Characterizing Breast and Cervical Cancer Burden Among Sexual Minority women

University Of Texas At Austin, Austin TX

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Abstract

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 orientation, we have no population-level estimates of cancer burden among sexual minority or heterosexual women and are unable to accurately evaluate differences or prioritize interventions to improve low screening rates. We propose to first characterize existing sexual orientation differences in cervical cancer screening uptake using a structural equation modeling approach (Aim 1). This approach will evaluate the extent to which previously described gaps 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 and sexual orientation (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 by sexual orientation (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 improve cancer care quality and reduce unnecessary cancer deaths. This award will allow me to take the next step in my career, building on my background in cancer care quality and decision modeling while facilitating my training in causal epidemiology approaches, breast cancer epidemiology, and the health needs of sexual minority women. The training plan draws on the extensive methodological expertise of my mentorship team and the exceptional educational and professional resources at Dell Medical School. The overall goal of this work is to reduce breast and cervical cancer burden for all women through characterizing multilevel differences in breast and cervical cancer screening, incidence, and mortality.