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Title: Human papillomavirus infection in UK women, and the potential for triage of women with low grade abnormal smears to alternative management policies using HPV testing
Author: Cotton, Seonaidh Claire
ISNI:       0000 0001 2410 8348
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2008
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The aims of this thesis were to investigate (1) the prevalence of high-risk HPV infection in UK women and factors associated with infection risk; and (2) the value of a single high-risk HPV test in identifying women with CIN2 or more severe disease.  Data from the UK TOMBOLA trial were used.  TOMBOLA recruited women aged 20-59 years, who were resident in Grampian, Tayside or Nottingham with a recent low-grade abnormal cervical smear.  Women underwent HPV testing using PCR methodology. The prevalence of high-risk HPV infection increased with increasing smear severity (16% among those with a current normal and previous BNA, 34-35% among those with a current BNA smear; 60-69% among those with a current mild smear depending whether the woman had had a previous BNA or not), and decreased with increasing age.  After taking into account these strong associations, and interactions, between HPV status and smear severity and age, modest associations between several lifestyle factors and prevalence of high-risk HPV infection remained. In women with a mild smear, sensitivity in terms of identifying women with CIN2 or more severe disease was 75.2% (95% CI 68.8-81.0) and specificity 46.9% (95% CI 42.2-51.6).  In those with a BNA smear, sensitivity was 69.9% (95% CI 61.7-7-77.3%) and specificity 71.3% (95% CI 68.5-74.1).  The negative predictive values were high (mild 80.5%, 95% CI 75.2-85.1%; BNA 94.5%, 95% CI 92.6-96.0) suggesting that HPV testing may be promising in avoiding referral to colposcopy, particularly among women with a BNA smear. Both analyses are relevant to the debate on HPV testing in a triage of women with low-grade cytological abnormalities.  The epidemiological data from the first aim is also relevant to the development of strategies for the delivery of HPV vaccination programmes.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available