Disparities in cervical cancer survival in the United States by race and stage at diagnosis: An analysis of 138,883 women diagnosed between 2001 and 2014 (CONCORD-3)

Abstract

Objective: During 2000-2014, age-standardized five-year net survival for cervical cancer was 63-64% in the United States. Using data from CONCORD-3, we analyzed cervical cancer survival trends by race, stage and period of diagnosis.

Methods: Data from 41 state-wide population-based cancer registries on 138,883 women diagnosed with cervical cancer during 2001-2014 were available. Vital status was followed up until December 31, 2014. We estimated age-standardized five-year net survival, by race (Black or White), stage and calendar period of diagnosis (2001-2003, 2004-2008, 2009-2014) in each state, and for all participating states combined.

Results: White women were most commonly diagnosed with localized tumors (45-50%). However, for Black women, localized tumors were the most common stage (43.0%) only during 2001-2003. A smaller proportion of Black women received cancer-directed surgery than White women. For all stages combined, five-year survival decreased between 2001-2003 and 2009-2014 for both White (64.7% to 63.0%) and Black (56.7% to 55.8%) women. For localized and regional tumors, survival increased over the same period for both White (by 2-3%) and Black women (by 5%). Survival did not change for Black women diagnosed with distant tumors but increased by around 2% for White women.

Conclusions: Despite similar screening coverage for both Black and White women and improvements in stage-specific survival, Black women still have poorer survival than White women. This may be partially explained by inequities in access to optimal treatment. The results from this study highlight the continuing need to address the disparity in cervical cancer survival between White and Black women in the United States.

Keywords: Cancer stage; Cervical cancer; Inequalities; Race; Survival.

Fig. 1.

Age-standardized five-year net survival (%) for women (aged 15–99 years) diagnosed with cervical cancer during 2001–2014. The circles in the figure represent state-specific survival estimates. Open circles represent the state-specific estimate for White women and closed circles represent the state-specific estimate for Black women. 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).

Fig. 2.

Trends in age-standardized five-year net survival (%) for women (aged 15–99 years) diagnosed during 2001–2014 with cervical cancer by SEER Summary Stage at diagnosis (all racial groups combined).

Fig. 3.

Trends in age-standardized five-year net survival (%) for Black and White women (aged 15–99 years) diagnosed during 2001–2014 with cervical cancer, by SEER Summary Stage at diagnosis and race.