Income and education linked to outcome in cervical cancer

Despite a backdrop of declining rates, a new study concludes cervical cancer continues to be a more serious threat to women with low incomes and educational levels.

The study, published July 26, 2004 in the online edition of CANCER, a peer-reviewed journal of the American Cancer Society, finds incidence and death rates for cervical cancer increased with increasing poverty and decreasing education levels.

While previous studies have linked socioeconomic status (SES) to the prognosis and incidence of cervical cancer, these are generally from narrow time periods and more often than not, fairly recent. Very little data exist to evaluate patterns of cervical cancer and SES across decades, particularly at the national level. The results of this new study may help assess the efficacy of public health control programs, such as cervical cancer screenings, and identify at-risk populations for future intervention.

To investigate changes over time in the relationship between SES and cervical cancer, Dr. Gopal K. Singh and his colleagues from the National Cancer Institute’s Division of Cancer Control and Population Science, analyzed demographic and cancer data from the 1990 U.S. census, the national mortality database, and the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2000.

The authors found that despite overall declining cervical cancer rates, significant incidence and outcome disparities persisted based on SES. For all American women cervical cancer incidence and mortality rates increased as the level of poverty increased and education levels decreased for the total population. Women in high poverty census tracts were 20 percent more likely to be diagnosed with late-stage disease than women in census tracts with low poverty levels. Survival, too, was 31 percent lower in patients with late-stage diseases from census tracts with high poverty levels compared to low poverty census tracts. When analyzed according to race/ethnicity, non-Hispanic white, black, American Indian, Asian/Pacific Islander, and Hispanic women each shared a similar pattern, though to varying degrees.

“This study has shown substantial socioeconomic disparities in cervical cancer, which have persisted over time against a backdrop of declining incidence and mortality rates,” conclude the authors.