Abstract Epidemiological and experimental studies indicate a causative role of viruses in malignancies. Recently, a link between bacterial infections and the development of cancer has been suggested. The purpose of this study was to evaluate the association between chlamydial infection and cancer. The association between C. trachomatis infection and cervix cancer was analysed in a prospective study. The presence of IgG antibodies to C. trachomatis and C. pneumoniae was determined from the serum samples of 182 Nordic women with invasive cervical carcinoma and 538 matched cancer-free controls by the microimmunofluorescence (MIF) method. Serum antibodies to C. trachomatis were associated with an increased risk for cervical squamous cell carcinoma (SCC) (OR 2.2, 95% CI 1.3-3.5), but not for cervical adenocarcinoma (OR 0.4, 95% CI 0.1-1.7). C. trachomatis serotype G was highly significantly associated with an increased risk for SCC (adjusted OR 6.6, 95% CI 1.6-27). The presence of serum IgG antibodies to more than one serotype of C. trachomatis, on the other hand, also increased the risk of SCC. The association between C. pneumoniae infection and lung cancer was analysed separately in men and women. C. pneumoniae-specific antibodies and immune complexes (IC) were analysed from 230 Finnish smoking males with lung cancer and their matched controls using serum samples collected before the lung cancer diagnosis. Suggestive chronic C. pneumoniae infection was associated with an increased risk for lung cancer (OR 1.6; 95% CI 1.0-2.3). The risk was increased especially in men younger than 60 years (OR 2.9; 95% CI 1.5-5.4), but not in the older age group (OR 0.9; 95% CI 0.5-1.6). Chlamydial antibodies and chlamydia-specific ICs were analysed from serum samples of 29 Finnish women with lung cancer and 87 matched cancer-free controls by MIF. The mean follow-up from serum sampling to cancer diagnosis was 6.7 years. IgG class antibodies to C. pneumoniae were common in pregnant Finnish women (66% among cases, 62% among controls), whereas IC-bound C. pneumoniae IgG antibodies were rare. No additional risk for lung cancer in association with chlamydial antibodies was found among women. The association between chlamydial infections and lymphomas was evaluated in a cross-sectional study. Seventy-two lymphoma patients from Tampere University Hospital and 72 matched controls were selected, and IgG antibodies and ICs to C. pneumoniae and C. trachomatis were analysed from their serum samples by MIF and enzyme immunoassay (EIA). The serological markers suggesting chronic chlamydial infection were associated with an increased risk for malignant lymphoma. The association was most evident for the presence of C. pneumoniae-specific ICs in non-Hodgkin's lymphoma (OR = 7.3, 95% CI 2.2-25) and appeared to be limited to men. Infection with C. trachomatis was found to increase the risk of subsequent development of invasive cervical SCC. Chronic C. pneumoniae infection was also found to be a new independent risk factor for lung cancer in males. Serological markers suggestive of chronic chlamydial infection were associated with lymphomas, proposing that chlamydial infection may have a similar role as H. pylori in the pathogenesis of lymphomas.

>Magister Scientiae - MSc / Cervical cancer is the leading cause of cancer mortality among black women in South Africa. It is estimated that this disease kills approximately 8 women in South Africa every day. Cervical cancer is caused by the human papillomavirus (HPV) with the most common screening method for cervical cancer being Papanicolaou (Pap) smear, test amongst others. However, less than 20% of South African women go for these tests. There are several reasons why women do not go for these tests but the invasiveness of the test is one of the major causes for the low rate of screening. Lateral flow devices offer medical diagnosis at the point- of-care, allowing for the quick initiation of the appropriate therapeutic response. These tests are more cost-effective for the healthcare delivery industry, and can potentially be used by patients to self-test in the privacy of their homes and allow them to make informed decisions about their health. Therefore, the aim of this study was to use computational methods to identify serum biomarkers for cervical cancer that can be used to develop a point-of-care diagnostic device for cervical cancer. An in silico approach was used to identify genes implicated in the initiation and development of cervical cancer. Several bioinformatics tools were employed to extract a list of genes from publicly available cancer repositories. Multiple gene enrichment analysis tools were employed to analyze the selected candidate genes. Through this pipeline, ~28190 genes were identified from the various databases and were further refined to only 10 genes. The 10 genes were identified as potential cervical cancer biomarkers. A subcellular compartmentalization analysis clustered the proteins encoded by these genes as cell surface, secretory granules and extracellular space/matrix proteins. The selected candidate genes were predicted to be specific for cervical cancer tissue in a cancer tissue specificity meta-analysis study. The expression levels of the candidate genes were compared relative to each other and a graph constructed using gene expression data generated by GeneHub-GEPIS and TiGER databases. Further gene enrichment analysis was performed such as protein-protein interactions, transcription factor analysis, pathway analysis and co-expression analysis, with 9 out of the10 of the candidate genes showing co-expression. A gene expression analysis done on cervical cancer cell lines, other cancer cell lines and normal fibroblast cell line revealed differential expression of the candidate genes. Three candidate genes were significantly expressed in cervical cancer, while the seven remaining genes showed over expression in other cancer types. The study serves as basis for future investigations to diagnosis of cervical cancer, as well as for cancers. Thus, they could also serve as potential drug targets for cancer therapeutics and diagnostics.

