Abstract B75: Association of insurance status and age with stage at diagnosis among cervical cancer patients, National Cancer Database 2000–2007

Abstract

Abstract Introduction: Late stage cervical cancer at diagnosis is associated with greater morbidity and mortality and higher treatment costs. Few studies have examined the association between insurance status and cervical cancer stage at diagnosis. Existing studies have been either state-specific or limited to elderly Medicare recipients. This study aims to examine the relationship between patient characteristics, with a particular focus on age at diagnosis and insurance status, and stage in a large number of cervical cancer patients aged 21–85 in the National Cancer Database (NCDB). Methods: Women diagnosed with their first primary invasive cervical cancer between 2000 and 2007 were selected from the NCDB. We evaluated the association between late stage (stage III/IV) and insurance and age while adjusting for race/ethnicity and other socio-demographic and clinical factors. Multivariate log binomial models were used to estimate risk ratios (RR) and 95% confidence intervals (CIs), respectively. Results: Among the 69,739 evaluable patients, the rate of late stage disease increased from 16.53% in 21–34 year olds to 42.44% in women ≥70. The adjusted risk of advanced stage of disease among women 50 years and older was 2.2 to 2.5 times that of patients aged 21–34. Uninsured (RR=1.44, 95% CI 1.40–1.49), Medicaid (RR=1.37, 95% CI 1.34–1.41), Younger Medicare (RR=1.12, 95% CI 1.06–1.19), and Older Medicare (RR=1.20, 95% CI 1.15–1.26) patients had a higher risk of late stage disease compared to privately insured patients. African Americans (RR=1.05, 95%CI 1.02–1.08) had slightly higher risks of advanced stage disease while Hispanics (RR=0.86, 95%CI 0.83–0.89) and other race/ethnicities (RR=0.88, 95%CI 0.84–0.92) had a lower risks compared to whites. Conclusion: In a large national sample of women diagnosed with cervical cancer, the strongest predictor of late stage at diagnosis was age. Patients without private insurance were also more likely to be diagnosed at later stages, particularly uninsured and Medicaid insured patients. Screening should be encouraged for those women for whom it is recommended, especially those at higher risk of advanced stage disease. Consideration of these findings in developing future guidelines for cervical cancer screening among older women is recommended. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B75.