Comparative Modeling for the Prevention and Control of Uterine Cancer

子宫癌是女性第四大常见癌症，也是癌症相关疾病的第七大常见原因。 死亡子宫癌的死亡率上升速度比任何其他肿瘤都快。重要的是，子宫癌 与深刻的种族差异有关。与白色女性相比， 可能死于子宫癌，而且这种差距正在扩大。本提案的总体目标是 宣传癌症控制和预防战略，以降低子宫癌的发病率和死亡率， 改善疾病的预防、筛查和治疗。我们将通过一个 协作建模联盟，其中三个小组开发子宫癌的自然史模型。 这些模型将纳入已知的子宫癌风险因素和人口水平的变化， 随着时间的推移，这些风险因素的普遍性。这些模型将包括有利预后（类型 I）子宫癌以及更具侵袭性的（II型）肿瘤。 一旦开发和验证，我们将执行比较建模，以检查重要的问题， 临床医生和决策者。首先，我们将研究目前可用的和新兴的筛查策略 和预防妇女子宫癌。第二，我们将研究危害，收益和成本- 子宫癌治疗策略的有效性，包括辅助治疗、转移性 疾病和复发性疾病的治疗，包括免疫疗法。第三，我们将评估如何改变 流行病学因素和健康的社会决定因素影响子宫癌的种族差异。第四， 我们将探讨肥胖率上升对子宫癌发病率和死亡率的影响， 新的，基于网络的工具，以确定国家一级的肥胖控制活动如何影响发病率和死亡率。 最后，我们将探讨子宫切除率的下降和妇科护理模式的变化如何影响子宫切除率。 疾病影响子宫癌的发病率和死亡率。在这项工作完成后，这些数据将 广泛传播给患者，提供者和政策制定者，并有可能显著影响 为患有子宫癌的妇女提供临床护理，并指导癌症控制策略。此外，这些模型将 作为子宫癌社区的宝贵资源，作为新的临床问题和挑战 出现。

Uterine cancer is the 4th most common cancer in women and the 7th most frequent cause of cancer-related death. The death rate from uterine cancer is rising faster than for any other tumor. Importantly, uterine cancer is associated with a profound racial disparity. Compared to white women, black women are significantly more likely to die from uterine cancer and this disparity is increasing. The overarching goal of this proposal is to inform cancer control and prevention strategies to reduce the incidence and mortality uterine cancer by improving the prevention, screening, and treatment of the disease. We will accomplish this goal through a collaborative modeling consortium in which three groups develop natural history models of uterine cancer. These models will incorporate known risk factors for uterine cancer and population level changes in the prevalence of these risk factors over time. The models will include pathways for both favorable prognosis (type I) uterine cancer as well as more aggressive (type II) neoplasms. Once developed and validated, we will perform comparative modeling to examine issues of importance to clinicians and policymakers. First, we will examine currently available and emerging strategies for screening and prevention of uterine cancer in women. Second, we will examine the harms, benefits, and cost- effectiveness of treatment strategies for uterine cancer including adjuvant therapy, treatment of metastatic disease, and treatment of recurrent disease including immunotherapy. Third, we will estimate how changing epidemiologic factors and social determinants of health influence racial disparities for uterine cancer. Fourth, we will explore the impact of the rising rate of obesity on incidence and mortality of uterine cancer and develop novel, web-based tools to determine how state-level obesity control activities influence incidence and mortality. Finally, we will explore how the declining hysterectomy rate and changing patterns of care for gynecologic diseases influence uterine cancer incidence and mortality. At the completion of this work, these data will be widely disseminated to patients, providers, and policy makers and have the potential to significantly impact the clinical care of women with uterine cancer and to guide cancer control strategies. Further, these models will serve as an invaluable resource for the uterine cancer community as new clinical questions and challenges emerge.