Cancer Epidemiology Used in Policy Questions

Abstract

This dissertation sought to answer policy questions concerning cancer using techniques and skills from epidemiology for three studies. First, trends in cancers associated with human papillomavirus (HPV) can help public health providers examine where to target prevention. Second, understanding the impact that legislation regarding HPV vaccination and education can have on teen sexual behaviors can also help inform policy. Third, understanding the burden that a breast cancer diagnosis has on young women (under age 45) in terms of income and employment allows providers to understand what populations may be vulnerable to changes. To answer these questions multiple methods were used. For the first study, data from the Massachusetts Cancer Registry were used to assess trends in HPV-associated cancers using Joinpoint regression. The second study used publicly available data from the Youth Risk Behavior Surveillance System (YRBSS). Difference-in-difference techniques were used to look at the impact of legislation on teen sexual behaviors. Lastly, we used data from the Young and Strong intervention trial to examine how stress, anxiety, and depression impacted changes in income status for young women with breast cancer using multinomial logistic regression models. Our first study found that the incidence rate of cervical cancer has been decreasing in Massachusetts while the incidence rate of oropharyngeal cancer has been increasing. Promoting cervical cancer screening and HPV vaccination will be important to prevent these cancers. Our second study found that enacting HPV legislation did not have any negative impacts on teen sexual behaviors of recent sexual intercourse or condom use during last intercourse. Concerns that HPV policies may negatively influence teen sexual behaviors should not be used when deciding whether to enact legislation. Lastly, we found that young women who had lower incomes and higher stage breast cancer had a higher risk of losing income than maintaining the same income under $100,000. Stress, anxiety and depression did not have an impact on change in income. These women represent a subset of young breast cancer patients that may be require more assistance during cancer treatment and survivorship. Cancer epidemiology can be used to answer policy questions concerning screening and prevention as well as issues related to survivorship for a wide range of cancer subtypes.