Background. Cervical cancer is a common female cancer in Hong Kong. Cervical screening has been used in detecting cervical lesions for several decades. Given that human papillomavirus (HPV) infection is the etiological cause of cervical cancer, highly efficacious HPV vaccines are recently developed for preventing against HPV infection. Hong Kong has a well-developed healthcare system but relatively high cervical cancer incidence compared to other developed countries partly due to its suboptimal cervical screening program. This highlights the significance to evaluate the potential of implementing organized HPV vaccination programs for further reducing cervical cancer burden on top of cervical screening in Hong Kong. Methods. Cross-sectional, population-based surveys were conducted to assess the acceptability of female adolescent HPV vaccination among girls from secondary schools in 2008 and among mothers of adolescent daughters in 2008 and 2012. Mathematical model with transmission dynamic and stochastic individual-based components was constructed to model the natural history of HPV infection and cervical cancer and thus to project the public health and economic impacts of organized female adolescent HPV vaccination programs in a societal perspective. The model used Markov Chain Monte Carlo algorithm to estimate natural history parameters of HPV infection and probabilistic sensitivity analysis to consider the uncertainty of costs and health utilities in the economic evaluation of organized HPV vaccination. Results. Reported vaccine uptake among11–18 year-old girls increased from 2.4% among schoolgirls in 2008 to 9.1% among daughters of interviewed mothers in 2012. Among interviewed mothers, 27.5% and 37.6% of them were willing to have their daughters vaccinated at market price in 2008 and 2012, respectively. The mathematical model projected that HPV prevalence decreased soon after mass HPV vaccination and vaccine-induced cervical cancer reduction became obvious after vaccination programs have been launched for 30 years. If HPV vaccinesprovided30-year protection, the median incremental cost-effectiveness ratio (ICER) of routine HPV vaccination programs for 12 year-old girls at 25–75% vaccination coverage was US$26,367–32,527 per quality-adjusted life-year (QALY). The median ICER was above US$48,000/QALY if adding 2-year catch-up program for13–18 year-old girls and above US$58,000/QALY if vaccines protect against HPV infection for only 15 years. Conclusions. This study presented the first evaluation of organized HPV vaccination programs in Hong Kong. If vaccine protection lasted for 30 years or longer, organized routine HPV vaccination for 12 year-old girls would potentially be a cost-effective add-on in substantially reducing cervical cancers and HPV-related diseases on top of cervical screening in Hong Kong at an ICER threshold of US$33,218/QALY. However, the current estimated vaccine uptake was unexpectedly low and vaccine acceptability was only moderate. The findings indicated the importance to devise efficient strategies in achieving high and universal coverage for maximizing the population-level benefits of HPV vaccination. Policymakers should consider integrating the organized HPV vaccination programs with existing infrastructures to promote higher acceptability, to translate willingness to vaccinate to actual uptake, to assess population effectiveness, and to monitor safety issue and potential replacement effect of non-vaccine targeted HPV types following mass vaccination. / published_or_final_version / Public Health / Doctoral / Doctor of Philosophy

published_or_final_version / Surgery / Master / Master of Surgery

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.

No description available.

This thesis is concerned with cervical cancer amongst New Zealand women, particularly Maori women. Maori women have an alarmingly high incidence of cervical cancer, approximately three times higher than non-Maori women. Maori women experience one of the highest rates of cervical cancer in the world. Chapter one, two and three form the introductory section of the thesis, Section A. Chapter one provides an overview of cervical cancer incidence in the world, followed by a more detailed analysis of the occurrence of cervical cancer in New Zealand and a discussion of the aetiological factors of cervical cancer. Cervical screening is discussed in Chapter two. The ethnic differences in incidence and mortality of cervical cancer between Maori and non-Maori and possible reasons for these differences are studied in Chapter three. Section B consists of the original work undertaken. A pilot study (Chapter four) was conducted to trial the methods for the national study (Chapter five). The national study was a retrospective review of the cervical smear histories of Maori women first diagnosed with invasive cervical cancer over a recent two year period in order to investigate why Maori women have not had their disease detected by screening and treated at the intraepithelial stage. Maori women�s knowledge of and attitudes towards cervical screening were obtained in a survey in Ruatoria (Chapter six). Section C concludes with a chapter (Chapter seven) on the conclusions and recommendations based on the material reviewed and the work undertaken.

Thesis (Ph.D.)--Kent State University, 2007. / Title from PDF t.p. (viewed Mar. 11, 2009). Advisor: Angelo L. DeLucia. Keywords: human papillomavirus, E6 oncogene, lignan, p53, apoptosis. Includes bibliographical references (p. 132-144).

Thesis (Ph. D.)--University of Texas at Austin, 2004. / Supervisor: Rebecca Richards-Kortum. Vita. Includes bibliographical references. Also available from UMI.

Thesis (Ph. D.)--Lehigh University, 2002. / Includes vita. Includes bibliographical references (leaves 112-125).

Thesis (Ph. D.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 226-240). Available also in a digital version from Dissertation Abstracts.