Ethnic differences in patterns of care of Stage 1A₁ and Stage 1A₂ cervical cancer: A SEER database study

Objective. The aim of this study was to evaluate patterns of care for women with Stage 1A₁ and 1A₂ cervical cancer utilizing the SEER database. Methods. Review of SEER data from 11 registries from 1990 to 1995 was performed. Data from 2358 women were reviewed and stratified by substage, ethnicity, type of therapy, and age. Results. Three remarkable differences among subgroups were identified. (1) Among women ≥35 years of age, whites were more likely to have Stage 1A₁ cancer than blacks or Hispanics; OR (95% CI) = 1.56 (1.05, 2.31) and 1.41 (1.04, 1.91), respectively. (2) Patients ≥35 years of age were more likely to undergo hysterectomy than younger patients both for 1A₁ and 1A₂ stages; OR (95% CI) = 2.31 (1.68, 3.19) and 2.78 (2.21, 3.50), respectively, with Mantel-Haenszel test of independence χ² = 102.9943, P value < 0.001. (3) Black and Hispanic women ≥35 years of age with 1A₂ disease were less likely to have a hysterectomy than whites. Only 15% of Hispanic patients and 9% of blacks over the age of 35 and with Stage 1A₂ were treated via hysterectomy, compared to 76% of white women. Differences in hysterectomies for <35 years of age, 1A₁ patients approached but did not reach statistical significance: blacks 36% versus Hispanic/whites 59%, P value = 0.07. Conclusions. Older white women were more likely to have cervical carcinoma diagnosed at an earlier stage (1A₁) than age-matched blacks or Hispanics. Older patients, across all ethnic groups analyzed, were also more likely to be treated for both Stage 1A₁ and 1A₂ disease via hysterectomy than younger patients. Ethnic differences in the management of women with Stage 1A₂ cervical cancer do exist: older minority women are less likely to have a hysterectomy and more likely to be treated via fertility- sparing, less definitive procedures than whites.