With the introduction of the HPV vaccine, policies toward screening practices will need to be reevaluated with a goal of achieving a reasonable balance between maximizing benefits, minimizing risks, and achieving cost-effectiveness. Although current practice is to treat CIN 2 the same as CIN 3, many question this practice in young women since these young women remain a vulnerable population to treatment side effects that are related to fertility. In addition, understanding mechanisms that are related to CIN 2 regression are important in developing treatment strategies. In a prospective study of adolescents and young women aged 13 to 24 years of age, our first aims are to:1a) define the rates of CIN 2 regression and examine the role of hormonal contraceptives, estrogen and progesterone receptor expression, and mucosal mRNA markers of cellmediated immunity (CMI) in regression of CIN-2 lesions.
The second aim i s to conduct a cost-effectiveness analysis of alternative strategies for adolescents and young women with CIN 2 in the US. This will conducted by 2a) Modifying a natural history model of cervical neoplasia in adolescents to explicitly include health states that reflect CIN 2 and CIN 3 separately, and calibrate the model to the U.S. population; 2b) Integrating the best available data, including the primary data collected in this study, to develop input model parameters with special attention to age-specific probabilities in adolescents and young girls; 2c) To use the refined model to estimate the short and long-term benefits, harms, and costs of alternative screening strategies for adolescents and young women with CIN 2. Women who were recruited into the Kaiser Permanente Medical Group of Northern California (KPMG-NC) study of CIN 2 (n=76) will be asked to continue follow-up. In addition, 25 young women aged 13-24 years of age diagnosed with CIN 2 by histology at 7 participating KPMG-NC Clinics will be asked to participate. The study proposes to observe young women with a biopsy verified CIN-2 lesion at 4 month intervals with HPV testing, cytology and colposcopy, b) examine risk factors using interview and chart review and c) examine estrogen and progesterone receptor expression and local immune responses (IFN-y, IL-12, IL-10 and T-reg) by sampling of cervical tissue. The data we obtain on the natural history of CIN 2 will be formally incorporated into a computer-based microsimulation model of cervical neoplasia and cancer. This study will be paramount in the development of proper guidelines for screening and triage of abnormal cytology and will give insight into immunologic and hormonal mechanisms associated with CIN-2 development. Relevance: The data gathered from this study will be used develop formal costeffectiveness analysis of alternative screening strategies for cervical neoplasia and cancer in adolescents in the U.S. and specifically assess how best to modify cytology-based screening, utilize HPV diagnostics, and tailor aoDrooriate follow-uo strategies for adolescents and vouna women diaanosed with CIN 2

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
3R01CA087905-05S1
Application #
7492028
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Starks, Vaurice
Project Start
2001-08-01
Project End
2009-07-31
Budget Start
2005-08-01
Budget End
2009-07-31
Support Year
5
Fiscal Year
2007
Total Cost
$268,000
Indirect Cost
Name
University of California San Francisco
Department
Pediatrics
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Halec, Gordana; Scott, Mark E; Farhat, Sepideh et al. (2018) Toll-like receptors: Important immune checkpoints in the regression of cervical intra-epithelial neoplasia 2. Int J Cancer 143:2884-2891
Moscicki, Anna-Barbara (2011) HPV-associated cancers: it's not all about the cervix. Prev Med 53 Suppl 1:S3-4
Moscicki, Anna-Barbara; Ma, Yifei; Wibbelsman, Charles et al. (2010) Rate of and risks for regression of cervical intraepithelial neoplasia 2 in adolescents and young women. Obstet Gynecol 116:1373-80
Scott, Mark E; Ma, Yifei; Kuzmich, Lili et al. (2009) Diminished IFN-gamma and IL-10 and elevated Foxp3 mRNA expression in the cervix are associated with CIN 2 or 3. Int J Cancer 124:1379-83
Lieberman, Jay A; Moscicki, Anna-Barbara; Sumerel, Jan L et al. (2008) Determination of cytokine protein levels in cervical mucus samples from young women by a multiplex immunoassay method and assessment of correlates. Clin Vaccine Immunol 15:49-54
Moscicki, Anna-Barbara (2008) HPV Vaccines: today and in the Future. J Adolesc Health 43:S26-40
Moscicki, Anna-Barbara (2008) Conservative management of adolescents with abnormal cytology and histology. J Natl Compr Canc Netw 6:101-6
Moscicki, Anna-Barbara; Ma, Yifei; Wibbelsman, Charles et al. (2008) Risks for cervical intraepithelial neoplasia 3 among adolescents and young women with abnormal cytology. Obstet Gynecol 112:1335-42
Moscicki, Anna-Barbara (2008) Management of adolescents who have abnormal cytology and histology. Obstet Gynecol Clin North Am 35:633-43;x
Daud, Ibrahim I; Scott, Mark E (2008) Validation of reference genes in cervical cell samples from human papillomavirus-infected and -uninfected women for quantitative reverse transcription-PCR assays. Clin Vaccine Immunol 15:1369-73

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