Age, substance abuse, and survival of patients with cervical carcinoma.

Abstract

The poor survival of young patients with cervical cancer in a low income, disadvantaged community stimulated an investigation of pathologic and behavioral risk factors. The records of 1173 patients with cervical cancer diagnosed in 1967-1988 were evaluated with respect to age, stage, histology, and presenting symptoms. Histopathologic risk factors were evaluated in 196 patients with Stage IB disease treated by initial hysterectomy. Substance abuse behaviors were evaluated for 332 symptomatic patients with Stages IB-III disease diagnosed from 1976 to 1988. There were no significant age-related differences in survival for patients without squamous cell carcinoma or those with Stage IA and asymptomatic Stage IB squamous cell carcinoma. Women age 70 years and older had a poorer survival rate than did younger women with Stages IB-III disease. Symptomatic patients with squamous cell carcinoma younger than age 50 years had a poorer survival than did patients age 50-69 years with Stages IB/IIA, IIB, and III disease. For patients with symptomatic Stage IB tumors, poor prognostic histopathologic factors were distributed equally among women younger than age 50 and those aged 50-69 years. Substance abuse was significantly more prevalent among younger patients, and patients who smoked or abused alcohol or drugs had significantly poorer survival than did nonsubstance abusers. However, in a multivariate analysis of age, stage, and substance abuse, young age remained a significantly poor prognostic factor. Substance abuse may contribute to poor outcome of young patients with symptomatic squamous cell carcinoma but does not explain adequately their poor survival.