||5UM1CA221940-02 Interpret this number
||Ut Southwestern Medical Center
||Multi-Level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations (METRICS)
For more than 5 decades, the US has sought to lower cervical cancer deaths through screening; however,
disparities remain. Introduction of oncogenic human papillomavirus (HPV)-based tests and HPV vaccines have
expanded cervical cancer prevention strategies and changed screening and management guidelines. As
technology, guidelines, and policies change, our MultilEvel OpTimization of the CeRvIcal Cancer Screening
Process in Diverse Settings & Populations (METRICS) PROSPR II Research Center will elucidate multilevel
factors that hamper or facilitate the cervical cancer screening process and reduce disparities in vulnerable
populations. METRICS unites three PROSPR I Research Centers with demonstrated capability to provide
validated data for a combined cohort of ~1.2 million screened and unscreened women. Our community
settings represent 3 care delivery models—safety-net system, managed care system, and primary care
provider networks in Texas, Washington, and Massachusetts. We will collect, harmonize, and document >
10 years of high-quality, comprehensive cervical cancer screening process data at the patient, provider,
clinic, and system levels using a rich array of electronic clinical information systems and novel data sources.
Our combined cohort is socioeconomically and geographically diverse and includes vulnerable groups
such as HIV-infected and uninsured women. Our three interconnected observational projects are
designed to understand how cervical cancer screening is delivered across our spectrum of delivery models,
and how to optimize the screening process to reduce disparities. Innovative geospatial and Bayesian statistical
methods in Project 1 will better elucidate at what levels variation in screening process occurs. Project 2 will
investigate how multilevel programs and policies influence adherence to guidelines for average-risk women.
Project 3 will inform precision screening for women with altered risk. Based on our observational findings, in
years 4-5, we will design and implement pilot interventions leveraging IT-enabled tools to address key failures
in the screening process and reduce disparities. Our transdisciplinary team has epidemiologists, primary and
specialty care physicians, and intervention, implementation, and healthcare delivery experts. We are poised to
efficiently evaluate the full cervical cancer screening process and provide expertise, leadership, and resources
for cross-organ PROSPR II collaborations. Our cores and research projects will achieve our goals of
advancing understanding of screening as practiced in community settings through: (1) analysis of
multilevel observational data from our heterogeneous settings with diverse populations, (2) development and
testing of impactful interventions to optimize the screening process, and (3) application of our novel
observational projects and quality metrics to the cancer screening processes for other organs. Based on our
successful experience leading and collaborating in PROSPR I, we thoughtfully organized our four cores to
be able to launch research activities and contribute to trans-PROSPR II activities quickly and effectively.
Cervical Cancer Incidence Among Elderly Women in Massachusetts Compared With Younger Women.
, Cook E.
, Davis M.
, Gershman S.T.
, Hanchate A.
, Haas J.S.
, Perkins R.B.
Journal of lower genital tract disease, 2018 Oct; 22(4), p. 314-317.
Cervical Cancer Burden and Opportunities for Prevention in a Safety-Net Healthcare System.
, Werner C.L.
, Borton E.K.
, Sanders J.M.
, Balasubramanian B.A.
, Barnes A.
, Betts A.C.
, Skinner C.S.
, Tiro J.A.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2018 12; 27(12), p. 1398-1406.