Original Research Article

Is There Racial/Ethnic Variance in Cervical Cancer-Specific Survival of Older Women in the United States?

Jobayer Hossain¹ and Laurens Holmes, Jr^2,3

¹Biomedical Research, A.I.duPont Hospital for Children, Wilmington, DE 19803.

²School of Public Health, University of Texas Health Sciences Center, Houston, TX 77030.

³Nemours Center for Childhood Cancer Research, 1700 Rockland Road, Wilmington, DE 19803.

*For Correspondence:  Tel: 302-651-6435; Fax: 302-651-5951 Email: holmes@medsci.udel.edu or drlholmesjr@gmail.com

International Journal of Health Research, December 2009; 2(4): 323-332

Abstract

Purpose: To examine racial/ethnic differences in cervical carcinoma survival of older US women, as well as the impact of income, cell type (tumor histology), tumor stage and treatment on survival of this cohort.

Methods: A population-based cohort of women diagnosed with incident cervical carcinoma, between 1992 and 1999, in the Surveillance Epidemiology and End Results (SEER) Data was linked with Medicare to examine the impact of race/ethnicity on overall and cancer-specific survival, using Kaplan Meier survival estimates and multivariable Cox Regression model.

Results: There was no significant racial/ethnic variation in overall and cervical cancer-specific survival. However, the advanced tumor stage at diagnosis, treatment received and advanced age at tumor diagnosis were the only significant predictors of survival.  Compared with no surgery, there was a significant 66% decreased risk of dying from overall cause of death (adjusted hazard ratio, AHR = 0.34, 95% Confidence Interval, CI = 0.26-0.46), and significant 51% decreased risk of dying from cervical cancer-specific cause,   AHR = 0.41, 95% CI, 0.28-0.58, for women who received radical surgery. There was a dose-response effect between tumor stage at diagnosis and survival. Relative to women who were diagnosed with stage I tumor (early stage), those who were diagnosed at stage IV (late stage) were almost three times as likely to die from overall cause (AHR = 2.78, 95% CI, 2.24 – 3.45), as well as  two times as likely  to die from cancer-specific cause, AHR = 2.28, 95%CI, 1.76 – 2.29.  The risk of dying also significantly increased with advancing age.

Conclusion: There was no racial/ethnic variance in overall and cervical cancer-specific survival among older US women but survival was significantly influenced by treatment received tumor stage at diagnosis and age at diagnosis.

Keywords: Cervical carcinoma; Race/ethnicity; Income; Histopathology; Survival.