The viral aetiology of cervical cancer: Psychosocial issues

This work stems from the discovery that certain sexually transmitted types of human papillomavirus (HPV) are the main causal agents in cervical carcinogenesis. The thesis sets out to explore the psychosocial issues that arise from linking a sexually transmitted infection with cervical cancer. Four studies were carried out. Study 1 was a survey of women attending a well-woman clinic (n=1032) and assessed awareness and knowledge about HPV. Study 2 used a population representative sample of men and women (n=1937) to assess beliefs about the risk factors for cervical cancer. Study 3 used in-depth interviews to explore the beliefs and experiences of 74 women who had taken part in HPV testing. Study 4 was a continuation of Study 3, in which 30 women were interviewed following participation in their second HPV test, a year after the first. Awareness of HPV and its link with cervical cancer was found to be low. Although there was higher awareness of sexual activity as a risk factor for cervical cancer, this was far from universal. Women testing positive for HPV who understood that it was sexually transmitted frequently reported negative emotional and social responses, different from those that have been found among women with abnormal smear test results. Leventhal's Common Sense Model of self-regulation in health and illness provided a useful framework within which to conceptualise the relationship between women's cognitive representations of HPV and their responses to the infection. It seemed that women were also engaged in the self-regulation of their relationships and were motivated to develop representations of HPV that did not impugn their current partners. Diagnosis with persistent HPV infection was associated with higher levels of anxiety about health and with the desire for immediate further investigation by colposcopy, rather than continued surveillance. The introduction of HPV testing and vaccination should be accompanied by widespread public education. If information provision is not handled in a sensitive way, it could cause confusion and stigmatise cervical cancer. More research is needed to develop ways to communicate information about HPV effectively

Break down of genitalia tumors excluded from the analysis.

<p>Break down of genitalia tumors excluded from the analysis.</p

Difference in 5 years survival calculated with the Kaplan Meier method.

<p>A positive value means that females have a survival advantage as compared with males. Green, not significant; Red, significant (P<0.05). In the interval 17–63 males exhibited the worst outcome as compared with females with differences averaging more than 10% until the age of 45.</p

Multivariate Cox analysis from the SEER 18 database for patients stratified for age range 62–84.

*<p>HR = Hazard Ratio **CI = Confidence Interval.</p

Kaplan-Meier plot according to A: Race. Blue, males; Red, females; Continuous lines, African-American; dashed lines, Caucasian; B: Type of tumor; Blue, males; Red, females; Continuous, epithelial solid tumors; dotted, hematologic malignancies; dashed, sarcomas; C: Tumor stage, Blue, males; Red, females; Continuous, distant; dotted, regional; dashed, localized disease.

<p>The major by gender differences are evident in conditions where tumors are featured by high mortality.</p

Homology between HR distribution and FTI.

<p>(A): Double Y chart reporting HR (left Y-axis; red) and FTI (right Y-axis; green) over age in years (X-axis). Homology between HR distribution and Hemoglobin (HGB) (B). Double Y chart reporting HR (left Y-axis; red) and HGB (right Y-axis; green males, blue females) over age in years (X-axis).</p

Homology of the NHANES III parameters with the distribution of HR calculated with the KS method.

<p>Homology of the NHANES III parameters with the distribution of HR calculated with the KS method.</p

Multivariate Cox analysis from the SEER 18 database.

*<p>HR = Hazard Ratio **CI = Confidence Interval.</p

Dot Plot showing the correlation (orange line) between FTI (Y-axis) and HR (X-axis).

<p>Each data point (n = 72) is the median of the values for the range 12–84.</p

Homology of the NHANES III parameters with the distribution of HR calculated with the Spearman correlation test.

*<p>Name of the variable in the attached dataset file;**calculated with Spearman Correlation test;</p