Stage 4 cervical cancer

SAN DIEGO - Higher death rates from cervical cancer in African Americans, compared with whites, disappear or at least diminish with equal access to care and treatment, according to two studies presented at the annual meeting of the Society of Gynecologic Oncologists.

In a retrospective review of data from 1,553 patients with cervical cancer in the US. Military Health Care System over a 10-year period, Dr. John Farley and his colleagues at Tripler Army Medical Center, Honolulu, found no difference in 5-year survival between African American and white patients, 75% and 76%, respectively.

Differences in overall survival between whites and all minorities--based on data on 544 patients, 29% of whom were African Americans--were due to higher disease stage at presentation in minorities: 40% of minorities had advanced disease, compared with 30% of all patients. Survival decreased from 86% for patients diagnosed with stage I cervical cancer to 12% for patients diagnosed with stage IV disease, said Dr. Farley, chief of the department of gynecologic oncology at the center.

As a result, 5-year survival rates in the study were 76% for whites and 69% for minorities; 10-year survival rates were 65% for whites and 59% for minorities.

A separate retrospective study looked at data on 209 patients seen over a 6-year period at Cook County Hospital in Chicago and 163 patients at Rush Presbyterian-St. Luke's Medical Center, a private teaching hospital for Rush University in Chicago.

Patients at the county hospital were more likely to be African American (62%) or Hispanic (29%) than were patients at the private hospital (28% African American, 8% Hispanic). Whites comprised 16% of patients in the county hospital cohort and 60% of patients at the private hospital.

Survival from cervical cancer at a median of 17 months did not differ between institutions when adjusted for stage of disease, said Dr. Kian Behbakht of Rush Medical College.

Patients at Cook County Hospital had more advanced disease: 49% were stage II or higher, compared with 32% at Rush Presbyterian-St. Luke's Hospital. Stage-dependent treatment methods were similar.

Lower overall survival rates for African Americans, compared with whites, disappeared at the private hospital when adjusted for stage and diminished but did not disappear at the county hospital, he said.

The two studies--like studies of colon, breast, prostate, and lung cancer--show that racial differences in survival can be eliminated or decreased by ensuring equal treatment through clinical trials, a single institution, or a single health care system such as the military, said Dr. Brown of Memorial Sloan-Kettering Cancer Center in New York.

To some extent, the findings corroborate earlier research. In a retrospective study of 555 patients, differences in 8-year survival (60% of whites and 34% of blacks with stage IIB-IVA disease) were due to lower hemoglobin levels, less radiation therapy and lower socioeconomic status among African Americans (Gynecol. Oncol. 71[2]:151-58, 1998). In a retrospective study of 6,050 patients African Americans with cervical disease were less likely to receive surgery and other treatments (Obstet. Gynecol. 94[4]:509-15, 1999).