Cervical cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study

Abstract

Background: Overall, cervical cancer survival in the United States has been reported to be among the highest in the world, despite slight decreases over the last decade. Objective of the current study was to describe cervical cancer survival trends among US women and examine differences by race and stage.

Methods: This study used data from the CONCORD-2 study to compare survival among women (aged 15-99 years) diagnosed in 37 states covering 80% of the US population. Survival was adjusted for background mortality (net survival) with state- and race-specific life tables and was age-standardized with the International Cancer Survival Standard weights. Five-year survival was compared by race (all races, blacks, and whites). Two time periods, 2001-2003 and 2004-2009, were considered because of changes in how the staging variable was collected.

Results: From 2001 to 2009, 90,620 women were diagnosed with invasive cervical cancer. The proportion of cancers diagnosed at a regional or distant stage increased over time in most states. Overall, the 5-year survival was 63.5% in 2001-2003 and 62.8% in 2004-2009. The survival was lower for black women versus white women in both calendar periods and in most states; black women had a higher proportion of distant-stage cancers.

Conclusions: The stability of the overall survival over time and the persistent differences in survival between white and black women in all US states suggest that there is a need for targeted interventions and improved access to screening, timely treatment, and follow-up care, especially among black women. Cancer 2017;123:5119-37. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: cervical neoplasms; population-based survival; prevention and control; trends.

Figure 1.

Five-year age-standardized net survival for females (15–99 years old) diagnosed between 2001–2003 and 2004–2009 and absolute changes. The states are grouped by US Census region. States are ranked within the US Census region by the survival estimate for 2004–2009. Dark colors denote states affiliated with the National Program of Cancer Registries; pale colors denote states affiliated with the Surveillance, Epidemiology, and End Results Program; and an asterisk denotes registries affiliated with both federal surveillance programs. Changes were not plotted if at least 1 calendar period estimate was not age-standardized.

Figure 2.

Cervical cancer: 5-year age-standardized net survival for females (15–99 years old) by state (circles), race, and calendar period of diagnosis. The pooled (US) survival estimates for each calendar period are shown by the horizontal (solid) line with corresponding 95.0% and 99.8% control limits (dotted lines).