Comparative Modeling for the Prevention and Control of Uterine Cancer

子宫癌是女性的第四大常见癌症，也是与癌症相关的第七大常见病因。 死亡。子宫癌死亡率的上升速度比其他任何肿瘤都要快。重要的是，子宫癌 与严重的种族差异有关。与白人女性相比，黑人女性明显更多 有可能死于子宫癌，而且这种差距还在扩大。这项提议的首要目标是 告知癌症控制和预防策略，通过以下方式降低子宫癌的发病率和死亡率 加强疾病的预防、筛查和治疗工作。我们将通过以下方式实现这一目标 协作性建模联盟，其中三个小组开发子宫癌的自然历史模型。 这些模型将纳入子宫癌的已知风险因素和人口水平的变化 随着时间的推移，这些危险因素的流行程度。模型将包括两种良好预后的路径(类型 I)子宫癌以及更具侵袭性的(第二类)肿瘤。 开发和验证后，我们将执行比较建模，以检查 临床医生和政策制定者。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，我们将研究其危害、收益和成本- 子宫癌辅助治疗、转移治疗等治疗策略的效果 疾病，以及复发性疾病的治疗，包括免疫疗法。第三，我们将估计如何改变 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, 我们将探索肥胖率上升对子宫癌发病率和死亡率的影响，并制定 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 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 临床护理子宫癌妇女并指导癌症控制策略。此外，这些模型将 作为新的临床问题和挑战，为子宫癌社区提供了宝贵的资源 浮出水面。

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.