The authors analyzed data for 8,119 patients with invasive cervical cancer from eleven population-based tumor registries in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (1992-96).

“Approximately 8.03% of Whites and 11.64% of Blacks did not receive surgery or radiation therapy (no therapy). The percentage of cases receiving no therapy was greatest for unstaged cases, and with cases with unknown grade or unknown lymph node status…. Black cases were more likely to be unstaged and unstaged cases are more likely to not receive therapy. Blacks were more likely than Whites not to receive surgery because it was not recommended, contraindicated due to other conditions, or refused.”

“The burden of cervical cancer in terms of the number of cases and deaths is greater for Blacks than Whites. Studies demonstrate a poorer survival rate among Black cases compared to White cases by stage and histology. A possible reason underlying the poorer prognosis among Black women is that they are less likely to receive cancer-directed surgery or radiation.”

“The percentages of White and Black women diagnosed with unstaged disease with no therapy were 39.61% (221 of 558) and 50% (68 of 136), respectively. The number of unstaged cases was significantly higher for Blacks than for Whites (P=.027). Hence, Blacks were more likely to be unstaged and unstaged cases were more likely not to have therapy.”

“For Whites, the most common reason for no surgery in the local and unstaged categories was ‘unknown’: 63.2% for local stage and 57.47% for unstaged. The corresponding percentages for Blacks are 20.83% and 30.88%. For Blacks, the most common reason for no surgery in the local and unstaged categories was ‘not recommended’: 58.3% for local stage and 50% for unstaged. For both White and Black cases diagnosed with regional or distant disease, the most common reason for no surgery is that it was ‘not recommended’: 46.46% for Whites and 55.56% for Blacks with regional disease and 76.99% for Whites and 58.82% for Blacks with distant disease.
The higher levels of unstaged disease in Blacks compared to Whites was observed for each response for not receiving surgery.”

“This study indicates factors that influence whether women with cervical cancer receive surgery or radiation…The high proportion of Black women with unstaged disease in our study would seem to be consistent with findings from previous studies that indicate a tendency among Black women not to have a follow-up exam after an abnormal Pap smear. In other words, the higher proportion of unstaged cases may be due to lack of stage assignment through lack of follow up. Furthermore, lower levels of follow up were consistent with lower levels of treatment.
On the basis of data used in this study, five-year observed survival was significantly lower for Blacks than for Whites diagnosed with local or regional cervical cancer. This disparity may be partly due to less accurate staging among Black women.”