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ZusammenfassungIn Deutschland weist mehr als die Hälfte der Bevölkerung eine geringe Gesundheitskompetenz auf. Diese Menschen haben Schwierigkeiten, gesundheitsrelevante Informationen zu finden, einzuordnen und anzuwenden. Unter ihnen sind auch viele junge Menschen, was den Stellenwert früher Interventionen zur Förderung der Gesundheitskompetenz verdeutlicht.Das Programm „Fit in Gesundheitsfragen“ der Gesundheitsinformationsdienste vom Forschungszentrum Helmholtz Munich und dem Deutschen Krebsforschungszentrum hat zum Ziel, einen Beitrag zur Förderung verschiedener Dimensionen von Gesundheitskompetenz bei Kindern und Jugendlichen zu leisten. Dazu werden innovative Fortbildungsformate für Lehrkräfte und Unterrichtsmaterialien für Lernende der Sekundarstufen I und II konzipiert und begleitend evaluiert. Am Modell der Volkskrankheiten Krebs und Diabetes mellitus wird Wissen zu deren Entstehung, Prävention, Behandlung und Erforschung vermittelt. Darüber hinaus werden Wissen über das Gesundheitssystem und Materialien zur Förderung der Gesundheitskompetenz bereitgestellt. Die Evaluation erhebt Indikatoren zu Reichweite und Akzeptanz der Maßnahmen.Seit 2018 wurden 46 Unterrichtsmaterialien und 3 Informationsschriften mit Hintergrundwissen für Lehrende veröffentlicht. Ferner wurden 50 Lehrerfortbildungen durchgeführt, an denen bis Ende 2021 rund 1600 Lehrkräfte und Multiplikatoren in Präsenz oder online teilnahmen. Sie erteilten den jeweiligen Veranstaltungen zu über 90 % sehr gute und gute Noten. Rund 80 % der Teilnehmenden gaben an, die vermittelten Themen in ihrem Unterricht aufgreifen zu wollen. Ein weiterer Ausbau des Angebots ist vorgesehen. Die Testung ausgewählter Materialien im Hinblick auf die Förderung der Gesundheitskompetenz in einer Stichprobe von Lernenden ist in Planung.

In Germany, more than half of the population has low health literacy. These people have difficulties in finding and classifying health-related information and adapting it to their own situation. Among them are many young people, highlighting the importance of interventions early in life to promote health literacy.This is where the "Fit in Health" program of the Health Information Services of the Helmholtz Munich Research Center and the German Cancer Research Center starts. The objective is to contribute to the promotion of different dimensions of health literacy among children and adolescents. To this end, innovative training formats for teachers and teaching materials for students at secondary levels I and II are being designed and evaluated. The major diseases cancer and diabetes mellitus are used as models to provide basic knowledge on their pathogenesis, prevention, treatment, and research. In addition, information about the structures of the healthcare system and materials to strengthen health literacy are provided. An accompanying evaluation collects indicator data on coverage and acceptance of the measures.Since 2018, the program has published 46 teaching materials and three course readers with background knowledge for teachers. Furthermore, 50 training courses have been held, with approximately 1600 teachers and multipliers taking part in face-to-face and online events by the end of 2021. More than 90% of the participants gave the respective events very good or good evaluations. Around 80% of the participants said they would like to include the topics taught in their lessons. Further expansion of the offers is planned. Testing of a set of materials with respect to the gain of health literacy in a sample of students is currently being prepared.In Deutschland weist mehr als die Hälfte der Bevölkerung eine geringe Gesundheitskompetenz auf. Diese Menschen haben Schwierigkeiten, gesundheitsrelevante Informationen zu finden, einzuordnen und anzuwenden. Unter ihnen sind auch viele junge Menschen, was den Stellenwert früher Interventionen zur Förderung der Gesundheitskompetenz verdeutlicht.Das Programm „Fit in Gesundheitsfragen“ der Gesundheitsinformationsdienste vom Forschungszentrum Helmholtz Munich und dem Deutschen Krebsforschungszentrum hat zum Ziel, einen Beitrag zur Förderung verschiedener Dimensionen von Gesundheitskompetenz bei Kindern und Jugendlichen zu leisten. Dazu werden innovative Fortbildungsformate für Lehrkräfte und Unterrichtsmaterialien für Lernende der Sekundarstufen I und II konzipiert und begleitend evaluiert. Am Modell der Volkskrankheiten Krebs und Diabetes mellitus wird Wissen zu deren Entstehung, Prävention, Behandlung und Erforschung vermittelt. Darüber hinaus werden Wissen über das Gesundheitssystem und Materialien zur Förderung der Gesundheitskompetenz bereitgestellt. Die Evaluation erhebt Indikatoren zu Reichweite und Akzeptanz der Maßnahmen.Seit 2018 wurden 46 Unterrichtsmaterialien und 3 Informationsschriften mit Hintergrundwissen für Lehrende veröffentlicht. Ferner wurden 50 Lehrerfortbildungen durchgeführt, an denen bis Ende 2021 rund 1600 Lehrkräfte und Multiplikatoren in Präsenz oder online teilnahmen. Sie erteilten den jeweiligen Veranstaltungen zu über 90 % sehr gute und gute Noten. Rund 80 % der Teilnehmenden gaben an, die vermittelten Themen in ihrem Unterricht aufgreifen zu wollen. Ein weiterer Ausbau des Angebots ist vorgesehen. Die Testung ausgewählter Materialien im Hinblick auf die Förderung der Gesundheitskompetenz in einer Stichprobe von Lernenden ist in Planung.

