Abstract C098: "Am I at risk for cervical cancer?": Racial disparity implications of an unexpected relationship between chronic conditions and precancerous lesions
Authors: Raman Shreya R. , Sullivan Stephanie A. , Winn Robert A. , Tossas Katherine Y. 
Published: January 2023

Abstract
Objective: Cervical cancer is a highly preventable malignancy caused by HPV that begins with the development of precancerous lesions (high risk cervical intraepithelial neoplasia grades 2 or 3 - hrCIN). As cancer is a metabolic disease, individuals with metabolic conditions such as diabetes, high cholesterol (hcho) and high blood pressure (hbp) may be at higher risk of developing hrCIN. Given the higher prevalence among Black women, we sought to determine whether these metabolic conditions increase the risk of hrCIN differentially by race. Methods: We used data from hospital and physician billing claims for any CIN diagnosis occurring at the Virginia Commonwealth University Health System (VCUHS) from 01/01/2014 through 12/04/2021, along with respective clinical and sociodemographic characteristics at the time of diagnosis. We estimated the risk of high-grade dysplasia (CIN2+ versus CIN1) among women with various metabolic diseases, using logistic regression (LR) with a backward selection approach (removing terms with p ≥ 0.2 and adding those with p &lt; 0.1) to identify most relevant confounding factors. Results: There were 2,761 women diagnosed with CIN 1, 2, 3, and unspecified dysplasia of the cervix uteri with respective prevalence of 30%, 45%, 11%, and 14%. The prevalence of hrCIN did not vary by race (48% versus 52% for non-Latina (nL)-whites versus nL-Blacks respectively). Of the variables included in the LR model (age, marital status, religion, preferred language, insurance status, Body Mass Index, HIV, HPV, presence of bacterial vaginosis, hypertension, cholesterol, diabetes, pulmonary conditions, arthritis, heart conditions, pregnancy status, parity, smoking, alcohol, and previous cancer diagnoses), only pregnancy status, diabetes, hypertension, cholesterol, insurance, language, pulmonary conditions, and HPV remained in the final LR model. We identified an interaction between hypertension and cholesterol (p=0.03) where the odds of a hrCIN among women with both, hypertension, and cholesterol, were more than twice compared to women with neither comorbidity (OR=2.2, 95%CI: 1.1, 4.3). Stratified by race, the elevated risk of hrCIN was only significant among nL-Black women (p=0.05, OR=2.9, 95%CI: 1.1, 8.6). Conclusions: Despite no apparent difference in the incidence of hrCIN by race in this dataset, our analysis revealed an excess risk of hrCIN that was only present for Black women with both hypertension and hypercholesterolemia. These comorbidities are both overrepresented in nL-Blacks and are associated with low grade systemic inflammation, which may promote HPV persistence and progression to hrCIN. If replicable, this association deserves further investigation to assess its biological underpinnings and potential as a point of intervention to reduce the risk of CIN progression and cervical cancer.
Citation Format: Shreya R. Raman, Stephanie A. Sullivan, Robert A. Winn, Katherine Y. Tossas. "Am I at risk for cervical cancer?": Racial disparity implications of an unexpected relationship between chronic conditions and precancerous lesions [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C098.