Invasive cervical cancer is largely preventable through vaccination and timely screening and intervention. Why are 4,000 women in the U.S. still dying from the disease annually?
A Battelle study seeks to find the answers by looking at the use of preventive screenings and treatment in women in the years before the diagnosis. Funded by the Centers for Disease Control and Prevention (CDC), the study is the first of its kind to use a population-based sample of cervical cancer survivors to (a) apply chart abstraction to compile historical health data, and (b) to survey women about the barriers they might have experienced in obtaining care. The goal is to identify missed opportunities for screening and treatment and inform the development of public health programs to help close these gaps.
The Case Investigation of Cervical Cancer (CICC) Study, which is now in its preliminary phases, is a partnership between Battelle, CDC, the Louisiana State University Health Sciences Center, the Michigan Department of Health and Human Services and the State University of New Jersey, Newark. It will use data from three population-based central cancer registries: the Louisiana Tumor Registry, the Michigan Cancer Surveillance Program and the New Jersey State Cancer Registry. The registries identified 1,670 women who were diagnosed with invasive cervical cancer in 2014–2016.
Researchers are currently enrolling eligible women in the study and beginning data collection. Chart abstraction will be used to extract data directly from patient medical charts for the five years prior to their diagnosis, including screening history, follow up of abnormal results and any additional information related to the initial cancer diagnosis and screening. Participating survivors will also be asked to complete a mail survey and telephone follow-up to elicit information on barriers and facilitators to screening and care.
Chart abstraction provides more thorough and accurate information on health behaviors, care received and diagnoses than is possible to get from self-reported information alone.
April Greek, the Battelle Project Leader for the study, explains, “information women have about their own care isn’t always accurate. They may misremember dates or not understand what types of tests were actually performed during an exam. Going directly to the medical charts provides a much clearer picture of timelines, care received and diagnostic information.”
Medical record abstraction is used by central cancer registries to track treatments, patient adherence and health outcomes after a diagnosis. It is believed that this is the first study of cervical cancer to use population-based cancer registries to perform chart abstraction that looks backwards at healthcare provided in the years prior to a diagnosis. Findings from the study will provide important information about barriers to screening and care and related medical issues that could inform future prevention programs. Researchers from Battelle and other study partners presented the study methods at the North American Association of Central Cancer Registries (NAACCR) Annual Conference in June 2017.
The CICC Study builds on Battelle’s earlier work for the CDC’s Cervical Cancer (Cx3) Study. This study evaluated the effectiveness of an educational intervention to increase cervical cancer screening intervals with the HPV and Pap co-test and investigated patient and provider knowledge, beliefs and behaviors around cervical cancer screening. Battelle assisted with study design, data collection, statistical analysis and reporting.
Battelle has a long history of research on cervical cancer as well as other gynecological cancers. In addition to the Cx3 and CICC studies, Battelle also worked with the CDC on two studies to monitor the impact of a prophylactic HPV vaccine on HPV-associated cancers. These studies use genotyping data extracted from tissues collected by cancer registries to provide surveillance information that can be used to determine the impact of HPV vaccines on HPV-related cancers resulting from different strains of HPV. The pilot study was conducted on cancers before the HPV vaccine was introduced, and the current study is working with cancers that were diagnosed after the HPV vaccine. Battelle also conducted an impact study of the Inside Knowledge public health campaign, a CDC initiative aimed at increasing awareness of gynecological cancers among women ages 40–60.
Work on the CICC study is still in the beginning phases. Over the next 12 months, researchers will collect and analyze data from patient medical records and surveys. Results of the study are anticipated to be released in the fall of 2018.