Abstract
Uterine cervix cancer (UCCx) is clinically and socioeconomically diverse among women in the United States (US), which obscures the discovery of effective radiochemotherapy approaches for this disease. UCCx afflicts 7.5 per 100,000 American women nationally but 11.7 per 100,000 women in Appalachian Kentucky (AppKY), when age-adjusted to the 2000 US standard population. Epidemiological chart review was performed on 212 women with UCCx treated at the University of Kentucky (UKY) between January 2001 and July 2021. Demographics, tumor characteristics, and relative radiochemotherapy dose and schedule intensity were compared among AppKY and non-AppKY cohorts as well as Surveillance, Epidemiology, and End Results (SEER) data. One hundred thirty-eight (65%) of 212 women seeking radiochemotherapy treatment for UCCx resided in AppKY. Most (80%) sought external-beam radiochemotherapy close to their AppKY residence. Brachytherapy was then most frequently (96%) conducted at UKY. Cancer stage at diagnosis was significantly more advanced in AppKY residents. Women residing in AppKY had a median 10-week radiochemotherapy course, longer than an 8-week guideline. Estimated survival in women residing in AppKY was 8% lower than US national averages. In summary, this study identified an increased percentage of advanced-stage UCCx cancer at diagnosis arising in AppKY residents, with a confounding population-specific delay in radiochemotherapy schedule intensity lowering survival.
Highlights
Uterine cervix cancer (UCCx) ranks 20th (0.8%) among all new cancer cases in the United States (US), with 14,480 new cases estimated annually [7.5 per 100,000, age-adjusted to the 2014–2018 US standard population, ref. [1]]
Cohorts consisted of a random sampling of women aged 18 years or older who were diagnosed with International Federation of Gynecology and Obstetrics (FIGO 1988) stages I to IVB UCCx treated by radiotherapy between January 2001 and July 2021 (n = 212 [25%] of 852 registered University of Kentucky (UKY) UCCx patients)
In 82 women with UCCx squamous cell cancers without paraaortic node metastases from Appalachian region of Kentucky (AppKY), 88% of women had tumors estimated at 3 cm or more in diameter, 93% had deep third invasion, 56% had grade 3 histology, and 39% had angiolymphatic invasion
Summary
Uterine cervix cancer (UCCx) ranks 20th (0.8%) among all new cancer cases in the United States (US), with 14,480 new cases estimated annually [7.5 per 100,000, age-adjusted to the 2014–2018 US standard population, ref. [1]]. Uterine cervix cancer (UCCx) ranks 20th (0.8%) among all new cancer cases in the United States (US), with 14,480 new cases estimated annually [7.5 per 100,000, age-adjusted to the 2014–2018 US standard population, ref. The Commonwealth of Kentucky is highest among US states in UCCx incidence [9.6 per 100,000, age-adjusted to the 2000 US standard population, ref. [2]], and the Appalachian region of Kentucky (AppKY) drives this extraordinary health burden [11.7 per 100,000, age-adjusted, ref. Prior studies reported improved survival among women with advanced-stage UCCx who received a dose-schedule intensity of five or more weekly cycles of cisplatin (40 mg m-2) during an 8-week course of radiotherapy [12,13,14].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
