title: Racial disparities in cervical cancer survival over time.
abstract: BACKGROUND
  The purpose of this study is to examine changes over time in survival for African American (AA) and white women diagnosed with cervical cancer (CC).
  
  
  METHODS
  Surveillance, Epidemiology, and End Results (SEER) Program data from 1985 to 2009 were used for this analysis. Racial differences in survival were evaluated between African American (AA) and white women. Kaplan-Meier and Cox proportional hazards survival methods were used to assess differences in survival by race at 5-year intervals.
  
  
  RESULTS
  The study sample included 23,368 women, including 3886 (16.6%) who were AA and 19,482 (83.4%) who were white. AA women were older (51.4 versus 48.9 years; P<.001) and had a higher rate of regional (38.3% versus 31.8%; P<.001) and distant metastasis (10.7% versus 8.7%; P<.001). AA less frequently received cancer-directed surgery (32.4% versus 46%; P<.001), and more frequently radiotherapy (36.3% versus 26.4%; P<.001). Overall, AA women had a hazard ratio (HR) of 1.41 (95% confidence interval=1.32-1.51) of cervical cancer (CC) mortality compared with whites. Adjusting for SEER registry, marital status, stage, age, treatment, grade, and histology, AA women had an HR of 1.13 (95% confidence interval=1.05-1.22) of CC-related mortality. After adjusting for the same variables, there was a significant difference in CC-specific mortality between 1985 to 1989 and 1990 to 1994, but not after 1995.
  
  
  CONCLUSIONS
  After adjusting for race, SEER registry, marital status, stage, age, treatment, grade, and histology, there was a significant difference in CC-specific mortality between 1985 to 1989 and 1990 to 1994, but not after 1995.
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: Joel T
authors.initials: JT
authors.lastname: Clemmer
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Bradford
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Clark
authors.forename: Whitfield B
authors.initials: WB
authors.lastname: Growdon
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
authors.forename: David M
authors.initials: DM
authors.lastname: Boruta
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
authors.forename: Marcela G
authors.initials: MG
authors.lastname: del Carmen
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D001741:Black or African American / Q000706:statistics & numerical data*; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D044465:White People / Q000706:statistics & numerical data*
keywords: African American; SEER; cervical cancer; disparities; race