Hysterectomy-corrected Cervical Cancer Incidence Reveal Larger Racial Disparities in Texas 2012-2014

Abstract

The purpose of this study was to determine the race specific age-standardized and age-specific annual Texas cervical cancer incidence after correcting for hysterectomy prevalence. A registry-based cross-sectional study design using Texas State level data for the years 2012-2014 was used to evaluate cervical cancer incidence after applying a correction for hysterectomy and examined racial disparities by age and race.  We merged into a single database annual age- and race-stratified hysterectomy prevalence, cervical cancer incident case counts, population at-risk denominators and US Census 2000 population weights using the Behavioral Risk Factor Surveillance System (BRFSS) and Texas Cancer Registry (TCR), and used these data to estimate hysterectomy-corrected, age-standardized and age-specific cervical cancer incidence. Significant differences in hysterectomy prevalence by race were seen. For women aged 35-44 years, hysterectomy rates were highest in non-Hispanic whites. Among non-Hispanic blacks and Hispanics, the prevalence of hysterectomy peaked between the ages of 55 and 64 years, but thereafter continued to increase dramatically with age but only in non-Hispanic whites. The largest adjustment between corrected and uncorrected cervical cancer rates (17.1%) was in non-Hispanic white women followed by Hispanics (4.1%) and non-Hispanic blacks (3.6%). Failing to correct reported cervical cancer rates underestimates the true burden of disease. Hysterectomy prevalence in Texas also suggest disparities in access to care based on race. These findings provide further evidence-based information to develop more effective region and ethnic specific cervical cancer prevention programs using unbiased estimates of disease burden.