Hysterectomy‐corrected cervical cancer mortality rates reveal a larger racial disparity in the United States

Abstract

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...

Increasing age predicts poor cervical cancer prognosis with subsequent effect on treatment and overall survival

“…There are a number of risk factors known to be associated with cervical cancer prognosis,including stage at diagnosis, histology, smoking and race 1; 3; 4; 5 . Age as an independent prognostic factor for cervical cancer is a question that has been debated and evaluated in the literature without a clear, definitive answer.…”

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“…Reproductive health care's success in advancing this vision is mixed [2,3], suggested by persistent reproductive health disparities in the US, particularly with respect to race, gender, and socioeconomic status. Women of color and low-income women fare worse than their white and higher-income counterparts in nearly every aspect of reproductive health, including access to prenatal care [4], maternal mortality [5], cervical cancer mortality [6], sexually transmitted infections [7,8], access to services (including assisted reproductive technologies) [2], and education [4].…”

Concurrent Infections With Human Papillomavirus and Cervical Intraepithelial Lesions: What Is the Relationship?

“…Cervical cancer incidence and mortality are 40-60% higher in African-Americans/Blacks and Hispanic/Latinas as compared to Caucasian/ White women [2][3][4][5]. The disparities persist among races even after controlling for differences in prior hysterectomy, screening and access to health care [2][3][4][5][6][7][8].…”

“…Cervical cancer incidence and mortality are 40-60% higher in African-Americans/Blacks and Hispanic/Latinas as compared to Caucasian/ White women [2][3][4][5]. The disparities persist among races even after controlling for differences in prior hysterectomy, screening and access to health care [2][3][4][5][6][7][8]. Differences also exist in survival rates between African American and Caucasian women even when controlled for stage of cancer at diagnosis, histological grade and type [1][2][3][4][5][6][7][8].…”