SINGLE VISIT CERVICAL CANCER PREVENTION PROGRAM

描述(申请人的描述) 宫颈癌筛查和治疗的障碍被很好地描述了。 宫颈癌的诊断和治疗的一个重要障碍是 对于那些接受巴氏涂片筛查的人来说，失去了随访。 此外，其他障碍包括缺乏教育，基于文化 态度和健康行为，以及社会经济因素。我们 相信通常的宫颈癌筛查诊断和治疗方法 管理层强调了由于失去跟进和这些障碍而产生的问题。 该项目的目标是实施和评估一种创新的癌症 可能彻底改变宫颈癌治疗方法的控制计划 预防。这项研究将确定一次访问的有效性 计划(SVP)，包括诊断和治疗 癌前状态，在降低随访的失败率方面 与常规护理计划(UCP)相比，患有异常巴氏涂片的妇女。 如果成功，拟议的计划将显著降低 巴氏涂片阳性并失去随访机会的妇女，因此 降低浸润性宫颈癌的发病率。此外，该计划还可以 被运送到美国和其他国家的社区 在世界各地，这种恶性肿瘤的发病率和死亡率 都增加了。我们之前已经证明了一种 在我们小组完成的一项试点研究中的一次访问方法表明 我们的方法在二级预防和控制方面是有希望的 子宫颈癌单次访问计划(SVP)由最初的 盆腔检查和巴氏涂片的即刻筛查 由细胞病理学家进行的细胞学分析。所有患者都会收到结果 他们在探视期间的巴氏涂片。此外，被发现患有 重度宫颈发育不良患者行子宫颈电热环切除术 在同一访问期间的变革区。通过结合即刻细胞学 筛查和DLE在同一次就诊中，对患者进行随访的最大障碍 合并宫颈发育不良是可以克服的。这项建议的具体目的 1)实施和评估宫颈癌的一次就诊计划 在为多族裔妇女人口提供服务的诊所进行预防；1a) 规范招聘计划、人员、 病人流动模式和后续计划；1b)建立有效的系统 对于SVP中患者的巴氏涂片解释，将最小化 等待时间；以及，c)招募3520名妇女(西班牙裔和非西班牙裔白人 妇女)，并将她们随机纳入SVP或普通护理计划(UCP)；以及， 2)根据异常巴氏涂片的随访率评估SVP， 患者满意度和成本效益。

DESCRIPTION (Applicant's Description) The barriers to cervix cancer screening and management are well described. A significant barrier to the diagnosis and management of cervical cancer is the loss to follow-up for those who undergo screening using the Pap smear. In addition, other barriers include lack of education, cultural-based attitudes and health behaviors, as well as, socioeconomic factors. We believe that the usual approach to cervix cancer screening diagnosis and management accentuates problems due to loss to follow-up and these barriers. The goal of this project is to implement and evaluate an innovative cancer control program that could revolutionize the approach to cervix cancer prevention. The study will determine the effectiveness of a single-visit program (SVP), including the diagnosis and treatment of patients with premalignant conditions, in decreasing the rate of loss to follow-up of women with abnormal Pap smears in comparison to a Usual Care Program (UCP). If successful, the proposed program will markedly decrease the proportion of women who have positive Pap smears and are lost to follow-up and thereby decrease the rates of invasive cervix cancer. Moreover, the program could be transported to communities in the United States and to other countries around the world where the incidence and mortality rates of this malignancy are increased. We have previously demonstrated the feasibility of a single-visit approach in a pilot study completed by our group that indicates that our approach is promising for the secondary prevention and control of cervix cancer The single-visit program (SVP) consists of an initial screening of patients with pelvic exams and Pap smears with immediate cytological analysis by a cytopathologist. All patients receive the results of their Pap smears during the visit. In addition, patients found to have severe cervix dysplasia undergo diathermy loop excision (DLE) of the transformation zone during the same visit. By combining immediate cytologic screening and DLE in the same visit, most barriers to follow-up for patients with cervix dysplasia can be overcome. The specific aims of this proposal are: 1) implement and evaluate a single-visit program for cervix cancer prevention in clinics serving a multi-ethnic population of women; 1a) standardize the operating procedures regarding recruitment plans, personnel, patient flow patterns, and follow-up plans; 1b) set up an efficient system for Pap smear interpretation for patients in the SVP that will minimize waiting time; and, c) recruit 3,520 women (Hispanic and Non-Hispanic White women) and randomize them into the SVP or a usual care program (UCP); and, 2) evaluate the SVP in terms of follow-up rates for abnormal Pap smears, patient satisfaction, and cost-effectiveness.