A Multidisciplinary Approach to Understanding the Role of Social, Economic, and Immunological Factors in Cervical Cancer: Defining Parameters for an Innovative Cancer Control Strategy
Team Leader:
Sue J. Goldie, M.D., M.P.H.,
Harvard School of Public Health
Key Investigators:
Paul Farmer, M.D., Ph.D., Harvard University;
Thomas C. Wright, Jr., M.D.,
Columbia University College of Physicians & Surgeons
Team Disciplines:
Decision Science, Gynecology-Pathology, Anthropology
Abstract
Haiti has among the highest rates of cervical cancer in the world. While screening for cervical cancer has been one of the most successful public health interventions in countries with sufficient resources to implement Pap smear programs, it has not been feasible in developing countries such as Haiti where more than 90% of cervical cancer deaths now occur. New screening options as well as vaccination against human papillomavirus (HPV), which is now recognized to cause cervical cancer, may eventually impact cervical cancer rates in these countries. However, in order for these interventions to be effective we need to have a better understanding of the immunobiology of HPV in disadvantaged women at highest risk for developing cancer, identify the impact of modifiable factors on expression of disease, and create an analytic framework in which this information can be formally synthesized, translated, and applied to the development of community-based interventions to reduce morbidity and mortality from cervical cancer. We propose to use a cross-disciplinary approach incorporating experts from the fields of clinical medicine, anthropology, and decision science to accomplish the following specific aims:
- To evaluate rates of persistent and incident high-risk types of HPV infection in a cohort of Haitian women between the ages of 30 and 65;
- To evaluate possible variables associated with HPV persistence by assessing biological parameters, socioeconomic factors, and clinical characteristics in this cohort of older Haitian women; and
- To develop a comprehensive epidemiologic model and decision-analytic policy model to assist in the design of the intervention trial, operational planning, and assessment of appropriate clinical study endpoints, operational planning, programmatic evaluation, and extrapolation of results to other populations.
Ultimately, this model will serve as a durable tool with which to evaluate the cost-effectiveness of novel multi-component interventions to reduce the persistence of HPV and project the long-term population-based benefits on cervical cancer reduction. Integration of an anthropological and ethnographic approach into this planning grant will allow us to assess the impact of sexual behavior on HPV persistence and insure that a culturally acceptable and ethical design is developed for the subsequent randomized intervention trial. A better understanding of the biologic, clinical and social determinants of HPV persistence will be relevant for scientists and clinical researchers involved in a wide range of cervical cancer activities, ranging from planning for cervical cancer screening programs to the development of an effective HPV vaccination.