Michigan Technological University Digital Commons @ Michigan Tech Dissertations, Master's Theses and Master's Reports 2016 THE INTEGRATION OF MOBILE TECHNOLOGY TO LOWER THE RISK OF DEVELOPING CERVICAL CANCER IN HIV POSITIVE WOMEN Tugce Kinik Michigan Technological University, tkinik@mtu.edu Copyright 2016 Tugce Kinik Recommended Citation Kinik, Tugce, "THE INTEGRATION OF MOBILE TECHNOLOGY TO LOWER THE RISK OF DEVELOPING CERVICAL CANCER IN HIV POSITIVE WOMEN", Open Access Master's Thesis, Michigan Technological University, 2016.etdr/183 Follow this and additional works at: https://digitalcommons.edu/etdr Part of the Female Urogenital Diseases and Pregnancy Complications Commons, Health Information Technology Commons, and the Immune System Diseases Commons www.com THE INTEGRATION OF MOBILE TECHNOLOGY TO LOWER THE RISK OF DEVELOPING CERVICAL CANCER IN HIV POSITIVE WOMEN By Tugce Kinik A THESIS Submitted in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE In Medical Informatics MICHIGAN TECHNOLOGICAL UNIVERSITY 2016 © 2016 Tugce Kinik www.com This thesis has been approved in partial fulfillment of the requirements for the Degree of MASTER OF SCIENCE in Medical Informatics. School of Technology Thesis Advisor: Dr. Guy Hembroff Committee Member: Dr. Yushin Ahn Committee Member: Dr.
Jinshan Tang School Dean: Dr. James Frendewey www.com Dedication To all women so that they could be free of AIDS and Cervical Cancer.com Table of Contents List of Figures. vii List of Tables. ix List of Abbreviations .2 Reasons of Cervical Cancer .1 Human Papillomavirus and Cervical Cancer .2 HIV and Cervical Cancer.4 Age of First Sexual Intercourse .7 Use of Alcohol .3 Cervical Cancer Treatment and Prevention .3 Aim of The Study .4 Risk Scores and Algorithms of Cervical Cancer .1 Low Risk Calculation .2 Medium Risk Calculation .3 High Risk Calculation.1 Data Collection and Analysis .1 The Evaluation of a Mobile Application to Assist in Determining the Risk of Cervical cancer in HIV + Women .2 Avaliao do aplicativo mvel para ajudar a determinar o risco de cancer cervical em mulheres com HIV+ .1 Education of Cervical Cancer Reduction .2 Educao para reduo de cncer cervical .com List of Figures 1.1 Progress of Cervical Cancer………………………………………………………….2 Cervical Cancer’s Stages and Affected Body Parts………….3 HIV Stages to AIDS ………………………………………………………….4 Prevention and Treatment of Cervical Cancer in Stages…………………………….1 Java Class Codes ………………………………………………………………….2 One of PHP Sample Codes of Our Application …………………………………….3 Main Algorithms of Cervical Cancer in Our Study………………………………….2 Picture of The Application’s Login and Registration Pages ……………………….3 Application’s Personal Information Pages …………………………………………65 B.4 Application Algorithm Page ……………………………………………………….5 Application Calculation Page …………………………………………………….1 One of PHP Sample Codes of Our Application …………………………………….com List of Tables Table 2.1 Risk Score Algorithms Part 1……….2 Risk Score Algorithms Part 2….3 Risk Score Algorithms Part 3……………………….4 Risk Score Algorithms Part 4…………….5 Low Risk Score Intervals.6 Medium Risk Score Intervals.7 High Risk Score Intervals.com Acknowledgments First of all, I would like to thank to the Almighty God for everything he gave me.
I would like to present many appreciation and thanks to my advisor Professor Guy Hembroff for his advice, guidance, confidence on me and hand in the procedure of this research until the end of the work. Also, my committee members, Professor Yuhsin Ahn and Professor Jinshan Tang shared their thoughts with me and supported this study. I would like to thank to Dr. Milena Bastos Brito, Escola Bahaina de Medicina e Saúde Pública and Participating Medical Personnel from Partner Hospitals and Clinics in Brazil.
