and younger women. The second and third aims will be achieved by analyzing existing data from the Heart Estrogen-progestin Study, a randomized, placebo-controlled trial of hormonal replacement therapy (HRT) in 2763 postmenopausal women. All women had normal cervical smears at trial entry and are screened annually. Determination of the incidence of smear abnormalities in this population is crucial to cost-effectiveness and decision analyses of screening protocols. Identification of risk factors would allow for more targeted screening and fewer false positive smears. Moreover, the independent risk of HRT will be assessed. Dr. Sawaya has assembled a multidisciplinary team of nationally-known sponsors who are enthusiastic about his research plan and are committed to his successful completion of this project. They are dedicated to assisting him in achieving his goal of becoming an excellent clinical investigator.