Many in the biomedical community have praised the recently released Human Papillomavirus (HPV) vaccine, Gardasil, for having the potential to significantly reduce the disease burden of cervical cancer and genital warts. However, complex intersections of ideology, morality, and politics have made this new vaccine considerably contested, particularly as public debate has turned to the ethics of state-mandated HPV vaccination for 11-12 year old girls. Subsequently, the extent to which mandatory vaccinations are accepted by parents and implications regarding the infringement of these coercive measures on their rights to make health care decisions for their children has become powerfully positioned in public discourse. This research seeks to examine how mothers of girls conceptualize Gardasil and the potential mandates in order to illuminate the multi-faceted socio-cultural context of risk embedded within this immunization. Major themes that emerged from in-depth interviews include diverse perceptions of the risk of HPV for their daughter(s) specifically, children as actual or potential sexual beings, concerns about vaccine safety, mistrust of pharmaceutical companies and government collusion, and conceiving of vaccination against HPV as imbued with a either a moral or cancer prevention subtext. The need for collaboration and communication between the medical and governmental institutions who promote vaccines such as Gardasil and the public who politically and socially consumes them has been apparent throughout my research. Applied anthropologists have a unique role to play by situating diverse stakeholder perspectives across interdisciplinary fields in order to develop more appropriate and informed policies.

Cervical cancer is the primary cause of cancer deaths among Haitian women; however, the social context of cervical cancer among Haitian immigrant women has not been systematically examined. The ways in which women assign meaning to this disease, understand its causality and situate it within the broader context of gynecological health are poorly understood. Further, Haitian immigrant women's perceptions of disease risk, including knowledge and understanding about Human Papillomavirus (HPV), the primary etiologic factor in cervical cancer, have not been explored. Few studies have assessed health behaviors, including culturally mediated feminine hygiene practices, among Haitian immigrant women, which may negatively impact gynecological health. This exploratory study examines these dimensions of gynecological health using ethnographic methods including participant observation, observation, informal and semistructured interviewing and surveys. Ethnographic data contextualize this disease in larger cultural and historical contexts. In addition, these data informed the construction of a 92-item survey, ensuring content validity of the personal questions women were asked about feminine hygiene practices and the agents they use. This survey, administered to 246 women in Little Haiti, Miami, represents an application of medical anthropology to epidemiologic research. Each survey respondent also was evaluated for cytology and sexually transmitted infections (STIs), including HPV, using a self-sampling medical device. Quantitative analysis of survey data indicates that prevalent STIs (Chlamydia) are significantly associated with feminine hygiene practices; however, HPV infection and cervical cancer are not associated with the practices. The practices are likely underreported in the survey sample. Qualitative analysis reveals that women's constructions of gynecological health are inseparable from cultural beliefs that emphasize feminine hygiene. Beliefs guide behaviors, which include vaginal douching and intravaginal washing, using plant-based therapies, imported commercial products and chemical compounds. These practices serve the purpose of not only cleaning, but also drying and tightening the vaginal environment for increased sexual pleasure of male partners. Attempts to preserve relationships, and reduce the chance that partners will take mistresses, occur through maintaining intimate hygiene and, in some cases, by other ethnomedical means.

Cervical cancer is the most common human papilloma virus (HPV) -associated cancer and is the second leading cause of death in the world. Vaccination against HPV is essential to reduce the incidence of HPV and subsequent morbidity and mortality. According to the Centers for Disease Control and Prevention (CDC), approximately 79 million Americans are currently infected with HPV. The site for this DNP project was a 163-bed facility with inpatient and outpatient services in the southern United States. The vaccination rate at the site was 48%. The facility lacked educational interventions to prepare and remind providers to offer HPV vaccine. The purpose of this DNP project was to address a significant gap by increasing clinician knowledge through the development of educational materials, the design and implementation of training sessions for staff, and the development of protocols that require providers to offer the vaccine to every eligible patient and to call the patient and remind them of appointments for vaccine injections. The academic center for evidence-based practice star model was used to translate knowledge into nursing practice to improve outcomes change. For this project, a panel of 10 experts from the facility was formed to conduct a formative and summative evaluation of the educational materials and protocols. The findings of the study showed an acceptance of the plan suggesting the importance of the educational materials and the educational process to increase HPV vaccination rates, which can thereby reduce death and disease associated with HPV through the empowerment of the clinicians to provide necessary and appropriate care.

Cervical cancer incidence in the United States has declined for the past 40 years, yet the odds of developing cervical cancer is much higher among marginalized women, particularly African American and Hispanic American women. Although preventable through vaccination against the human papillomavirus (HPV) prior to infection, uptake and completion rates of the vaccine among African American and Hispanic American women are low. The purpose of the study was to determine if a significant relationship existed between the health literacy levels of African American and Hispanic American women, ages 18-26, and the low HPV vaccination uptake. The integrated behavioral model, which identifies factors antecedent to behavioral intention, as well as the motivating variables, was the theoretical framework. Secondary data from the 2015 National Health Interview Survey were used to examine the relationships among the variables of interest. A logistic regression (n = 2093) showed that health literacy is a strong determinant of HPV vaccine behavior intention, and that there was a significant relationship between health literacy and HPV vaccine initiation. Health literacy mediated the relationships between the motivating variables and the vaccine uptake, and completely mediated the relationship between ethnicity and HPV vaccine uptake. Health literacy did not independently predict the vaccine initiation. The findings from this study might (a) provide public health practitioners with enough information to guide health promotion activities to increase the vaccination coverage to the level expected in Healthy People 2020, (b) save economic resources through cancer prevention, and (c) improve lives by curbing the excess deaths among racial minority women.

