Project 1

MARKERS OF PROGRESSION

TO CERVICAL CANCER IN RURAL INDIA

Description

Cervical cancer, the most common female cancer in India, is a preventable malignancy. The proposed project will be carried out in Medchal Mandal, a rural community in Andhra Pradesh, India. Its broad objectives are to help identify the optimum  cervical cancer screening strategy for rural India and to evaluate the viral and cellular markers of progression to cancer. It is anticipated that almost all of the about 12,000  women 30 years old or older in this community will each be screened for cervical cancer with four methods (Pap smear, visual inspection of the cervix, HPV DNA in cervix, HPV DNA in self collected vaginal swabs). Women abnormal in any one or more screens will be colposcoped and biopsied if necessary, and those found to have high grade lesion or cervical cancer will be treated. Women who have abnormal screens but do not require treatment as well as women without abnormal screens will be monitored for five years for high grade lesions or cervical cancer. It is estimated that over 200 women with high grade lesions and about 20-30 women with cervical cancer will be identified in the study period. The specific aims are to (a) compare the four screening methods  for their ability to  identify concurrent disease and to predict future disease, (b)  characterize viral genotype, viral variants, viral load and viral integration for their role in disease progression and (c) characterize cellular markers such as p16 over expression, loss of FHIT expression, gain of chromosome 3q, and altered patterns of methylation for their role in disease progression. The study may help identify screening methods and biological markers that may be most useful for cervical cancer prevention.