Objective: To determine the general and genotype-specific prevalence of HPV and to identify potential risk factors for the infection in a population-based screening of Peruvian women. Results: A total of 524 samples were analyzed by PCR and a total of 100 HPV positive samples were found, of which 89 were high-risk, 19 were probably oncogenic, 9 were low-risk and 27 other HPV types. The 26–35 and 36–45 age groups showed the highest proportion of HPV positive samples with a total of 37% (37/100) and 30% (30/100), respectively. Moreover, high-risk HPV was found in 33.7% of both groups and probably oncogenic HPV in 52.6% and 31.6%, respectively. High-risk HPV were the most frequent types identified in the population studied, being HPV-52, HPV-31 and HPV-16 the most commonly detected with 17.6%, 15.7% y 12.9%, respectively. Demographic characteristics and habits were assessed in the studied population. A total of 62% high-risk HPV were detected in married/cohabiting women. Women with two children showed the highest proportion (33.8%) of high-risk HPV, followed by women with only one child (26.9%). Those women without history of abortion had a higher frequency of high-risk HPV (71.9%), followed by those with one abortion (25.8%). / Revisión por pares

BACKGROUND: Cervical cancer is one of the most common forms of gynecologic cancers both in the United States and worldwide. The morbidity and mortality associated with cervical cancer has decreased significantly with the development of effective screening for cervical cancer.1 However, refugee women in the United States are often impacted by the disparities in health care and experience increased risk of adverse health outcomes. LITERATURE REVIEW: Current research finds that refugee women in the United States often receive inadequate sexual and reproductive health services, including Pap smears for cervical cancer screening. This disparity leads to a higher burden of preventable morbidity and mortality. For refugee populations, numerous barriers to access have been identified including language, financial, and cultural barriers. Previous studies have identified that refugee women may have limited experience with preventative health care or confront cultural barriers in accessing sexual and reproductive health services. Further research must be done to study barriers to accessing cervical cancer screening among specific populations of refugee women. METHODS AND INTERVENTION: This study proposes to interview Iraqi, Bhutanese, and Somali refugee women in the greater-Boston area in order to better characterize experiences and understanding of cervical cancer screening. Investigators will conduct semi-structured interviews to collect narrative data, which will then be analyzed using qualitative analysis software to identify major themes. CONCLUSION: This study will seek to characterize perceptions and experiences of cervical cancer screening services among female refugees in the greater-Boston area. Limitations of this study include lack of generalizability and question-order bias. SIGNIFICANCE: The goal of characterizing barriers to access affecting refugee women in the greater-Boston community is to inform development of more effective public health interventions that will be targeted to the specific needs of local refugee populations. Efforts to increase uptake of cervical cancer screening services could result in decreased morbidity and mortality from cervical cancer for a vulnerable sector of the population.

