title: Racial differences in cervical cancer survival in the Detroit metropolitan area.
abstract: BACKGROUND
  African-American (AA) women have lower survival rates from cervical cancer compared with white women. The objective of this study was to examine the influence of socioeconomic status (SES) and other variables on racial disparities in overall survival among women with invasive cervical cancer.
  
  
  METHODS
  One thousand thirty-six women (705 white women and 331 AA women) who were diagnosed with primary invasive cancer of the cervix between 1988 and 1992 were identified through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a registry in the Surveillance, Epidemiology, and End Results (SEER) database. Pathology, treatment, and survival data were obtained through SEER. SES was categorized by using occupation, poverty, and educational status at the census tract level. Cox proportional hazards models were used to compare overall survival between AA women and white women adjusting for sociodemographics, clinical presentation, and treatment.
  
  
  RESULTS
  AA women were more likely to present at an older age (P<.001), with later stage disease (P<.001), and with squamous histology (P=.01), and they were more likely to reside in a census tract categorized as Working Poor (WP) (P<.001). After multivariate adjustment, race no longer had a significant impact on survival. Women who resided in a WP census tract had a higher risk of death than women from a Professional census tract (P=.05). There was a significant interaction between disease stage and time with the effect of stage on survival attenuated after 6 years.
  
  
  CONCLUSIONS
  In this study, factors that affected access to medical care appeared to have a more important influence than race on the long-term survival of women with invasive cervical cancer.
authors.affiliation: Department of Internal Medicine, Mclaren Regional Medical Center, Michigan State University, Flint, Michigan, USA.
authors.forename: Sujana
authors.initials: S
authors.lastname: Movva
authors.forename: Anne-Michelle
authors.initials: AM
authors.lastname: Noone
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Divya A
authors.initials: DA
authors.lastname: Patel
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
authors.forename: Cecilia L
authors.initials: CL
authors.lastname: Yee
authors.forename: Michael S
authors.initials: MS
authors.lastname: Simon
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000556:secondary; D001741:Black or African American; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012307:Risk Factors; D018426:SEER Program; D012959:Socioeconomic Factors; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000208:ethnology* / Q000401:mortality*; D044465:White People