Racial Disparity in Diagnostic Evaluation of Uterine Cancer

子宫癌是美国最常见的妇科恶性肿瘤，死亡率是普通人的两倍 比白色女性更喜欢黑人女性早期诊断对患者的预后至关重要，因为它可以大大改善患者的预后。 后续治疗的效果。有证据表明，在子宫内膜癌中， 诊断时的癌症分期（53%的黑人女性与69%的白色女性在早期诊断）， 这比任何其他因素都更能解释死亡风险的种族差异。然而， 阐明导致早期诊断差异的诊断途径障碍的研究，以及 黑人妇女中更晚期子宫癌的原因在很大程度上仍不清楚，阻碍了我们的研究。 解决这一重大健康不平等问题的能力。由于诊断途径中的许多因素可能 可修改和易于干预，这反映了失去了二级预防的机会（即，早期 癌过程的检测和控制）。该项目的总体目标是减少种族歧视， 通过系统检查患者的诊断途径， 确定黑人女性早期诊断的障碍。我们将通过以下具体措施实现这一目标 目的：1）检查患有子宫癌的黑人和白色妇女之间的种族差异， 她们接受的诊断评估; 2）比较患有乳腺癌的女性的症状和诊断评估 早期与晚期子宫癌，并研究它们在影响分期的种族差异中的作用。 诊断;和3）进行基于人群的患者体验调查，并链接到癌症登记数据， 研究社会文化，行为和获取障碍如何影响子宫癌诊断的差异。目标1- 2将利用三个独特的大型医疗保健数据库，这些数据库具有患者级别的种族/民族指标， 社会经济状况，包含从以下时间开始的患者诊断路径的完整记录 症状被报告给提供者，并且覆盖了包括商业上的 被保险人，医疗补助登记者和医疗保险受益人。这些数据库包括Optum Clinformatics 数据集市，MarketScan多州医疗补助数据库，以及监测，流行病学和结束 结果（SEER）-Medicare数据库。目标3将利用全州癌症登记处的基础设施和 最新的快速病例确定技术，用于调查新诊断的妇女人群样本 子宫癌患者的经历通过进一步将患者报告的调查数据与病理学/临床 癌症登记处的数据，我们可以独特地研究社会文化，行为和患者感知的障碍 影响诊断时的子宫癌分期和肿瘤特征之间的潜在相互作用（例如， 组织学类型）和患者经验。这项研究的结果将提供一个重要的证据基础， 子宫癌诊断中的种族差异的原因。这些信息可以指导有意义的设计， 有针对性的干预措施，以促进黑人妇女的早期诊断和减少差距。

Uterine cancer is the most common gynecologic malignancy in the U.S., with a two-fold higher risk of mortality for black women than white women. Early diagnosis is vital for patients’ prognosis as it greatly improves the effectiveness of subsequent treatment. Evidence has shown a significant black-white difference in uterine cancer stage at diagnosis (53% of black women versus 69% of white women are diagnosed at early stage), which explains more of the racial gap in mortality risk than any other factor. However, there has been little research elucidating barriers in the diagnostic pathway that lead to this disparity in early diagnosis, and reasons for the more advanced-stage uterine cancer in black women remain largely unclear, hindering our ability to address this important health inequity. Since many factors in the diagnostic pathway may be modifiable and amenable to interventions, this reflects a lost opportunity of secondary prevention (i.e., early detection and control of the cancerous process). The overarching objective of this project is to reduce racial disparity in the early diagnosis of uterine cancer by systematically examining patients’ diagnostic pathway and identifying barriers to early diagnosis in black women. We will achieve this objective via the following specific aims: 1) to examine racial disparity between black and white women with uterine cancer in the quality of diagnostic evaluation they receive; 2) to compare symptoms and diagnostic evaluation of women who have early versus advanced stage uterine cancer and examine their role in influencing racial disparity in stage at diagnosis; and 3) to conduct a population-based patient experience survey and link to cancer registry data to examine how sociocultural, behavioral and access barriers affect disparity in uterine cancer diagnosis. Aims 1- 2 will draw on three unique large healthcare databases that have patient-level indicators of race/ethnicity and socioeconomic status, contain a complete record of patients’ diagnostic pathway starting from the time when symptoms are reported to a provider, and cover a diverse patient population encompassing the commercially insured, Medicaid enrollees, and Medicare beneficiaries. These databases include the Optum Clinformatics Data Mart, the MarketScan Multi-State Medicaid Database, and the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Aim 3 will exploit the infrastructure of statewide cancer registries and the latest technology of rapid case ascertainment to survey a population-based sample of women newly diagnosed with uterine cancer about their experience. By further linking patient reported survey data to pathology/clinical data in cancer registry, we can uniquely examine how sociocultural, behavior, and patient-perceived barriers affect uterine cancer stage at diagnosis and the potential interplay between tumor characteristics (e.g., histologic type) and patient experience. Findings from this study will provide an essential evidence base about causes of racial disparity in uterine cancer diagnosis. Such information can guide meaningful design of targeted interventions to promote early diagnosis in black women and reduce disparity.