Although cervical dysplasia is a major cause of morbidity in women worldwide, few published studies have assessed the risk factors for its development. American Indian women are at high risk for development of both cervical dysplasia and cervical cancer, yet published data are scant that identify the risk factors for the development of cervical lesions in this minority group. To assess the risk factors for the development of moderate dysplasia, severe dysplasia, and carcinoma in situ in New Mexico's American Indian women, we propose to conduct a case-control study at several Indian Health Service-affiliated outpatient clinics. The study design incorporates an integrated approach to investigate the relationship of numerous exposures in the development of high-grade dysplastic cervical lesions. Data will be obtained from study participants through extensive interviews, physical and colposcopic examinations, microbiologic studies, serologic studies of antibodies to sexually transmitted disease agents, and laboratory studies of cervical cytologic and histologic specimens. Interviews will be specifically directed to assess the associations of sexual behavior, past sexually transmitted diseases, contraceptive techniques, hygienic practices, cigarette smoking, and micronutrient consumption in the development of cervical dysplasia. Laboratory studies will be primarily directed to assessment of effects of current and past sexually transmitted infections, plasma micronutrients, and presence of specific HLA alleles in the development of cervical dysplasia. This research will identify risk factors for development of high-grade cervical dysplasia among American Indian women in New Mexico. This research will also allow comparison of prevalence and patterns of risk factors for cervical dysplasia in American Indian women with data obtained from a similar, recently completed study in New Mexico Hispanic and non- Hispanic white women. Thus, from an etiologic perspective, the investigation will allow evaluation of heterogeneity of risk factors for cervical dysplasia among culturally-diverse populations in the same geographic region. From a public health perspective, this research should lead to prevention strategies that will ultimately decrease the rates of cervical dysplasia and cervical cancer, particularly among the high-risk American Indian women of the Southwest.