India has one of the highest rates of cervical cancer morbidity and mortality globally. Despite this, there are no national or state-wide screening efforts for cervical cancer and its prevention in India. In an effort to understand the magnitude of cervical cancer in Bangalore, India, this research draws upon data collected in hospital contexts over a month-long period to explore the ways in which physician attitudes contribute to understandings of cervical cancer and its prevention in the growing urban context of Bangalore.

Although Grenada has an extensive health care infrastructure and cervical cancer screening rates are relatively high, Grenada also has a disproportionate rate of morbidity and mortality from cervical cancer. The aim of this study was to explore factors that contribute to these disproportionate rates in Grenada. Using a phenomenological qualitative approach, Andersen's behavioral model of health care utilization and a systems based model for assessing care were used as a guide to explore Grenadian women's follow-up experiences with Pap test and cervical cancer screening. Purposive sampling was used to recruit 8 women for semi-structured in-depth interviews. Data were collected on enabling, need, process and quality factors and coded using apriori and open strategies. Results showed that communication strategies used by private practitioners and good interpersonal relationships with nurses enabled follow-up whereas inadequate treatment services, delays in the receipt of test results, and lack of trust in the government clinics were hindrances. This research identified gaps in the follow-up system and is, therefore, significant for the Grenada Ministry of Health to inform planning and restructuring in order to increase system effectiveness. Implications of positive social change include broadening the knowledge base and skill sets of nurses, highlighting strengths of the public system, and identifying target areas for resource allocation. These changes can result in increased workforce efficiency, improved accessibility and quality, a more user-friendly follow-up process and, thus, reduced morbidity and mortality from cervical cancer.

Introduction: Previous literature indicates that foreign-born women have lower rates of cervical cancer testing and higher mortality rates when compared to U.S.-born women. Factors that influence receipt of cervical cancer screening among foreign-born women include acculturation and human papillomavirus (HPV) knowledge. Methods: In this cross-sectional study, the 2007 California Health Interview Survey (CHIS) was used to examine the impact of acculturation on cervical cancer screening and HPV knowledge and the 2000-2008 Surveillance Epidemiology and End Results (SEER) database was used to determine differences in stage of diagnosis and survival time. The study population included a total of 3,603,412 foreign-born and 6,749,557 U.S-born women in the CHIS between the age of 18 to 65 and a total of 10,733 U.S.-born and 5,069 foreign-born women in the SEER database. Logistic regression was used to examine the predictors for cervical cancer screening and Cox’s proportional hazards ratios were used to determine the effect of covariates on survival time. Kaplan-Meier survival analysis generated survival curves. Results: Acculturation levels were positively associated with ever having a Pap test, ever hearing about HPV, knowledge that HPV causes cancer and HPV does not cause AIDS, but not with current receipt of a Pap test, knowledge that HPV can be sexually transmitted and that HPV can go away without treatment. Women with low (0.38, (CI, 0.22, 0.66)) and medium (0.50, (CI, 0.39, 0.81) levels of acculturation were less likely to ever receive a Pap test and less likely to ever hear of HPV compared to highly acculturated women. Foreign-born women had a lower risk of death than U.S.-born women. Conclusions: Despite a reported lower risk of death, foreign-born women, particularly those less acculturated, may benefit from targeted interventions to increase cervical cancer screening utilization and general HPV awareness. / acase@tulane.edu

