Disparities in Gynecological Malignancies

Abstract

ObjectivesHealth disparities and inequalities in access to care among different socioeconomic, ethnic, and racial groups have been well documented in the U.S. healthcare system. In this review, we aimed to provide an overview of barriers to care contributing to health disparities in gynecological oncology management and to describe site-specific disparities in gynecologic care for endometrial, ovarian, and cervical cancer.MethodsWe performed a literature review of peer-reviewed academic and governmental publications focusing on disparities in gynecological care in the United States by searching PubMed and Google Scholar electronic databases.ResultsThere are multiple important underlying issues that may contribute to the disparities in gynecological oncology management in the United States, namely geographic access and hospital-based discrepancies, research-based discrepancies, influence of socioeconomic and health insurance status, and finally the influence of race and biological factors. Despite the reduction in overall cancer-related deaths since the 1990s, the 5-year survival for Black women is significantly lower than for White women for each gynecologic cancer type and each stage of diagnosis. For ovarian and endometrial cancer, black patients are less likely to receive treatment consistent with evidence-based guidelines and have worse survival outcomes even after accounting for stage and comorbidities. For cervical and endometrial cancer, the mortality rate for black women remains twice that of White women.ConclusionHealth care disparities in the incidence and outcome of gynecologic cancers are complex and involve biologic factors as well as racial, socioeconomic, and geographic barriers that influence treatment and survival. These barriers must be addressed to provide optimal care to women in the U.S. with gynecologic cancer.

Racial/Ethnic Disparities in Cervical Cancer Screening and Outcomes

“…However, African American women are more likely to be diagnosed with advanced disease compared to Caucasians [19,20,21,22]. A Texas study observed that 20% of Hispanic women presenting with stage IV disease had never had a Pap smear, compared to 3% of women presenting at a similar disease stage [20,22,23].…”

“…In the most recent analysis of cervical cancer screening uptake by the Centers for Disease Control, 81% of women in the USA had undergone cytological screening within the last 3 years, and this rate was slightly higher in African American women, while rates were significantly lower among Asian and Hispanic women [19,20]. However, African American women are more likely to be diagnosed with advanced disease compared to Caucasians [19,20,21,22].…”

“…Many women diagnosed with ICC in this age group have either never been screened or have not been screened in the 3 years prior to diagnosis [32]. This is especially true for elderly black women [20,21,22,25]. The clinical significance of screening women for cervical cancer over the age of 65 years remains controversial [33].…”

“…However, African American women are more likely to be diagnosed with advanced disease compared to Caucasians [19,20,21,22]. A Texas study observed that 20% of Hispanic women presenting with stage IV disease had never had a Pap smear, compared to 3% of women presenting at a similar disease stage [20,22,23]. Data extracted from the Surveillance Epidemiology and End Results (SEER) database (1973-2009) showed that stages II to IV disease were higher among white Hispanic than white non-Hispanic women, and there was a higher incidence of cervical cancer in white Hispanic women [24,25].…”

Rural–urban differences in surgical treatment, regional lymph node examination, and survival in endometrial cancer patients

“…Numerous studies have explored racial/ethnic treatment and survival disparities in endometrial cancer [20–24]. Black women are less likely to receive appropriate staging and guideline-concordant treatment and have poorer survival than their white peers [20–24]. However, there is a paucity of research evaluating disparities between rural and urban populations.…”