The risk of invasive cervical cancer among Hispanics: evidence for targeted preventive interventions.
BACKGROUND
Mass screening for cervical cancer has considerably reduced invasive cancer rates; however, Hispanic Americans have not fully benefited. This study examined the relationship of demographic, socioeconomic, and acculturation factors to diagnostic stage prior to preventive interventions in a large Hispanic community (San Diego, CA, 1988-1991).


METHODS
Age-adjusted incidence rates (IR) were estimated for three subareas: Hispanic community targeted with interventions, comparison Hispanic community, and remainder of county. Incident cases of cervical cancer in the California Cancer Registry were used to calculate incidence rate ratios (IRR) of in situ to invasive stage cancer and estimate differences in early detection between Hispanics and white non-Hispanics. Multiple logistic regression was used to examine the relationship of cancer stage to census-linked income, education, poverty status, foreign birth, and language spoken.


RESULTS
The in situ cervical cancer IR is significantly lower for Hispanics than for white non-Hispanics in all three regions (P < 0.05). The overall IRR is 3.65 (95% CI 3.19, 4.18) for white non-Hispanics compared with 1.09 (95% CI 0.86, 1.38) for Hispanics. Hispanics in census tracts in the highest versus remaining quartiles for percentage of language-isolated households are at greater risk for invasive stage (OR = 2.10, 95% CI 1.27, 3. 40). White non-Hispanic women residing in census tracts in the highest versus lowest quartile of adults with less than 12 years education are at greater risk for invasive stage (OR = 2.10, 95% CI 1.31, 3.38).


CONCLUSIONS
Results show efforts aimed at cervical cancer early detection for Hispanic women are needed and well targeted. White non-Hispanic women in low-education communities are also at risk. Population-based methods in this study can focus efforts in communities needing preventive interventions.
Howe
S L
SL
Graduate School of Public Health, San Diego State University, San Diego, California, 92182, USA.
Delfino
R J
RJ
Taylor
T H
TH
Anton-Culver
H
H
D000069:Acculturation; D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008403:Mass Screening; D009367:Neoplasm Staging; D016017:Odds Ratio; D012307:Risk Factors; D012959:Socioeconomic Factors; D014504:Urban Health; D002583:Uterine Cervical Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000517:prevention & control*; D044465:White People / Q000706:statistics & numerical data