Despite cancer being the leading cause of death across most racial/ethnic groups, Hispanic women have the second highest mortality rate attributed to diabetes (4.7%) according to the Centers for Disease Control and Prevention (CDC). While cancer and diabetes are two distinct diseases, previous studies have demonstrated that diabetic women have a poor chance of breast cancer survival when compared to nondiabetic women. Well-known key drivers of hyperinsulinemia and insulin resistance, such as insulin and AMPK, are also those involved in breast cancer. This link could possibly contribute to the increased mitogenic effects and risk for aggressive breast cancers in Hispanic women. Based on these findings, metformin, a drug standardly used to treat and prevent hyperglycemia, may be a possible alternative (other than tamoxifen) for breast cancer prevention. Eat, Move, Live (EML), a 5-week community-based program, focuses on targeting possible treatments of chronic diseases and risk reduction through attitude and lifestyle modifications. Exercise, nutritional and health awareness classes were implemented to change participants' perspectives regarding chronic diseases and their susceptibility to other morbidities. Questionnaires were given to the participants at baseline and at two follow-ups (5 weeks and 12 weeks) to assess any changes in their attitudes, behaviors, nutrition, lifestyle and beliefs around taking medication for preventative treatments. A total of 56 participants' pretreatment responses were collected via a five-point Likert scale (1-strongly disagree, 5-strongly agree). Demographic data showed that 69% of the respondents were Hispanic women, of whom 46% completed an education level of high school or less. A majority of the responses averaged a “neutral” response to taking medication for management and prevention of diabetes. We infer that their inability to select a stance in their responses may be associated with the lack of knowledge that the community has regarding chronic diseases and risk-prevention methods. Therefore, we anticipate that availability of proper education tools and resources is essential to potentially prevent future morbidities and mortalities. Ultimately, we aim to establish a pilot study that emphasizes the necessity and importance of interventional programs, like EML, to enhance chemoprevention using metformin and improve health outcomes in high-risk breast cancer populations. Citation Format: Mayra Serrano, Angelica Sanchez, Christine Thai, Katty Nerio, Cristal Resto, Marisela Garcia, Tanya A. Chavez, Laura L. Kruper, Veronica C. Jones, Lisa D. Yee, Alan Nuñez, Ellen J. Rippberger, Angela K. Wong, Noé R. Chávez, Karen Herold, Chidimma M.K. Kalu, Jackelyn A. Alva-Ornelas, Jerneja Tomsic, Krista M. Round, Regina Agulto, Margarita Robles, Ombeni M. Idassi, Kendall J. Kennedy, Christopher Sistrunk, Victoria L. Seewaldt. Receptiveness of metformin as a breast cancer prevention drug within the Hispanic community [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B119.

