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. 2023 Feb 10;41(5):1059-1068.
doi: 10.1200/JCO.22.01424. Epub 2022 Dec 1.

Racial and Ethnic Disparities in Cervical Cancer Incidence, Survival, and Mortality by Histologic Subtype

Camryn M Cohen  1 , Nicolas Wentzensen  1 , Philip E Castle  1   2 , Mark Schiffman  1 , Rosemary Zuna  3 , Rebecca C Arend  4 , Megan A Clarke  1
Affiliations

Racial and Ethnic Disparities in Cervical Cancer Incidence, Survival, and Mortality by Histologic Subtype

Camryn M Cohen et al. J Clin Oncol. .

Abstract

Purpose: We conducted an integrated population-based analysis of histologic subtype-specific cervical cancer incidence, survival, and incidence-based mortality by race and ethnicity, with correction for hysterectomy prevalence.

Methods: Using the SEER 21 and 18 registries, we selected primary cases of malignant cervical cancer diagnosed among women ≥ 15 years. We evaluated age-adjusted incidence rates among cases diagnosed between 2000 and 2018 (SEER21) and incidence-based mortality rates among deaths from 2005 to 2018 (SEER18), per 100,000 person-years. Rates were stratified by histologic subtype and race/ethnicity (incidence and mortality), and stage, age at diagnosis, and county-level measures of social determinants of health (incidence only). Incidence and mortality rates were corrected for hysterectomy using data from the Behavioral Risk Factor Surveillance System. We estimated 5-year relative survival by histologic subtype and stratified by stage at diagnosis.

Results: Incidence rates of cervical squamous cell carcinoma were highest in Black and Hispanic women, while incidence rates of cervical adenocarcinoma (ADC) were highest among Hispanic and White women, particularly for localized ADC. County-level income and education variables were inversely associated with squamous cell carcinoma incidence rates in all racial and ethnic groups but had less influence on ADC incidence rates. Black women had the highest overall mortality rates and lowest 5-year relative survival, irrespective of subtype and stage. Disparities in survival were particularly pronounced for Black women with regional and distant ADC, compared with other racial/ethnic groups.

Conclusion: Although Black women are less likely to be diagnosed with ADC compared with all other racial/ethnic groups, they experience the highest mortality rates for this subtype, likely attributed to the poor survival observed for Black women with regional and distant ADC.

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Conflict of interest statement

Racial and Ethnic Disparities in Cervical Cancer Incidence, Survival, and Mortality by Histologic Subtype

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Figures

FIG 1.
FIG 1.
Age-specific incidence rates expressed per 100,000 person-years by race and ethnicity for (A) cervical SCC and (B) ADC subtypes, corrected for hysterectomy prevalence among women in the United States age 15 to 75+ years according to SEER21 (2000-2018). ADC, cervical adenocarcinoma; AI/AN, American Indian and Alaska Native; API, Asian or Pacific Islander; SCC, squamous cell carcinoma.
FIG 2.
FIG 2.
Five-year relative survival by race and ethnicity and stage at diagnosis for cervical SCC and ADC among women in the United States age 15 to 75+ years according to SEER18 (2000-2018). Relative survival was estimated as the ratio of observed to expected survival rates among patients matched in the survival cohort using the actuarial method. Expected survival was estimated using the Ederer II method. ADC, cervical adenocarcinoma; AI/AN, American Indian and Alaska Native; API, Asian or Pacific Islander; SCC, squamous cell carcinoma.
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