title: Racial disparities and changes in clinical characteristics and survival for vulvar cancer over time.
abstract: OBJECTIVE
  The purpose of this study was to examine changes over time in survival for African-American (AA) and white women diagnosed with squamous cell carcinoma of the vulva.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) Program for 1973-2009 was used for this analysis. We evaluated racial differences in survival between AA and white women. Kaplan-Meier and Cox proportional hazards survival methods were used to assess differences in survival by race by decade of diagnosis.
  
  
  RESULTS
  The study sample included 5867 women, including 5379 whites (91.6%) and 488 AA (8.3%). AA women were younger (57 vs 67 years; P < .001) and had a higher rate of distant metastasis (6.1% vs 3.7%; P < .001). AA women had surgery less frequently (84.2% vs 87.6%; P = .03) and more frequently radiotherapy (24.2% vs 20.6%; P < .001). AA women had a hazard ratio (HR) of 0.84 (95% confidence interval [CI], 0.74-0.95) of all-cause mortality and 0.66 (95% CI, 0.53-0.82) of vulvar cancer mortality compared with whites. Adjusting for SEER Registry, marital status, stage, age, surgery, radiotherapy, grade, lymph node status, and decade, AA women had an HR of 0.67 (95% CI, 0.53-0.84) of vulvar cancer-related mortality compared with whites. After adjusting for the same variables, there was a significant difference in survival between AA and whites in the periods of 1990-1999 (HR, 0.62; 95% CI, 0.41-0.95) and 2000-2009 (HR, 0.46; 95% CI, 0.30-0.72) but not earlier.
  
  
  CONCLUSIONS
  AA presented at a significantly younger age compared with white women and had better survival compared with whites.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: Joel
authors.initials: J
authors.lastname: Clemmer
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Clark
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Bradford
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: D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009026:Mortality / Q000208:ethnology* / Q000639:trends; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000706:statistics & numerical data; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D014846:Vulvar Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D044465:White People / Q000706:statistics & numerical data*
keywords: African-American; disparities; race; vulvar cancer