title: Impact of race and ethnicity on treatment and survival of women with vulvar cancer in the United States.
abstract: OBJECTIVE
  To examine racial/ethnic differences in treatment and survival in women diagnosed with invasive vulvar cancer in the United States.
  
  
  METHODS
  Women with invasive vulvar cancer were identified from the Surveillance, Epidemiology, and End Results database from 1/1/92 to 12/31/02. Statistical analysis using Chi-square, Fisher's Exact Test, Kaplan-Meier survival methods, and Cox regression proportional hazards models was performed.
  
  
  RESULTS
  Of the 2357 cases of invasive vulvar cancer included in this study, 1974 (83.8%) were non-Hispanic white, 209 (8.9%) were non-Hispanic black, 119 (5.0%) were Hispanic, and 55 (2.3%) women were of another race/ethnicity. After adjustment for stage, black women were half as likely (OR=0.48, 95% CI 0.31-0. 74) to undergo surgery and 1.7 times more likely (OR=1.67, 95% CI 1.18-2.36) to receive radiation than white women. In multivariable analysis, surgical treatment reduced the risk of death from vulvar cancer by 46% (HR 0.54, 95% CI 0.43-0.67), whereas radiation was not shown to impact the risk of death (HR 0.99, 95% CI 0.84-1.19), after adjusting for age, race, stage, and grade. There was no significant difference in risk of death by race/ethnicity group after adjusting for the previously described variables.
  
  
  CONCLUSIONS
  Based on this study, race/ethnicity is not an independent risk factor for poor prognosis in women diagnosed with invasive vulvar cancer, despite differences in treatment modality by race/ethnicity. Further research to define the factors contributing to differences in treatment selection according to race/ethnicity and the resulting impact on quality of life is warranted.
authors.affiliation: Division of Gynecologic Oncology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, United States. atergas1@jhmi.edu
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.forename: Jill H
authors.initials: JH
authors.lastname: Tseng
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States; D014846:Vulvar Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D044465:White People