Racial disparities in the treatment of advanced epithelial ovarian cancer.

OBJECTIVE: To examine whether treatment with guideline-recommended care (surgery and chemotherapy) is associated with mortality differences between black and white women with advanced epithelial ovarian cancer. METHODS: We conducted an observational cohort study using the Surveillance, Epidemiology, and End Results (SEER) linked to Medicare claims for 1995-2007. We evaluated long-term survival for 4,695 black and white women with stage III or stage IV epithelial ovarian cancer with Kaplan-Meier analysis and Cox regression, and then in patients matched by propensity score to create two similar cohorts for comparison. We investigated the association between race, stage, and survival among women who were treated with guideline-recommended care and those who received incomplete treatment. RESULTS: Black women with advanced epithelial ovarian cancer were more likely to die than white women (unadjusted hazard ratio [HR] 1.27; 95% confidence interval [CI] 1.10-1.46). Black women were less likely than white women to receive guideline-recommended care (54% compared with 68%; P<.001), and women who did not receive recommended treatment had lower survival rates than women who received recommended care. Cox proportional hazards models demonstrated no differences in black women compared with white women regarding mortality among women who were treated with guideline-recommended care (adjusted HR 1.04; 95% CI 0.85-1.26), or among women who received incomplete treatment (adjusted HR 1.09; 95% CI 0.89-1.34). The survival analysis of patients matched by propensity score confirmed these analyses. CONCLUSIONS: Differences in rates of treatment with guideline-recommended care are associated with black-white mortality disparities among women with advanced epithelial ovarian cancer. LEVEL OF EVIDENCE: III.

PET/CT evaluation of cervical cancer: spectrum of disease.

The prognosis of invasive cervical cancer is based on the stage, size, and histologic grade of the primary tumor and the status of the lymph nodes. Assessment of disease stage is essential in determining proper management in individual cases. In the posttherapy setting, the timely detection of recurrence is essential for guiding management and may lead to increased survival. However, the official clinical staging system of the International Federation of Gynecology and Obstetrics has inherent flaws that may lead to inaccurate staging and improper management. Combined positron emission tomography (PET)/computed tomography (CT) represents a major technologic advance, consisting of two integrated complementary modalities whose combined strength tends to overcome their respective weaknesses. PET/CT has higher sensitivity and specificity than do conventional anatomic modalities and is valuable in determining the extent of disease and detecting recurrent or residual tumor. The combination of 2-[fluorine-18]fluoro-2-deoxy-d-glucose PET with intravenous contrast material-enhanced high-resolution CT has proved useful for avoiding the interpretative weaknesses associated with either modality alone and in increasing the accuracy of staging or restaging. Nonetheless, accurate PET/CT interpretation requires a knowledge of the characteristics of disease spread or recurrence and an awareness of various imaging pitfalls if false interpretations are to be avoided.