Review
Gynecologic cancer disparities: A report from the Health Disparities Taskforce of the Society of Gynecologic Oncology

https://doi.org/10.1016/j.ygyno.2013.12.039Get rights and content

Highlights

  • Gynecologic cancer disparities persist even with improving treatment and technology.

  • The lack of access to quality care remains a burden for women diagnosed with gynecologic cancers.

  • Ongoing research and policy intervention are required to eliminate health disparities.

Abstract

Objectives

To review the extent of health disparities in gynecologic cancer care and outcomes and to propose recommendations to help counteract the disparities.

Methods

We searched the electronic databases PubMed and the Cochrane Library. We included studies demonstrating quantifiable differences by race and ethnicity in the incidence, treatment, and survival of gynecologic cancers in the United States (US). Most studies relied on retrospective data. We focused on differences between Black and White women, because of the limited number of studies on non-Black women.

Results

White women have a higher incidence of ovarian cancer compared to Black women. However, the all-cause ovarian cancer mortality in Black women is 1.3 times higher than that of White women. Endometrial and cervical cancer mortality in Black women is twice that of White women. The etiology of these disparities is multifaceted. However, much of the evidence suggests that equal care leads to equal outcomes for Black women diagnosed with gynecologic cancers. Underlying molecular factors may play an additional role in aggressive tumor biology and endometrial cancer disparities.

Conclusion

Gynecologic cancer disparities exist between Black and White women. The literature is limited by the lack of large prospective trials and adequate numbers of non-Black racial and ethnic groups. We conclude with recommendations for continued research and a multifaceted approach to eliminate gynecologic cancer disparities.

Introduction

According to the National Cancer Institute, healthcare disparities are defined as differences in the incidence, prevalence, and mortality of a disease and the related adverse health conditions that exist among specific population groups [1]. Ten years since the publication of Unequal Treatment, in which the Institute of Medicine (IOM) documented root causes for health disparities in the United States (US) [2], disparities persist. An example from internal medicine documents the disparate burden of stroke incidence, mortality, prevention, and treatment in Blacks compared to Whites [3]. From the surgical literature, Blacks are more likely to undergo leg amputations and be placed on dialysis, but less likely to undergo renal transplant than Whites [4], [5], [6]. In the field of surgical oncology, Blacks are less likely than Whites to undergo cancer surgery for the treatment of most solid tumors [7]. Finally, Blacks have a higher risk of death from cancer than Whites, despite an overall declining cancer mortality rate in the US [8].

The underlying causes of health disparities are multifactorial and include systemic, provider, and patient factors according to the IOM [2]. Systemic factors include differences in health care delivery, including differences in hospital systems (e.g. large cancer center versus small county hospital). Provider factors involve expectations and beliefs that impact clinical decisions and the persistent lack of ethnic and racial diversity among providers [9]. Patient factors take into account cultural, educational, socioeconomic, and geographic barriers to care. These factors often overlap, but the relative influence of each remains poorly understood in gynecologic cancer disparities.

In this report, we document gynecologic cancer disparities in endometrial cancer, the most common; ovarian cancer, the most lethal; and cervical cancer, the most preventable. We focus our report on disparities in gynecologic cancer care and outcomes between Black and White women, based on available data. We conclude our report with recommendations for a multi-pronged strategy to eliminate disparities in gynecologic cancer care.

Section snippets

Methods

The Health Disparities Taskforce convened in 2010 under the auspices of the Society of Gynecologic Oncology (SGO) to review and provide recommendations for addressing health disparities in gynecologic cancer. We performed a literature search of primary research articles from January 1985 to December 2012, from the PubMed and the Cochrane Library electronic databases. The search criteria included the following MeSH terms: health care disparities AND racial and ethnic health disparities AND

Discussion

The reasons for health disparities in gynecologic cancer care and outcomes are multifactorial and still not completely understood. Since the publication of the IOM ten years ago [2], there appears to be increased awareness and understanding about ethnic and racial health disparities, including gynecologic cancer care and outcomes. However, most published studies have focused on disparities between Black and White women, while studies including non-Black women are sparse. Most studies relied

Conclusion

As molecular genetic information becomes more readily accessible and the cost of new technologies such as whole genome sequencing decreases [77], the prospect of individualized therapy with the promise of improving treatment and outcomes in cancer approaches a reality. At the same time, gaps in cancer disparities persist and are even widening in some instances. As a result of our review, we conclude that the lack of access to quality care remains a major burden for women diagnosed with

Statement from the Society of Gynecologic Oncology

This document was prepared through the auspices of the Society of Gynecologic Oncology. However, the authors are solely responsible for the content.

Conflict of interest statement

Drs. Yvonne Collins and Kevin Holcomb disclose that they have received honoraria for the Merck speaker bureau. Additionally, Dr. Dineo Khabele discloses that she has received a õresearch grant from the Celgene Corporation. Drs. Eloise Chapman-Davis and John H. Farley have no financial relationships and/or conflicts of interest to disclose.

Acknowledgments

We would like to thank Daniele A. Sumner, BA for her assistance in editing this manuscript. However, the authors are solely responsible for the content.

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