Abstract A75: Nativity disparities in late-stage diagnosis and cause-specific survival among Hispanic women with invasive cervical cancer: An analysis of Surveillance, Epidemiology, and End Results data.
Authors: Montealegre Jane R. , Zhou Renke , Amirian E. Susan , Follen Michele , Scheurer Michael E. 
Published: August 2014

Abstract
Introduction: While cervical cancer screening and risk behaviors have been found to vary among U.S.- and foreign-born Hispanic women, many cancer epidemiology studies conceptualize Hispanics as a homogenous group. Here we examine differences in cervical cancer stage at diagnosis and survival among Hispanic women by nativity.
Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER) program. Cases were Hispanic women diagnosed with primary invasive cervical cancer between 1988 and 2008. Nativity was based on place of birth and was categorized as U.S.- versus foreign-born. Missing nativity values were imputed using a multiple imputation by logistic regression strategy that has high sensitivity (0.95) and specificity (0.90) for detecting foreign-born status. Distant and regional tumors were classified as late-stage, while local tumors were classified as early-stage. Multivariable logistic regression was used to assess the association between late-stage diagnosis and nativity. Multivariable Cox regression was used to assess the association between cause-specific survival and nativity.
Results: Forty seven percent of cases of invasive cervical cancer among Hispanics were diagnosed at a late stage and over half of invasive cervical cancer cases were among foreign-born women. Foreign-born Hispanic women were significantly more likely than U.S.-born Hispanics to have late-stage diagnosis, after adjusting for age at diagnosis and tumor histology (adjusted odds ratio= 1.09, p-value = 0.003). There was heterogeneity in the association between nativity and survival by stage at diagnosis. Among cases with early-stage diagnosis, survival was poorer among foreign-born versus U.S.-born Hispanics after adjusting for age at diagnosis, histology, and cancer-directed therapy (adjusted HR = 1.31, p-value = 0.030). However, among cases with late-stage diagnosis, survival was poorer among U.S.-born Hispanics (adjusted HR = 0.81, p-value &lt; 0.001).
Conclusions: The increased prevalence of late-stage diagnosis among foreign-born Hispanic women is likely a reflection of the lower screening rates in this population relative to those born in the U.S. While we expected the increased prevalence of late-stage diagnosis to result in decreased survival among foreign-born cases, we found significant heterogeneity in the association between nativity and survival by stage at diagnosis. Specifically, when cervical cancer is diagnosed at a late stage, foreign-born Hispanic women have improved survival over U.S.-born women. However, for early-stage diagnoses, our results suggest decreased survival among foreign-born versus U.S.-born Hispanics. We hypothesize that nativity differences in survival may be indicative of diverse risk, screening, and treatment profiles. Given such differences, it may be inappropriate to aggregate Hispanics as a single group for cervical cancer research.
Citation Format: Jane R. Montealegre, Renke Zhou, E. Susan Amirian, Michele Follen, Michael E. Scheurer. Nativity disparities in late-stage diagnosis and cause-specific survival among Hispanic women with invasive cervical cancer: An analysis of Surveillance, Epidemiology, and End Results data. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A75.