Diseno y metodos de un estudio de la historia natural de la neoplasia de cuello uterino en la poblacion de una provincia rural de Costa Rica: El Proyecto de Guanacaste

Translated title of the contribution: Design and methods of a population-based natural history study of cervical neoplasia in a rural province of Costa Rica: The Guanacaste Project

Rolando Herrero, Mark H. Schiffman, Concepción Bratti, Allan Hildesheim, Ileana Balmaceda, Mark E. Sherman, Mitchell Greenberg, Fernando Cárdenas, Víctor Gómez, Kay Helgesen, Jorge Morales, Martha Hutchinson, Laurie Mango, Mario Alfaro, Nancy W. Potischman, Sholom Wacholder, Christine Swanson, Louise A. Brinton

Research output: Contribution to journalArticle

60 Scopus citations

Abstract

This paper reports on the enrollment phase of a population-based natural history study of cervical neoplasia in Guanacaste, a rural province of Costa Rica with consistently high rates of invasive cervical cancer. The main goals of the study are to investigate the role of human papillomavirus (HPV) infection and its co-factors in the etiology of high-grade cervical neoplasia, and to evaluate new cervical cancer screening technologies: To begin, a random sample of censal segments was selected and enumeration of all resident women 18 years of age and over was conducted with the aid of outreach workers of the Costa Rican Ministry of Health. Of the 10 738 women who were eligible to participate, 10 049 (93.6%) were interviewed after giving written informed consent. After the interview on cervical cancer risk factors was administered, a pelvic examination was performed on those women who reported previous sexual activity. The pelvic examination included a vaginal pH determination and collection of cervical cells for cytologic diagnosis using three different techniques. Additional cervical cells were collected for determination of the presence and amount of DNA from 16 different types of HPV, and two photographic images of the cervix were taken and interpreted offsite by an expert colposcopist. Finally, blood samples were collected for immunologic and micronutrient assays. Women with any abnormal cytologic diagnosis or a positive Cervigram, as well as a sample of the whole group, were referred for colposcopy, and biopsies were taken when lesions were observed. The enrollment screening will serve as the basis for a prevalent case-control study, and the members of the cohort free from serious disease will be followed actively, at intervals of no more than a year, to study the natural history of HPV infection and the origins of high-grade squamous intraepithelial lesions (HSIL). Details of the field operation are outlined, with particular reference to the realization of this kind of study in developing countries. Descriptive data on the prevalence of disease and exposure to various risk factors are also presented.

Translated title of the contributionDesign and methods of a population-based natural history study of cervical neoplasia in a rural province of Costa Rica: The Guanacaste Project
Original languageSpanish
Pages (from-to)411-425
Number of pages15
JournalRevista Panamericana de Salud Publica/Pan American Journal of Public Health
Volume1
Issue number6
StatePublished - Jun 1997
Externally publishedYes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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    Herrero, R., Schiffman, M. H., Bratti, C., Hildesheim, A., Balmaceda, I., Sherman, M. E., Greenberg, M., Cárdenas, F., Gómez, V., Helgesen, K., Morales, J., Hutchinson, M., Mango, L., Alfaro, M., Potischman, N. W., Wacholder, S., Swanson, C., & Brinton, L. A. (1997). Diseno y metodos de un estudio de la historia natural de la neoplasia de cuello uterino en la poblacion de una provincia rural de Costa Rica: El Proyecto de Guanacaste. Revista Panamericana de Salud Publica/Pan American Journal of Public Health, 1(6), 411-425.