Black women are the least likely to be diagnosed with cervical adenocarcinoma (ADC) but the most likely to die from it, according to a new study looking at racial/ethnic disparities in cervical cancer.
Researchers looked at primary cases of malignant cervical cancer among women aged 15 or older in the SEER 21 and 18 registries. They evaluated both age-adjusted incidence rates and incidence-based mortality rates.
“Most understanding of cervical cancer, including optimal treatment, has resulted from studies in predominantly White patients with SCC,” the researchers wrote. “Currently, there are no explicit differences in treatment recommendations for cervical cancer by histologic subtype, despite important histologic differences with respect to clinical behavior, recurrence risk, response to therapy, and prognosis.”
From 2000 to 2018, 80,580 incident cervical cancer cases were diagnosed. After the exclusion of noncervical primaries, most of the remaining cases were squamous cell carcinoma (SCC; 71.6%), followed by ADC (21.8%), cervical adeno-squamous carcinoma (ADSC; 3.9%), and other (2.6%).
Rates of SCC were highest in Black women, followed by Hispanic, American Indian/Alaska Native (AI/AN), Asian Pacific Islander (API), and then White women. Compared with White women, Black women had a twofold higher rate of hysterectomy-corrected SCC.
Black women had the lowest rates of uncorrected and corrected ADC; Hispanic women had the highest.
“It is not clear why Black women have the lowest incidence of ADC despite having the highest incidence of SCC. We hypothesized that racial differences by subtype could be partially explained by social determinants of health associated with access to care and screening,” they suggested.
“It is possible that differences in the distribution of HPV genotypes and variants contribute to subtype-specific differences in incidence. For example, Black women have a lower prevalence of HPV16 compared with White women, and HPV16 is more likely to cause ADC compared with other HPV types.”
In addition, Black women had lower survival for ADC compared with SCC. For both subtypes and at every stage, Black women had the lowest 5-year relative survival. Hispanic women generally had the highest survival regardless of subtype or stage.
Compared with White and Hispanic women, Black women with regional and distant ADC had lower 5-year relative survival (regional: 37.6 v 61.5 and 65.1, respectively, and distant: 9.2 v 21.1 and 24.9, respectively).
“More research is needed to better understand the influence of factors such as differences in detection (screening; including later ages at diagnosis), treatment, and management, as well as potential biological differences, on these disparities,” the researchers concluded.
Racial and Ethnic Disparities in Cervical Cancer Incidence, Survival, and Mortality by Histologic Subtype.