Cervical cancer is still a serious problem in South Carolina, and African American women are disproportionately affected by this disease. This proposal investigates the determinants of persistent high-risk human papillomavirus (HR-HPV) infection in female college students from the University of South Carolina (USC) and from Claflin University (CU), a Historically Black College/University (HBCU). The rationale for this study is: while HR-HPV infection is the major cause of cervical cancer, most HPV infections clear spontaneously in a matter of months, and only women who have persistent HR-HPV infection are truly at risk for cancer. However, in order to diagnose HPV infection as persistent, multiple HPV tests must be conducted at six month intervals for up to two years, and the specific HPV type must be identified each time. Hence, this approach is not applicable to large scale screening. If markers of HPV persistence could be identified at a first visit, then careful follow-up could be directed to those women that really need it, in a cost-effective and efficient fashion. We propose to recruit 300 female college students from USC and CU into this study. Both African American and Caucasian women are well represented in this cohort. Study participants will be followed from their freshman year and throughout the course of their college studies, with Pap smears and cervical mucus collections performed every six months. Specifically, we will monitor: cytology, HPV infection by specific type, viral load, HPV E7 mRNA expression in the Pap smear material, and the profile of 16 cytokines in the cervical mucus. Questionnaires administered at each visit collect information concerning lifestyle factors, stress, smoking, diet, and physical activity. Study Questions: 1. Is there a correlation between specific cytokine profiles and HR-HPV persistence? 2. Is there a correlation between viral load and HR-HPV persistence? 3. Is high E7 mRNA expression correlated with persistence? 4. Is there a relationship between HPV DMA viral loads and E7 mRNA expression? And 5. Is there a correlation between HR-HPV persistence and diet, stress, lifestyle factors, physical activity? By comparing the factors that determine HPV persistence in African American and Caucasian women who receive the same standard of care, we will identify factors that, together with access to care, may contribute to determining the disparity in cervical cancer incidence and mortality rates observed between these two ethnic groups in South Carolina.
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