title: The impact of race and partner status on patterns of care and survival in young women with early-stage cervical cancer.
abstract: OBJECTIVE
  Although outcomes for surgery versus radiotherapy (RT) for stage IB patients are similar, young women are often preferentially treated with surgery rather than RT. Adjuvant RT is indicated for high-risk patients after surgery. Our goal was to study the impact of race and partner status on patterns of care of young women with stage I cervical cancer.
  
  
  METHODS
  We identified a cohort of 6586 women, aged 15 to 39 years, in the Surveillance, Epidemiology and End Results database diagnosed with stage I cervical cancer between 1988 and 2007.
  
  
  RESULTS
  In our cohort, 93% (n = 5080) of white women had surgery, and 86.5% (n = 985) of nonwhite women had surgery as primary treatment. On multivariate analysis, higher FIGO (International Federation of Gynecology and Obstetrics) stage (IA2 odds ratio [OR] 3.09 [P = 0.01]; IB OR, 21.41 [P < 0.001]), widowed/single (OR, 1.39; P = 0.02), squamous histology (OR, 1.69; P < 0.001), diagnosis during 1993-1997 time period (OR, 1.69; P < 0.001), and nonwhite race (OR, 1.95; P ≤ 0.001) were more likely to receive RT as primary treatment. Of the surgical patients, 15.45% of white women versus 20.4% in the nonwhite women (P < 0.001) had high-risk disease, and 66% of the white women versus 71% of the nonwhite women received adjuvant RT (P = 0.136). Race and marital status were not significant predictors of receiving adjuvant RT on multivariate analysis. Predictors of worse overall survival included RT as primary treatment (hazard ratio [HR], 1.89; P < 0.001) and nonwhite race (HR, 1.6; P = 0.001). Marital status was not a significant predictor of overall survival. Race was a significant predictor of survival for women who received surgery as primary treatment (nonwhite HR, 1.93; P < 0.001).
  
  
  CONCLUSIONS
  Nonwhites are more likely than whites to have RT as primary treatment. This suggests that nonwhite women may have social/cultural barriers impacting their treatment decision making or may have a higher likelihood of other comorbidities that limit their surgical options.
authors: Department of Radiation, Perelman School of Medicine, University of Pennsylvania, PA 19104, USA. Surbhi.grover@uphs.upenn.edu
authors: Surbhi
authors: S
authors: Grover
authors: Shayna
authors: S
authors: Showalter
authors: Kate H
authors: KH
authors: Kraft
authors: Gita
authors: G
authors: Suneja
authors: Lilie
authors: L
authors: Lin
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D018196:Carcinoma, Adenosquamous / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018426:SEER Program; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult