SAN DIEGOBlack women with cancer have generally worse
outcomes than white cancer patients, and some cancer experts suspect
underlying differ-ences in cancer susceptibility or progression. US
military medical researchers suggest that, at least for cervical
cancer, they are looking in the wrong place.
With equal access to medical care, cervical cancer outcomes are
virtually the same in black and white patients, Major John H. Farley,
MD, reported at the 31st Annual Meeting of the Society of Gynecologic
This review shows that cervical cancer survival for blacks can
approach that of their nonminority counterparts, 75%. We have shown,
in a nonracial, equal-access-to-health-care environment, that race,
in and of itself, is not an independent predictor of survival for
cervical cancer patients. Physician-patient interaction and
impediments to care, not race, should be considered when evaluating
cervical cancer survival, Dr. Farley, of the Tripler Army
Medical Center, Tripler, Hawaii, told ONI in an interview.
The investigators analyzed data for patients with the diagnosis of
invasive cervical cancer recorded in the Automated Central Tumor
Registry for the US Military Health Care System from 1988 to 1998.
The analysis included race, age at diagnosis, histology, grade,
stage, treatment modality, and survival.
The purpose of this study was to investigate whether race is an
independent prognostic factor in the survival of cervical cancer in a
health care system with minimal racial bias and modest impediments to
access to care, Dr. Farley said.
The study included 1,553 patients (see Table ). Mean age at diagnosis
was 44 years for black women and 42 years for white women. The
investigators reported that 72% of cases were stage I; 15% stage II;
11% stage III; and 2% stage IV. Histology distribution was 75%
squamous, 12% adenocarcinoma, and 6% adenosqua-mous. Nine percent of
patients had grade 1 tumors, 31% grade 2, and 25% grade 3.
The researchers found no significant difference in distribution of
stage, grade, histology, or age between whites and nonwhites, and
specifically between whites and blacks. Dr. Farley said that
socioeconomic status (mean income) was greater for whites than for
blacks (P = .006). There was no difference in the percentage of
patients among each group who received surgery (46%) or radiation
Five-year survival was 76% for blacks vs 75% for whites. Ten-year
survival was 65% for blacks vs 64% for whites (P = .59). The
investigators concluded that race per se has no significant impact on
cervical cancer outcome.
Our study clearly lends credence to the possibility that
racially related impediments to care may be the real variables that
adversely affect cervical cancer survival in minority patients,
Dr. Farley said.
Physician bias to care based on ethnicity would be expected to be
less in the military, he said, given the militarys diverse
population and long history of integration. Equally important, he
said, is the unique, nonmonetary, equal-access-to-care
environment of the military health care system. This distinctive
system provides direct access not only to primary care physicians but
also to subspecialists, including gynecologic oncologists.
Finally, he said, the long history, since the 1970s, of military
participation in NIH/NCI-sponsored studies has not only allowed women
in the military access to state-of-the-art care but also provided an
additional level of standardization and regulation in the treatment
of women with gynecologic malignancies.
These factors must undoubtedly play a role in the equivalent
survival found in our population, Dr. Farley said.
He emphasized that the report is the first demonstration that
survival for cervical cancer among black women can be comparable to
that of their white counterparts. This difference in survival
of 16% to 18% is of paramount importance not only for black women but
also for their health care providers. A comparable survival rate for
blacks would mean that every day, one black woman diagnosed with
cervical cancer would have a chance at life rather than succumbing to
her disease, Dr. Farley said.
He noted that the data do not affect the basic understanding of the
mechanisms of cervical cancer. It is basically a sexually
transmitted disease, he said. What should change is our
understanding of the treatment of this disease among the minority
population once it is diagnosed.
Racial bias and impediments to standard care can have a pronounced
effect on survival, Dr. Farley said. When these barriers are removed,
survival can be and is equal. The decreased survival of
minorities in the community is not an absolute fact that cannot be
influenced by screening and treatment, he con-cluded.