Title: Using Evolutionary Biology to Identify Disparities in Cervical Dysplasia at a Safety Net Hospital in the Southeast

Purpose Despite widespread cervical cancer screening, up to 13,000 invasive cervical cancer cases and >40,000 cases of carcinoma in situ are diagnosed in the US annually. This burden of disease is disproportionately heavy in the southeast and is fraught with disparities, improved understanding of which can help target improvements in clinical care. A majority of lesions do not progress to cervical cancer. This poses an interesting area of research to understand regression, persistence, or progression of an abnormal pap smear. High risk strains of human papilloma virus have an intimate connection to cervical dysplasia. However, HPV infection is not sufficient to lead to high grade lesions. Other cofactors such as age, parity, tobacco use, long‐term oral contraceptive use, and failed adherence to treatment, are thought to increase risk by altering the underlying epigenetics of the host. Given the disproportionately high impact of cervical cancer in Louisiana, it is key to understand the unique cofactors that affect our population's risk. We pose that examining these disparities through the lens of evolutionary biology will aid in our understanding of the burden of disease and guide our clinical practice. Methods We are pursuing a retrospective chart analysis to identify how, outside of HPV, the cofactors noted above contribute to regression, persistence, or progression of abnormal cervical pathology in a population seeking care at UMCNO Health, New Orleans from August, 2015 to present. Inclusion criteria are: initial abnormal pap with no history of prior abnormality, a cotest for HPV virus, ethnicity, ages 21–65, parity, smoking status, HPV vaccination status, and at least two subsequent visits for cervical cancer screening. Results We anticipate that disparities exist in regression, persistence, and progression among ethnic groups. We anticipate that there is an ethnic difference in HPV viral subtype, cofactors, and vaccination rates that may contribute to these outcomes. Conclusions An understanding of the factors contributing to health disparities as they pertain to cervical cancer development would be insufficient were it not examined through the lens of evolutionary biology. This most basic of biologic concepts can help shed light on one of healthcare's most puzzling questions – despite standard of care, why do health disparities exist and persist? Cervical cancer screening is one such puzzle where we can apply evolutionary biology to unravel our limitations as clinicians and, ideally, to better target our efforts to mitigate them. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .