Abstract IA30: Approaching “precision disparities” in cervical cancer outcomes

In the United States, Black women experience an increased risk of developing and dying from cervical cancer, primarily due to more advanced stage of disease at diagnosis. Black women tend to be diagnosed with later stage disease, when the prognosis for survival is poor, despite screening rates that meet and in some instances, exceed, those reported for white women. Thus, the observed survival difference between women of varying race/ethnicity may, in part, be biologically based. Research has identified key differences in the genotype, or strain, of Human Papillomavirus (HPV) associated with the cervical tumors of Black vs. white women with disease, and also found racial variability in the mutations expressed in other cancer sites. However, little is known about racial variability in epigenetic processes associated with disease onset and progression in cervical cancer, though there is increasing evidence that the methylation status of genes involved in carcinogenesis also varies by race. This is perhaps not surprising. Epigenetic alterations, such as DNA methylation, play an important role in various cellular functions, and are influenced by known cancer risk factors, including diet, tobacco, alcohol consumption, stress, and socio-environmental conditions, among others. Such factors vary across the population at large and between racial/ethnic groups, specifically. Blacks also have higher levels of methylation at birth relative to their white counterparts and, therefore, may be exposed to poorer outcomes, given the likely interaction between baseline biology and undue exposure to causal risk factors and risk conditions. We have developed a novel statistical approach, PRISM, which enables a more intuitive understanding of how biological factors interact with more upstream, social determinants to influence disease etiology and outcome. Using PRISM, we examine data from the publically available Cancer Genome Atlas (TCGA), and our ongoing work in Little Haiti, the largest enclave of Haitian settlement in the United States, to better understand the complex interplay between multilevel determinants of cervical cancer on disease survival. Citation Format: Erin Kobetz, R. Sunil Rao, Huilin Yu, Phillip Miller, Ruslan Garcia, Karina Hew, Julia Seay. Approaching “precision disparities” in cervical cancer outcomes. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA30.