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

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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.