Disparities in survival among women with invasive cervical cancer

Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Cancer (Impact Factor: 4.9). 01/2009; 115(1):166-78. DOI: 10.1002/cncr.24007
Source: PubMed

ABSTRACT In this study, the authors sought to understand the effects of patient race, ethnicity, and socioeconomic status (SES) on outcomes for cervical cancer.
The Florida Cancer Data System and the Agency for Health Care Administration data sets (1998-2003) were merged and queried. Survival outcomes for patients with invasive cervical cancer were compared between different races, ethnicities, and community poverty levels.
In total, 5367 patients with cervical cancers were identified. The overall median survival was 43 months. Significantly longer survival was observed for Caucasians (47.1 months vs 28.8 months for African Americans [AA]; P<.001), Hispanics (52.8 months vs 41.6 months for non-Hispanics; P<.001), the insured (63 months vs 41.2 months for uninsured; P<.001), and patients from more affluent communities (53.3 months where <5% lived in poverty vs 36.9 months where >15% lived in poverty; P<.001). Surgery was associated with dramatically improved survival. AA women who were diagnosed with cervical cancer were significantly less likely to undergo surgical treatment with curative intent compared with Caucasian women (P<.001). However, on multivariate analysis, independent predictors of poorer outcomes were insurance status, tumor stage, tumor grade, and treatment. Neither race, nor ethnicity, nor SES was an independent predictor of poorer outcome.
Race, ethnic, and SES disparities in cervical cancer survival were explained by late-stage presentation and under-treatment. Earlier diagnosis and greater access to surgery and other treatments would significantly improve the survival of women with cervical cancer.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The main purpose of this study was to model and analyze the dynamics of cervical cancer mortality rates for African American (Black) and White women residing in 13 states located in the eastern half of the United States of America from 1975 through 2010. Methods The cervical cancer mortality rates of the Surveillance, Epidemiology, and End Results (SEER) were used to model and analyze the dynamics of cervical cancer mortality. A longitudinal hyperbolastic mixed-effects type II model was used to model the cervical cancer mortality data and SAS PROC NLMIXED and Mathematica were utilized to perform the computations. Results Despite decreasing trends in cervical cancer mortality rates for both races, racial disparities in mortality rates still exist. In all 13 states, Black women had higher mortality rates at all times. The degree of disparities and pace of decline in mortality rates over time differed among these states. Determining the paces of decline over 36 years showed that Tennessee had the most rapid decline in cervical cancer mortality for Black women, and Mississippi had the most rapid decline for White Women. In contrast, slow declines in cervical cancer mortality were noted for Black women in Florida and for White women in Maryland. Conclusions In all 13 states, cervical cancer mortality rates for both racial groups have fallen. Disparities in the pace of decline in mortality rates in these states may be due to differences in the rates of screening for cervical cancers. Of note, the gap in cervical cancer mortality rates between Black women and White women is narrowing.
    PLoS ONE 09/2014; 9(9):e107242. DOI:10.1371/journal.pone.0107242 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A better understanding about the factors associated with cervical cancer survival disparities is an important step in developing more effective cervical cancer intervention strategies. This study investigates cervical cancer survival disparities from three different perspectives based on data from the Texas Cancer Registry from 1995 to 2005. These perspectives are race/ethnicity, area socioeconomic status (SES), and geographic locations. We examined the role of both individual- and contextual-level factors in cervical cancer survival disparities using a multilevel survival analysis. Individual-level factors included race/ethnicity, age at diagnosis, year of diagnosis, tumor grade, stage at diagnosis, and type of treatment received. Contextual-level factors are census-tract-level variables, including demographic characteristics, health insurance expenditure, behavioral factors, extent of urbanization, and spatial access to primary care physicians. This study reveals that African-Americans had a higher mortality risk (HR, 1.19; 95% CI, 1.03-1.38) especially if stage was unknown (HR, 1.72; 95% CI, 1.08-2.75) compared with non-Hispanic whites. Among women diagnosed at regional or distant stage, Hispanics had a survival advantage over their non-Hispanic white counterparts (HR, 0.80; 95% CI, 0.69-0.94). We also identified geographic areas where longer-than-expected or shorter-than-expected cervical cancer survival was statistically significant. Only a small portion of these disparities were explained by individual- and contextual-level factors. This study suggests that Race/Ethnicity, SES, and geography are associated with cervical cancer survival in Texas.
    Applied Geography 01/2015; 56:21-28. DOI:10.1016/j.apgeog.2014.10.004 · 3.08 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Disparities in breast and cervical cancer screening by socioeconomic status persist in the United States. It has been suggested that social support may facilitate screening, especially among women of low socioeconomic status. However, at present, it is unclear whether social support enables mammogram and Pap test compliance. Purpose. This study examines the association between social support and compliance with mammogram and Pap test screening guidelines, and whether social support provides added value for women of low education. Method. Data were from a countywide 2009-2010 population-based survey, which included records of 2,588 women 40 years and older (mammogram) and 2,123 women 21 to 65 years old (Pap test). Compliance was determined using the guidelines in effect at the time of data collection. Results. Social support was significantly related to mammogram (adjusted odds ratio = 1.43; 95% confidence interval [1.16, 1.77]) and Pap test (adjusted odds ratio = 1.71; 95% confidence interval [1.27, 2.29]) compliance after controlling for age, race, having a regular health care provider, and insurance status. The interaction between social support and education had a significant effect on Pap test compliance only among women younger than 40; the effect was not significant for mammogram compliance. Conclusion. Social support is associated with breast and cervical cancer screening compliance. The association between education and cancer screening behavior may be moderated by social support; however, results hold only for Pap tests among younger women. Practitioners and researchers should focus on interventions that activate social support networks as they may help increase both breast and cervical cancer screening compliance among women with low educational attainment.
    Health Education &amp Behavior 11/2014; 42(1). DOI:10.1177/1090198114557124 · 1.54 Impact Factor

Full-text (2 Sources)

Available from
Feb 25, 2015