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