Abstract
We investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities.
Non-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC).
This study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35–1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15–1.24 for SCC; HR = 2.32, 95% CI = 2.12–2.54 for AC, interaction p < 0.0001). After balancing the selected demographic, socioeconomic and clinical factors, survival in Black vs. White patients was no longer different in those with SCC (AHR = 1.01, 95% CI 0.97–1.06) or AC (AHR = 1.09, 95% CI = 0.96–1.24). In SCC, the largest contributors to survival disparities were neighborhood income and insurance. In AC, age was the most significant contributor followed by neighborhood income, insurance, and stage. Diagnosis of AC (but not SCC) at ≥65 years old was more common in Black vs. White patients (26% vs. 13%, respectively).
Histology matters in survival disparities and diagnosis at ≥65 years old between Black and White cervical cancer patients. These disparities were largely explained by modifiable factors.
Survival disparities between Black and White patients with squamous cell carcinoma of the cervix or adenocarcinoma of the cervix with inserts displaying hazard ratio (HR) and 95% confidence interval (CI) for risk of death for Black vs. White patients with cervical squamous cell carcinoma or adenocarcinoma, respectively (A). Shift in age at diagnosis in Black vs. White patients with squamous cell carcinoma (SCC) of the cervix or adenocarcinoma (AC) of the cervix (B). [Display omitted]
•Survival disparities between Black and White patients with cervical cancer varied by histology.•Cervical adenocarcinoma subtype dominated the survival disparities between Black and White patients with cervical cancer.•Age, income, insurance, and stage were the largest contributors to the 2.3-fold disparities in survival in adenocarcinoma.•Neighborhood income and insurance were the largest contributors to the 20% survival disparities in squamous cell carcinoma.•26% of all adenocarcinoma cases in Black patients were diagnosed >65 years beyond the standard cervical screening guidelines.