Cervix
DCEG researchers conduct studies on cancers of the cervix, more commonly referred to as cervical cancer. The primary cause of cervical cancer is persistent infection with the human papillomavirus (HPV). Selected studies include:
Research Studies
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ASC-US/LSIL Triage Study (ALTS)
ALTS is a study of the clinical management of low-grade cervical cytologic abnormalities conducted by the Clinical Genetics Branch and the NCI Division of Cancer Prevention.
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Biopsy Study to Improve Detection of Cervical Precancer
A collaborative study on colposcopic biopsy with aims to study cervical disease on the lesion level, optimize criteria for biopsy placement, and analyze the incremental benefit of taking multiple biopsies
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Cancer Moonshot: HPV Vaccine Trial and Accelerated Cervical Cancer Control
Researchers in the Infections and Immunoepidemiology Branch (IIB) and the Clinical Epidemiology Unit (CEU), Clinical Genetics Branch, are leading priorities of the Cancer Moonshot. IIB is running the one-dose HPV vaccine trial in Costa Rica. CEU is creating new cervical cancer screening approaches that are effective and efficient. For high-resource settings, they are designing a quick and cost-effective HPV genotyping assay to improve the detection and management of cervical cancer.
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Cervical Cancer Screening Among HIV-Infected Women in India
A study to evaluate a cohort of HIV-infected women using two novel and potentially sustainable, lower-cost tests for accurate screening for cervical cancer
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Cervical Visualization Study
A collaboration with the National Library of Medicine to produce an open source multi-media database tool for real-time data exploration of cervical images, histology, HPV, and text data from NCI studies of HPV and cervical neoplasia.
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Costa Rica HPV Vaccine Trial (CVT)
The Costa Rica HPV Vaccine Trial (CVT) was a randomized, controlled phase III trial of the bivalent human papillomavirus-16/18 virus-like particle (VLP) vaccine. In addition to strong evidence for vaccine safety and efficacy, data from the trial demonstrated that three doses of the HPV vaccine may not be necessary, as similar vaccine efficacy against cervical HPV 16/18 infection was observed among women who received two, and even a single dose, after over 10 years of follow-up. At the completion of CVT in 2010, the CVT Long Term Follow-Up Study (LTFU) was implemented to extend the follow-up of CVT participants to 10 years, in order to address questions related to duration of protection, long-term safety, prolonged efficacy of fewer than three doses, and behavior of other carcinogenic HPV types in the absence of HPV 16/18 infections.
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Enduring Consensus Cervical Cancer Screening and Management Guidelines
The Enduring Guidelines Effort is a process to provide regular updates to the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. A consensus committee reviews new evidence from population-based and other studies to continually improve clinical management.
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ESCUDDO Efficacy Trial
The ESCUDDO Efficacy Trial is a scientific evaluation of one or two doses of the bivalent or nonavalent vaccine against human papillomavirus (HPV). Findings from the trial will provide the definitive evidence of the non-inferiority of one dose compared to two doses, the global gold standard in young girls. Positive results from the trial will provide actionable evidence needed to update the current HPV vaccine policy both domestically and globally.
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Federal Cervical Cancer Collaborative to Advance Equity in Cervical Cancer Control
The Federal Cervical Cancer Collaborative (FCCC) is a multi-year effort to control cervical cancer across safety-net settings of care in the U.S. The FCCC is the first partnership formed across HHS to improve cervical cancer care in safety-net settings. DCEG is one of the federal partners.
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Genomic Analysis of Human Papillomavirus (HPV)
There is huge variability in risk of precancer and cancer conferred by different HPV types that is poorly explained. HPV type 16 is known to cause half of all cervical cancer cases worldwide, however, the specific reason for its carcinogenicity has been elusive. The HPV Genomics Project is designed to interrogate the relationship between sequence changes in the HPV genome and carcinogenicity.
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Guanacaste HPV Natural History Study
A population-based natural history study of HPV and cervical neoplasia launched with Costa Rican colleagues in 1993.
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Improvement of Risk-Informed Screening (IRIS)
IRIS is a comprehensive evaluation of candidate biomarkers for use in cervical cancer screening and triage in a large cohort study in partnership with Kaiser Permanente Northern California. This is a Cancer Moonshot priority.
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Methylation of Human Papillomavirus (HPV) and Cervical Cancer Risk
A Cancer Moonshot priority to study methylation of the HPV viral genome and risk of cervical intraepithelial neoplasia 3+ to prevent cervical cancer.
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Natural History, Genomics and Risk Assessment for Human Papillomavirus (HPV)
Studies of human papillomavirus (HPV) natural history, genomics and risk assessment that led to advances in screening and clinical management
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PaP Cohort: Persistence and Progression of Human Papillomavirus (HPV) Infection
The Persistence and Progression Cohort (PaP Cohort) is a collaborative study with Kaiser Permanente Northern California to create a repository of specimens for natural history studies, HPV typing, methylation, and HPV variant genomics.
