# Elucidating the Role of the Vaginal Microbiome in Racial Disparities in Precancerous Cervical Lesions: A Multi-level Study

> **NIH NIH K01** · VIRGINIA COMMONWEALTH UNIVERSITY · 2024 · $183,708

## Abstract

PROJECT SUMMARY
Despite progress in human papillomavirus (HPV) vaccination uptake, about three million women are still
diagnosed with precancerous cervical lesions each year in the US. Most spontaneously regress, but yearly follow
up and invasive prophylactic care (e.g., endocervical curettage and cervical biopsy) is still required as it is not
clear which may progress to cervical cancer. Since Black women have more persistent HPV infections and
precancerous lesions, as well as a higher incidence of cervical cancer than white women, they are
disproportionately impacted by these invasive prophylactic procedures and their sequelae (e.g., pain, bleeding,
scarring, infertility, future miscarriages, and preterm births). The vaginal microbiome (VMB) has been implicated
in sustaining HPV infection and development of precancerous lesions. HPV-positive women, women with
precancerous lesions, and Black women are more likely to have a suboptimal VMB with high taxonomic diversity
with depletion of Lactobacillus spp. (both features of vaginal inflammation and dysbiosis) and are also associated
with worse prognosis for precancerous lesions. My preliminary data shows that an optimal, Lactobacillus
predominant VMB is protective against the risk of a precancerous cervical lesion for white but not Black women.
Since the VMB is susceptible to the host micro and macro environments, it is plausible that these differences
override the protective effect of the VMB in Black women. At the micro level, differences in species-specific
metabolic profiles might be contributing to lesion prognosis by disturbing vaginal homeostasis. At the macro
level, psychological stress, which is disproportionately experienced by Black women may be influencing the VMB
through a cortisol pathway which has been biologically implicated with VMB dynamics and known to be
dysregulated in Black women in response to stress. In this K01 application, I will test the hypothesis that racial
differences in daily experiences of stress and respective cortisol response result in VMB changes that influence
differential precancerous lesion regression by race. I will measure VMB changes and psychological (ecological
momentary assessments), and physiological stress (salivary cortisol) among 75 Black and 75 White women
diagnosed with a cervical lesion, assessed during the critical time between their routine pap screen and abnormal
follow-up. The proposed mentorship, training and research will give me critical skills in bioinformatics, statistical
and molecular biology to interrogate plausible mechanisms through which the VMB might underlie racially
differential etiologies for pre-cancerous cervical lesions. The training described in this proposal will prepare me
to become an independent translational investigator leading to the identification of practical solutions to the
reduction of cancer outcome disparities.

## Key facts

- **NIH application ID:** 10785528
- **Project number:** 1K01CA285946-01
- **Recipient organization:** VIRGINIA COMMONWEALTH UNIVERSITY
- **Principal Investigator:** Katherine Y Tossas
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $183,708
- **Award type:** 1
- **Project period:** 2024-07-01 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10785528

## Citation

> US National Institutes of Health, RePORTER application 10785528, Elucidating the Role of the Vaginal Microbiome in Racial Disparities in Precancerous Cervical Lesions: A Multi-level Study (1K01CA285946-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10785528. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*