Characterizing Disparities and Elucidating Opportunities Across the Cervical Cancer Continuum among Native American Women

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PROJECT SUMMARY/ABSTRACT Although cervical cancer is a preventable disease, American Indian/Alaska Native (AI/AN) women suffer from substantially lower cervical cancer screening rates, disproportionately higher cervical cancer incidence rates; and are more often diagnosed at distant stages of the disease than their non-Native counterparts. Despite progress in reducing the overall cervical cancer rate in the U.S., the higher (and increasing) incidence rate among AI/AN women, and the unfavorable profile of local versus advanced stage of disease at diagnosis, indicate a continued need for aggressive and comprehensive screening and timely follow-up of abnormal results. At a time when efficacious and well-known cervical cancer control interventions such as Pap screening, testing for human papillomavirus (HPV), and HPV vaccinations are widely available, these stark disparities across the cervical cancer continuum are alarming for AI/AN women and reflect a significant public health problem. This study will aim to fill in these critical gaps in knowledge, understanding, and translation by utilizing linked data for AI/AN women in the IHS Epi Data Mart with women in the highly unique New Mexico HPV Pap Registry (NMHPVPR) to characterize cervical cancer screening coverage, rates and intensity, failures in cervical cancer screening, diagnosis and treatment, and correlates of cervical screening with HPV vaccination among AI/AN women. Our aims are to use the linked dataset to: a) reduce any racial misclassification of AI/AN women in the NMHPVPR and characterize cervical cancer screening coverage, intensity, intervals, and annual screening rates and to identify disparities in screening among AI/AN women registered at IHS/Tribal/Urban (I/T/U) health care facilities in New Mexico; b) assess failures in follow-up to abnormal Pap/HPV tests, and treatment following a diagnosis of cervical precancer among New Mexican AI/AN women and to geospatially analyze the failures so as to guide targeted interventions in the areas of most need; and c) to estimate HPV vaccination coverage, vaccine dose delivery, and screening initiation by HPV vaccination status in AI/AN women attending I/T/U facilities. The overarching premise of this study is that comprehensive elucidation of the specific pathways through which failures occur among AI/AN women across the cervical cancer continuum will inform cost-effective and data-driven strategies for intervention that can mitigate the pervasive health disparities witnessed among this underserved population. Study findings will be translated into several peer-reviewed manuscripts and will be translated into reports and presentations to inform tribal leadership and I/T/U administrators/providers about key opportunities for improvement.