Racial disparities and changes in clinical characteristics and survival for vulvar cancer over time.
OBJECTIVE
The purpose of this study was to examine changes over time in survival for African-American (AA) and white women diagnosed with squamous cell carcinoma of the vulva.


STUDY DESIGN
The Surveillance, Epidemiology, and End Results (SEER) Program for 1973-2009 was used for this analysis. We evaluated racial differences in survival between AA and white women. Kaplan-Meier and Cox proportional hazards survival methods were used to assess differences in survival by race by decade of diagnosis.


RESULTS
The study sample included 5867 women, including 5379 whites (91.6%) and 488 AA (8.3%). AA women were younger (57 vs 67 years; P < .001) and had a higher rate of distant metastasis (6.1% vs 3.7%; P < .001). AA women had surgery less frequently (84.2% vs 87.6%; P = .03) and more frequently radiotherapy (24.2% vs 20.6%; P < .001). AA women had a hazard ratio (HR) of 0.84 (95% confidence interval [CI], 0.74-0.95) of all-cause mortality and 0.66 (95% CI, 0.53-0.82) of vulvar cancer mortality compared with whites. Adjusting for SEER Registry, marital status, stage, age, surgery, radiotherapy, grade, lymph node status, and decade, AA women had an HR of 0.67 (95% CI, 0.53-0.84) of vulvar cancer-related mortality compared with whites. After adjusting for the same variables, there was a significant difference in survival between AA and whites in the periods of 1990-1999 (HR, 0.62; 95% CI, 0.41-0.95) and 2000-2009 (HR, 0.46; 95% CI, 0.30-0.72) but not earlier.


CONCLUSION
AA presented at a significantly younger age compared with white women and had better survival compared with whites.
['Rauh-Hain|J Alejandro|JA|', 'Clemmer|Joel|J|', 'Clark|Rachel M|RM|', 'Bradford|Leslie S|LS|', 'Growdon|Whitfield B|WB|', 'Goodman|Annekathryn|A|', 'Boruta|David M|DM|', 'Schorge|John O|JO|', 'del Carmen|Marcela G|MG|']
D001741:African Americans D017677:Age Distribution D000368:Aged D000369:Aged, 80 and over D002294:Carcinoma, Squamous Cell D005260:Female D013509:Gynecologic Surgical Procedures D054624:Health Status Disparities D006801:Humans D053208:Kaplan-Meier Estimate D008875:Middle Aged D009026:Mortality D016016:Proportional Hazards Models D011878:Radiotherapy D018426:SEER Program D014481:United States D014846:Vulvar Neoplasms D044465:Whites
disparities vulvar cancer African-American race