Survival disparities in non-Hispanic Black and White cervical cancer patients vary by histology and are largely explained by modifiable factors.

PURPOSE: We investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities. METHODS: Non-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC). RESULTS: This study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35-1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15-1.24 for SCC; HR = 2.32, 95% CI = 2.12-2.54 for AC, interaction p < 0.0001). After balancing the selected demographic, socioeconomic and clinical factors, survival in Black vs. White patients was no longer different in those with SCC (AHR = 1.01, 95% CI 0.97-1.06) or AC (AHR = 1.09, 95% CI = 0.96-1.24). In SCC, the largest contributors to survival disparities were neighborhood income and insurance. In AC, age was the most significant contributor followed by neighborhood income, insurance, and stage. Diagnosis of AC (but not SCC) at ≥65 years old was more common in Black vs. White patients (26% vs. 13%, respectively). CONCLUSIONS: Histology matters in survival disparities and diagnosis at ≥65 years old between Black and White cervical cancer patients. These disparities were largely explained by modifiable factors.

Esophageal cancer in Hispanics: a demographic analysis of the National Cancer Database.

BACKGROUND: Hispanics are the fastest-growing minority and the second largest ethnic group in the United States, accounting for 18% of the national population. The American Cancer Society estimated 18,440 new cases of esophageal cancer (EC) in the United States in 2020. Hispanics are reported to be at high risk of EC. We sought to interrogate the demographic patterns of EC in Hispanics. Secondary objective was to examine evidence of socioeconomic disparities and differential therapy. METHODS: We identified Hispanic vs non-Hispanic patients with EC in the National Cancer Database between 2005 and 2015. Groups were statistically equated through propensity score-matched analysis. RESULTS: A total of 3205 Hispanics (3.8%) were identified among 85,004 patients with EC. We identified significant disparities between Hispanic and non-Hispanic groups. Disparities among Hispanics included higher prevalence of squamous EC, higher likelihood of stage IV cancer diagnosis, younger age, uninsured status, and income< $38,000. Hispanics were less likely to have surgical intervention or any type of treatment when compared to non-Hispanics. Multivariate analysis showed that age, ethnicity, treatment, histology, grade, stage, and Charlson-Deyo scores were independent predictors of survival. Treated Hispanics survived longer than non-Hispanics. CONCLUSION: Despite the lower prevalence of EC, there is a disproportionately higher prevalence of metastatic and untreated cases among Hispanics. This disparity may be explained by Hispanics' limited access to medical care, exacerbated by their socioeconomic and insurance status. Further study is warranted to examine these health disparities among Hispanics.

Carcinoma espinocelular de língua: análise dos dados clínicos, sociodemográficos / Squamous cell carcinoma of oral tongue: analysis of clinical and social demographic features and prognostic factors

No presente estudo foram avaliados 895 casos de carcinoma espinocelular de língua (2/3 anteriores) tratados no Hospital A. C. Camargo no período de 1953 à 1990. Quanto aos dados clínicos, houve um predomínio do sexo masculino, raça branca e idade acima dos 50 anos. Apenas 9,2 por cento dos casos foram diagnosticados no estádio clínico I, sendo que o sexo feminino apresentou uma maior freqüência de disgnósticos neste estádio. O consumo de fumo foi encontrado em 86,0 por cento dos casos e 72,2 por cento dos pacientes consumiam bebidas alcoólicas. O período médio de duraçäo dos sintomas foi de até 6 meses. Apenas 2,2 por cento dos casos foram encaminhados ao Hospital por cirurgiöes-dentistas. A taxa de ocorrência de segunda neoplasia foi de 8,5 por cento. Na análise univariada da sobrevida global, encontrou-se um melhor prognóstico associado aos estádios iniciais, ausência de metástase regional, sexo feminino, näo fumantes ou alcoólatras e submetidos a tratamento cirúrgico. Houve uma melhora progressiva do prognóstico ao longo das décadas estudadas. Na análise multivariada, as variáveis relacionadas ao aumento do risco de óbito foram estadiamento T e N avançados, década de admissäo ao tratamento, consumo de álcool e idade acima de 60 anos. No grupo submetido a tratamento cirúrgico encontrou-se um aumento do risco de óbito no sexo feminino