BACKGROUND:The objectives of this study were to determine the age-standardized and age-specific annual US cervical cancer mortality rates after correction for the prevalence of hysterectomy and to evaluate disparities by age and race. METHODS: Estimates for deaths due to cervical cancer stratified by age, state, year, and race were derived from the National Center for Health Statistics county mortality data (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). Equivalently stratified data on the prevalence of hysterectomy for women 20 years old or older from the Behavioral Risk Factor Surveillance System survey were used to remove women who were not at risk from the denominator. Agespecific and age-standardized mortality rates were computed, and trends in mortality rates were analyzed with Joinpoint regression. RESULTS: Age-standardized rates were higher for both races after correction. For black women, the corrected mortality rate was 10.1 per 100,000 (95% confidence interval [CI], 9.6-10.6), whereas the uncorrected rate was 5.7 per 100,000 (95% CI, 5.5-6.0). The corrected rate for white women was 4.7 per 100,000 (95% CI, 4.6-4.8), whereas the uncorrected rate was 3.2 per 100,000 (95% CI, 3.1-3.2). Without the correction, the disparity in mortality between races was underestimated by 44%. Black women who were 85 years old or older had the highest corrected rate: 37.2 deaths per 100,000. A trend analysis of corrected rates demonstrated that white women's rates decreased at 0.8% per year, whereas the annual decrease for black women was 3.6% (P <.05). CONCLUSIONS: A correction for hysterectomy has revealed that cervical cancer mortality rates are underestimated, particularly in black women. The highest rates are seen in the oldest black women, and public health efforts should focus on appropriate screening and adequate treatment in this population. Cancer 2017;123:1044-50. V C 2017 American Cancer Society. KEYWORDS:Behavioral Risk Factor Surveillance System, cervical cancer, disparities, hysterectomy, mortality, Surveillance, Epidemiology, and End Results (SEER). INTRODUCTIONEach year in the United States, more than 12,000 women are diagnosed with cervical cancer, and more than 4,000 women die of it.1 Racial minorities, particularly black women, have significantly higher incidence and mortality rates for this disease. [2][3][4][5][6][7] Prior studies have shown that a failure to account for the prevalence of hysterectomy has resulted in an underestimation of cervical cancer incidence rates because women who have had their cervix surgically removed are inappropriately retained in the population-at-risk denominator. 2,3,8 This underestimation has the most profound effect in black women because they have the highest prevalence of hysterectomy: age specific cervical cancer incidence rates in black women increase by as much as 125% after correction, whereas there is an 83% increase in white women of the same age.2 As such, the uncorrected race-specific incidence rates represent an underestimat...

We show for the first time that early childhood poverty leads to accelerated weight gain over the course of childhood into early adulthood. Cumulative risk exposure during childhood accounts for much of this accelerated weight gain.

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Purpose To determine the impact of obesity on the rate of successful sentinel lymph node (SLN) mapping in patients with uterine cancer undergoing robotic surgery, and compare SLN detection rates using indocyanine green (ICG) versus blue dye. Methods We reviewed robotic cases undergoing SLN mapping with a cervical injection from 1/2011–12/2013 using either blue dye or ICG with near-infrared (NIR) fluorescence imaging. Data were stratified by body mass index (BMI) and dye used. Appropriate statistical tests were applied. Results Four hundred seventy-two cases were identified. Bilateral mapping was successful in 352 cases (75%), unilateral mapping in 73 cases (15%). Bilateral mapping was achieved in 266 (85%) of 312 ICG cases compared with 86 (54%) of 160 blue dye cases (p<0.001). Cases with successful bilateral mapping had a median BMI of 29.8 kg/m2 (range, 16.3–65.3 kg/m2); cases with no mapping had a median BMI of 34.7 kg/m2 (range, 21.4–60.4 kg/m2) (p=0.001). With increasing BMI, there was a significant decrease in successful bilateral mapping rates for both the ICG (p<0.001) and blue dye groups (p=0.041). However, the use of ICG resulted in better bilateral (p=0.002) and overall (p=0.011) mapping rates compared with the use of blue dye in all BMI groups. Conclusions ICG results in a higher overall and bilateral SLN detection than blue dye in women with uterine cancer. Successful mapping decreases with increasing BMI irrespective of dye used; however, it is significantly improved with the use of ICG and NIR fluorescence imaging compared to blue dye.

Human papillomavirus (HPV) vaccination rates for preadolescent and adolescent girls in the United States are far behind those of other developed nations. These rates differ substantially by region and state, socioeconomic status, and insurance status. In parents and young women, a lack of awareness and a misperception of the risk of this vaccine drive low vaccination rates. In physicians, lack of comfort with discussion of sexuality and the perception that the vaccine should be delayed to a later age contribute to low vaccination rates. Patient- and physician-targeted educational campaigns, systems-based interventions, and school-based vaccine clinics offer a variety of ways to address the barriers to HPV vaccination. A diverse and culturally appropriate approach to promoting vaccine uptake has the potential to significantly improve vaccination rates in order to reach the Healthy People 2020 goal of over 80% vaccination in adolescent girls. This article reviews the disparities in HPV vaccination rates in girls in the United States, the influences of patients’, physicians’, and parents’ attitudes on vaccine uptake, and the proposed interventions that may help the United States reach its goal for vaccine coverage.