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

项目摘要 Bruegl博士是俄勒冈州卫生局妇产科系的助理教授， 科学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的差距， 美国印第安人/阿拉斯加原住民（AI/AN）的死亡率;这一目标与使命一致， 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其他女性的1.5倍，死于宫颈癌的可能性是其他女性的2倍。 与非西班牙裔白色女性相比，多种风险因素有助于发展 宫颈癌，包括没有获得巴氏涂片筛查，吸烟，社会经济地位和收购 人乳头瘤病毒（hrHPV）的高危亚型。这项建议旨在深入研究这些问题， 通过严格评估宫颈癌预防的利用和适用性， 工具，如HPV疫苗接种，巴氏涂片筛查，以及高危HPV（hrHPV）类型的分布 AI/AN人群。HPV疫苗接种是预防宫颈癌及其前体的一级预防工具 美国建议接种11-12岁的青少年。高危型HPV有14种 与癌症相关的hrHPV（hrHPV）和16型和18型占癌症病例的约70%。一个拟议的 研究的目的是全面评估俄勒冈州的HPV疫苗接种率和趋势以及巴氏涂片率 AI/AN。这些数据将用于确定疫苗接种率高和低的社区以及 卫生保健提供者和社区成员将出现，以确定HPV疫苗接种的障碍和促进因素。 很少有研究评估AI/AN女性中hrHPV亚型的患病率，数据表明， 这14种类型的分布与美国普通人群不同，这可能导致真实的临床 后果第一，疫苗接种可能不能充分覆盖流行的亚型。第二、 阴道镜检查是一种在办公室进行的检查，可以更全面地评估宫颈，但在检测发育异常方面的敏感性较低 非hrHPV 16和18亚型。AI/AN人群中其他hrHPV亚型的患病率更高 会导致早期疾病的漏诊将进行一项横断面研究，以确定 和hrHPV在AI/AN妇女中的分布。 作为NCI指导临床科学家研究职业发展奖培训奖的一部分，Bruegl博士 将参加一个强大的教育课程，以成功地实现她成为一个独立的目标， 临床科学家她已确定创建了一个强大的导师团队，并确定了具体的学习 帮助她实现这一目标。

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.