Assessing Cervical Cancer Healthcare Inequities in Diverse Populations: The ACHIEVE Study

PROJECT SUMMARY/ABSTRACT No one should die from cervical cancer—a preventable disease. Up to 93% of invasive cervical cancer cases are preventable through human papillomavirus (HPV) vaccination and early detection, yet over 4,300 individuals die from cervical cancer annually in the United States. HPV vaccines and cervical cancer screening have yielded declining incidence over the past several decades but these advances have not improved survival across all groups. Racial and ethnic minority and low-income women are less likely to receive guideline-concordant cervical cancer treatment, which is associated with increased cervical cancer-specific mortality. Recent research, including ours, indicate a need to examine influences beyond individual-level factors, to better understand social, structural, and health system-level influences on treatment and survivorship outcomes among underserved women. Our prior work (which demonstrates successful recruitment and follow-up of cases through cancer registries, linkage with administrative datasets, and multi-modal data collection), and data from others show that healthcare system characteristics contribute to inequitable access to timely and high-quality care delivery across the cervical cancer care continuum. To address critical gaps in knowledge, the proposed study seeks to examine upstream indicators of structural racism as contributors to inequities in receipt of guideline-concordant cervical cancer treatment and survival in a diverse study sample drawn from population-based cancer registries. Guided by the NIMHD research framework and socio-structural models, this mixed-methods study will leverage two National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program registries (New Jersey State Cancer Registry and Los Angeles Cancer Surveillance Program), to prospectively examine the impact of micro- mezzo-, and macro-level factors on receipt of guideline-concordant treatment for and survival from cervical cancer. We will assemble a multiethnic cohort of individuals diagnosed with cervical cancer between 2021-2024 and obtain retrospective and prospective data (collected 12 months after baseline) from cancer registry records, self-reported questionnaires, medical records, and publicly available datasets to address these specific aims: 1.) Evaluate the association of social and structural factors on receipt of guideline- concordant care for invasive cervical cancer, 2.) Evaluate the association of social and structural factors on cervical cancer outcomes, and 3.) Identify actionable strategies for addressing social and structural risks and health system-level factors to optimize delivery of equitable cervical cancer care through one-on-one depth interviews with key stakeholders. This study will elucidate the multilevel causes of suboptimal cervical cancer treatment and poorer survival outcomes among marginalized groups to develop actionable system-level practice and policy change to address the persistent inequities cervical cancer outcomes.