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Geographic Variation in Late-Stage Cervical Cancer Diagnosis.
Sokale, Itunu O; Thrift, Aaron P; Montealegre, Jane; Adekanmbi, Victor; Chido-Amajuoyi, Onyema G; Amuta, Ann; Reitzel, Lorraine R; Oluyomi, Abiodun O.
Afiliação
  • Sokale IO; Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas.
  • Thrift AP; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.
  • Montealegre J; Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas.
  • Adekanmbi V; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.
  • Chido-Amajuoyi OG; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston.
  • Amuta A; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston.
  • Reitzel LR; Department of Internal Medicine, Texas A&M School of Medicine/Christus Health, Longview.
  • Oluyomi AO; School of Health Promotion and Kinesiology, Texas Woman's University, Denton.
JAMA Netw Open ; 6(11): e2343152, 2023 Nov 01.
Article em En | MEDLINE | ID: mdl-37955896
Importance: There are stark disparities in cervical cancer burden in the United States, notably by race and ethnicity and geography. Late-stage diagnosis is an indicator of inadequate access to and utilization of screening. Objective: To identify geospatial clusters of late-stage cervical cancer at time of diagnosis in Texas. Design, Setting, and Participants: This population-based cross-sectional study used incident cervical cancer data from the Texas Cancer Registry from 2014 to 2018 of female patients aged 18 years or older. Late-stage cervical cancer cases were geocoded at the census tract level (n = 5265) using their residential coordinates (latitude and longitude) at the time of diagnosis. Statistical analysis was performed from April to September 2023. Exposures: Census tract of residence at diagnosis. Main Outcome and Measures: Late-stage cervical cancer diagnosis (ie, cases classified by the National Cancer Institute Surveillance, Epidemiology and End Results summary stages 2 to 4 [regional spread] or 7 [distant metastasis]). A Poisson probability-based model of the SaTScan purely spatial scan statistics was applied at the census tract-level to identify geographic clusters of higher (hot spots) or lower (cold spots) proportions than expected of late-stage cervical cancer diagnosis and adjusted for age. Results: Among a total of 6484 female patients with incident cervical cancer cases (mean [SD] age, 48.7 [14.7] years), 2300 (35.5%) were Hispanic, 798 (12.3%) were non-Hispanic Black, 3090 (47.6%) were non-Hispanic White, and 296 (4.6%) were other race or ethnicity. Of the 6484 patients, 2892 with late-stage diagnosis (mean [SD] age, 51.8 [14.4] years were analyzed. Among patients with late-stage diagnosis, 1069 (37.0%) were Hispanic, 417 (14.4%) were non-Hispanic Black, 1307 (45.2%) were non-Hispanic White, and 99 (3.4%) were other race or ethnicity. SaTScan spatial analysis identified 7 statistically significant clusters of late-stage cervical cancer diagnosis in Texas, of which 4 were hot spots and 3 were cold spots. Hot spots included 1128 census tracts, predominantly in the South Texas Plains, Gulf Coast, and Prairies and Lakes (North Texas) regions. Of the 2892 patients with late-stage cervical cancer, 880 (30.4%) were observed within hot spots. Census tract-level comparison of characteristics of clusters suggested that hot spots differed significantly from cold spots and the rest of Texas by proportions of racial and ethnic groups, non-US born persons, and socioeconomic status. Conclusions and Relevance: In this cross-sectional study examining geospatial clusters of late-stage cervical cancer diagnosis, place-based disparities were found in late-stage cervical cancer diagnosis in Texas. These findings suggest that these communities may benefit from aggressive cervical cancer interventions.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias do Colo do Útero Limite: Adult / Female / Humans / Middle aged País/Região como assunto: America do norte Idioma: En Revista: JAMA Netw Open Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias do Colo do Útero Limite: Adult / Female / Humans / Middle aged País/Região como assunto: America do norte Idioma: En Revista: JAMA Netw Open Ano de publicação: 2023 Tipo de documento: Article