Disparities in survival among women with invasive cervical cancer: A problem of access to care

Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Cancer (Impact Factor: 4.89). 01/2009; 115(1):166-78. DOI: 10.1002/cncr.24007
Source: PubMed


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.

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Available from: Leonidas G Koniaris, Feb 25, 2015
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    • "One possibility is that the influence of social support varies over the life span, resulting in different effects among younger and older women (Wrzus, Hanel, Wagner, & Neyer, 2013). It is also possible that there are nonindividual factors related to SES that were not addressed in the present study, such as residential area, that may influence breast and cervical cancer screening (Brookfield et al., 2009; Dailey et al., 2011; Pruitt, Shim, Mullen, Vernon, & Amick, 2009). This study addresses only the effects of individual-level factors. "
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    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.
    Full-text · Article · Nov 2014 · Health Education & Behavior
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    • "Additionally, in the US, Brookfield et al (2009) found an overall median survival in 5367 ICC patients of 43 months. However, this was lower at 28.8 months in African Americans when compared to 47.1 months in Caucasians (p<0.001) [37]. In our study, the median survival was extremely low at 15.1 months. "
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    ABSTRACT: In contrast to the developed nations, invasive cervical cancer (ICC) is the most common womens malignancy in Kenya and many other locations in sub-Saharan Africa. However, studies on survival from this disease in this area of the world are severely restricted by lack of patient follow-up. We now report a prospective cohort study of ICC in Kenyan women analysing factors affecting tumour response and overall survival in patients undergoing radiotherapy. Between 2008 and 2010, 355 patients with histologically confirmed ICC were recruited at the Departments of Gynaecology and Radiotherapy at Kenyatta National Hospital (KNH). Structured questionnaires were completed recording socio-demographics, tumour response and overall survival following treatment with combinations of external beam radiation (EBRT), brachytherapy and adjuvant chemotherapy. Of the 355 patients, 42% (146) were lost to follow-up while 18% (64) died during the two year period. 80.5% of patients presented with advanced stage IIB disease or above, with only 6.7% of patients receiving optimal combined EBRT, brachytherapy and adjuvant chemotherapy. Kaplan Meier survival curves projected two year survival at <20%. Cervical cancer is preventable yet poverty, poor education, lack of cancer awareness coupled with an absence of regular screening programs, late patient presentation, sub-optimal diagnosis and treatments are major factors contributing to the alarmingly low survival rate of cervical cancer patients in Kenya. It is concluded that simple cost-effective changes in clinical practice could be introduced which would have a marked impact on patient survival in this setting.
    Full-text · Article · Oct 2013 · PLoS ONE
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    • "They reported that this difference was almost entirely due to staging at diagnosis, indicating that ethnic differences in access to and uptake of screening and treatment of premalignant lesions may have played a role. Brookfield et al27 reported similar findings for a population in Florida that included Caucasian, African-American, and Hispanic women. Their study concluded that racial, ethnic, and socioeconomic disparities in cervical cancer survival rates were explained by late-stage presentation and undertreatment.27 "
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    ABSTRACT: Cervical cancer is the second most common cancer among women in Sudan, with more than two-thirds of all women with invasive cervical cancer being diagnosed at an advanced stage (stages III and IV). The lack of a screening program for cervical cancer in Sudan may contribute to the late presentation of this cancer, but other factors potentially associated with advanced stages of cervical cancer at diagnosis are unknown. The purpose of this research was to investigate the relationship between age, marital status, ethnicity, health insurance coverage, residence in an urban vs a rural setting, and stage (at diagnosis) of cervical cancer in Sudan. This was a cross sectional study of 197 women diagnosed with different stages of cervical cancer. Data was obtained from the cancer registry unit at the Radiation and Isotopes Centre in Khartoum for all women diagnosed with cervical cancer in 2007. THERE WAS AN ASSOCIATION BETWEEN OLDER AGE AND ADVANCED STAGE (AT DIAGNOSIS) OF CERVICAL CANCER (ODDS RATIO [OR]: 1.03, 95% confidence interval [CI]: 1.01-1.05). Being of African ethnicity was associated with 76% increased odds (OR: 1.76, 95% CI: 1.01-3.05), living in a rural area was associated with 13% increased odds (OR: 1.13, 95% CI: 1.78-5.50), and being uninsured was associated with an almost eight-fold increase in odds (OR: 7.7, 95% CI: 3.76-15.38). Marital status and education level were not associated with an advanced stage of cervical cancer at diagnosis. Women with cervical cancer who are elderly, not covered by health insurance, of African ethnicity, and living in a rural area are more likely to be diagnosed at an advanced stage of cervical cancer in Sudan. These women should be targeted for cervical cancer screening and a health education program, and encouraged to have health insurance.
    Full-text · Article · Nov 2011 · International Journal of Women's Health
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