Cervical Cancer in the USA: Prevention, Detection, and Disease Outcomes in Relation to Novel Factors and Disparities
Loading...
Authors
Hagen, Molly Marie
Issue Date
2025
Type
Dissertation
Language
en_US
Keywords
cancer screening , Cervical cancer , childhood trauma , COVID-19 , HPV vaccination , racial disparities
Alternative Title
Abstract
Due to the availability of HPV vaccines and cervical cancer screening services in the United State (USA) cervical cancer has recently become preventable given adequate healthcare infrastructure and women’s ability and willingness to follow health guidelines. Any case of invasive cervical cancer should be viewed as a failure of screening or vaccination. Although the number of cervical cancer cases has been gradually/generally decreasing over the past 20 years, in 2024 alone about 13,000 women were diagnosed with late-stage cervical cancer in the USA and about 4,000 women died from it. Clearly, efforts to improve prevention via the HPV vaccine and adherence to screening/PAP smears guidelines remain important research topics. Moreover, because cervical cancer and treatment outcomes in the USA are well known to suffer from systemic racial and ethnic disparities, research and efforts to alleviate cervical cancer burden in the USA must consider the presence of these disparities. The purpose of this study was to identify the impacts of potentially important novel factors on cervical cancer prevention and disease outcomes. The specific aims were to evaluate (1) childhood sexual abuse (CSA) as a risk factor for non-adherence to cervical cancer screening guidelines, (2) individual and joint impacts of adverse childhood experiences (ACEs) and obesity on HPV vaccination, and (3) impacts of COVID-19 on cervical cancer outcomes. Women with CSA may find screening procedures to be retraumatizing but impacts of CSA of cervical cancer screening are poorly understood. CSA and other forms of adverse forms of childhood (ACE) also increase the risk for cancer and associated risk behaviors including obesity, smoking, alcohol and drug misuse, high-risk sexual behavior, and may be related to other important factors such as trust/distrust of authority figures.
The results of this dissertation increase knowledge needed to lower cervical cancer burdens in the USA. By considering the influence of childhood trauma on cervical cancer screening and HPV vaccination, these findings will help advance cervical cancer prevention research though enhanced understanding of novel risk factors that may be important for cancer risk behaviors and cancer risk. This dissertation also builds upon knowledge of disparities in cervical cancer outcomes by investigating impacts of the novel COVID-19 pandemic and impacts on existing cancer disparities like race/ethnicity.