My fiance, Musa Cetin, deserves many thanks for his support to me during my graduate years. I would like to thank to my family for their support.com List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ASCUS Atypical Squamous Cells of Undetermined Significance ASC-H Atypical Squamous Cells Cannot Exclude HSIL CIN Cervical Intraepithelial Neoplasia HIV Human Immunodeficiency Virus HPV Human Papillomavirus HSIL High-Grade Squamous Intraepithelial Lesion HSV Herpes Simplex Virus Ig Immunoglobin LSIL Low-Grade Squamous Intraepithelial Lesion OC Oral Contraceptives CC Cervical Cancer WHO World Health Organization x www.com Abstract Cervical cancer is the most common cancer in HIV positive women in the world [1]. According to epidemiologists, HPV infection alone will not initiate cervical cancer [2]. In addition to high risk HPV types, smoking, long term hormonal contraceptive use, high parity, HIV/AIDS infection, sexual activity before 20 years of age, multiple sexual partners, exposure to sexually transmitted disease, and family history of cervical cancer are other reasons to turn an HPV infection to the cervical cancer [3].
With the increasing global population, cervical cancer cases are expected to increase 46% until 2030 [4]. Effective prevention and control efforts will be needed. In order to prevent cervical cancer in HIV infected women, it is important to notice risk factors of cervical cancer, calculate the risk percentages to be caught by cervical cancer in order to identify and lower these risks. The aim of the study is to create a mobile application which enables to reduce cervical cancer cases by showing possible cervical cancer risk percent and the ways of decreasing the risk.
By using this application, women will be directed to obtain healthy habits and will help to avoid risk. First, main algorithms of cervical cancer were decided by considering WHO’s procedures and three groups of risk intervals were created by accepted lab results. Second, the application was created by using Android Studio with PHP and MYSQL. Results showed that 80% of the physicians were satisfied about the application, and 60% of the physicians thought that the calculated risk percent of cervical cancer was accurate in the assessment.
Also, 80% of the physicians believed the sample education section of the application helpful of very helpful to change patients habits to increase the prevention of cervical cancer. More importantly, 80% of the physicians xi www.com found the application quite useful to educate patients to understand the correlation between HIV + and cervical cancer.com Chapter 1 Introduction 1.1 Background In 2012, more than 550,000 incidents and 270,000 deaths due to the cancer of uterine cervix were detected worldwide [5]. About 85% of these incidents and 87% of total deaths happened in developing countries chiefly due to low attainment to health care for detection and treatment of early lesions [5]. The primary reason of cervical cancer is human papillomavirus (HPV) which is one of the most common sexually transmitted infections (STIs).
It has more than 200 types, which are categorized in two parts, high risk and low risk. Low risk types have the risk of causing anogenital warts, while high risk types are responsible in provoking the cancer of uterine cervix [6]. According to studies carried out in various countries by the International Association, the most prevalent high risk HPV types are HPV-16 53%, HPV-18 15%, HPV-45 9%, HPV-31 6%, and HPV-33 3% [7]. In 1981, the first HIV instance was cıted in the world [8].
Since that time, HIV continues to spread. According to WHO’s 2014 statement, 36.9 million people have been living with HIV [9]. There are some cancers associated with AIDS. These cancers are especially dangerous for HIV positive people.
Cervical cancer is one of these cancers, since HIV infected women have much more risk of gaining HPV. Cervical cancer is the most common cancer in HIV positive women all over the world. HPV is three times frequent 1 www.com in HIV positive women than with HIV negative women [10]. What is more, HIV infected women have a quite rapid progression of cervical cytology abnormalities [11].
