Population-level trends in relative survival for cervical cancer

Abstract

Objective: While the last 3 decades have seen numerous advances in the treatment of cervical cancer, it remains unclear if population-level survival has improved. We examined relative survival, the ratio of survival in cervical cancer patients to matched controls over time.

Study design: Patients with cervical cancer diagnosed from 1983 through 2009 and recorded in the Surveillance, Epidemiology, and End Results database were examined. Survival models were adjusted for age, race, stage, year of diagnosis, and time since diagnosis. Changes in stage-specific relative survival for patients with cervical cancer compared to the general population matched by age, race, and calendar year were examined over time.

Results: A total of 46,932 patients were identified. For women with stage I tumors, the excess hazard ratio for women diagnosed in 2009 was 0.91 (95% confidence interval [CI], 0.86-0.95) compared to 2000, 0.81 (95% CI, 0.73-0.91) compared to 1990, and 0.75 (95% CI, 0.64-0.88) compared to 1983. For patients with stage III tumors, the excess hazard ratios for patients diagnosed in 2009 (relative to those diagnosed in 2000, 1990, and 1983) were 0.83 (95% CI, 0.80-0.87), 0.68 (95% CI, 0.62-0.75), and 0.59 (95% CI, 0.52-0.68). Similar trends in improved survival over time were noted for women with stage II tumors. There were no statistically significant improvements in relative survival over time for women with stage IV tumors.

Conclusion: Relative survival has improved over time for women with stage I-III cervical cancer, but has changed little for those with metastatic disease.

Keywords: cervical cancer; cervical carcinoma; relative survival; survival; trends.

Figure 1

Cumulative relative survival among women aged 50 to 59 years diagnosed with cervical cancer in 1983 (solid lines), 1990 (dashed lines) and 2000 (dotted lines), based on models that adjust for age, race, year of diagnosis, and time since diagnosis. Stage I white (P=0.0007), black (P=0.0006); stage II white (P<0.0001), black (P<0.0001); stage III white (P<0.0001), black (P=0.0002); stage IV white (P=0.0041), black (P=0.0003).

Figure 1

Cumulative relative survival among women aged 50 to 59 years diagnosed with cervical cancer in 1983 (solid lines), 1990 (dashed lines) and 2000 (dotted lines), based on models that adjust for age, race, year of diagnosis, and time since diagnosis. Stage I white (P=0.0007), black (P=0.0006); stage II white (P<0.0001), black (P<0.0001); stage III white (P<0.0001), black (P=0.0002); stage IV white (P=0.0041), black (P=0.0003).