Study Finds that More African American Women Die from Cervical Cancer than White Women
The racial disparity was thought to have decreased but is actually much larger than believed
A new study has found that not only is the death rate due to cervical cancer in the U.S. much higher than was previously estimated, the gap between the number of black women and the number of white women who die from it is far wider.
The researchers reported that the rate at the disease is killing black American women is similar to the rate at which it kills women in several developing countries. However, according to experts who did not take part in the research, the most disturbing part is that cervical cancer is largely preventable when guidelines for screening and follow-up monitoring are done.
"This shows that our disparities are even worse than we feared," said Dr. Kathleen M. Schmeler, who works as an associate professor of gynecologic oncology at the University of Texas M. D. Anderson Cancer Center. "We have screenings that are great, but many women in America are not getting them. And now I have even more concerns going forward, with the" — expected — "repeal of the Affordable Care Act, which covers screening, and the closing of family planning clinics, which do much of that screening."
Previous studies had made note of the racial gap, but it had been thought to be growing smaller since cervical cancer death rates for black women were falling. According to this study, however, the disparity was actually much wider than had been believed.
The new analysis estimates the mortality rate for black women at 10.1 per 100,000 and for white women at 4.7 per 100,000. Earlier studies had put those rates at 5.7 and 3.2, respectively.
The new numbers do not reflect an increased number of deaths, however, which have recently been estimated at more than 4,000 per year in the U.S. Instead, they are the result of a new examination in an adjusted context of numbers that already existed.
Cervical cancer death rates are typically calculated by assessing how many women die from a disease against the general population that is at risk for it. These researchers, who examined health data from 2000 to 2012, also decided to exclude women who had had hysterectomies from that bigger population, since such surgeries nearly always remove the cervix and thus the possibility of developing cervical cancer.
"We don't include men in our calculation because they are not at risk for cervical cancer and by the same measure, we shouldn't include women who don't have a cervix," said Anne F. Rositch, lead author of the study and an assistant professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. "If we want to look at how well our programs are doing, we have to look at the women we're targeting."
Though the study did not examine possible reasons for the gap between the races, some doctors said that it might reflect unequal levels of screening access, the ability to try to get early-warning test results, and insurance coverage. Another recent study examining more than 15,194 patients who had advanced cervical cancer discovered that more than half of the participants did not get treatment considered to be standard of care and that those same patients were more likely to be black and poor.
According to the new analysis, the newly-adjusted mortality rates place black American women on par with women living in certain underdeveloped countries in Latin America, Asia, and Africa, especially in sub-Saharan Africa.
Mortality and incidence rates of cervical cancer are expected to fall in coming years as more women are vaccinated for the human papillomavirus (HPV), which causes the disease. The HPV vaccine prevents several cervical cancers.
Although current guidelines suggest ending screening at age 65 for women who have had two or three consecutive negative results over the past 10 years, the study says that black women 85 and older had the highest mortality rates from the disease.
However, experts said that the new study's findings did not necessarily indicate a need for revising that part of the guidelines. The disease grows so slowly and has so many early-warning stages, they said, that it is very unlikely that a 65-year-old women who had fulfilled the requirements of the guidelines would then develop the cancer.
But if the guidelines and screenings are so rigorous, Dr. Rositch asked, why do women in the U.S. not only still develop the disease but even die from it? And why are there such large divides in race and age?
According to the American Cancer Society's Chief Medical Officer, Dr. Otis W. Brawley, the study points to unequal levels of access and quality treatment.
"When we look at the difference between black and white, and rich and poor, we find the same disparity," he said. "The quality of assessment and follow-up treatment can be different. The question becomes: how do we get adequate preventive care to all people?"
According to Dr. Schmeler, the study raises alarms for other poor women in addition to African Americans. Rates of incidence and death due to cervical cancer in Texas border towns whose populations are overwhelmingly poor and Hispanic were much higher than national figures.
Dr. M. Margaret Kemeny directs the Queens Cancer Center of Queens Hospital. Recently she had to operate on two women, one Chinese and the other Hispanic, each of whom had recurring cervical cancer.
"One was 39," she said, "And the other was 25."