Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer mortality in women in developing countries. In the United States (U.S.) over $6 billion are spent annually in the evaluation and treatment of low-grade precursor lesions. Cervical cancer goes undetected in developing countries because of the cost of the tests and the lack of trained personnel and resources to screen and diagnose. In the U.S., resources are wasted on the evaluation and treatment of lesions not likely to progress to cancer. Both the screening and detection of cervical cancer could be vastly improved by technologies which improve, automate, and decrease the cost of screening and detection. The goal of this program project is to assess the emerging technologies of fluorescence and reflectance spectroscopy and quantitative cytology and histopathology for the diagnosis of cervical neoplasia. The program project seeks to address: (1) Biologic Plausibility, by examining the fluorescence/reflectance and quantitative images of cell lines, tissue cultures, and live tissue sections; (2) Technical Feasibility, by conducting large screening and diagnostic trials of fluorescence and reflectance spectroscopy and quantitative cytology and histopathology; (3) Intermediate Effects, by using the fluorescence and reflectance spectrometer in a randomized clinical trial; (4) Patient Outcomes, by assessing patient and provider acceptability of fluorescence and reflectance spectroscopy and quantitative cytology and histopathology; and (5) Societal Outcomes, by assessing the performance and cost-effectiveness of fluorescence and reflectance spectroscopy and quantitative cytology and histopathology in the screening and diagnostic setting. The four cores will support the projects by focusing on (A) Administration, (B) Biostatistics and Informatics, (C) Instrumentation, and (D) Pathology. Our group is a multidisciplinary one including gynecologic oncologists, pathologists, cell biologists, epidemiologists, behavioral scientists, and decision scientists from The University of Texas M.D. Anderson Cancer Center in Houston, Texas, biomedical engineers from The University of Texas in Austin, Texas, and biomedical engineers and gynecologic oncologists from the British Columbia Cancer Centre in Vancouver, British Columbia, Canada. The University of Texas components have been successfully collaborating with each other since 1990 and with the British Columbia Cancer Centre since 1994. The innovative aspects of this program project are three-fold: 1) the project uses the cervix, a small and accessible organ for which the dysplasia-carcinoma sequence is well-understood as the basis for examining emerging optical technologies, 2) optical spectroscopy and quantitative cytology and histopathologic analyses are evaluated for biological plausibility, effectiveness, acceptability, and cost-effectiveness, and 3) both technologies will have broad applications to other organ sites such as the oral cavity and lung, the digestive tract, the bladder, and skin.
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