A new study corrects cervical cancer incidence and mortality rates to account for hysterectomy, and finds both incidence and mortality of cervical cancer has been grossly underestimated, especially in the black population, in which hysterectomy rates are higher. The study, led by Anna L. Beavis, M.D., MPH of Johns Hopkins Medicine finds the prevalence of hysterectomy was greatest in white and black women aged 65 to 69 years, but the peak was significantly higher in black women (58% vs 43% for white women). After correction, the black mortality rate was 10.1 per 100,000 (5.7 per 100,000 without correction), whereas the corrected rate for white women was 4.7 per 100,000 (3.2 per 100,000 without correction). Without correction, the disparity in mortality between the races was underestimated by 44%. The oldest black women had the highest corrected mortality rate at 37.2 deaths per 100,000, a rate that rivals the rates of undeveloped countries.
We asked Otis W. Brawley, M.D. MACP , the American Cancer Society chief medical officer, to respond to the study.
“This is an important and very well-done study that has real implications in cancer medicine. The United States has very high rates of hysterectomy, so recalculating incidence and mortality after removing those who have had a hysterectomy, and who therefore cannot get cervical cancer, makes sense. After all, statistics are usually provided only for those at risk. For example, testicular cancer rates include only men and not men and women. Even with breast cancer, for which men have very low incidence, we commonly report incidence and mortality in women only.
“The message to healthcare providers, insurers, policy makers, and patients is the same: Disparities not only exist in cervical cancer, but at even higher rates than we knew. This study should clearly focus public health efforts about the magnitude of this problem, and help strengthen efforts to overcome it.
“Why do these disparities exist? The reasons are complex, and deeply ingrained in our society. There is good evidence in a number of diseases, even beyond cancer, that even when screening rates are similar, the quality of screening is not. This concept of disparity has been shown true not only in screening, but also in diagnostics and treatment of breast cancer and colon cancer as well as in the treatment of hypertension, diabetes, and cardiovascular disease. It seems quite plausible this is also the case in cervix cancer. We frequently focus on whether screening, diagnostics, and treatment occurred, but we often forget to take into account the quality of these interventions. Even in the case of radiation therapy there is a significant literature on the disparities in completion of treatment.
“Common reasons for the disparities include things like overcrowding and overtaxed doctors and clinics in socioeconomically deprived communities. Patients also have challenges in getting care; simple things such as transportation, especially for radiotherapy where one needs to receive it on a regular basis can be an obstacle. In addition, disparities are often tied up in issues that lead to patients leaving treatment before their therapy is complete.”