Image credit: monkeybusinessimages/iStock/Thinkstock
African-American women have poorer cervical cancer outcomes than Caucasian women. A new study that corrected previous analyses by excluding women who had hysterectomies found sizeable gaps in mortality rates between these two groups.
More than 12,000 U.S. women receive diagnoses of cervical cancer annually, with about one-third dying of the disease. However, the authors of the new research, published in the journal Cancer, found that prior studies of the disease’s prevalence did not account for women who had undergone hysterectomies, thereby underestimating cervical cancer incidence.
This has important implications for black women, whose incidence of and mortality rates for cervical cancer are especially high. They are also more likely to have hysterectomies than white women.
When such a correction for hysterectomy takes place, the investigators estimated that age-specific incidence rates rise by 125% for black women, compared to 83% in white women. “As such, the uncorrected race-specific incidence rates represent an underestimation of the true racial disparity,” the study’s authors noted.
Recently, it appeared as if the gap in cervical cancer mortality between black and white women was growing smaller, due to evidence that mortality rates in black women were on the decline.
Yet, no one had ever studied the impact on correction for hysterectomy prevalence on national mortality rates for this disease. The study’s researchers decided to analyze this further using several national data resources to calculate age-specific and age-standardized death rates for cervical cancer, and then assess data trends.
Their research included cervical cancer mortality statistics from the National Center for Health Statistics and Surveillance, Epidemiology, and End Results cancer registries. To remove women who reported a hysterectomy, researchers looked at the Behavioral Risk Factor Surveillance System survey’s hysterectomy prevalence data for women 20 years and older. The information was stratified by age, race, state, and year.
The corrected mortality rate rose significantly in both races, although it was especially prominent for black women. Compared with the uncorrected mortality rate, which was 5.7 per 100,000 individuals, the corrected rate was nearly twice as high: 10.1 per 100,000. In white women, the mortality rate rose from 3.2 per 100,000 to 4.7, when corrected for hysterectomy prevalence. The highest corrected rate, 37.2 deaths per 100,000, was reported in elderly black women.
“Without the correction, the disparity in mortality between races was underestimated by 44%,” the researchers indicated.
Some good news came out of the study: The researchers determined that mortality rates in black women and white women decreased at 3.6% and 0.8% per year, respectively—a sign that the gap in death rates is, in fact, still closing between these two groups.
The findings underscore a need to target screening and prevention methods in black women. This is especially true for older African-American women, even though current guidelines don’t recommend screening after age 65 if there’s been a recent history of negative tests.
Cervical cancer is preventable, and women should not be contracting it or dying from it, said study leader Anne F. Rositch, PhD, MSPH, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, in a statement.
“Since the goal of a screening program is to ultimately reduce mortality from cervical cancer, then you must have accurate estimates within the population targeted by those programs—adult women with a cervix. These findings motivate us to better understand why, despite the wide availability of screening and treatment, older and black women are still dying from cervical cancer at such high rates in the United States.”
As discussed by the study’s authors and in a related editorial in Cancer, there may be several potential contributors to this disparity in mortality rates. One is that adenocarcinoma rates are much more likely to rise as black women age. “Compared with a squamous histology, adenocarcinoma is associated with a worse prognosis and worse survival for both early- and late-stage disease,” wrote the editorial’s authors, Heather J. Dalton, MD, and John H. Farley, MD.
African-American women tend to present with cervical cancer at a more advanced stage of disease, and disparities in care and treatment may also exist. “Access to cervical cancer screening has been investigated as a significant contributor to racial disparities. Data suggest that women at high risk for cervical cancer either do not have adequate access to preventive services or choose not to use preventative services,” wrote the editorial’s authors.
Black women might also not trust healthcare providers and instead seek out community-based interventions that are more in line with their cultural beliefs, the authors noted.