Black women with cervical cancer had worse five-year relative survival rates compared to white women in a study of patients in Alabama.
Cervical cancer is the world’s fourth most common cancer and in the U.S. ranks number 14, according to the study authors. Screening in the U.S. has led to a significant drop in mortality, from 5.6 per 100,000 in 1975 to 2.2 per 100,000 in 2016. However, mortality still differs by region. The nationwide cervical cancer mortality rate in the U.S. from 2005 to 2014 was 2.3 per 100,000 but was significantly higher in Alabama: 3.2 per 100,000. Alabama also has notable racial disparities in cervical cancer: black women have a 5.2 per 100,000 mortality rate, while the rate for white women is 2.7 per 100,000.
Although the overall drop in mortality has spanned all racial and ethnic groups, the disparity between white and black women remains; the latter are also more likely to be diagnosed with a later stage disease.
To determine the relative survival rates between white versus black women, the study authors queried the Surveillance, Epidemiology, and End Results (SEER) database for data on 3,484 black patients and 21,059 white patients from 2004 to 2013. Outcomes were compared by age, cancer stages, county (urban, rural Black Belt [BB], and other rural counties), and year of diagnosis.
Overall, white women diagnosed with localized stages of cervical cancer in all three county groups always had higher relative survival rates than black women; according to the researchers, “The only exception was in Blacks living in the other rural counties and in Whites living in [Black Belt counties] who had the same overall highest [relative survival ratios].”
The relative survival rate for white women in urban counties, compared to black women in urban counties, was significantly higher (77.8%; 95% confidence interval [CI], 70.7% to 83.3% vs. 72.7%; 95% CI, 55.4% to 84.2%). Black women in BB counties had a significantly lower relative survival rate than their white counterparts (73.2%; 95% CI, 47.4% to 87.8% vs. 83.8%; 95% CI, 74.5% to 89.9%).
In other rural counties, white patients had a slightly lower relative survival rate (83.7%; 95% CI, 79.9% to 86.8%) than black women (83.8%; 95% CI, 74.2% to 90.1%). However, the relative survival rate was still considered better for white women because the sample size was larger and variability lower for white women.
The study was published in BMC Cancer.
“The findings in this study indicate that Blacks diagnosed with distant stage of [cervical cancer] especially those who are 65 years and older are less likely to survive 5 years after diagnosis with this stage of [cervical cancer]. This highlights the need to investigate the genetic etiology, as well as the timing of diagnosis, treatment efficacy, and participation in clinical trials,” the study authors concluded.