The United States (US) is racially and culturally diverse. Still, white women disproportionately comprise clinical trial participants, stemming largely from the fact that minorities often decline participation. Clinical trial findings, therefore, have not been representative of the diverse patient population, and have stymied progress in precision medicine and cancer prevention. According to the CDC, among Asian/Pacific Islander females, the leading cause of death is cancer. Moreover, they have more total cancer-related deaths than any other racial group. Per the 2017 US Census, Asians are the third largest minority group of the population (6.6%). Despite the grave health disparities faced by a sizable proportion of the population, the literature is sparse with regards to their research engagement. For example, several studies have focused on Black and Hispanic consenting rates, including one study that demonstrated no significant differences between the two groups (Wendler, Kington, Madans, Wye, Christ-Schmidt, Pratt et al., 2005) and another that indicated relatively lower enrollment rates among Hispanics and Blacks (Murthy, Krumholz, Gross, 2004). This gap in research is largely due to the marked heterogeneity with respect to language, nationality, and acculturation status. We examined Asian participation in three therapeutic, noninterventional trials that aim to develop early detection methods and accurate prognosis in women at high risk for breast cancer. Primarily, we collect leftover tissue and/or cells from fine needle aspirations (FNA) to better understand the cellular microenvironment that correlates with breast cancer development. We analyzed demographic data across these studies to investigate refusal rates among Asian women. Across the three trials, 3,119 participants were screened. Of the total number screened, 426 participants were eligible, 368 consented, and 58 declined. Of those who declined, 23.5% were Asians, 13.9% Hispanic, 8.3% Blacks, 5.6% Native Americans, and 11.4% White/non-Hispanic. Notably, Asians had the highest refusal rate. Fisher's exact test (two-tailed) was conducted to examine refusal rates for Asians compared to Whites, Blacks, and Hispanics. Results suggest that Asians had significantly higher rates of compared to Whites (p = .02, observed odds ratio = .42, 95% CI [.20, .86]), but were not significantly different than Blacks or Hispanics. The under-representation of Asians in research may exacerbate health disparities. Thus, further studies should examine ways, such as increasing racial and cultural competency, for increasing Asian representation in clinical research studies. Ultimately, we believe that illuminating under-representation of the “forgotten” Asian population in clinical research can inform future interventions that promote chemoprevention and treatment of this high-risk population. Citation Format: Stacey N. Doan, Christine Thai, Angela K. Wong, Tanya A. Chavez, Angelica Sanchez, Laura L. Kruper, Veronica C. Jones, Sharon Clancy, Amy C. Polverini, Lisa D. Yee, Courtney Vito, Alan Nunez, Ellen J. Rippberger, Noe R. Chavez, Karen Herold, Chidimma M.K. Kalu, Jackelyn A. Alva-Ornelas, Jerneja Tomsic, Krista M. Round, Margarita Robles, Ombeni M. Idassi, Kendall J. Kennedy, Christopher Sistrunk, Victoria L. Seewaldt. The forgotten race: Under-representation of Asians in clinical research [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A084.

Purpose: To highlight the importance of building a high-risk breast cancer clinic for women who do not have a BRCA 1, BRCA 2 or other highly penetrant cancer susceptibility mutation. Background: Breast cancer is the most common cancer in women and the second most prevalent cause of cancer death of women in the United States; the lifetime risk for breast cancer in women is approximately 12%. Women may be at increased risk for breast cancer for many reasons including family history, genetic alterations, age, reproductive status and menstrual history. Most women who are at increased risk of developing breast cancer do not have a BRCA 1, BRCA 2 or other mutation. The majority of breast cancer diagnoses are due to acquired somatic mutations; only 5 to 10% of breast cancer diagnoses are attributable to highly penetrant Mendelian cancer susceptibility genes. White women with Ashkenazi Jewish ancestry tend to have a higher incidence of BRCA 1 and 2 mutations; traditionally, most research efforts about highly penetrant genes have been focused on this group rather than other racial and ethnic groups. However, there is a great need to study breast cancer risk-reduction strategies in racial and ethnic minorities in the United States, particularly because most breast cancers are not caused by BRCA 1 and 2 mutations. City of Hope is located approximately 21 miles northeast of Los Angeles and operates 13 clinical practice locations including Los Angeles, Orange, Riverside, San Bernardino and Ventura counties. These five counties are home to the majority of California's multicultural and ethnic residents where San Bernardino County has the highest percentage of Hispanics (49.9%) and blacks (8.3%), Ventura