Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 48-53). Also available in print.

Thesis (M. Med. Sc.)--University of Hong Kong, 2005.

Thesis (Ph. D.)--University of Texas at Austin, 2005. / Vita. Includes bibliographical references.

Thesis (M. Phil.)--University of Hong Kong, 2006. / Also available online.

Invasive carcinoma of the cervix was compared in women under and over 35 years of age in a 10-year cohort study for the period 1974 - 1983. The aim was to determine if there were any significant differences in disease characteristics and survival. A non-concurrent prospective study design was employed with a follow-up period of at past 5 years. All eligible young patients (n = 82) were studied out of a total patient population of 1522 and compared with a 13% random sample (n = 82) of equally eligible older patients. There were three study losses in each group (3,7%), giving a final comparison number of 79. Patient data included disease stage, treatment type and complications, recurrence time and site and survival time. Tumour pathological characteristics were reviewed and evidence of Human Papillomavirus (HPV) was sought on histology and cytology specimens. Life table analyses were performed on the survival data and compared by the logrank test. The covariates of disease stage, treatment type and tumour type were included in the analysis of the effect of age group on survival. Multivariate analysis with a proportional hazards general linear model was performed for simultaneous control of confounding factors. Other disease characteristics were compared using the Chi-square test. The overall proportion of young women was 11,6%. (This did not change for the period 1984 1988.) Five-year survival was 57% for the young and 46% for the older group (not statistically significant: p = 0,198). There was no statistically significant difference in a number of characteristics, including tumour size, endocervical site, grade or type. There were 8 non-squamous tumours in the young {10%). Residual disease, time to recurrence, rate and site of distant metastasis, and treatment of recurrent tumour did not differ significantly; nor did rate of spread to lymph nodes, adequacy of follow-up or treatment complications. Evidence of HPV was found in 35% of evaluable histology and 21% of malignant cytology. There was no significant excess of HPV in the young group. The same applied to the length of the preinvasive phase and the false negative cytology rate - no significant differences were found. There were significantly more Stage lB tumours in the young group (p = 0,01), surgery was used more often for treatment in young patients (p = 0,027) and the difference in survival between the disease stages was highly significant (p 0,0001). Multivariate analysis showed that the effect of age on survival was non-significant (p = 0,850). The conclusion of the study is that cervical carcinoma in young women is not a different disease with a worse prognosis than in older women. Furthermore, it is not becoming more common in the young locally. Young women tend more often to have early stage disease.

published_or_final_version / Community Medicine / Master / Master of Public Health

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.

published_or_final_version / Pathology / Master / Master of Medical Sciences

published_or_final_version / Pathology / Master / Master of Medical Sciences

published_or_final_version / Pathology / Doctoral / Doctor of Philosophy