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Risk Prediction Modeling for Cervical Cancer
This study, a Cancer Moonshot priority, is designed to develop a cervical cancer risk prediction model incorporating clinical and laboratory covariates. The goal is to classify women’s risks of cervical intraepithelial neoplasia 2 (CIN 2), CIN 3, and cancer into strata upon which clinical management decisions can be based. Eight articles comprising a supplemental issue in the Journal of Lower Genital Tract Disease formed the early core of this effort.
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PRIMAVERA Immunobridging Trial
The PRIMAVERA Immunobridging Trial was designed to provide convincing and actionable evidence that a single dose of the HPV vaccine will elicit an immune response sufficient to protect against targeted HPV infections and subsequent neoplasms. A single-dose schedule can potentially simplify vaccine delivery and vaccination program costs, which can ultimately ensure that more girls receive the vaccine.
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PRISMA Efficacy Trial
Researchers are conducting the PRISMA Efficacy trial to determine if one dose of HPV vaccine is sufficient to reduce the risk of HPV infection in women, compared to a non-HPV vaccine—the standard in the majority of the world. If one dose is sufficient, vaccinating women could help to accelerate the timeline for cervical cancer control, averting potentially millions of projected HPV-related cervical cancers expected over the coming decades as the population of the globe ages.
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STRIDES: Studying Risk and Improving Disparities of Cervical Cancer in Mississippi
The NCI is partnering with the University of Mississippi Medical Center to evaluate risk of cervical precancer and to study novel biomarkers in women undergoing cervical cancer screening. STRIDES is a Cancer Moonshot priority.
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Study to Understand Cervical Cancer Early Endpoints and Determinants (SUCCEED)
A study to comprehensively assess biomarkers of risk for progressive cervical neoplasia, and thus develop a new set of biomarkers that can distinguish those at highest risk of cervical cancer from those with benign infection
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The Selfie Study to Detect Cervical Precancers
The NCI is partnering with the George Washington University to evaluate novel biomarkers measured from self-collected samples in women undergoing cervical cancer screening. The Selfie Study is a Cancer Moonshot priority.
Research News
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Nicolas Wentzensen Talks About Self-Collection in the NCI Cancer Currents Blog
Nicolas Wentzensen discusses the recent FDA approval of self-collection kits for use in clinics for cervical cancer screening. His interview was published in the NCI Cancer Currents Research Blog.
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Enduring Guidelines: Methods and Dual Stain for Cervical Cancer Screening Triage
Continual improvement of cervical cancer screening and management to include new technologies and approaches requires a flexible approach to guidelines. A description of the Enduring Guidelines effort—methods and principles to ensure swift adoption of changes—and a review and decision on the first new technology to be added to the guidelines—dual stain cytology—were published in the Journal of the Lower Genital Tract Diseases.
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Differences in Knowledge of HPV and the HPV Vaccine by Education, Race, and Ethnicity
Ms. Erica Stephens and Dr. Jaimie Shing used data from a nationally representative sample of U.S. adults to ascertain awareness of HPV and the HPV vaccine, as well as knowledge that HPV can cause cancers, by educational attainment, race, and ethnicity. They found profound disparities that signal the importance of continued education around HPV and the HPV vaccine.
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Catch-Up HPV Testing May Help Prevent Cervical Cancer in Some Over 65
It may be worthwhile for some individuals between ages 65 and 69 to get tested for HPV, findings from a Danish study suggest. Specifically, the testing may help prevent cervical cancer among those who haven’t had cervical cancer screening for at least 5 years.
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Disaggregating Data on Asian American and Native Hawaiian and Pacific Islander Populations by Ethnicity Reveals Disparities in HPV-Associated Cancers
An analysis led by Drs. Jacqueline B. Vo in the Radiation Epidemiology branch and Jaimie Z. Shing in the Infections and Immunoepidemiology Branch revealed disparities in incidence rates of human papillomavirus (HPV)-associated cancers in Asian American and Native Hawaiian and Pacific Islander populations when disaggregated by race and ethnicity.
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Validation of a Low-cost, Rapid HPV DNA Genotyping Test for Cervical Cancer Prevention
A key deliverable of the Cancer Moonshot initiative to Accelerate Cervical Cancer Control is a rapid, mobile, simple, and affordable HPV DNA typing assay for risk-based screening and management in resource-limited settings where routine screening is logistically and cost prohibitive. Drs. Kanan Desai, Mark Schiffman, Silvia de Sanjose, and colleagues in the Clinical Epidemiology Unit, Clinical Genetics Branch, in cooperation with Atila Biosystems scientists, guided the redesign of an existing test for this purpose.