Lorenzato, Felipe Rinald Barbosa; (2001) Cervical cancer prevention and the role of human papilloma virus. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Cervical cancer is the second most common cancer in women worldwide and the highest incidence is found in Recife, Brazil. This thesis investigates the relationship between various local risk factors in Recife, including the sexually transmitted infection of high-risk human papillomavirus (HR HPV) types, age of first sexual intercourse and first pregnancy, number of sexual partners, the male factor, effect of hormonal status, methods of contraception, smoking habits and education status. Two methods of HR HPV detection were evaluated. These were the Hybrid Capture I assay which was available commercially at the start of the PhD project in 1997 and a technique previously developed in UCL involving polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). The association between individual risk factors and cervical lesions presenting with different cytological grades (ASCUS, mild dyskaryosis, moderate dyskaryosis, severe dyskaryosis and cancer) and histological grades (cervicitis, cervical intraepithelial neoplasia grades 1, 2 and 3 and cancer) was also investigated. Infection with HR HPV was found to be the major risk factor for cervical cancer in Recife as is the case worldwide. Poor socio-economical conditions, poor education and an inadequate cytological screening system also contributed to the high incidence of cervical cancer. The results presented in this thesis show that, relative to cytological screening, HR HPV detection by PCR/RFLP provides greater accuracy in the identification of women with risk to have cervical neoplasia, simpler specimen manipulation, no requirement for subjective interpretative skills and lower unit cost. In addition, the test increases coverage for all eligible women as it can be carried out safely during pregnancy when most women will attend at least one antenatal visit. The potentials and the problems of self-sampling as a means of further increasing coverage of the at risk population were also investigated. A cost-effective protocol is proposed based on HR HPV detection for the early identification of women in Recife with or at increased risk of developing cervical precancer and cancer.

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