Racial Disparity, Age Play Role in Cervical Cancer Mortality Rates in the United States

Cervical cancer mortality rates are higher in the United States than previously estimated, according to a study published in the March 2017 issue of Cancer. This risk is particularly high in older black women, reported Anna L. Beavis, MD, Department of Gynecology and Obstetrics, Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, and colleagues, who corrected the mortality rates for hysterectomy, something that has not been done previously when estimating the mortality rates for cervical cancer (Beavis AL, et al. Cancer. 2017;123:1044-1050).

The study suggests that racial disparity affects cervical cancer mortality rates. The hysterectomy-corrected mortality rate was 10.1 per 100,000 for black women versus 4.7 per 100,000 for white women; without correcting for hysterectomy, the mortality rates were 5.7 per 100,000 and 3.2 per 100,000, respectively.

Dr Beavis and her team excluded women who had hysterectomies, allowing the data to more accurately reflect those who are actually at risk for cervical cancer.

“This is a preventable disease and women should not be getting it, let alone dying from it,” said lead study investigator Anne F. Rositch, PhD, MSPH, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, in a Johns Hopkins press release.

“Since the goal of a screening program is to ultimately reduce mortality from cervical cancer, then you must have accurate estimates within the population targeted by those programs—adult women with a cervix. These findings motivate us to better understand why, despite the wide availability of screening and treatment, older and black women are still dying from cervical cancer at such high rates in the United States,” Dr Rositch added.

The researchers used data from the National Center for Health Statistics from 2000 to 2012 to study deaths that were attributed to cervical cancer. Women aged ≥20 years who had a hysterectomy and were not at risk for cervical cancer were not included.

The mortality rates were higher than expected for black and white women when corrected for hysterectomy, with disparity between races underestimated by 44% if the correction was not performed. The corrected mortality rate was 10.1 per 100,000 (95% confidence interval [CI], 9.6-10.6) for black women, and 4.7 per 100,000 (95% CI, 4.6-4.8) for white women; the uncorrected mortality rate was 5.7 (95% CI, 5.5-6.0) versus 3.2 (95% CI, 3.1-3.2), respectively.

In addition to race, the study showed that age affects a woman’s risk for dying from cervical cancer. Black women aged ≥85 years had the highest corrected mortality rate in the cohort—37.2 deaths per 100,000, which is an increase of 101% from the uncorrected mortality rate of 18.6 per 100,000.

A trend analysis demonstrated that white women’s mortality rates decreased at 0.8% annually, and black women’s mortality rates decreased at 3.6% annually (P <.05).

The American Cancer Society’s guidelines for the prevention and early detection of cervical cancer recommend that women aged >65 years should stop cervical cancer screenings if they have not had any serious precancers found during regular screenings in the past 20 years.

“These data tell us that as long as a woman retains her cervix, it is important that she continue to obtain recommended screening for cervical cancer since the risk of death from the disease remains significant well into older age,” said Dr Rositch in the press release.

Because older age and black race are independent predictors of inadequate treatment after a cervical cancer diagnosis, healthcare professionals should be cognizant of this racial disparity to help provide equal treatment.

“Although corrected rates demonstrate a decline in mortality rates in black women over time, overall, the rate of death is still twice that for white women; this is a public health disparity that cannot be ignored,” the researchers concluded.

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