Failures to screen women for cervical cancer are well documented. The current U.S. screening program fails to reach small pockets of populations living mainly in low-resource, medically underserved regions as part of a complex of diseases linked to poverty and/or racial disparities. These populations have cen/ical cancer rates that are similar to middle-income countries and contribute approximately 60% of the cervical cancer cases that occur annually in the U.S. it is reasonable to suggest that the current cervical cancer prevention program has reached its limits and innovative strategies are needed to overcome these barriers and further reduce the burden in underserved populations. HPV DNA testing offers a promising strategy to enhance cervical screening coverage and address both patient and primary care provider challenges along the care process. HPV DNA testing is highly sensitive (90-95%) for identifying women with cervical precancer and cancer when using a clinician-collected specimen, and 20-50% more sensitive than routine cytology programs. Thus, self-collection combined with HPV DNA testing can potentially be used to extend access to women who are not reached by current Pap-based programs. However, there are only limited, small studies of self-collection in the U.S. and more work is needed to determine whether self-collection is acceptable to diverse patient populations as well as potential barriers toward integration of this approach into primary care settings. This mixed method study is designed to: 1. fully describe the current cervical cancer screening and treatment care continuum, and to assess the translational potential of a promising new approach?self-collection?by conducting a three-phase sequential mixed-method translational study (Phase la): 2. involve American Indian and Hispanic women in the co-development of a culturally-appropriate approach to self-collection (Phase lb): 3. integrate practice assessment and patient findings (Aims 1 and 2) in an intervention to assess the feasibility and comparability of self-collection methods for HPV testing and routine cervical cytology with HPV co-testing in four purposefully selected primary care clinical settings: (Phase 2)

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-SRLB-R)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of New Mexico Health Sciences Center
United States
Zip Code
Cuzick, Jack; Myers, Orrin; Hunt, William C et al. (2015) Human papillomavirus testing 2007-2012: co-testing and triage utilization and impact on subsequent clinical management. Int J Cancer 136:2854-63
Kim, Jane J (2014) Practice-based evidence for primary HPV testing in the United States. J Natl Cancer Inst 106:
Burger, Emily A; Sy, Stephen; Nygård, Mari et al. (2014) Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys. PLoS One 9:e89974
Kinney, Walter; Hunt, William C; Dinkelspiel, Helen et al. (2014) Cervical excisional treatment of young women: a population-based study. Gynecol Oncol 132:628-35
Burger, Emily A; Kim, Jane J (2014) The value of improving failures within a cervical cancer screening program: an example from Norway. Int J Cancer 135:1931-9
Campos, Nicole G; Burger, Emily A; Sy, Stephen et al. (2014) An updated natural history model of cervical cancer: derivation of model parameters. Am J Epidemiol 180:545-55
Cuzick, Jack; Myers, Orrin; Hunt, William C et al. (2014) A population-based evaluation of cervical screening in the United States: 2008-2011. Cancer Epidemiol Biomarkers Prev 23:765-73
Wheeler, Cosette Marie (2013) The natural history of cervical human papillomavirus infections and cervical cancer: gaps in knowledge and future horizons. Obstet Gynecol Clin North Am 40:165-76
Kim, Jane J; Sharma, Monisha; Ortendahl, Jesse (2013) Optimal interval for routine cytologic screening in the United States. JAMA Intern Med 173:241-2
Bosch, F Xavier; Broker, Thomas R; Forman, David et al. (2013) Comprehensive control of human papillomavirus infections and related diseases. Vaccine 31 Suppl 8:I1-31