Racial and ethnic disparities over time in the treatment and mortality of women with gynecological malignancies

Gynecol Oncol. 2018 Apr;149(1):4-11. doi: 10.1016/j.ygyno.2017.12.006.

Abstract

Objective: To examine temporal trends in treatment and survival among black, Asian, Hispanic, and white women diagnosed with endometrial, ovarian, cervical, and vulvar cancer.

Methods: Using the National Cancer Database (2004-2014), we identified women diagnosed with endometrial, ovarian, cervical, and vulvar cancer. For each disease site, we analyzed race/ethnicity-specific trends in receipt of evidence-based practices. Professional societies' recommendations were used to define these practices. Using data from the Surveillance, Epidemiology, and End Results Program (2000-2009) we analyzed trends in 5-year survival.

Results: Throughout the study period black (64.8%) and Hispanic (68.3%) women were less likely to undergo lymphadenectomy for stage I ovarian cancer compared to Asian (79.5%) and white patients (74.6%). Black women were the least likely group to undergo lymphadenectomy in all periods. Among patients with stage II-IV ovarian cancer, 76.6% of white and Asian women received both surgery and chemotherapy, compared to 70.8% of black and 73.9% Hispanic women. Hispanic women with deeply invasive or high-grade stage I endometrial cancer underwent lymphadenectomy less frequently (74.5%) than all other groups (80.7%). Black women were less likely to have chemo-radiotherapy for stage IIB-IVA cervical cancer (75.6% versus 80.4% of all others). Black women were also less likely to have a surgical lymph node evaluation for vulvar cancer (58.8% versus 63.5% of all others). Among women diagnosed with ovarian, endometrial, and cervical cancer, black women had lower five-year survival than other groups.

Conclusion: Significant racial disparities persist in the delivery of evidence-based care. Black women with ovarian, endometrial, and cervical cancer continue to experience higher cancer-specific mortality than other groups.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Asian Americans / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Genital Neoplasms, Female / ethnology
  • Genital Neoplasms, Female / mortality*
  • Genital Neoplasms, Female / therapy*
  • Healthcare Disparities / ethnology*
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Kaplan-Meier Estimate
  • Lymph Node Excision / statistics & numerical data
  • Medical Oncology / methods
  • Medical Oncology / statistics & numerical data
  • Middle Aged
  • SEER Program
  • United States / epidemiology