Cervical Cancer in Shanxi Province, China

中国山西省的宫颈癌

• 批准号: 7291917
• 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/7291917
• 关键词: Cervical; Cancer; Shanxi; Province; China

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.

子宫颈癌是世界上第三大最常见的女性癌症，也是发展中国家女性最大的癌症杀手。在估计每天死于宫颈癌的600名妇女中，80%来自第三世界，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，所有有机会并利用筛查的妇女都可以在宫颈上皮内瘤变（CIN）的早期阶段得到诊断和治愈。人类乳头状瘤病毒（HPV）致癌亚型被认为是子宫颈癌的病因，巴氏涂片检查一直是子宫颈癌筛查的主要方法。然而，子宫颈抹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来进行标本收集；2)训练细胞病理学家评估载玻片；3)建立召回制度，及时通知并重新评估结果异常的患者。在中国农村，妇女没有接受宫颈癌筛查，也没有机会获得接受过标本收集和评估培训的保健提供者的服务。事实上，1990-1992年中国年龄标准化宫颈癌死亡率为3.84/10万，最高的是山西省（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）与中国国家癌症研究所（CCR）合作的一组研究人员设计了一项研究，在山西省从未接受过HPV筛查的女性中，比较HPV自我检测与直接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调查问卷，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。在完成了一项评估文化特异性膳食食物频率问卷的试点研究后，1997年完成了两项主要研究中的第一项（SPOCCS I），这些研究于1999年从山西省选定村庄的所有妇女中选出35-50岁的妇女。研究设计包括一个初始阶段，培训妇女如何使用HPV自检收集宫颈标本，然后实际收集标本。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，以及访谈者管理的流行病学和饮食食物频率问卷。2002年对从该省选出的9183名相同年龄范围的妇女进行了一项设计类似的研究（SPOCCS II）。研究目的：作为未筛查的35-50岁女性人群中HPV自我检测的敏感性和特异性研究的一部分，总体目的是研究营养状况、免疫状况及其与以下风险的关系：HPV +、持续性HPV +、CIN I、II、III和浸润性宫颈癌。具体假设涉及饮食中摄入富含叶酸、异硫氰酸酯和其他具有化学预防潜力和上述终点风险的微量营养素的水果和蔬菜的作用，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。