Abstract C023: Cervical cancer survival analysis based on screening practices and the socioeconomic position index in Puerto Rico
Authors: Gómez-Vargas Vanessa , Almodóvar-Rivera Israel , Ortiz-Ortiz Karen J , Torres-Cintrón Carlos R , Ortiz-Martínez Ana P 
Published: September 2020

Abstract
Background: Cervical cancer ranks as the 7th most diagnosed cancer among women in Puerto Rico (PR). When compared to all the states and territories of the United States of America (USA), PR has the highest rate of cervical cancer. Cervical cancer is preventable through screening. While the Healthy People’s 2020 goal is a screening rate of 93%, PR falls short at 77%. There is extensive research on how women with screen-detected cancers have better survival than those whose cancer is detected symptomatically. Cancer stage is the primary prognostic factor affecting survival. Yet, stage at diagnosis is a complex interaction among many factors, including social and economic inequities. Evaluating how socioeconomic status and screening behavior affect survival will provide insight into how disparities affect health outcomes. Objective: The purpose of this study is to evaluate the effect of screening behavior and socioeconomic position on the survivorship of cervical cancer patients diagnosed in PR during the period of 2011-2014. Methods: The Puerto Rico Central Cancer Registry (PRCCR) was used to identify all incident cases of primary cervical cancer in women 21 years of age or older, determine the occurrence of the event of interest, and obtain study variables. The database acquired through the PRCCR was linked with health insurance data claims. Through this linkage, cervical cancer screening behavior was documented for at least 3 years before patients’ diagnosis. From 937 patients with primary cervical cancer diagnosed during this period, 44% (n=408) were included for this analysis as they had complete information on insurance coverage during the past 3 years (continuous enrollment) and had a microscopically confirmed diagnosis. These patients were followed up to 2017 in order to measure 3-year survival. The Kaplan-Meier Method was used to describe 3-year survival. Also, the Cox Model was used to estimate the risk of death from cervical cancer depending on screening behavior, while controlling for potential confounders. Results: Over half of the patients (52.7%) were insured by Medicaid, 41.2% resided in the area of lowest socioeconomic position (SEP), and only 72.1% were screened 3 years before their diagnosis. Although there weren’t any observable differences in survival curves by SEP, 3-year survival was 77% (95% CI 71.3-81.0) among screened patients and 60% (95% CI 50.1-84.6) among unscreened patients. The overall 25th percentile survival time was about 31 months. The 25th percentile survival time was higher for screened patients (42 months) when compared to unscreened patients (14 months). After controlling for age, stage, histology, and tumor stage, screened patients had lower risk of death when compared to unscreened patients (HR= 0.53, 95% CI 0.4-0.8). Conclusions: Screening behavior is an important predictor in cervical cancer survival. Study findings highlight the relevance to continue increasing compliance with screening guidelines in PR in order to positively impact patient survival.
Citation Format: Vanessa Gómez-Vargas, Israel Almodóvar-Rivera, Karen J Ortiz-Ortiz, Carlos R Torres-Cintrón, Ana P Ortiz-Martínez. Cervical cancer survival analysis based on screening practices and the socioeconomic position index in Puerto Rico [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C023.