Carcinoma of the cervix in Southwestern American Indian women

Regional differences in cervical cancer incidence among American Indians and Alaska Natives, 1999-2004

BACKGROUND

Reports from limited geographic regions indicate higher rates of cervical cancer incidence in American Indian and Alaska Native (AI/AN) women than in women of other races. However, accurate determinations of cervical cancer incidence in AI/AN women have been hampered by racial misclassification in central cancer registries.

METHODS

The authors linked data from cancer registries participating in the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program with Indian Health Service (IHS) enrollment records to improve identification of AI/AN race. NPCR and SEER data were combined to estimate annualized age-adjusted rates (expressed per 100,000 persons) for the diagnosis years 1999 to 2004. Analyses focused on counties known to have less racial misclassification, and results were stratified by IHS Region. Approximately 56% of AI/ANs in the US reside in these counties. The authors examined overall and age-specific incidence rates and stage at diagnosis for AI/AN women compared with non-Hispanic white (NHW) women.

RESULTS

Invasive cervical cancer incidence rates among AI/AN women varied nearly 2-fold across IHS regions, with the highest rates reported in the Southern Plains (14.1) and Northern Plains (12.5); the lowest rates were in the Eastern region and the Pacific Coast. Overall, AI/AN women had higher rates of cervical cancer than NHW women and were more likely to be diagnosed with later stage disease.

CONCLUSIONS

The wide regional variation of invasive cervical cancer incidence indicates an important need for health services research regarding cervical cancer screening and prevention education as well as policy development regarding human papillomavirus vaccine use, particularly in the regions with high incidence rates. Cancer 2008;113(5 suppl):1234-43. Published 2008 by the American Cancer Society.

Decreasing rates of cervical cancer among American Indians and Hispanics in New Mexico (United States)

Minority women in New Mexico (United States)--including American Indian and Hispanic women--have shown disproportionately high incidence rates of invasive cervical cancer during the 1960s and 1970s. Several public health programs in New Mexico were directed toward early detection of cervical cellular abnormalities, particularly targeting the state's minority women. To evaluate the effectiveness of these programs, we examined the New Mexico Surveillance, Epidemiology, and End Results (SEER) data collected from 1969-92, and calculated average annual, age-specific, and age-adjusted incidence rates by ethnic group (American Indian, Hispanic, and non-Hispanic White) for five-year time intervals. We also calculated age-adjusted mortality rates for cervical cancer in the same ethnic groups using state vital records. Age-adjusted incidence rates for invasive cervical cancer show substantial temporal decreases, especially for minority women in the state. The age-adjusted incidence rate decreased by 66 percent, from 30.3 to 10.3 per 100,000 for American Indian women, and by 61 percent, from 26.1 to 10.2 per 100,000 for Hispanic women. A stage shift to earlier stages of cervical neoplasia occurred over the study period, with a substantially higher proportion of in situ compared with invasive cancers diagnosed in the most recent cf the most remote time period. The ratio of incidence rates of in situ to invasive cancers changed dramatically for both American Indian and Hispanic women. Cervical cancer mortality rates decreased steadily among Hispanic women from 1958 to 1992; the decrease among American Indian women was less stable and fluctuated due to small numbers. Ongoing targeted screening programs should help to reduce cervical cancer incidence and mortality further in New Mexico.

Carcinoma of the cervix in Southwestern American indians: results of a cytologic detection program

Age-specific detection rates for newly diagnosed in situ and invasive uterine cervical carcinoma were determined in a nine-year cytologic cancer detection program during which 34,700 Southwestern American Indian women and 46,200 medically indigent non-Indian women were screening for cervical cancer. For patients less than 35 years of age, cervical carcino a was found more frequently among Indians and Spanish-American Caucasians than among other Caucasian women. At ages 60 and older, the Indian cervical cancer rate was much higher than that of non-Indians. The detection rate for invasive cervical carcinoma among Indian patients is inversely related to the proportion screened at 30 years of age or older. Although at least 60% of Indian women 20 years old, and older, in the geographic area served by the detection program were screened for cervical cancer during the nine-year period, only 27% of those 50 years or older were screened. The age-related variation in screening percentage, in conjunction with the disproportionately large numbers of younger low-risk women, serves to explain the finding of significant invasive cervical carcinoma in an extensively screened population.

Cervical carcinoma in Malawi: a histopathologic study of 260 cases

Cervical carcinoma is the commonest malignancy seen in histopathologic material from Malawi. Between 1975 and 1978, 460 cases were diagnosed, of which 431 were invasive squamous carcinomas. These were reviewed for degree of differentiation and placed into three histologic types. Large cell non-keratinizing carcinoma was the commonest type, and presented at an earlier clinical stage than either large cell keratinizing or small cell non-keratinizing tumors. Of all tumors, 2.8% showed a massive eosinophil infiltrate which was not related to schistosome infection. The clinicopathologic features of cervical carcinoma in Malawi appear to be similar to those found in the United States and Europe.