Abstract PO-086: Disproportionate burden of cervical cancer survival by race and rurality in South Carolina, 2001 - 2016
Authors: Ranganathan Radhika , Zahnd Whitney , Adams Swann Arp 
Published: December 2020

Abstract
Introduction: In 2020, an estimated 4,290 deaths in the United States (U.S.) will be attributed to cervical cancer, the most frequently detected in women of ages between 35 to 44 years of age. For the years 2011 to 2015, South Carolina (SC) ranked 19th in the U.S. for cervical cancer incidence and 14th for mortality. South Carolina has a higher proportion of both rural and Black residents compared to the U.S. population. Drastic differences in cervical cancer incidence by race exist with Black women having an approximately 18% higher incidence rate (8.9 per 100,000 women) compared to white women (7.5 per 100,000 women).The purpose of this study is to identify and compare cervical cancer survival by race and rural-urban status in South Carolina. Methods: We analyzed data from South Carolina Central Cancer Registry (SCCCR), available at the SC Department of Health & Environmental Control (DHEC). Our cohort included 3,016 women diagnosed with cervical cancer between 2001 to 2016. Rural Urban Commuting Area codes were used to classify rural residence based on place of residence at the time of diagnosis. Descriptive statistics were calculated and compared by rurality using a chi-square test. We constructed Kaplan-Meier curves and calculated 3, 5, and 10-year survival rates. Adjusting for rurality, race, age, SEER staging, type of insurance & census tract poverty estimates, multivariable Cox regression models were used to estimate the hazard ratio (HR). All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). Results: The 10-year overall survival proportion was 51% for rural residents [vs 58% urban, P&lt;.05]. Significant rural & racial differences were observed in overall 10-year survival proportion [urban white 63% vs 46% in urban Black & 55% in rural white vs 44% for rural Black, P&lt;.001]. Similarly, rural residents who live in 0% - 5% census tract poverty levels had much lower overall 10-year survival of &lt;40% [vs urban 72%, P&lt;.001]. In Cox multivariable model stratified by SEER staging of the disease, even after accounting for rurality and other factors, the risk of death was higher among Black women with regional stage as compared to white women for disease-free survival (HR,1.42; 95% CI, 1.16 – 1.74) and overall survival (HR, 1.40; 95% CI, 1.16 – 1.68). Women aged 66 or higher, with a localized cancer had significantly greater risk of death as compared to 30-49 year olds for both disease free survival (HR, 8.22; 95% CI, 5.22 – 12.94) and overall survival (HR, 8.92; 95% CI, 6.29 – 12.66). Conclusions: Significant racial & geographic disparities exist in cervical cancer survival for South Carolina residents with the poorest survival rate experienced by rural Black women. Assessing the geographic variations in survival among patients diagnosed with cervical cancer can inform opportunities to improve screening rates and treatment to improve mortality especially in high risk populations.
Citation Format: Radhika Ranganathan, Whitney Zahnd, Swann Arp Adams. Disproportionate burden of cervical cancer survival by race and rurality in South Carolina, 2001 - 2016 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-086.