Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States

Abstract

BackgroundAlthough black women experienced greater cervical cancer incidence and mortality rate reduction in recent years, they continue to have higher incidence rates than whites. Great variations also exist among geographic regions of the US, with the South having both the highest incidence and mortality rates compared to other regions. The present study explores the question of whether living in the South is associated with greater racial disparity in cervical cancer incidence and mortality by examining race- and region-specific rates and the trend between 2000 and 2012.MethodsThe Surveillance, Epidemiology, and End Results (SEER) 18 Program data was used. Cervical cancer incidence and mortality rates, annual percent changes, and disparity ratios were calculated using SEER*Stat software and Joinpoint regression for four groups: US14-Non-Hispanic White (NHW), US14-Non-Hispanic Black (NHB), South-NHW, and South-NHB, where South included 4 registries from Georgia and Louisiana and US14 were 14 US registries except the four South registries.ResultsThe average age-adjusted cervical cancer incidence rate was the highest among South-NHBs (11.1) and mortality rate was the highest among US14-NHBs (5.4). In 2012, the degree of racial disparities between South-NHBs and South-NHWs was greater in terms of mortality rates (NHB:NHW = 1.80:1.35) than incidence rates (NHB:NHW = 1.45:1.15). While mortality disparity ratios decreased from 2000–2012 for US14-NHB (APC: -1.9(-2.3,-1.4), mortality disparity ratios for South-NHWs (although lower than NHBs) increased compared to US14-NHW. Incidence rates for NHBs continued to increase with increasing age, whereas rates for NHWs decreased after age 40. Mortality rates for NHBs dramatically increased at age 65 compared to a relatively stable trend for NHWs. The increasing racial disparity with increasing age in terms of cervical cancer incidence rates became more pronounced when corrected for hysterectomy prevalence.ConclusionsBlack race and South region were associated with higher cervical cancer incidence and mortality. Cervical cancer rates uncorrected for hysterectomy may underestimate regional and racial disparities. Increasing incidence rates for older NHBs compared to NHWs warrant further research to determine whether screening should continue for NHBs over age 65.

Cancer statistics for African Americans, 2019

“…The incidence rate of cervical cancer is 30% higher in NH black women than in NH white women (Table ) with the largest disparity among older women . The black‐white disparity is even greater when incidence rates are adjusted for hysterectomy prevalence, which is higher in black women . Nevertheless, a faster decline in the cervical cancer incidence rate among NH black women than among white women has substantially narrowed the racial disparity overall and has eliminated it among women younger than 50 years as of the mid‐2000s .…”

“…107 The blackwhite disparity is even greater when incidence rates are adjusted for hysterectomy prevalence, which is higher in black women. 108,109 Nevertheless, a faster decline in the cervical cancer incidence rate among NH black women than among white women has substantially narrowed the racial disparity overall and has eliminated it among women younger than 50 years as of the mid-2000s. 30 Declines in cervical cancer incidence and mortality have slowed in black women and stabilized in white women over the last decade (Table 4), perhaps approaching a nadir.…”

Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature

“…7 Further, disparities in HPV infection and cervical cancer rates, particularly among black women and those living in the Southern US, persist. 8 Although cervical cancer is preventable through Pap screening and early treatment, vaccination against high-risk HPV types commonly associated with cervical cancer is a promising primary prevention strategy that could reduce cancers, even among women who are not screened according to guidelines. The majority of HPV-related cancers are preventable through HPV vaccination if it is administered before exposure.…”

Treatment-Related Radiation Toxicity Among Cervical Cancer Patients

“…Whereas racial disparities in cervical cancer have been described with regard to mortality rates 26 and receipt of standard of care treatment, 27 little is known regarding differences in toxicity experience by racial and ethnic groups. Prior studies have reported that Hispanic women were less likely to experience severe late small bowel toxicity than non-Hispanic white or black women, and this difference was not explained by differences in smoking status or other comorbidities.…”