County has the highest percentage of whites (48.1%), and Orange County has the highest concentration of Asians (18.2%). It has been established in the literature that the greatest benefit from breast cancer prevention strategies comes from treating women who are at high risk of the disease. While it is important to build a high-risk breast cancer clinic for women with genetic mutations, it is equally important to build a high-risk breast clinic for women who are at increased risk of breast cancer but do not have a mutation, particularly because most breast cancer is diagnosed in this population. In addition, it is crucial to educate high-risk patients that although they may have tested negative for a genetic mutation if they have a family history of breast cancer, they warrant close clinical surveillance. Methods: We are proposing a retrospective, descriptive study of data that will be collected as part of a high-risk breast cancer program implemented by City of Hope. Results/Conclusions: We expect to discuss the findings related to serving women of all races and ethnicities who do not have a mutation in a highly penetrant gene mutation. Citation Format: Karen Herold, Lisa D. Yee, Chidimma M. Kalu, Laura L. Kruper, Veronica C. Jones, Amy C. Polverini, Sharon Clancy, Tanya A. Chavez, Jackelyn A. Alva-Ornelas, Noe R Chavez, Ellen J. Rippberger, Jerneja Tomsic, Christopher Sistrunk, Ombeni Idassi, Daniel B. Schmolze, Courtney Vito, Alan Nunez, Angela K. Wong, Krista M. Round, Christine Thai, Angelica Sanchez, Margarita Robles, Kendall Kennedy, Terry Hyslop, Victoria L. Seewaldt. Architecture of increased breast cancer risk [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B109.

Background: Recruiting participants who are representative of the population as a whole is essential to ensure the development of treatments that benefit all rather than a select few. Understanding the reasons patients accept or decline participation, and then making adjustments to the recruiting process based on these findings, is one way to encourage study participation. Aim: To better understand what factors influence a potential participant's decision to either accept or decline participation in breast cancer trials. Methods: These are preliminary data from a pilot study that uses a short questionnaire to investigate which factors influence a woman's consent or decline to study participation. Women are approached for this study after being asked to participate in one of three other breast cancer trials targeting women who either have breast cancer or are at high risk for breast cancer. Women are approached for this study regardless of their decision to participate in the previous study. Participants are asked a set of questions about 1. the specific interaction they had with the consenter from the previous study, 2. general characteristics of a consenter, and 3. research in general. Demographic information is also collected for future analysis of responses based on race/ethnicity, income, education level, and primary language. Results: A total of 24 participants have completed the questionnaire so far, with an accrual rate of approximately 25 patients per month. Participants ranked the importance of the various factors on a 4-point scale with 1 being “not important at all” and 4 being “very important.” Factors that participants indicated were the least important to their decision to participate were: financial compensation (xÌ… 1.07), racial/ethnic parity between consenter and consentee (\bar x $ 1.19), consenter looking like someone from their community (\bar x $ 1.19), gender parity (\bar x $ 1.19), religious beliefs (\bar x $ 1.38), pleasing their doctor (\bar x $ 1.56), and feeling overwhelmed (\bar x $ 1.85). Factors participants indicated were the most important to them were: the desire to benefit others in the future (\bar x $ 3.63), to benefit their family (\bar x $ 3.56), to acknowledge the contributions of past generations (\bar x $ 3.20), the feeling participation was “the right thing to do” (\bar x $ 3.15), presence or lack of potential side effects associated with participation ((\bar x $ 3.15), feeling empowered by the consenter (\bar x $ 3.15), feeling the consenter was listening (\bar x $ 3.11), and trust in research (\bar x $ 3.07). Conclusions: Concerning the consenter, physical characteristics such as race/ethnicity and gender parity were less important than the actual interaction with the consenter, including their flexibility, listening skills, and ability to make the patient feel empowered. For research in general, the idea of contributing to the “greater good” emerged as a powerful motivation to participate. An emphasis on this, as well as well-trained consenters, may help studies attract more participants. Note: This abstract was not presented at the conference. Citation Format: Ellen Rippberger, Noe Chavez, Tanya Chavez, Christine Thai, Angelica Sanchez, Angela Wong, Karen Herold, Alan Nenez, Krista Rounds, Victoria Seewaldt. Factors influencing women's attitudes toward participation in breast cancer clinical research [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A086.

