Understanding Barriers to Delayed-Stage Diagnosis of Cervical Cancer

Morgan, John

INTRODUCTION: California Hispanic women experience highest cervical adeno- and epidermoid- carcinomas(CACX) risk, followed by non-Hispanic blacks (NHB), Asian-others and Non-Hispanic whites (NHW). The California Cancer Registry (CCR) is the statewide population-based cancer reporting system and consists of the three largest SEER registries.

METHODS: We conducted a non-concurrent cohort investigation assessing independent roles of age, race/ethnicity, socioeconomic status (SES), and marital status as independent predictors of stage II-IV (delayed-) vs stage I (early-stage) CACX.

FINDINGS: Among 5,324 early- and 5,222 delayed-stage CACX cases in the CCR from 1996-2005, 61.8% were age 50+ years. Logistic regression adjusted odds ratios (OR) with 95% confidence intervals (OR, 95% CI) contrasting delayed- vs early-stage CACX for age-categories were: OR_20-34/50-69=0.29, 0.26-0.33; OR_35-49/50-69=0.50, 0.46-0.54 and OR_70+/50-69=1.45, 1.29-1.62; Trend p<0.0002. Similar contrasts for race/ethnic groups with NHWs showed: OR_{Asian-other/NHW}=1.04, 0.94-1.15; OR_NHB/NHW=1.27, 1.11-1.46; and OR_Hispanic/NHW=1.06, 0.99-1.14. Contrasts of lower SES-categories with highest showed: OR_SES1/5=1.53, 1.38-1.71; OR_SES2/5=1.40, 1.25-1.56; OR_SES3/5=1.23, 1.09-1.38; and OR_SES4/5=1.04, 0.92-1.17 (Trend p<0.0001). Marital status contrasts of single (S); separated, divorced, or widowed (SDW); and unknown with married (M) were: OR_S/M=1.27, 1.18-1.38; OR_SDW/M=1.97, 1.81-2.14; and OR_Unknown/M=0.84, 0.71-1.01.

DISCUSSION: Lower ratio of delayed- vs early-stage CACX during reproductive years, with increased odds for age 50+ is consistent with poorer screening after menopause. Absence of differences in odds of delayed- vs early-stage cervical cancer among Asian/other and Hispanic women versus NHW suggests similar success screening in these race/ethnic groups, while a higher odds of delayed- vs early-stage among NHB women persists in the adjusted model. An inverse dose-gradient for delayed- versus early-stage CACX with progressively higher SES was evident, with markedly higher odds of delayed-stage among SDW compared to married women.

CONCLUSIONS: Progressively lower SES showed an inverse dose-gradient for delayed- versus early-stage CACX that is more robust than race/ethnicity, while SDW versus married was the strongest independent predictor of delayed-stage CACX.