Nativity disparities in late-stage diagnosis and cause-specific survival among Hispanic women with invasive cervical cancer: an analysis of Surveillance, Epidemiology, and End Results data
Nativity disparities in late-stage diagnosis and cause-specific survival among Hispanic women with invasive cervical cancer: an analysis of Surveillance, Epidemiology, and End Results data
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DOI：
10.1007/s10552-013-0274-1
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发表时间：
2013-11-01
影响因子：
2.3
通讯作者：
Scheurer, Michael E.
中科院分区：
文献类型：
--
作者：
Montealegre, Jane R.;Zhou, Renke;Scheurer, Michael E.
虽然宫颈癌筛查和风险行为在美国和外国出生的西班牙裔妇女中存在差异，但许多癌症流行病学研究将西班牙裔概念化为同质群体。在这里，我们使用1998-2008年监测、流行病学和最终结果项目的数据，研究了西班牙裔妇女在出生时宫颈癌诊断分期和生存率的差异。出生是基于出生地，并被归类为美国与外国出生。远处和局部肿瘤被归类为晚期，而局部肿瘤被归类为早期。47%的西班牙裔宫颈癌病例在晚期被诊断出来，超过一半的宫颈癌病例是在外国出生的妇女中。在调整诊断时的年龄和肿瘤组织学后，外国出生的西班牙裔女性比美国出生的西班牙裔女性更有可能患有晚期诊断（调整后的比值比= 1.09，p值= 0.003）。在诊断阶段，出生和生存之间的关联存在异质性。在早期诊断的病例中，在调整诊断时的年龄、组织学和癌症导向治疗后，外国出生的西班牙裔与美国出生的西班牙裔之间的生存率较差[调整后的风险比（HR）= 1.31，p值= 0.030]。然而，在晚期诊断的病例中，外国出生的西班牙裔患者的生存率更好（校正HR = 0.81，p值< 0.001）。我们假设，生存率的出生差异可能表明不同的风险、筛查和治疗特征。考虑到这些差异，将西班牙裔作为宫颈癌研究的单一群体进行汇总可能是不合适的。
While cervical cancer screening and risk behaviors have been found to vary among US- and foreign-born Hispanic women, many cancer epidemiology studies have conceptualized Hispanics as a homogenous group. Here, we examine differences in cervical cancer stage at diagnosis and survival among Hispanic women by nativity.We use data from the Surveillance, Epidemiology, and End Results program, 1998-2008. Nativity was based on place of birth and was categorized as US versus foreign born. Distant and regional tumors were classified as late stage, while local tumors were classified as early stage.Forty-seven percent of cases of invasive cervical cancer among Hispanics were diagnosed at a late stage, and over half of invasive cervical cancer cases were among foreign-born women. Foreign-born Hispanic women were significantly more likely than US-born Hispanics to have late-stage diagnosis, after adjusting for age at diagnosis and tumor histology (adjusted odds ration = 1.09, p value = 0.003). There was heterogeneity in the association between nativity and survival by stage at diagnosis. Among cases with early-stage diagnosis, survival was poorer among foreign-born versus US-born Hispanics after adjusting for age at diagnosis, histology, and cancer-directed therapy [adjusted hazard ratios (HR) = 1.31, p value = 0.030]. However, among cases with late-stage diagnosis, survival was better among foreign-born Hispanics (adjusted HR = 0.81, p value < 0.001).We hypothesize that nativity differences in survival may be indicative of diverse risk, screening, and treatment profiles. Given such differences, it may be inappropriate to aggregate Hispanics as a single group for cervical cancer research.