Imaging Studies - Cervical: SPECTROSCOPIC IMAGING AND DIAGNOSIS OF CERVICAL NEOPLASIA

PRINCIPAL INVESTIGATOR: Dr. Elizabeth Stier

Women with an abnormal cervical pap test are referred for colposcopic examination with possible biopsy to diagnose precancerous changes in the cervix. This study aims to develop an optical device, using spectroscopy techniques, for making these diagnoses. Spectroscopic techniques are based on the measurement of the pattern and intensity of the reflected or fluorescent light to extract the chemical and structural composition of tissue. The use of spectroscopic techniques as a tool for diagnosis of disease relies on the hypothesis that the chemical composition and/or architecture of normal tissue is different from that of diseased tissue. The subjects will only be contacted initially, at the time of their visit in the colposcopy clinic. If the subject is required for their standard of care to return to the colposcopy clinic for follow-up visits, and she meets all inclusion and exclusion criteria, she will be approached again to participate in research study. This study is being conducting in conjunction with the Massachusetts Institute of Technology.

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Imaging Studies – Anal: SPECTROSCOPIC IMAGING AND DIAGNOSIS OF ANAL NEOPLASIA

PRINCIPAL INVESTIGATOR: Dr. Elizabeth Stier

This study aims to develop an optically based technique for the diagnosis of neoplastic changes in the anus. Based on the success of the cervical and oral spectroscopic studies we believe that optically based technique would be beneficial for the diagnosis of anal dysplasia. Anal and cervical dysplasia and cancers have many similarities: They are both strongly associated with infection with the human papillomavirus, arise in the transformation zone and have similar histology. The spectroscopic device used will be the same device used in the cervical neoplasia project. The subjects will be contacted at the time of their High Resolution Anoscopy clinic visit and will be asked if they would like to participate in this research study.

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Imaging Studies – Anal: FREQUENCY OF ANAL CYTOLOGIC ABNORMALITIES IN HIV INFECTED WOMEN AND THEIR HISTOLOGIC CORRELATES

PRINCIPAL INVESTIGATOR: Dr. Elizabeth Stier

The objective of this study is to estimate the prevalence and incidence of anal cytological and histological abnormalities in HIV infected women seen at Boston Medical Center. This study consists of an initial visit where HIV infected women presenting for gynecologic care will be approached If the patient is eligible and consents for the study, then she will have an anal pap test as well as the routine cervical Pap test. Human papilloma virus (HPV) hybrid capture assay for high-risk associated HPV types will be performed on all cervical and anal cytology specimens. Patients with either abnormal anal cytology or infection with HPV in the anal canal will be referred for further evaluation with High Resolution Anoscopy. Patients with a normal anal cytology and negative anal HPV results will be recommended to return to clinic in 6 months for repeat cervical and anal pap tests.

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HPV Study: FACTORS AFFECTING HUMAN PAPILLOMA VIRUS (HPV) VACCINATION IN POOR AND UNDERSERVED GIRLS

PRINCIPAL INVESTIGATOR: Dr. Rebecca B. Perkins

This study will determine the HPV vaccination rate in a racially diverse cohort of poor and underserved girls ages 11-18. We will also examine reasons why parents decide to vaccinate or decide not to vaccinate their daughters. We will review medical records to determine how many girls are vaccinated against HPV as compared with tetanus (TdaP). We will calculate the percentage of girls who are vaccinated in the whole population, and then we will compare individual racial groups. Parents will be interviewed to determine what influences their decisions to vaccinate or not to vaccinate their daughters. Specifically, we will ask about HPV-related knowledge, beliefs about vaccination causing promiscuity, feelings about other vaccines, and trust in their doctors. Using the data collected from this research, we will design a culturally-appropriate educational program to maximize vaccination rates in disadvantaged racial groups.

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HPV Study - Honduras: DEMOGRAPHIC CORRELATES OF HUMAN PAPILLOMA VIRUS (HPV) VACCINE ACCEPTANCE IN HONDURAN WOMEN

PRINCIPAL INVESTIGATOR: Dr. Rebecca B. Perkins

This study will explore knowledge related to cervical cancer and the HPV vaccine in a cohort of Honduran women. Demographic factors, prior Pap smear and sexually transmitted disease histories, and cervical cancer knowledge will be abstracted from medical records and correlated with women's reported likelihood of accepting HPV vaccination if it were available for themselves and their daughters.

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Cost Effectiveness Study: COST-EFFECTIVENESS OF VISUAL INSPECTION WITH ACETIC ACID (VIA) COMPARED TO THAT OF PAP SMEARS FOR CERVICAL CANCER SCREENING IN HONDURAS

PRINCIPAL INVESTIGATOR: Dr. Rebecca B. Perkins

This study will compare the cost-effectiveness of Pap smears to that of visual inspection with acetic acid (VIA) for cervical cancer screening in Honduras. Cost effectiveness and decision analysis will be performed. The primary outcome variable will be 10-year cancer prevalence. Three hypothetical populations of 35-year-old women will be compared: never-screened women, women screened with VIA, and women screened with Pap smears. Primary data from our cervical cancer screening program in Honduras will be used to determine screening characteristics of Pap smear and VIA, loss-to-follow-up, prevalence of precancerous lesions, and cost of screening and treatment. Published data will be used to model the natural history of cervical dysplasia with and without treatment.