Utilization of cervical cancer prevention tools and role of high-risk HPV type in the persistent cervical cancer disparities experienced by American Indian/Alaska Native women

项目总结 布鲁格尔博士是俄勒冈州卫生和妇产科的助理教授。 理科大学和国家罗伯特·伍德·约翰逊基金会哈罗德·阿莫斯少数民族学院 发展研究员。她的长期职业目标是消除宫颈癌发病率和 美洲印第安人/阿拉斯加原住民(AI/AN)人口死亡率；与使命和 国家癌症研究所的愿景。 AI/AN女性被诊断为宫颈癌的可能性是女性的1.5倍，死于 疾病与非西班牙裔白人女性相比。多重风险因素促成了 宫颈癌包括不接触宫颈涂片筛查、吸烟、社会经济地位和获得性 人类乳头瘤病毒(HrHPV)的高危亚型。这项提案旨在更深入地研究这些问题 通过批判性评估宫颈癌预防的应用和适用性，持续的健康差距 HPV疫苗接种、宫颈涂片筛查和高危HPV(HrHPV)类型分布等工具 AI/An人口。接种人乳头瘤病毒疫苗是预防宫颈癌及其前驱疾病的主要预防工具 美国建议11-12岁的青少年接种疫苗。高危HPV有14种 与癌症相关的人乳头瘤病毒(HrHPV)以及16型和18型占癌症病例的70%。其中一项建议 研究目标是全面评估俄勒冈州的HPV疫苗接种率和趋势以及宫颈涂片率 爱/安。该数据将确定疫苗接种率高和低的社区和重点人群 卫生保健提供者和社区成员将举行会议，以确定HPV疫苗接种的障碍和促进者。 很少有研究评估人工授精/再生障碍性贫血妇女中hrHPV亚型的流行率，数据表明 这14种类型的分布与美国普通人群不同，这可能导致真正的临床 后果。首先，疫苗接种可能不足以覆盖流行的亚型。第二, 阴道镜检查是一种以办公室为基础的程序，可以更全面地评估宫颈，但在检测异常增生方面不太敏感。 由于非hrHPV 16和18亚型。其他hrHPV亚型在AI/AN人群中的更高流行率 可能会导致漏诊的早期疾病。将进行一项横断面研究以确定患病率 HrHPV在AI/AN妇女中的分布。 作为NCI临床科学家导师研究职业发展奖培训奖的一部分，Bruegl博士 将参加一个健全的教育课程，以成功实现她成为一个独立的人的目标 临床科学家。她已经创建了一个强大的指导团队，并确定了具体的学习 帮助她实现这一目标的目标。

PROJECT SUMMARY Dr. Bruegl is an Assistant Professor in the Department of Obstetrics and Gynecology at Oregon Health and Science University and a national Robert Wood Johnson Foundation Harold Amos Minority Faculty Development Fellow. Her long-term career goal is to eliminate the disparities in cervical cancer incidence and mortality in the American Indian/Alaska Native (AI/AN) population; a goal that aligns with the mission and vision of the National Cancer Institute. AI/AN women are 1.5 times more likely to be diagnosed with cervical cancer and 2X as likely to die of the disease compared to Non-Hispanic White women. Multiple risk factors contribute to the development of cervical cancer including not accessing pap smear screening, smoking, socioeconomic status, and acquisition of high-risk subtypes of the human papillomavirus (hrHPV). This proposal seeks to look deeper in to these persistent health disparities by critically evaluating the utilization and applicability of cervical cancer prevention tools such as HPV vaccination, pap smear screening, and distribution of high-risk HPV (hrHPV) types in the AI/AN population. HPV vaccination is a primary prevention tool to prevent cervical cancer and its precursor lesions with U.S. recommendations to vaccination youth ages 11-12. There are 14 types of high-risk HPV (hrHPV) associated with cancer and types 16 and 18 contribute to ~70% of cancer cases. One of the proposed study goals is to fully evaluate the HPV vaccination rates and trends and pap smear rates among Oregon AI/AN. This data will to identify communities with high and low vaccination rates and focus groups of healthcare providers and community members will occur to identify barriers and facilitators of HPV vaccination. There are few studies evaluating the prevalence of hrHPV subtypes in AI/AN women and data suggest that the distribution of the 14 types differ from the general U.S. population, which can lead to real clinical consequences. First, vaccination may provide inadequate coverage for prevalent subtypes. Second, colposcopy, an office-based procedure to more fully evaluate the cervix, is less sensitive at detecting dysplasia due to non hrHPV 16 and 18 subtypes. A greater prevalence of other hrHPV subtypes in the AI/AN population can lead to missed, early-stage disease. A cross-sectional study will be performed to determine the prevalence and distribution of hrHPV among AI/AN women. As part of the NCI mentored clinical scientist research career development award training award, Dr. Bruegl will participate in a robust educational curriculum to successfully meet her goal of becoming an independent clinician scientist. She has identified created a robust mentorship team and identified specific learning objectives to help her meet this goal.