Background: Cervical cancer is the most common gynecological malignant disorder worldwide. Activated platelets play a key role in cancer development and progression. Mean platelet volume (MPV) is an early indicator of platelet activation. The aim of the present study was to evaluate MPV levels in patients with cervical cancer. Materials and methods: A total of 181 patients with cervical cancer and 181 controls between January 2015 and June 2015 were included in the study. Patient characteristics and hematologic test data at initial diagnosis were collected and odds ratios (ORs) and 95% confidence intervals (CIs) for risk of cervical cancer were calculated using multivariate logistic regression analyses across MPV quartiles. Results: MPV levels were decreased in patients with cervical cancer compared with control subjects. A significant correlation between MPV and FIGO stage was found. Moreover, after adjusting for other risk factors, the ORs (95%CIs) for cervical cancer according to MPV quartiles were 4.450 (1.975-10.026), 2.505 (1.206-5.202), 0.573 (0.261-1.259), and 1.000, respectively. Conclusions: MPV was found to be independently associated with the presence of cervical cancer. Our results suggest that MPV could be potential diagnostic screening tool.

Indiana University-Purdue University Indianapolis (IUPUI) / Women who are medically underserved may be less likely to obtain provider-based cervical cancer screening because of structural and intrapersonal barriers. Self-collection for human papillomavirus (HPV) testing, a method for women to collect their own sample through a vaginal swab or urine collection, has accuracy comparable to provider-based cervico-vaginal HPV testing and may be useful in overcoming barriers to provider-based cervical cancer screening. The purpose of this dissertation study is to examine factors associated with self-collection for HPV testing, psychometrically test Diffusion of Innovations (DOI) instruments, and identify preferences for self-collection for HPV testing. Three distinct aims were developed: 1) factors (sociodemographic, health-related, and theoretical variables) associated with mailed return of vaginal self-collection for HPV testing, 2) psychometric examination of DOI ÷instruments (relative advantages and complexity), and 3) dimensions of self-collection and characteristic preferences to self-collection for HPV testing stratified by age cohorts. This dissertation involved two cross-sectional studies. In Chapters 2-3, data were collected from women (n=168) at food pantries and online. Women were eligible if they were: 1) female, 2) between the ages of 30-65, 3) could read and speak English, and 4) at 2019 federal poverty guidelines for income and family size as defined by the Department of Health and Human Services. Women were not eligible if they had a history of hysterectomy or were adherent to cervical cancer screening guidelines. Logistic regression analyses, item analysis, Cronbach’s alpha, exploratory factor analysis, and tests were used to analyze data. Chapter 4 involved collection of data from an online survey with a sample (n=878) provided by Dynata. Participants evaluated 9 scenarios that varied along 4 attributes: HPV self-collection kit type (vaginal swab or urine collection), HPV self-collection kit delivery (mail, pharmacy pick-up, or clinic pick-up), HPV self-collection kit return (mail, pharmacy drop-off, or clinic drop-off), and HPV test result communication (mail, phone call, or text message). Ratings-based conjoint analysis (RBCA) determined how each attribute influenced the ratings of each scenario.

Thesis (M.S.)--Boston University, 1956 / This thesis represents one part of a group study conducted jointly by four Boston University social work students. The purpose of this group study is to examine first same of the social and emotional factors that affect the rehabilitation of cancer patients, and second, the role of social service in this rehabilitation. The study is based on the cases comprising the Harvard Medical School project.

BACKGROUND: Cervical cancer is one of the most common forms of gynecologic malignancies worldwide with increased incidence in lower income countries. Bolivia, a lower-income country, experiences high rates of morbidity and mortality related to cervical cancer. The increased incidence is a multifactorial issue that includes low cervical cancer literacy, barriers to healthcare access, and poor follow-up rates. LITERATURE REVIEW FINDINGS: The current research finds that Bolivia's fragmented healthcare system has significantly influenced the country’s high cervical cancer burden. Women often receive inadequate sexual and reproductive health services that has led to a higher incidence of preventable morbidity and mortality. Previous research, however, has shown that the implementation of HPV self-screening and use of point of care testing are effective interventions in rural areas of Bolivia to increase screening. In addition, studies have shown that vaccination of school aged children utilizing a school-based model is another promising intervention in hopes of lowering the country’s burden of disease. Lack of cervical health knowledge in rural areas of Bolivia is another finding. Previous research has proposed that community education and optimization of cervical cancer knowledge can have a great impact on screening. METHODS: The study proposes to conduct an interventional study. The study will initially seek to implement an education intervention to improve the knowledge and understanding of cervical health for school aged and adult women in a single school district of rural Cochabamba, Bolivia. Phase I and II of the study will then aim to implement a vaccination campaign and an HPV self-screening program with point of care testing in the same school district. CONCLUSION: This study will seek to implement an HPV- self screening program and a vaccination campaign in rural Cochabamba, Bolivia through a multidisciplinary approach which involves vaccination, screening, and community education. Limitations of the proposed study includes lack of generalizability, time constraints, and financial constraints. SIGNIFICANCE: Cervical cancer is highly preventable through adequate screening and prophylaxis with vaccination. The goals of the study will seek to implement affordable and easily accessible screening methods and vaccination for a population in rural Bolivia to ultimately improve screening rates and follow up care. Efforts to increase screening in this population can lead to decreased rates of mortality and morbidity from cervical cancer in vulnerable, resource limited countries.

