Characterizing Breast and Cervical Cancer Burden Among Sexual Minority women

项目摘要 在美国，超过800万女性被认为是性少数群体，包括女同性恋、男同性恋、 双性恋或同性恋者，但这一人群的健康需求仍未得到充分研究。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性护理 筛选关于性少数女性患乳腺癌和宫颈癌风险的研究结果喜忧参半， 吸烟、饮酒和肥胖等风险因素的患病率较高，但 危险因素的流行，如HPV感染和使用激素避孕药。因为没有 国家癌症登记处收集关于性别身份的信息，我们没有人口水平 估计性少数妇女的癌症负担，无法准确地 评估差距或确定干预措施的优先次序，以提高低筛查率。我们建议首先 描述宫颈癌筛查中现有的性别认同差异， 结构方程建模方法（目标1）。这种方法将评估在多大程度上 先前描述的在筛查摄取方面的差异是由护理可及性的差异介导的， 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一个模拟中， 癌症进展模型，以产生可行的宫颈癌发病率估计值， 按阶段分列的性少数妇女死亡率（目标2）。最后，我们将重复应用 评估乳腺癌筛查的相关介质，并更新 现有模型反映我们对乳腺癌自然史的理解，以估计发病率 性少数妇女的死亡率（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 在传统上得不到充分服务的人群中开展预防工作。我的最终目标是独立的 研究职业生涯侧重于有效的战略，以减少癌症健康的不平等， 性和性别少数群体。这个奖项将使她在她的下一步 职业生涯，建立在她的健康公平和决策建模的背景，同时促进她 因果流行病学方法、乳腺癌流行病学和健康需求方面的培训 性少数群体女性。斯宾塞博士的培训计划借鉴了广泛的方法论， 她的导师团队的专业知识和卓越的教育和专业资源， 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状况 通过确定乳腺癌和宫颈癌不平等的多层次根源， 筛查、发病率和死亡率。

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.