Background: Breast cancer (BC) prevention clinical trials (CTs) play a vital role in the progress of preventative measures and treatments for all races and ethnicities. However, Northern European whites (NE/W) continue to be disproportionally enrolled (e.g., 93.5% were non-Hispanic white in the STAR trial), while minorities such as Asians, blacks, Latinas, and Native Americans (NA) lag in participation. Current studies suggest that minorities are not approached as frequently as NE/W; however, they are just as willing to participate. Here we present a successful recruitment strategy to improving minority accrual in CTs at a Comprehensive Cancer Center located in Duarte, CA. Method: Results from community focus groups suggested the need to mentor local youth who strive to pursue a career in the medical field. Consequently, from February 2016 to July 2018, four bilingual, bicultural clinical research assistants (CRAs) were recruited from the catchment area of City of Hope (CoH). The CRAs, in collaboration with seven surgeons, two radiologists, and one medical oncologist, led the recruitment for three nontherapeutic BC prevention CTs at CoH. Results: All four CRAs were 1) first-generation American, 2) fluent in Spanish or Vietnamese, 3) born and raised in Southern California, and 4) pre-health. Of the 3,148 patients who were screened, 398 were eligible for enrollment, 369 consented, and 58 declined. Primary languages and races/ethnicities of those who declined include the following: 7% Armenian, 9% Chinese, 78% English, 2% Thai, and 5% Spanish; 28% Asian, 3% black, 28% Latina, 2% NA, and 67% white (22% NE, 17% Middle Eastern/North African). Demographics of the consenting population include the following: primary language - >1% Armenian, 4% Chinese, 89% English, >1% Korean, and 7% Spanish; race/ethnicity - 14% Asian, 6% black, 30% Latina, 5% NA, and 75% white (40% NE). Of the white population (n = 277), 11% were Middle Eastern/North African, 53% NE, and 36% Latina. Accrual surpassed both the CoH catchment area (11.3% Asian, 8% black, 24% Hispanic, 1% NA, and 32% NE/W) and the CoH interventional/nontherapeutic CT population (10% Asian/Pacific Islander, 4% black, 21% Hispanic, >1% NA, and 55% NE/W). Conclusion: Contrary to current accrual of CTs, here we show that minorities can have a large representation in CT accrual, as long as they are provided the opportunity. Accrual of Asians, Latinas, and NAs exceeded the catchment area and accrual of other CoH CTs. Interestingly, Chinese-speaking women comprised the highest declination group of the non-English speakers, and Asians and Latinas declined the most outside of non-whites. Cultural competency and bilingualism appear to be characteristics of a CRA that may help in accruing minority women into CTs. Our findings suggest that they are just as willing to participate, and the first step is to simply ask. Citation Format: Tanya A. Chavez, Christine Thai, Angelica Sanchez, Laura L. Kruper, Veronica C. Jones, Sharon Clancy, Amy C. Polverini, Lisa D. Yee, Courtney A. Vito, Noé R. Chávez, Alan Nuñez, Ellen J. Rippberger, Angela K. Wong, Karen Herold, Chidimma M.K. Kalu, Jackelyn A. Alva-Ornelas, Jerneja Tomsic, Krista M. Round, Margarita Robles, Ombeni Idassi, Kendall J. Kennedy, Terry Hyslop, Carola M. Zalles, Christopher Sistrunk, Victoria L. Seewaldt. Diversifying breast cancer clinical trial accrual: An approach to recruitment at a Comprehensive Cancer Center [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A083.

