Cervical Cancer in Shanxi Province, China

中国山西省的宫颈癌

• 批准号: 7064522
• 负责人: Michele Robin Forman
• 金额: --
• 依托单位: DIVISION OF BASIC SCIENCES - NCI
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7064522
• 关键词: China; cervix neoplasms; clinical research; female; human data; human papillomavirus; medically underserved population; method development; neoplasm /cancer epidemiology; neoplasm /cancer immunology; nutrition aspect of cancer; nutrition related tag; questionnaires; self examination; training

Cancer of the cervix is the third most common cancer in women worldwide and the greatest cancer killer of women in the developing world. Of the estimated 600 women who die each day of cervical cancer, 80% are from the third world where access to adequate cancer screening and therapeutic interventions is limited. Yet we know that all women, who have access to and utilize screening, can be diagnosed and cured at the early stages of cervical intraepithelial neoplasia (CIN). Human Papilloma Virus (HPV) oncogenic subtypes are recognized as the cause of cervical cancer and the Pap smear has been the mainstay of cervical cancer screening. The Pap smear however requires many practical and technical considerations, including: 1) accessibility to health care providers with the necessary skills to perform the specimen collection; 2) trained cytopathologists to evaluate the slides; and 3) a recall system to promptly notify and re-evaluate patients with abnormal results. In rural China, women are not screened for cervical cancer and do not have access to health care providers trained to collect specimens and evaluate them. Indeed, the 1990-1992 age-standardized cervical cancer mortality rates in China were 3.84/100,000 and the highest rates occurred in Shanxi Province (12.4/100,000). Therefore a team of investigators from the Cleveland Clinic, Ohio and from the Cancer Institute, Chinese Academy of Medical Sciences (CICAMS), Beijing, China in collaboration with the National Cancer Institute (CCR) designed a study to compare the sensitivity and specificity of a self-test for HPV in contrast with the direct HPV test among women who have never been screened in Shanxi Province. As part of this overall study, I was responsible for development of an epidemiology and nutritional questionnaire to assess recognized reproductive risk factors and explore the role of diet, infection and family history of cancer on risk of HPV positivity, CIN, and invasive cervical cancer. After completing a pilot study to evaluate the culture-specific dietary food frequency questionnaire, the first (SPOCCS I) of two main studies was completed in 1997 women aged 35-50 years, who were selected from all women in select villages in Shanxi Province in 1999. The study design included an initial session to train women how to collect a cervical specimen using the HPV self-test, followed by the actual specimen collection. Approximately 4 to 12 months later, the women returned for clinical assessment and a fasting blood draw as well as an interviewer-administered epidemiology and dietary food frequency questionnaire. A similarly designed study (SPOCCS II) was conducted in 2002 on 9183 women of the same age range, who were selected from the Province. Research AimsAs part of a study of the sensitivity and specificity of HPV self-test in an unscreened population of women aged 35-50 y, the overall aims are to examine the relation of nutritional status, immunological conditions, and their interaction on risk of the following: HPV +, persistent HPV +, CIN I, II, III and invasive cervical cancer. Specific hypotheses relate to the role of dietary intake of fruits and vegetables rich in folate, isothiocyanates, and other micronutrients with chemopreventive potential and risk of the abovementioned endpoints, while other hypotheses relate to the role of infections as well as the interaction of nutritional status and immunological status on risk.

子宫颈癌是全世界妇女第三大常见癌症，也是发展中国家妇女的最大癌症杀手。据估计，每天有600名妇女死于宫颈癌，其中80%来自第三世界，在那里，获得适当的癌症筛查和治疗干预的机会有限。然而，我们知道，所有妇女，谁可以获得和利用筛查，可以诊断和治愈的早期阶段的宫颈上皮内瘤变（CIN）。人类乳头瘤病毒（HPV）致癌亚型被认为是导致宫颈癌的原因，巴氏涂片一直是宫颈癌筛查的主要方法。然而，巴氏涂片检查需要许多实际和技术方面的考虑，包括：1）获得具有必要技能的卫生保健提供者进行标本采集; 2）训练有素的细胞病理学家评估载玻片; 3）召回系统，以及时通知和重新评估结果异常的患者。在中国农村地区，妇女没有接受宫颈癌筛查，也没有受过收集标本和评估标本培训的卫生保健提供者。实际上，1990-1992年中国年龄标准化宫颈癌死亡率为3.84/10万，山西省死亡率最高（12.4/10万）。因此，来自俄亥俄州克利夫兰诊所和中国医学科学院癌症研究所（CICAMS）的一组研究人员与中国国家癌症研究所（CCR）合作设计了一项研究，在山西省从未接受过筛查的妇女中比较HPV自检与直接HPV检测的敏感性和特异性。作为这项整体研究的一部分，我负责制定流行病学和营养问卷，以评估公认的生殖风险因素，并探讨饮食，感染和癌症家族史对HPV阳性，CIN和浸润性宫颈癌风险的作用。在完成了一项试点研究，以评估特定文化的饮食食物频率问卷，第一（SPOCCS I）的两个主要研究是在1997年完成的妇女年龄在35-50岁，谁是从所有妇女在山西省选定的村庄在1999年。研究设计包括培训女性如何使用HPV自检采集宫颈标本的初始课程，然后是实际标本采集。大约4到12个月后，这些妇女返回进行临床评估和空腹抽血，以及由采访者管理的流行病学和饮食频率问卷。2002年对该省9 183名同龄妇女进行了一项类似的研究（SPOCCS II）。研究目的作为在35-50岁未筛查女性人群中进行HPV自测的敏感性和特异性研究的一部分，总体目标是检查营养状况，免疫状况及其相互作用对以下风险的关系：HPV +，持续性HPV +，CIN I，II，III和浸润性宫颈癌。具体的假设涉及富含叶酸、异硫氰酸盐和其他微量营养素的水果和蔬菜的饮食摄入对上述终点的化学预防潜力和风险的作用，而其他假设涉及感染的作用以及营养状况和免疫状况对风险的相互作用。