Cervical Cancer-Related Deaths in U.S. Underestimated, Particularly Among Black and Older Women

Cervical Cancer-Related Deaths in U.S. Underestimated, Particularly Among Black and Older Women

Mortality rates associated with cervical cancer may have been underestimated in the United States, particularly among older and black women, a new Johns Hopkins Bloomberg School of Public Health research study suggests.

The study found that mortality rates for blacks with cervical cancer in the U.S. are 77 % higher than previously thought; for whites, the rates are 47% higher.

The findings were published in the journal Cancer, under the title “Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States.”

The figures reflect a change in how mortality rates were calculated. Researchers considered that, since the risk of a woman who has had a hysterectomy (removal of the cervix) developing cervical cancer is zero,  this group of women should be excluded from the calculation. The new data paints a more accurate picture of who is actually at risk of developing cervical cancer.

“This is a preventable disease and women should not be getting it, let alone dying from it,” Anne F. Rositch, PhD, MSPH, the assistant professor at Johns Hopkins’s Bloomberg School of Public Health who led the study, said in a press release.

Moreover, many of the women who are dying of this disease are older than 65 years, which is the age at which guidelines stop recommending regular Pap smear screening. Cervical cancer is preventable with routine screening, but it still affects about 12,000 people each year in the U.S., and causes nearly 4,000 deaths.

“Since the goal of a screening program is to ultimately reduce mortality from cervical cancer, then you must have accurate estimates within the population targeted by those programs — adult women with a cervix. These findings motivate us to better understand why, despite the wide availability of screening and treatment, older and black women are still dying from cervical cancer at such high rates in the United States,” Rositch said.

The researchers used data from the Surveillance, Epidemiology and End Results (SEER) national registry and from other national health statistics to find these numbers, which were later corrected by removing the proportion of women who had previously reported undergoing a hysterectomy.

When corrected for hysterectomy, mortality rates in blacks were 10.1 per 100,000 per year, and in whites  the rates were 4.7 per 100,000 per year. These rates are close to those seen in less-developed nations.

Including all women, calculations underestimated the racial disparity in death rates between blacks and whites by 44%.

Blacks are more likely to have hysterectomies, and at younger ages, largely because they are more susceptible to fibroids, or benign masses in the uterus. But this hardly justifies such a significant difference in results.

Rositch calls for answers to why older and black women are dying of cervical cancer at higher rates, and claims answering these questions is critical to identify the most appropriate interventions that could lower those rates.

“While trends over time show that the racial disparities gap has been closing somewhat, these data emphasize that it should remain a priority area,” Rositch said. “Black women are dying of cervical cancer at twice the rate as white women in the United States and we need to put in place measures to reverse the trend,” she said.

In addition, “these data tell us that as long as a woman retains her cervix, it is important that she continue to obtain recommended screening for cervical cancer since the risk of death from the disease remains significant well into older age,” Rositch added.

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