The effect of country of birth on cervical cancer outcomes in Florida (591)

Abstract

<b>Objectives:</b> Racial disparities among women with cervical cancer have been reported but understudied in Caribbean immigrants. The objective of this study was to describe the disparities in clinical presentation and outcomes among Caribbean-born Black (CBB) women with cervical cancer in comparison to US-born Black (USB) and US-born White (USW) women. <b>Methods:</b> A review of the Florida Cancer Data Service (FCDS), the statewide cancer registry, was performed to identify women diagnosed with invasive cervical cancer between 1981-2019. Women were classified as USB, USW, or CBB, and clinical data were abstracted. Analysis was done using Chi-square, Cox proportional hazards models, and the Kaplan-Meier methods, with significance set at p<0.05. <b>Results:</b> Total 57,225 women with cervical cancer were identified during this study period; 20,042 had data on country of birth available. The mean age at diagnosis was higher in CBB women (52.8y) in comparison to USB women (46.8y) and USW women (46.7y) (p<.0001). Fewer CBB women presented with localized disease (34.1%) compared to USB (40.9%) and USW (47.1%) (p<0.0001). When examining country of birth, CBB women had a much higher risk of death compared to USW women (HR: 1.62, 95% CI: 1.50-1.75, p<.0001), while USB had a lower risk of death compared to USW women (HR: 0.86, 95% CI: 0.81-0.91, p<0.001). The overall survival rate was lower in Black CB women (median OS 38.3 months, 95% CI: 30.2-47.7) versus USW (median OS: 190.5 months, 95% CI: 209.5-241.3) and USB (median OS: 223.2 months, 95% CI: 209.5-241.3) (p<0.0001). <b>Conclusions:</b> CBB women with cervical cancer have a more advanced stage and worse OS than women born in the US. The impact of immigrant status and recognizing Black women as polylithic are both crucial to appreciate to improve health outcomes. Providers working with minority populations should ensure that cancer prevention and management strategies focus on culturally and contextually appropriate care. Fig. 1