Caribbean Investigation of Cancer Stigma and its effect on Cervical Cancer Screening and HPV Vaccination

Beckman Research Institute/City Of Hope, Duarte CA

Investigators

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Abstract

Project Summary/Abstract Title: Caribbean Investigation of Cancer Stigma and its effect on Cervical Cancer Screening and HPV Vaccination This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-21-026 Cancer stigma is an understudied barrier to cancer treatment seeking, early diagnosis, screening and other prevention practices. In particular, cervical cancer (CCA) stigma must be prioritized for research as CCA is among the most deadly but highly preventable cancers. CCA is the fourth most common cancer in the world despite an accurate screening test and a preventive HPV vaccine. The Human papilloma Virus (HPV) causes 99% of cervical, as well as much of anal, penile and oral cancers. The burden of CCA persists, and CCA incidence and mortality are even increasing among Black women in low resourced countries globally. Specifically, CCA incidence is highest, and is the leading cause of premature mortality among Caribbean women. Despite heightened risk for HPV-related cancer, and readily available, low cost screening and HPV vaccination (HPVV), both CCA screening and HPV vaccine uptake in the Caribbean region is perilously low. Our prior, preliminary research suggest that CCA stigma is associated with inadequate screening, advanced cancer stage at diagnosis, and low uptake of the HPV vaccine among Caribbean populations, both in the Caribbean region and United States (US). However, both our preliminary studies as well as the literature on CCA-related stigma, suffer from a lack of population studies that employs qualitative and quantitative methods to rigorously quantify stigma, and measure stigma?s impact on CCA screening and HPVV. Therefore in an effort to further understand the impact of cancer stigma on CCA screening and HPVV for the Caribbean context, we aim to 1) culturally transcreate the existing validated Cancer Stigma Scale (CASS) for population appropriateness, 2) assess cancer stigma in a non-patient population of men and women using the culturally transcreated CASS in Jamaica and Grenada, 3) assess the association of stigma and a) cervical cancer screening among women and b) HPVV knowledge and practice --- for participants with HPVV eligible adolescents. For this study, social norms theory formed the theory, and we will use a mixed-methods design, rooted in the community engaged research approach. A community advisory council will be appointed in both Jamaica and Grenada, to inform the transcreation of CASS and overall cultural responsiveness of the study. The study will use qualitative methods with stakeholders to transcreate and modify CASS. The study survey with the modified CASS will be distributed via social media and electronic platforms to a population sample (n=1,240). Participants will complete the survey using a paper-based format and the Research Electronic Data Capture System (REDCap). Based on our preliminary findings and the lierature, we hypothesize similar stigma scores in the Caribbean (Grenada and Jamaica), and that Caribbean stigma scores will be higher compared to other countries, and higher stigma scores will be associated with less cancer screening and lower knowledge, acceptability, and uptake of the HPV vaccine (for those with age eligible children). The Caribbean region must be emphasized in global cancer research because of its close proximity to the US and Caribbean immigrants account for 12% of US Blacks. Therefore, the results will inform interventions to reduce stigma and increase cancer prevention e.g., CCA screening and HPVV among Caribbean populations both in the Caribbean region and among US Caribbean immigrants to ultimately reduce Black cancer disparities.