Comparative Modeling to Inform Cervical Cancer Control Policies

项目总结/文摘

Project Summary/Abstract Advances in cervical cancer prevention and treatment have resulted in substantial reductions in incidence and mortality in the United States (US) over the past twenty years. However, even as overall rates improve, Black women remain at higher risk than White women for cervical cancer incidence, diagnosis at distant stage, and mortality. Reasons for these persistent disparities are multifactorial, likely resulting from additive failures along the cancer care continuum, including increased prevalence of predisposing risk factors, lower receipt of recommended cervical cancer screening, and delays in receipt of treatment after abnormalities are diagnosed. To make progress in improving cancer care equity, it is essential to delineate the determinants of racial disparities in cervical cancer incidence and mortality as a first step towards identifying feasible, effective, and high-value interventions. We propose to adapt the Harvard Chan’s cervical cancer model current default “all race” (i.e., population average) to reflect variations in the disease burden, as well as both screening and vaccination practice patterns, among Black women in the US. We will adapt an all-race cervical cancer model by updating key demographic input parameters to reflect Black women in the US, such as all-cause mortality and hysterectomy rates. We then will perform analyses using our Black-specific cervical cancer model to identify the main contributors to disparities in cervical cancer incidence and mortality. Specifically, we will start by changing the values in each of the main categories of parameters (i.e., natural history, screening practice patterns, treatment patterns) sequentially from the all-race values to the Black-specific calibrated values to understand how influential each block of parameters is in explaining the differences in incidence and mortality. Finally, we will use the adapted model to examine the potential for interventions to alleviate cervical cancer disparities. This work, led by the Harvard modeling site, will lay the groundwork for comparative modeling across the other four CISNET-Cervical modeling sites, as well as enable collaboration across the other CISNET cancer sites in identifying strategies to reduce overall cancer disparities among Black individuals in the US population.