Comparative Modeling to Inform Cervical Cancer Control Policies

项目总结/摘要 宫颈癌预防和治疗的进展已导致发病率大幅下降， 美国（US）在过去20年中的死亡率。然而，即使整体利率提高，黑色 妇女在宫颈癌发病率、远期诊断以及 mortality.这些持续差异的原因是多方面的，可能是由于添加剂失效沿着 癌症护理的连续性，包括易感风险因素的流行率增加， 建议的宫颈癌筛查，以及在诊断出异常后延迟接受治疗。 为了在改善癌症护理公平性方面取得进展，必须描述种族差异的决定因素。 宫颈癌发病率和死亡率的差异，作为确定可行的，有效的， 高价值的干预措施。 我们建议调整哈佛陈的宫颈癌模型当前默认的“所有种族”（即，人口 平均值），以反映疾病负担以及筛查和疫苗接种实践的变化 在美国黑人女性中。 我们将通过更新关键人口统计学输入参数来适应全种族宫颈癌模型，以反映黑人 美国女性，如全因死亡率和子宫切除率。然后，我们将使用我们的 确定宫颈癌发病率差异的主要因素的黑人特异性宫颈癌模型 and mortality.具体来说，我们将首先更改每个主要参数类别中的值 (i.e.,自然史，筛查实践模式，治疗模式）顺序从所有种族的价值观， 特定于黑人的校准值，以了解每个参数块在解释 发病率和死亡率的差异。最后，我们将使用调整后的模型来检查 采取干预措施，以缓解宫颈癌的差距。 这项工作，由哈佛建模网站领导，将奠定基础，比较建模在其他 四个CISNET-Cervical建模站点，并实现其他CISNET癌症站点之间的协作， 确定战略，以减少美国人口中黑人个体的总体癌症差异。

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.