title: Disparities in treatment and survival between African American and White women with vaginal cancer.
abstract: OBJECTIVE
  The study aims to compare the difference in treatment and survival between White (W) and African American (AA) patients with vaginal cancer (VC).
  
  
  METHODS
  Patients with a diagnosis of invasive vaginal cancer were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007 and were divided into White (W) and African American (AA) subgroups. Student's t test, Kaplan-Meier survival methods, and Cox regression proportional hazards were performed.
  
  
  RESULTS
  A total of 2675 patients met the inclusion criteria, with histologic distribution of squamous cell carcinoma (SCC; 2190, 82%) and adenocarcinoma (AC; 485, 18%); 2294 (85.8%) were W, and 381 (14.2%) were AA. Median age was 69 for W and 65 for AA (p<0.001). SCC and AC were equally distributed between W and AA. Advanced stage disease (FIGO III and IV) was more prominent in AA compared with W (30.4% vs. 23.1%, p=0.019). Radiation therapy was utilized equally in both racial groups; however, surgical treatment alone or combined with radiation therapy was more frequent in W compared with AA (27.7% vs. 17.5%, p<0.001). The 5-year survival was 45% in W and 38.6% in AA (p=0.008). In multivariate analysis, AA had significantly poorer survival compared with Whites when controlling for age, histology, stage, grade and treatment modality (HR 1.2, 95% CI 1.1-1.4, p=0.007).
  
  
  CONCLUSIONS
  African American women with vaginal cancer were more likely to present, at a younger age, advanced stage and less likely to receive surgical treatment. Our data suggests that AA race is an independent predictor of poor survival in vaginal cancer.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA. mahdih@uw.edu
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.forename: Rabbie K
authors.initials: RK
authors.lastname: Hanna
authors.forename: Adnan R
authors.initials: AR
authors.lastname: Munkarah
authors.forename: David
authors.initials: D
authors.lastname: Lockhart
authors.forename: Robert T
authors.initials: RT
authors.lastname: Morris
authors.forename: Hisham
authors.initials: H
authors.lastname: Tamimi
authors.forename: Ron E
authors.initials: RE
authors.lastname: Swensen
authors.forename: Mark
authors.initials: M
authors.lastname: Doherty
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D001741:Black or African American; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D014625:Vaginal Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D044465:White People