Age-specific trends in black–white disparities in cervical cancer incidence in the United States: 1975–2009

Simard, Edgar P.; Naishadham, Deepa; Saslow, Debbie; Jemal, Ahmedin

doi:10.1016/j.ygyno.2012.08.021

Cited by 44 publications

(48 citation statements)

References 27 publications

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“…Patient age, race, and socioeconomic status have all been associated with treatment and cancer specific outcome disparities in cervical cancer. 4–7 Analyses of invasive cervical cancer patients in the National Cancer Database found increased rates of late-stage (stage III/IV) disease among uninsured, Medicaid, and Medicare beneficiaries compared to privately insured patients. 5,8 …”

Section: Introductionmentioning

confidence: 99%

Disparities in the management and outcome of cervical cancer in the United States according to health insurance status

Churilla

Egleston

Lango

et al. 2016

Gynecologic Oncology

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Introduction Our study sought to characterize the presentation, local management and outcomes of invasive cervical cancer with regard to patient insurance status. Methods We queried the NCI-SEER database for invasive cervical cancer cases in patients aged 18–64 from 2007–2011. We analyzed clinical and socioeconomic data with regard insurance status (insured, Medicaid, or uninsured). We tested for associations between patient insurance status and treatment with definitive surgery for FIGO IA2-IB1 patients, and treatment with suboptimal radiation therapy (RT) for FIGO IB2-IVA patients (other than combination external beam and brachytherapy). We evaluated overall and cause specific survival according to insurance status. Results 11,714 cases were analyzed: 60% insured, 31% Medicaid, and 9% uninsured. FIGO III/IV stage at presentation was more frequent with Medicaid (40%) and uninsured (42%) compared to insured patients (28%) (p<0.001). For FIGO IA2-IB1 patients, receipt of definitive surgery was inversely associated with uninsured status (OR[95%CI]=0.65[0.47–0.90],p<0.001) in univariable analysis; however the relationship lost significance after multivariable adjustment. For FIGO IB2-IVA patients, the use of suboptimal RT was associated with uninsured status (OR[95%CI]=1.33[1.07–1.65],p=0.011) in adjusted analyses. Among all patients, overall mortality was increased with Medicaid (HR[95%CI]=1.16[1.05–1.28],p=0.003) and uninsured status (HR[95%CI]=1.17[1.01–1.34],p=0.031) in multivariable analysis. Cancer specific mortality survival trended towards significance in multivariable analyses for both Medicaid (HR[95%CI]=1.11[1.00–1.24] and uninsured status (HR[95%CI]=1.14[0.98–1.33]). Conclusions Disparities in cervical cancer treatment with regard to insurance status are apparent in a recent cohort of American patients. Later stage at presentation and differences in management partially account for the inferior prognostic outcomes associated with Medicaid and uninsured status.

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Section: Introductionmentioning

confidence: 99%

Disparities in the management and outcome of cervical cancer in the United States according to health insurance status

Churilla

Egleston

Lango

et al. 2016

Gynecologic Oncology

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“…Similar to screening for colorectal cancer, cervical cancer screening (e.g., pap smear test) is a primary prevention technique that results in the complete removal of premalignant lesions [5]. Although cervical cancer is not a leading cause of cancer incidence or mortality in the United States, there are significant proportions of minority populations (African American, Latina, and individuals from rural Appalachia) who suffer an unequal burden of disease incidence and mortality for this cancer compared to the general population [6–8]. For these reasons, it is vitally important to monitor the burdens of disease within specific geographic regions and racial groups.…”

Section: Introductionmentioning

confidence: 99%

Decreased Cancer Mortality-to-Incidence Ratios with Increased Accessibility of Federally Qualified Health Centers

et al. 2015

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Federally qualified health centers (FQHCs) offer primary and preventive healthcare, including cancer screening, for the nation’s most vulnerable population. The purpose of this study was to explore the relationship between access to FQHCs and cancer mortality-to-incidence ratios (MIRs). One-way analysis of variance was conducted to compare the mean MIRs for breast, cervical, prostate, and colorectal cancers for each U.S. county for 2006–2010 by access to FQHCs (direct access, in-county FQHC; indirect access, adjacent-county FQHC; no access, no FQHC either in the county or in adjacent counties). ArcMap 10.1 software was used to map cancer MIRs and FQHC access levels. The mean MIRs for breast, cervical, and prostate cancer differed significantly across FQHC access levels (p < 0.05). In urban and healthcare professional shortage areas, mean MIRs decreased as FQHC access increased. A trend of lower breast and prostate cancer MIRs in direct access to FQHCs was found for all racial groups, but this trend was significant for whites only. States with a large proportion of rural and medically underserved areas had high mean MIRs, with correspondingly more direct FQHC access. Expanding FQHCs to more underserved areas and concentrations of disparity populations may have an important role in reducing cancer morbidity and mortality, as well as racial-ethnic disparities, in the United States.

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“…Multiple studies have shown a much higher 8–10 incidence of cervical cancer among black and Hispanic women compared to non-Hispanic white women, although this has been improving. 11,12 It is unclear if screening may have had a disparate effect on cervical cancer incidence by race.…”

Section: Introductionmentioning

confidence: 99%

Impact of Widespread Cervical Cancer Screening

Yang

Soulos

Davis

et al. 2018

American Journal of Clinical Oncology

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Objectives With recent approval of standalone HPV testing and increasing uptake of HPV vaccination, some have postulated that we are moving towards a “post-Pap” era of cervical cancer prevention. However, the total number cases that have been prevented by Pap smear screening as well as its impact on racial disparities are unknown. Methods We estimated national cervical cancer incidence from 1976 to 2009 using the Surveillance, Epidemiology, and End Result (SEER) database. Screening data were obtained from literature and National Cancer Institute Progress Reports. We examined early, late, and race-specific trends in cancer incidence, and calculated the estimated number of cancers prevented over the past three decades. Results From 1976 to 2009, there was a significant decrease in the incidence of early-stage cervical cancer, from 9.8 to 4.9 cases per 100,000 women (p < .001). Late-stage disease incidence also decreased, from 5.3 to 3.7 cases per 100,000 women (p < .001). The incidence among black women decreased from 26.9 to 9.7 cases per 100,000 women (p < .001), a greater decline compared to that of white women and women of other races. After adjusting for “pre-screening era” rates of cervical cancer, we estimate that Pap smears were associated with a reduction of between 105,000 to 492,000 cases of cervical cancer over the past three decades in the U.S. Conclusions A large number of early and late-stage cervical cancers were prevented and racial disparity in cancer rates were reduced during an era of widespread Pap smear screening.

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Age-specific trends in black–white disparities in cervical cancer incidence in the United States: 1975–2009

Cited by 44 publications

References 27 publications

Disparities in the management and outcome of cervical cancer in the United States according to health insurance status

Disparities in the management and outcome of cervical cancer in the United States according to health insurance status

Decreased Cancer Mortality-to-Incidence Ratios with Increased Accessibility of Federally Qualified Health Centers

Impact of Widespread Cervical Cancer Screening

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