Cervical cancer remains the third most commonly diagnosed gynecological malignancy in the United States and throughout the world despite being potentially preventable. Patients diagnosed with cervical cancer may develop local recurrence in the cervix and surrounding structures (vaginal apex, parametrial, or paracervical), regional recurrence in pelvic lymph nodes, distant metastasis, or a combination of all. The management of such treatment outcomes has not been subject to rigorous investigation. Therefore, there is a need for studies and clinical trials that focus on decision making to support the choice of the best treatment modality that leads to the minimal number of adverse treatment outcomes. Medical imaging plays a vital role in the initial diagnosis, staging, and guiding treatment decisions for cancer patients. Positron Emission Tomography-Computed Tomography (PET/CT) hybrid scanner has proven to be a primary functional imaging modality in the oncology clinic. A typical oncological application of PET/CT aims to examine the whole body for high tracer uptake as a sign of tumorous lesions or metastasis using 18F-Fluoro-2-deoxy-D-glucose (18F-FDG). This radiopharmaceutical has been proven to be useful for the quantitative determination of regional glucose metabolism localized in the brain, heart, bladder, and, fortunately, in tumors. Currently, 18F-FDG measured on PET is the prominent radiotracer in cancer staging and follow-up imaging. In the –omics1 era, mining data to derive inherent information about a system has influenced the medical field, especially oncological imaging. The process of radiomics involves high throughput analysis of medical images to extract a large number of quantified features that are presented as a decision supporting tool for clinicians in terms of various clinical tasks such as staging, prediction, and prognosis. In recent studies, the focus of radiomics has exceeded the whole-tumor analysis to include the quantification of habitats, sub-regions within the tumor volume defined based on specific criteria, with the intent to investigate the diversity extent of the intratumor heterogeneity as robust descriptors and predictors of clinicopathological factors. The presented work is a retrospective analysis of a cohort consisting of pretreatment Positron Emission Tomography and Computed Tomography (PET/CT) hybrid scans of cervical cancer patients consecutively treated with radiochemotherapy. We extracted radiomic features from the primary cervical tumor volumes, and voxel intensity-based features from tumor habitats to analyze the tumors’ heterogeneity based on 18Flourodeoxyglocuse (18F-FDG) uptake of PET, and Hounsfield Units (HU) of CT to obtain useful tumor information, which might be associated with treatment outcomes. To our knowledge, a limited number of studies have focused on investigating the potential role of radiomic features on cervical cancer PET/CT images. Briefly, the workflow of this study consisted of investigating parameters that might affect radiomic features predictive performance by evaluating the reproducibility of radiomic features extracted from 18F-FDG PET images for segmentation methods, gray levels discretization, and PET reconstruction algorithms. Afterward, we used these features to predict cervical treatment outcomes after radiochemotherapy. Due to the use of human data, this research study acquired the approval of the institutional review board (IRB) at the University of South Florida.

<p>Human Papillomavirus (HPV) is a key factor in the development of cervical cancer. Out of the more than 100 known HPV types 13 are considered oncogenic. In addition to presence of the virus several other factors have been proposed to influence risk of cervical cancer. This thesis focuses on viral load and HLA class II alleles as risk factors for cervical cancer.</p><p>To enable quantification of the most common oncogenic HPV types, a real-time PCR-based assay was developed and evaluated in terms of technical sensitivity and specificity.</p><p>This assay was then employed on archival smears from 457 cases and 552 controls to assess associations between viral load and cervical carcinoma <i>in situ</i> (CIS). Whereas the data indicate a pronounced dose dependent effect of HPV 16 load on the risk of CIS, other HPV types only seem to increase CIS risk at higher viral loads. These effects were observed even when cytology indicated that cells were normal.</p><p>We then investigated viral load as a risk factor for invasive cervical carcinoma (ICC) in a retrospective study comprising 139 cases and 550 controls. Viral load contributed similarly to the risk of ICC as to the risk of CIS.</p><p>Finally, associations between HLA class II alleles, viral load and CIS were investigated. Carriers of the DRB1*1301 allele were less prone to infections and high viral loads of HPV 31 and -18/45. Moreover, DRB1*1301 had a protective effect against CIS among women infected by HPV 31 or -18/45. In contrast, carriers of DRB1*1501 and DQB1*0602 were more susceptible to infections and high viral loads of HPV 16.</p><p>These results indicate that HPV load may have HPV-type specific effects on cervical cancer risk. Furthermore, HLA class II alleles may confer either susceptibility or protection against cervical cancer by acting on the HPV infections preceding tumor development.</p>

<p>Cervical cancer is a multifactorial disease. Infection by oncogenic types of the human papillomavirus (HPV) is the major environmental risk factor and host genetic susceptibility also influences disease development. </p><p>The aim of this thesis is to identify and analyse risk genes involved in the genetic predisposition to cervical carcinoma. A unique and extensive population-based affected sib-pair (ASP) material and a large case-control sample were used in the investigations.</p><p>In paper I the human leukocyte antigen (HLA) class II DQB1 and DRB1 loci are confirmed, for the first time in a family-based material, as genetic susceptibility factors for cervical cancer. It is also proposed that the HLA class II DPB1 locus independently contributes to risk of developing disease. In addition, no evidence is found for an involvement of the class I HLA-B and HLA-A loci in the genetic predisposition. Paper II conclude that the Fas receptor –670 single nucleotide polymorphism (SNP) do not have a major impact on the susceptibility to cervical carcinoma <i>in situ</i> in the Swedish population. In paper III we show that interactions between the HPV16 E6 gene subtype and host HLA class II genotype potentially occur during infection and disease progression. Paper IV suggests that three chromosomal regions, 9q32, 12q24 and 16q24, contain risk factors of low to moderate effects on cervical cancer development. In paper V linkage signals are further identified between a 9q32 gene encoding the thymic stromal co-transporter (TSCOT) and the disease in ASPs with mean age over 30.5 years at diagnosis within the sib-pair.</p><p>These findings are important contributions towards understanding more about the aetiology of this complex cancer. The identification of new susceptibility regions opens up for further characterisation, replication and candidate gene analysis.</p>