This study was conducted to assess the racial differences in the 5-year Relative Survival Rates (RSRs) of CerCancer by stage at diagnosis between Black and White women, living in the urban, BB and other rural counties of Alabama. The study results indicate that there are significant racial differences in the RSRs. However, examination of the characteristics (age at diagnosis, stages of the CerCancer, and geographical locations) between Blacks and Whites showed that these two groups of women were dissimilar in these characteristics. Comparing ostensibly dissimilar groups remains a challenging aspect of epidemiological studies.
In a previous study, the RSR for all women with CerCancer was 66%. However, survival rates can vary by factors such as race, ethnicity and age. The RSRs for White women was 69% and for Black women was 56%. For White women under 50 years, the RSR was 78%. For Black women 50 years and older, their RSR was 47% [36]. The RSRs also depend on the diagnosed stage of CerCancer. When detected at an early stage, the RSR for women with invasive CerCancer was 92%. About 44% of women with CerCancer was diagnosed at an early stage. If CerCancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the RSR was 56%. If the cancer has spread to a distant part of the body, the RSR was 17% [36].
Our analysis showed that there were racial differences in the 5-year relative survival rate (RSRs) of CerCancer. Overall, Black women experienced the worst RSRs compared to their White counterparts. This study found that Whites diagnosed with localized stages of CerCancer and living in all the three county groups always had better chances of survival. This was because their RSRs were always more than 77%, compared to their Black counterparts. The only exception was in Blacks living in the other rural counties, who had significantly highest RSR of 83.8%, which was the same as in Whites living in the BBC. Although, Whites living in the other rural counties had a slightly lower RSR of 83.7%, compared to both Blacks and Whites with a slightly higher RSR of 83.8%, their RSR was better. This was because of the precision of the statistics, which depended on their larger sample size and a lower variability therefore, more reliability resulting in a tighter confidence interval with a smaller margin of error.
This study also highlights the comparisons of the RSRs for both Blacks and Whites by CerCancer stages (localized, regional, distant and unknown), age groups (15–44, 45–54, 55–64, 65–74, and 75 years and older) and living in the urban, BB and other rural counties of Alabama. In all the three groups of counties, the study results indicate that Whites 15–44 years old diagnosed with localized stage of CerCancer had a higher RSR of 93.6% for those living in both the urban and BB counties, and the RSR of 94.6% for those living in the other rural counties. The only exception was in Blacks 65–74 years old and living in the other rural counties who had the highest RSR of 96.9%. However, Whites were considered to have a better RSR. As previously stated, this was because of the precision of the statistics, which depended on their larger sample size and a lower variability therefore, more reliability resulting in a tighter confidence interval with a smaller margin of error.
Age is known to be an important prognostic factor for developing CerCancer. It has been found that the RSR is highly dependent on the age at diagnosis, which was in agreement with the findings from the European Alcohol Policy Alliance (EUROCARE) Study conducted in the European countries [37] as well as the results reported by Adami et al. [38]. Additionally, in this study we compared the RSRs not only by race but also by age groups, stages of CerCancer and geographical locations. Similarly, our results are in agreement with the findings from the above previous studies [37, 38] regarding the age. This was observed to be mostly true in Whites, especially those living in other rural counties, diagnosed with localized, regional, distant and unknown stages, their RSRs for CerCancer gradually declined with increasing age. Overall, in this study, both Blacks and Whites diagnosed with CerCancer in all its stages living in the urban, BB and other rural counties, it was observed that as the age increased the chances of surviving CerCancer 5 years after diagnosis decreased. This was irrespective of the race, stages of CerCancer and geographical locations with few exceptional cases.
The results of this study are in agreement with what Hicks et al. reported in their findings there was clearly, a notable disparity in CerCancer survival between various minority populations and Whites [7]. In our recent study [7], the results were similar to those of Hicks et al., whereby it was found that, identifiable factors that affect survival disparity were inadequate screening and/or treatments, inappropriate treatments or comorbid illnesses [7]. In addition, according to the National Health Survey, similar CerCancer screening rates were reported among Black and White Americans [39]. Significantly, in contrast, our recent study findings [40] regarding CerCancer screening, showed high rates of CerCancer mortality, which was more than triple in Black Alabamians (between 2002 and 2012), despite their high screening rates (between 2000 and 2010), compared to their White counterparts. This study shows conclusively that in Alabama, a disparity still exists for the high CerCancer mortality in Blacks, despite the higher rates of screening as would otherwise be expected [40]. In spite of all this, Blacks were still more likely to be diagnosed with advanced stages of CerCancer, and their chances of surviving 5 years after diagnosis was lower compared to their White counterparts. The racial differences in CerCancer stage at diagnosis may be due to differences in the quality of screening and follow-up after abnormal Pap test results [39]. Access to quality health care was often compromised among underserved minorities, particularly Blacks, the uninsured and older women [7, 41].
In this study, we had some limitations in our analysis. Although various prognostic factors were available for many States in the SEER database and in other tumor registry databases, Alabama factors were not fully accessible in the databases. This is why these factors were not taken into consideration in the analysis. These factors included information on life-style or other individual factors such as screening access, socioeconomic status (SES) and comorbidities. Despite these limitations, the differences in CerCancer survival clearly highlight the importance of affordability and accessibility to and use of diagnostic and treatment facilities for minority populations. Differences in CerCancer survival and making adequate facilities affordable and accessible should be given priority. To reduce and/or eliminate the racial differences in CerCancer stages at diagnosis. Emphasis should also be given to promoting early diagnosis through quality screening, follow-up after abnormal Pap test results and access to quality health care, particularly in Blacks, the uninsured and older women living in Alabama, especially in the BBC.