Thesis (MPA.) -- University of Limpopo, 2018 / Background: Cancer of the cervix is the fourth most common cancer affecting women worldwide and is currently considered as a sexually transmitted cancer. This type of cancer is caused in most cases by a viral infection, Human Papilloma Virus (HPV) strains 16 and 18. Cervical screening aims to prevent invasive cervical carcinoma by detection and treatment of its precursors cervical intraepithelial neoplasia grade 2 (CIN2) and, particularly, grade 3 (CIN3). The current study aimed at determining the distribution of cervical cancer and the association of cervical cancer with HIV infection in Limpopo Province. Methods: The current study used quantitative retrospective method to systematically review the available data on Papanicolaou (Pap) smears from National Health Laboratory Services at Polokwane hospital from the year 2013 to 2015. The data was kept anonymously by not using the names of the patients and ethical clearance was received from the Turfloop Research Committee of University of Limpopo in consideration of section 14, 15, 16, and 17 of National Health Act 61 of 2004. The data was exported to excel spreadsheet and cleaned before exported into SPSS 23.0 software which was used for data analysis. Results: The findings from the current study show a decline of 33% in the number of Pap smears that were submitted for cytology between 2013 (82 041) and 2015 (23 527) in Limpopo province. However, the study revealed that there is an increase in prevalence of cervical cancer from 16.7% in 2013 to 19.2% in 2015 in Limpopo Province. In the same period this rural province already demonstrates a high burden of cervical cancer among the middle aged women. The positive cervical smears were classified as cervical intraepithelial neoplasia (CIN) I, II, or III and therefore, 78.5% were CIN I, 21% CIN II and 0,5% CIN III. HIV infections have been found to be associated with cervical cancer as the prevalence of cervical cancer among HIV positive women was found to be 25% and most of the affected women are the middle aged group. vi Conclusion: The screening coverage for cervical cancer has decreased in Limpopo Province but the prevalence of cervical cancer has increased by 2.5% therefore, this translates to the need for community awareness about prevention of cervical cancer. Majority of the cases were classified as CIN 1 at 78.5% which can be cured if treatment started early. The Limpopo Province should therefore strengthen strategies to integrate HIV and cervical cancer services as it was found that there is a strong association between the HIV and cervical cancer.

Cervical cancer is the fifth most common cancer in United States with more than 12,000 women diagnosed each year and more than 4,000 preventable deaths with minorities disproportionally represented. Cervical cancer prevention strategies rarely focus on the management of abnormal screening results. The purpose of this quality improvement project was to standardize the management program for abnormal cervical cancer screening results within an integrated health delivery system serving a large minority community. The Plan-Do-Study-Act model guided a comprehensive program evaluation with process improvement, including the creation of an electronic quality data reporting tool to formalize the work process and a quality control and assurance program with exception reports. The evaluation was completed with data to measure the timeliness of abnormal results outreach and continued clinical management. The data were evaluated over time with run charts. Also, an analysis of the data was done through pre- and post-test comparisons with 2-sample t tests to evaluate abnormal cervical cancer screening management before and after the revisions. Although the project did not show a statistically significant difference in the timeliness of outreach and follow-up of abnormal cervical cancer screening results due to the limited data set, the run charts trended positively for timeliness and consistent data reporting with no missed screening reports. Effective cervical cancer screening includes the accurate and timely management of abnormal results to reduce disparities in cervical cancer deaths. This project contributes to positive social change by responding to the Healthy People 2020 goal to reduce the incidence of cervical cancer deaths through a formal process to insure timely intervention for abnormal results in a largely minority community.