Even if HIV positive women have negative cytology findings, they may have huge pervasiveness of one or more oncogenic HPV characters [12]. Additionally, HIV positive women are more likely to be diagnosed with cervicovaginal convections such as bakteriel vaginosis [12]. All these are because of the weak immune system in HIV positive women. The cervix areas are covered by squamous and the grandular cells.
Primary area of cervical cancer is the cervical transformation zone which is the shape of ring of these squamous epithelium tissues in the vagina. When the HPV firstly is obtained, cervix will have some atypical changes in squamous cells, which are called Atypical Squamous Cells (ASCUS). Every HPV infection does not ensure to cervical cancer. There is pre-invasive period of cervical cancer, which is called Cervical Intraepithelial Neoplasia (CIN), and it does not mean cancer.
Rather, it results from cytologic cervical tissue changes after HPV infection first starts. CIN consists of three stages, CIN I, CIN II, and CIN III. These stages define the progress of dysplasia (Figure 1. CIN I refers to Low Grade Squamous Intraepithelial Lesion (LSIL).
In this stage, HPV infection mostly would clear itself, but in case of triggers or any unhealthy habits, it could progress to CIN II and CIN III, which refer to High Grade Squamous Intraepithelial Lesion. These stages are indicators of progression to cervical cancer. If they are left untreated, it is most likely to result in cervical cancer. There are many investigations about precancerous lesions of the cervix.
According to previous studies, regression of CIN I is over 60% then progression to cancer 2 www.com is about 1 %. CIN II have 40% regression and 5% progression to cancer. CIN III’s regression is 30% and progression to cancer is 12% [13]. The average progression time to CIN III from HPV’s initial infection is anticipated to be about 10 years.
There is 10 to 15 years average to develop cervical cancer after CIN III [14]. Nicholas et al. detected 5- 6 years to progression to CIN I from first HPV infection, and about 7 years to progression to CIN II or CIN III from CIN I [15]. Nicholas highlighted that HPV types must be considered to define progression times [15], because every high risk HPV types affect body differently and their carcinogenic effects are different.1: Progress of Cervical Cancer 3 www.com Cervical cancer (CC) characteristically is introduced by an infection of high risk HPV type, but there may be decades to progress to cervical cancer.
Women older than 40 years have the most common prevalence of CC with 70%. The most affected population by HPV is the women are 15 and 25 years old [16]. In Brazil, there are 64 million women, who are 15 years and above [17]. The HIV positive women population was 360,000 in Brazil in 2014 [18].
The risk of developing CIN and CC is quite related in this population. Cervical cancer needs to be screened, and its abnormalities should be followed up regularly. The high incidence of cervical cancer is quite related to missing of cervical cancer screening and follow up of abnormalities. Recent studies prove that the highest prevalence of cervical cancer is seen in SubSaharan Africa 24%, Eastern Europe 18%, Latin America and Caribbean 16%, unlike Western Asia 1.7% has the lowest percentage [19].
There is a study in the city of Sao Paulo among prostitutes. The risk of obtaining sexually transmitted infection include HIV and HPV is higher for these women. This is due to prostitution behaviors such as large number of partners, not using condom, and socioeconomic agents [20]. Another scientific study shows that Hispanic and black women are in greatly impressionable to gain cervical cancer [21].
They are twice the risk compared to non-hispanic women [22]. This may be because of some genetic factors or risky behaviors. By 2050 in the United States, hispanic population is expected to increase 128%, from 49 million to 111 million, while non Hispanics expected 11% [23]. As a result of this increase, the USA is expected to increase in cervical cancer diagnosis.com Cervical cancer has some stages (Figure1.2) that define the infection’s enlargement and situation.
The first stage is 0 which is not totally cancer, but if it is not treated, cervical cancer may develop. In stage 1, cervical cancer’s area is contained to the cervix. There are two groups in stage 1; group A and B. In stage 1A, there is a minor 5-7 millimeters microscopic cancer in the cervix.
In stage 1B, the cancer might spread slightly and is between 7 mm and 4 cm which is visible without a microscope.