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Progress in Chronic Disease Prevention Black-White Differences in Cervical Cancer Mortality -- United States, 1980-1987

Although a higher proportion of black women than white women of all ages report having been screened for cervical cancer (CDC, unpublished data), cervical cancer mortality rates for black women are twice those for white women (rate ratio 2.6 in 1987). This report summarizes differences in cervical cancer deaths for black women and white women greater than or equal to 15 years of age for 1980-1987.

Cervical cancer (International Classification of Diseases, Ninth Revision, Clinical Modification, rubric 180) deaths were identified by using total mentions from the multiple cause-of-death file* compiled by CDC's National Center for Health Statistics (NCHS). Denominators for rate calculations were determined from intercensal population estimates (2,3). Mortality rates were standardized to the 1980 age distribution of the U.S. population.

From 1980 through 1987, cervical cancer mortality rates for black women were consistently more than twice those for white women (Figure 1). Although the rates for both races declined during that period (for black women, from 10.1 to 7.6 per 100,000; for white women, from 3.6 to 2.9 per 100,000), the black-white rate ratio remained stable (2.8 in 1980 compared with 2.6 in 1987).

For the 8-year period, cervical cancer mortality rates increased with age for both races. The black-white rate ratio for cervical cancer mortality varied by age (Figure 2): the ratio was 1.6 for ages 15-24 years, 1.9 for ages 25-34 years, 2.5 for ages 35-44 years, 3.0 for ages 45-54 years, 2.7 for ages 55-64 years, and 2.6 for ages greater than or equal to 65 years.

Cervical cancer mortality rates varied by race and state. For black women, rates ranged from 5.7 per 100,000 in Washington to 11.5 per 100,000 in Delaware and Nevada (Table 1). For white women, rates ranged from 1.8 per 100,000 in Utah to 5.2 per 100,000 in West Virginia. Reported by: Office of Surveillance and Analysis and Cancer Prevention and Control Br, Div of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Virtually all cervical cancer deaths are preventable by early detection and appropriate therapeutic intervention and follow-up (4). The widespread implementation of preventive services for the early detection of this disease has been associated with substantial reductions in morbidity and mortality; from 1947 through 1984, cervical cancer mortality declined approximately 70%, primarily because of extensive use of the Papanicolaou (Pap) smear test (5). From 1980 through 1987, the number of women for whom cervical cancer was the underlying or contributing cause of death declined by 11% (from 5537 deaths to 4951 deaths). This report underscores the substantial and persistent difference between invasive cervical cancer rates for black women and white women. Lower socioeconomic status, higher cervical cancer incidence rates (6), and poorer survival from cervical cancer (6) among black women may partially explain the excess in cervical cancer mortality among black women. Less frequent Pap smears for black women before the 1980s (7) may have contributed to the excess in cervical cancer mortality among older black women. For younger black women who were screened more frequently than their white counterparts, disparities in follow-up and treatment may have contributed to excess cervical cancer mortality.

The draft publication Promoting Health/Preventing Disease: Year 2000 Objectives for the Nation includes a goal to reduce cervical cancer mortality from 3.2 per 100,000** women in 1986 to 1.5 per 100,000 in the year 2000 (8). Approaches that may contribute to achieving this reduction include: 1) ensuring that quality screening and follow-up are available to all women, regardless of ability to pay; 2) educating health professionals about the importance of regular screening; 3) educating women about the importance of regular screening; 4) examining the occurrence of and circumstances leading to invasive disease and death; and 5) promoting quality assurance in cervical cytology to improve the accuracy of the Pap smear screening test.

Public health professionals, clinicians, and other health-care providers can reduce cervical cancer mortality through the use of the Pap smear test combined with appropriate follow-up and treatment. Cervical cancer intervention efforts that encompass the above components, with particular focus on black women, could reduce cervical cancer mortality for all races and the black-white difference in cervical cancer mortality.

References

  1. NCHS. Public use data tape documentation: multiple cause of death for ICD-9 1985 data. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1987.

  2. Bureau of the Census. 1970-1980 intercensal population estimates by race, sex, and age (machine-readable data files). Washington, DC: US Department of Commerce, Bureau of the Census, nd.

  3. Irwin R. 1980-1988 Intercensal population estimates by race, sex, and age (machine-readable data file). Alexandria, Virginia: Demo-Detail, 1988.

  4. CDC. Cervical cancer control--Rhode Island. MMWR 1989;38:659-62.

  5. Devesa SS, Silverman DT, Young JL, et al. Cancer incidence and mortality trends among whites in the United States, 1947-84. J Natl Cancer Inst 1987;79:701.

  6. National Cancer Institute. Cancer statistics review, 1973-1986. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1989; NIH publication no. (PHS)89-2789.

  7. Moss AJ, Wilder MH, NCHS. Use of selected medical procedures associated with preventive care, United States: 1973. Rockville, Maryland: US Department of Health, Education, and Welfare, Public Health Service, 1977; DHEW publication no. (HRA)77-1538. (Vital and health statistics; series 10, no. 110).

  8. Public Health Service. Promoting health/preventing disease: year 2000 objectives for the nation (Draft). Washington, DC: US Department of Health and Human Services, Public Health Service, 1989. *A public-use tape file that contains a data record for all deaths processed by NCHS. Each data record includes multiple cause, underlying cause, and demographic data for a death (1). **Age adjusted to the 1970 U.S. population.



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