Approximately 15 HPV types cause virtually all cervical cancers; however, the current HPV vaccines cover only 2 HPV types causing ~70% of invasive cervical cancer and have no therapeutic effect on established infections that place women at risk. Thus, all women will need some kind of routine cervical screening for the foreseeable future. Importantly, the majority of women alive today have not been vaccinated and therefore are at risk for cervical cancer. The US Preventive Services Task Force recommendation on cervical cancer screening were recently updated in 2012, as were the recommendations of the American Cancer Society, American Society of Colposcopy and Cervical Pathology (ASCCP) and the American Society for Clinical Pathology. Performance measures for cervical cancer screening however have focused on population coverage rather than on follow-up among women with positive screening and diagnostic tests.
Toward improving US cervical cancer prevention, we engage in multi-tiered assessments at the statewide, systems, provider and patient levels including targeted medical record review of failures in the screening process; geospatial mapping of population-based screening, diagnosis and treatment; and application of community-based participatory approaches (CBPR) in clinical settings to identify barriers and facilitators across the processes of care including those that may enable novel patient-centered screening options. With the advent of new prevention tools targeting HPV, comparative- and cost-effectiveness assessments are critical to making decisions regarding best practices.
The cornerstone of our coordinated, multidisciplinary program is the New Mexico HPV Pap Registry (NMHPVPR) which transcends limitations of organizational monitoring by mandating statewide surveillance of all cervical cancer screening, diagnosis and treatment. New Mexico is home to a high proportion of ethnically diverse (i.e., American Indian and Hispanic), rural, impoverished, medically disenfranchised and health-disparate populations at high-risk for cervical cancer. New Mexico was selected as one of the seven founding screening centers awarded in 2011 under the US National Cancer’s PROSPR (Population-Based Research Optimizing Screening through Personalized Regimens) research program.
The specific aims of the New Mexico PROSPR Center are to:
- Establish the New Mexico HPV Outcomes, Practice Effectiveness and Surveillance (NM-HOPES) PROSPR Research Center (PRC);
- Establish a sustainable Screening Process Documentation Unit providing data on patients during their course of cervical cancer screening care;
- Integrate and fund research projects with the overarching aim of informing clinical practice and targeted interventions supported by comparative effectiveness evaluations of real-world cervical cancer screening practice and outcomes versus guidelines and innovations.
Toward improving cervical prevention efforts among the populations of the Southwestern US, we are creating a multidisciplinary research center focusing on barriers and facilitators of systems and primary care practice, cost- and comparative effectiveness evaluations and participatory research approaches to enable patient-centered solutions.
- University of New Mexico Health Sciences Center (Primary Location)
- UNM Bureau of Business and Economics Research
- Harvard University
- University of Alabama at Birmingham
- Texas A&M
- Clinical Partners throughout New Mexico (Under Development)
PROSPR Trans-network and Dissemination Capabilities of the NM-HOPES-PROSPR Research Center (PRC)
The overarching and unifying themes of the NM-HOPES-PRC synergistic programs are 1) population-based comparative effectiveness of real-world practice versus compliance with current and emerging guidelines, 2) coverage and managed follow-up care, 3) barriers to access and equitable healthcare, and 4) integration of new technologies with patient-centered approaches to increase dissemination of innovations to improve cervical cancer prevention (HPV vaccination and testing). Our unique and comprehensive state-wide cervical cancer screening, diagnostic and treatment surveillance program conducted in populations that are at higher risk for cervical cancer and our partnering community-based provider networks provide data that contrasts with and compliments that available through studies of Managed Care Organizations (MCO) populations.