Background: The most common type of headache that propels patients to seek care from their clinician is a migraine headache. Migraine headaches vary from person to person, but they typically last from four hours to 72 hours. A migraine may occur with symptoms such as nausea, vomiting, or sensitivity to light. Patients may get migraines several times per month while otherpatients may get them much more frequently. Migraine headaches have no known cure, but in most cases they can be managed effectively with a variety of medications and/or alternative modalities for prevention, pain relief and abortive therapy. Objective: Recently the American Academy of Neurologyand the American Headache Societyupdated pharmacologic treatment guidelines for episodic migraine prevention in adults. These guidelines were presented at the April 2012 meeting of the American Academy of Neurology.This article will review the recommendations from the American Academy of Neurology and the American Headache Society that were presented at their April 2012 meeting. Methods: Retrospective published studies and current empirical knowledge from June 1999 to May 2009 were reviewed by authors from the American Academy of Neurology and the American Headache Society to establish and classify evidence related to the efficacy of various medications available in the United States for migraine prevention. Results: After review of 284 abstracts, the author panel from the American Academy of Neurology and the American Headache Society found 29 Class I or Class II articles to review. This appraisal yielded seven pharmacologic agents that should be offered to patientsfor migraine prevention, migraine frequency and/or migraine severity: divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, timolol, andfrovatriptan for prevention of menstrual migraine (Level A). Keywords––Migraine, American Academy of Neurology, American Headache Society, evidence-based recommendations, pharmacologic treatment of migraines

Background: Invasive cervical cancer develops from a pre-invasive state named cervical intraepithelial neoplasia (CIN).CIN 1 represents mild dysplasia and is now classified as low-grade squamous intraepithelial lesion (LGSIL); CIN 2 and 3lesions encompass moderate-to-severe dysplasia and are now classified as high-grade squamous intraepithelial lesions(HGSILs) based on the Bethesda cervical cytology reporting system. Most LGSIL lesions resolve spontaneously, whereasHGSIL lesions are more likely to progress to invasive cervical cancer. However, HGSILs are typically detected an averageof 10 to 15 years before invasive cervical cancer. In women, the typical age range for diagnosis of invasive cancer isgreater than 40 years. High-risk Human Papilloma Virus (HRHPV) infection is required for the development of virtuallyall cervical cancer, and the time from initial HPV infection to development of cervical cancer usually exceeds 10 years.Colposcopies that are performed for abnormal papanicolaou (pap) smears of LGSIL and HRHPV can include ectocervicaland endocervical biopsies. Given the likelihood of (a) spontaneous resolution of LGSIL and HRHPV, (b) the time todevelopment of cervical cancer after initial diagnosis of HPV and (c) the improbability of invasive cervical cancerdeveloping in women less than 40 years of age, there is evidence to suggest that endocervical curettage at the time ofcolposcopy is not necessary in a subgroup of women who are at low risk of developing invasive cervical cancer. At thecurrent time, no evidence based guidelines exist about the necessity of endocervical curettage (ECC) at the time ofcolposcopy in women who are at low risk for invasive cervical cancer. Therefore, a literature review was conducted toanalyze literature as it related to ECC at the time of colposcopy in who are at low risk for invasive cervical cancer. Aparticular subgroup of women that are at low risk for development of cervical cancer are less than 35 years of age withLGSIL or HRHPV cytology, and women who are less than 35 years of age are at an even lower risk of developing invasivecervical cancer because of their more robust immune system. The purpose of the literature review was to summarizefindings about endocervical curettage at the time of colposcopy to propose a study that could be conducted to establishevidence based guidelines for ECC that could be utilized in practice. Methods: The literature review summarizes current empirical and theoretical knowledge related to ECC at the time ofcolposcopy in women who are less than 35 years of age with LGSIL or HRHPV cytology. Concepts and keywords of theproposed literature review include: ECC-based diagnosis in each of three categories (benign, CIN 1 and CIN >1),ectocervical-based biopsy in each of three categories (benign, CIN 1 and CIN >1), LGSIL, HRHPV, colposcopy, andcervical cancer. Primary and secondary literature was examined to elucidate gaps in the literature related to evidence basedguidelines for ECC at the time of colposcopy. Results: The literature review includes an analysis of the literature related to ECC at the time of colposcopy in womenwho were less than 35 years of age with Cervical Cytology of LGSIL or HRHPV. Additionally, the literature reviewprovides a critique of the studies that were reviewed, details gaps in the literature and enumerates the problem of noevidence based guidelines for ECC curettage at the time of colposcopy. Conclusions: There is an absence in the literature about evidence based guidelines for performing ECC at the time ofcolposcopy in women who are less than 35 years of age with LGSIL or HRHPV; and additionally a paucity exists in theliterature about ECC at the time of colposcopy in this same subgroup of women. Therefore, the literature reviewestablishes the foundation and background for future studies that examine the need for ECC in Women less than 35 yearsof age with Cervical Cytology of LGSIL or HRHPV at the time of colposcopy.

Sexual assault is a widespread devastating crime with the potential to involve medical, psychological, and legal systems. According to the survey, “Rape in America: A Report to the Nation. Arlington, VA: National Victim Center” large population-based surveys indicate the lifetime prevalence of rape to be about 13 to 39% among women. Unfortunately, these data are most likely an underestimation, because most large studies do not sample vulnerable populations (e.g., homeless, sheltered, or institutionalized persons).