REDUCING SMOKING-RELATED RISK FOR CERVICAL CANCER

13500名美国妇女将在2020年患上宫颈癌。 1992年;另有4,400人将死于宫颈癌。 吸烟会显著增加;如果所有有宫颈癌风险的妇女 癌症戒烟后，发病率可降低近一半。 拟议研究的长期目标是降低发病率 降低妇女吸烟率， 妇女其中一个最重要的可教的时刻，其中建议和 协助妇女戒烟可能是在诊所访问宫颈癌 癌症筛查一个有希望的干预策略是设计 教育讯息强调吸烟对子宫颈癌的风险 癌症，培训医生和护士谁提供巴氏试验提供 在诊所就诊期间提供有效的戒烟咨询， 适合宫颈癌的书面教材 减少风险。 虽然这种方法已经成功实施 在其他情况下，它尚未在宫颈癌的协议中进行测试， 癌症筛查本提案描述了一项探索性研究， 指导开展大规模随机干预试验 旨在减少宫颈癌高危妇女的吸烟率 癌提出了两个有前途的创新。第一，子宫颈样本 将进行可替宁检测，可替宁是暴露于吸烟的生物标志物， 并将在其中一次干预中向妇女传达结果 组第二，这是第一次研究开发和测试 个性化的教育材料， 子宫颈癌的风险。具体目标是1）适应和应用 成功的戒烟策略，从国家癌症研究所申办的试验， 医生发起的咨询，产前戒烟咨询，以及 宫颈癌风险的特殊背景下的自助干预 减少; 2）比较两种咨询的相对有效性 干预措施，其中之一包括检测到的可替宁信息 在宫颈样本中，与对照组。吸烟者从两个 杜克大学医学中心的诊所将被随机分配到 接受1）戒烟咨询，特别针对 宫颈癌风险，2）咨询加个性化反馈可替宁 在宫颈样本中，或3）既没有咨询也没有可替宁反馈。 将对患者进行基线和随访调查， 有关协会的知识、态度和行为的变化 吸烟和宫颈癌之间的关系，风险感知，以及吸烟对宫颈癌的影响。 感知和巴氏试验结果对戒烟意愿的影响。预计退出率 在接受咨询加可替宁反馈的小组中最高， 在对照组中最低;停止也应该与 风险感知和巴氏检查结果。这项研究是一项创新 使用癌症风险教育和咨询的方法，以促进 行为改变和降低癌症风险。最终，这项研究可以 有助于大幅减少宫颈癌，并改善 在预防和控制的卫生保健实践标准中， 宫颈癌和其他与吸烟有关的癌症。

Thirteen thousand five hundred U.S. women will develop cervical cancer in 1992; another 4,400 will die from it. Cervical cancer risk is significantly increased by smoking; if all women at risk for cervical cancer quit smoking, the incidence rate could be reduced by nearly half. The long-term objective of the proposed research is to reduce morbidity and mortality from cervical cancer by reducing smoking prevalence among women. One of the most important teachable moments in which to advise and assist women in quitting smoking may be during clinic visits for cervical cancer screening. A promising intervention strategy is to design educational messages to emphasize smoking-related risk for cervical cancer, train physicians and nurses who provide Pap tests to deliver effective smoking cessation counseling during clinic visits, and use written educational materials adapted to the context of cervical cancer risk reduction. Although this approach has been successfully implemented in other contexts, it has yet to be tested in protocols for cervical cancer screening. This proposal describes an exploratory study which will guide the development of a large-scale randomized intervention trial designed to reduce smoking prevalence among women at risk for cervical cancer. Two promising innovations are proposed. First, cervical samples will be tested for cotinine, which is a biomarker for exposure to smoking, and results will be communicated to women in one of the intervention groups. Second, this is the first research effort to develop and test personalized educational materials designed to communicate smoking-related risk for cervical cancer. The specific aims are to 1) adapt and apply successful smoking cessation strategies from the NCI-sponsored trials in physician-initiated counseling, prenatal smoking cessation counseling, and self-help interventions to the particular context of cervical cancer risk reduction; and 2) compare the relative effectiveness of two counseling interventions, one of which includes information about cotinine detected in cervical samples, with a control group. Smokers recruited from two clinics in the Duke University Medical Center will be randomly assigned to receive either 1) smoking cessation counseling specifically addressing cervical cancer risk, 2) counseling plus personalized feedback on cotinine in cervical samples, or 3) neither counseling nor cotinine feedback. Baseline and follow-up surveys of patients will be conducted to assess changes in knowledge, attitudes and behavior regarding the association between smoking and cervical cancer, perception of risk, and the effect of perceptions and Pap results on readiness to quit. Quit rates are expected to be highest in the group receiving counseling plus cotinine feedback and lowest in the control group; cessation should also be associated with perception of risk and Pap results. This research is an innovative approach to the use of cancer risk education and counseling to facilitate behavior change and reduce cancer risk. Ultimately, this research could contribute to substantial reductions in cervical cancer, and improvements in the standard of health care practice in the prevention and control of cervical and other smoking-related cancers.