New approaches to screening for cervical cancer.

摘要

In this thesis, I explore using self-collection of specimens for cervical cancer screening in the United States (US). In the first chapter, I review the natural history and burden of cervical cancer, principles of screening and how they pertain to cervical cancer, existing technologies used for cervical cancer screening and the use of mathematical models to explore cost-effectiveness and reductions in morbidity and mortality related to screening. In the second chapter, I describe results from a clinical study assessing the validity and reliability of using a self-lavaging device, the Delphi Screener, for liquid based cytology and high-risk human papillomavirus testing. In the third chapter, I describe women's experiences and preferences related to use of the self-lavaging device compared to clinician-collected specimens from the same clinical study. In the Furth chapter, I compare the cost-effectiveness of using the Delphi Screener versus clinician-collected specimens with liquid based cytology and high-risk HPV testing in a hypothetical cohort of women aged 30 in the US. Finally, I conclude the thesis in the fifth chapter, highlighting and summarizing main findings.