Racial disparities in cervical cancer survival over time

Authors

  • J. Alejandro Rauh-Hain MD,

    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Joel T. Clemmer BA,

    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Leslie S. Bradford MD,

    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Rachel M. Clark MD,

    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Whitfield B. Growdon MD,

    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Annekathryn Goodman MD,

    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • David M. Boruta II MD,

    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • John O. Schorge MD,

    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Marcela G. del Carmen MD, MPH

    Corresponding author
    1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
    • Corresponding author: Marcela G. del Carmen, MD, MPH, Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9 E, Boston, MA 02114; Fax: (617) 724-6898; mdelcarmen@partners.org

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  • Because all information from the Surveillance, Epidemiology, and End Results (SEER) Program data is deidentified, informed consent by the study participants and approval of an ethics committee were unnecessary to perform the analyses in this study.

  • An abstract of this manuscript was accepted at the 2013 American Society of Clinical Oncology Annual Meeting.

Abstract

BACKGROUND

The purpose of this study is to examine changes over time in survival for African American (AA) and white women diagnosed with cervical cancer (CC).

METHODS

Surveillance, Epidemiology, and End Results (SEER) Program data from 1985 to 2009 were used for this analysis. Racial differences in survival were evaluated between African American (AA) and white women. Kaplan-Meier and Cox proportional hazards survival methods were used to assess differences in survival by race at 5-year intervals.

RESULTS

The study sample included 23,368 women, including 3886 (16.6%) who were AA and 19,482 (83.4%) who were white. AA women were older (51.4 versus 48.9 years; P < .001) and had a higher rate of regional (38.3% versus 31.8%; P < .001) and distant metastasis (10.7% versus 8.7%; P < .001). AA less frequently received cancer-directed surgery (32.4% versus 46%; P < .001), and more frequently radiotherapy (36.3% versus 26.4%; P < .001). Overall, AA women had a hazard ratio (HR) of 1.41 (95% confidence interval = 1.32-1.51) of cervical cancer (CC) mortality compared with whites. Adjusting for SEER registry, marital status, stage, age, treatment, grade, and histology, AA women had an HR of 1.13 (95% confidence interval = 1.05-1.22) of CC-related mortality. After adjusting for the same variables, there was a significant difference in CC-specific mortality between 1985 to 1989 and 1990 to 1994, but not after 1995.

CONCLUSIONS

After adjusting for race, SEER registry, marital status, stage, age, treatment, grade, and histology, there was a significant difference in CC-specific mortality between 1985 to 1989 and 1990 to 1994, but not after 1995. Cancer 2013;119:3644–3652. © 2013 American Cancer Society.

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