Cervical cancer prevention processes are rapidly transforming. Changes in guidelines, and resulting changes in practice, stem from breakthroughs in basic research on cervical cancer and technological advances in testing, diagnosis, and prevention. For example discovery of the role of human papillomavirus (HPV) in cervical carcinogenesis has led to development of HPV vaccines and recommendations for their use in the general public. As cervical cancer prevention practices change, we face widening gaps in our knowledge about the impact of these changes on women's health, that is, the balance of risk and harms affected by newly recommended screening intervals, and how this balance differs for vaccinated and unvaccinated women. We also need more information about barriers to screening uptake and adherence to guidelines screening intervals. To address these gaps, we propose supplementing our Studying Colorectal Cancer Effectiveness of Screening Strategies (SuCCESS) PROSPR Research Center with a Cervical Cancer Unit that will collect population-based data and work with the PROSPR network to guide studies of the cervical cancer screening process. Our study team, located at Group Health Research Institute, has access to extensive data from Group Health, a health care and coverage system in Washington State. Multilevel data are available from patients (e.g., characteristics, screening dates, cancer outcomes), providers (e.g., specialty), and facilities that include both health system owned-and-operated clinics and contracted community affiliates. Group Health members represent a diverse population of patients who receive care under a range of insurance coverage programs available in the US, ranging from Medicare and Medicaid to new plans offered beginning January 1, 2014 under the Affordable Care Act. Our study team is well positioned to carry out this proposed work. We are already closely linked to Group Health clinical providers, and have a breadth and depth of experience in cervical cancer screening research that includes knowledge of Group Health data systems and methods for extracting information from these systems, and up-to-date methodology including study design and analysis of complex data.
Cervical cancer screening recommendations have undergone dramatic changes, shifting from annual Papanicolaou (Pap) testing to 2- to 3-year rescreening intervals, and incorporating HPV DNA testing. This supplement to our PROSPR Research Center will enable our team to provide population-level data to improve our understanding of the benefits and harms of cervical cancer screening as practiced.
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