Late stage cervical cancer diagnosis: Determinants and trends, 1990-2011

Introduction: Although there has been a steady decline in cervical cancer mortality over the past two decades, disparities still exist. These disparities could be reduced by increasing the number of patients who are diagnosed at an early stage.

Purpose: We sought to identify the influence of socio-demographic and tumor characteristics on stage at cervical cancer diagnosis, and trends in late stage diagnosis, between 1990 and 2011.

Methods: A retrospective study using the Surveillance, Ends Result and Epidemiology data (SEER) was conducted. Descriptive statistics were conducted using chi-square tests for categorical variables and student’s t-test for continuous variables. A multilevel multivariate logistic regression was also conducted. Dependent variable was stage at diagnosis. We controlled for individual level, county level and tumor characteristics.

Results: Descriptive analyses showed that a greater proportion of rural residents received a late stage diagnosis compared to urban residents (51.27% vs. 47.94%; p-value=0.007).  On multivariate analysis, compared to whites, there was increased likelihood of late stage diagnosis among blacks (OR=1.06; 95% CI=1.16-1.30), American Indians (OR=1.30; 95% CI=1.03-1.63), Asian/Pacific Islanders (OR=1.14; 95% CI=1.07-1.23). Residents of high poverty areas were more likely to have advanced stage diagnosis compared to residents of low poverty areas (OR=1.37; 95% CI=1.05-1.81). Compared to those who were diagnosed in 1990, there was significantly increased likelihood of late stage diagnosis among those diagnosed between 2002 and 2011.

Conclusion: Our findings point to the need to increase awareness of the importance of early stage diagnosis. Culturally relevant strategies to improve screening rates among minority populations are also needed.