Characterizing Breast and Cervical Cancer Burden Among Sexual Minority women

性少数女性乳腺癌和宫颈癌负担的特征

• 批准号: 10739450
• 负责人: Jenny Spencer
• 金额: $ 11.94万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-27 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739450
• 关键词: Address; Affect; Alcohol consumption; Award; Behavior; Bisexual; Breast Cancer Detection; Breast Cancer Epidemiology; Breast Cancer Risk Factor; Calibration; Cancer Burden; Caring; Cervical Cancer Screening; Contraceptive Usage; Data; Decision Modeling; Disease; Disparity; Education; Epidemiology; Equation; Etiology; Frequencies; Goals; Health; Health Services Accessibility; Heavy Drinking; Heterosexuals; High Prevalence; Human Papilloma Virus Vaccination; Human Papillomavirus; Human papilloma virus infection; Incidence; Inequity; Insurance; Intervention; Knowledge; Lesbian; Lesbian Gay Bisexual; Low Prevalence; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Mediating; Mediator; Mentorship; Methodology; Methods; Modeling; National Health Interview Survey; Natural History; Nulliparity; Obesity; Oncogenic; Outcome; Patient Self-Report; Pattern; Physical activity; Population; Poverty; Prevalence; Preventive care; Process; Recommendation; Reporting; Research; Research Personnel; Resources; Risk Behaviors; Risk Factors; Role; Screening for cancer; Sex Orientation; Sexual and Gender Minorities; Smoking; Source; Structure; Time; Training; Underserved Population; Update; Visit; Woman; Work; cancer care; cancer risk; care providers; care systems; career; causal model; cervical cancer prevention; econometrics; gender minority group; health disparity; health equity; health inequalities; hormonal contraception; improved; insight; large scale data; malignant breast neoplasm; medical schools; models and simulation; modifiable risk; mortality; neoplasm registry; parity; perceived discrimination; queer; racial disparity; screening; screening guidelines; sexual disparity; sexual identity; sexual minority; sexual minority group; sexual minority health; sexual minority men; sexual minority women; social; social determinants; tumor progression; uptake

Project Summary More than 8 million women in the US identify as a sexual minority- including lesbian, gay, bisexual, or queer, yet the health needs of this population remain understudied. Studies show sexual minority women are less likely to receive routine preventive care, including cancer screening. Studies of breast and cervical cancer risk among sexual minority women are mixed, with higher prevalence of risk factors including smoking, alcohol use, and obesity, but lower prevalence of risk factors such as HPV infection and use of hormonal contraceptives. As no national cancer registries collect information on sexual identity, we have no population-level estimates of cancer burden among sexual minority women and are unable to accurately evaluate disparities or prioritize interventions to improve low screening rates. We propose to first characterize existing sexual identity disparities in cervical cancer screening uptake using a structural equation modeling approach (Aim 1). This approach will evaluate the extent to which previously described disparities in screening uptake are mediated by differences in care access, prevalence of cancer risk factors, or both. We will then incorporate these data into a simulation model of cancer progression to produce feasible estimates of cervical cancer incidence and mortality by stage among sexual minority women (Aim 2). Finally, we will repeat the application of this full framework to assess relevant mediators of breast cancer screening and update the existing model to reflect our understanding of breast cancer natural history to estimate incidence and mortality among sexual minority women (Aim 3). My career to date has focused on using econometric and simulation modeling to better understand and address gaps in cervical cancer prevention among traditionally underserved populations. My ultimate goal is an independent research career focusing on effective strategies to reduce cancer health inequities among sexual and gender minority individuals. This award will allow her to take the next step in her career, building on her background in health equity and decision modeling while facilitating her training in causal epidemiology approaches, breast cancer epidemiology, and the health needs of sexual minority women. Dr. Spencer's training plan draws on the extensive methodological expertise of her mentorship team and the exceptional educational and professional resources at Dell Medical School. The overall goal of this work is to improve the health of sexual minority women through characterizing multilevel sources of inequities in breast and cervical cancer screening, incidence, and mortality.

项目摘要 在美国，超过800万女性认为自己是性少数--包括女同性恋、男同性恋、 双性恋，或同性恋，然而这一人群的健康需求仍然没有得到充分的研究。研究表明 性少数群体妇女不太可能接受包括癌症在内的常规预防护理 放映。关于性少数女性患乳腺癌和宫颈癌风险的研究喜忧参半， 吸烟、饮酒和肥胖等危险因素的患病率较高，但较低 危险因素的流行，如HPV感染和使用激素避孕药。作为否 国家癌症登记机构收集有关性别身份的信息，我们没有人口水平 对性少数女性癌症负担的估计，无法准确 评估差异或优先采取干预措施，以提高低筛查率。我们建议首先 在宫颈癌筛查中利用性别认同差异来表征现有的性别差异 结构方程建模方法(目标1)。这种方法将评估在多大程度上 前面描述的筛查摄取方面的差异是由护理途径的差异所调节的， 癌症危险因素的流行，或两者兼而有之。然后我们将把这些数据合并到模拟中 癌症进展模型，以产生可行的宫颈癌发病率和 按阶段分列的性少数群体妇女死亡率(目标2)。最后，我们将重复该应用程序 评估乳腺癌筛查的相关媒介的完整框架，并更新 现有的模型反映了我们对乳腺癌自然病史的认识，以估计发病率 和性少数群体妇女的死亡率(目标3)。到目前为止，我的职业生涯主要集中在使用 计量经济学和模拟建模，以更好地了解和解决宫颈癌的差距 在传统上服务不足的人群中进行预防。我的最终目标是成为一名独立的 专注于减少癌症健康不平等的有效策略的研究生涯 性少数群体和性别少数群体。这一奖项将让她在自己的人生道路上迈出下一步 职业生涯，以她在健康公平和决策建模方面的背景为基础，同时促进她 因果流行病学方法、乳腺癌流行病学和卫生需求方面的培训 性少数族裔女性。斯宾塞博士的训练计划借鉴了广泛的方法论 她的指导团队的专业知识以及 戴尔医学院。这项工作的总体目标是改善性少数群体的健康 通过表征乳腺癌和宫颈癌中不平等的多层次来源 筛查、发病率和死亡率。