Farley John, Risinger John I, Rose G Scott, Maxwell G Larry
Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda Maryland, USA.
Cancer. 2007 Jul 15;110(2):234-43. doi: 10.1002/cncr.22797.
Black women have a lower incidence of gynecologic cancers but they have a higher mortality associated with their disease. The etiology of the racial disparity in outcome among gynecologic cancer patients is multifactoral and site-specific. Black women with endometrial cancer often present with more advanced stage tumors that are associated with a worse prognosis compared with White women. Evidence suggests that observed disparities in outcome are due to inequalities in treatment or differing biologic etiologies. For cervix cancer, studies have suggested that survival among Black women may be lower than survival among White women that develop this disease. This occurs despite evidence that indicates that Pap smears are utilized similarly by Black and White women for cervix cancer screening. These differences in outcome may become less pronounced when comorbidities are accounted for and inequalities in treatment are eliminated. For ovarian cancer patients, survival has improved with the use of contemporary therapies over the past 30 years in Whites but less so for Blacks. This may be due to differences in the likelihood of primary surgical cytoreductions, which are performed less frequently in some Black women because of extensive metastatic spread or comorbidities. The observed decreases in survival for all 3 gynecologic cancers potentially may be affected by socioeconomic status of the patient in some healthcare settings. An improved understanding of the causative factors associated with racial disparities in gynecologic cancer outcome is necessary to facilitate efforts aimed at correcting this important healthcare problem.
黑人女性妇科癌症的发病率较低，但她们因该病导致的死亡率较高。妇科癌症患者种族差异结果的病因是多因素的且具有部位特异性。与白人女性相比，患有子宫内膜癌的黑人女性通常表现为肿瘤分期更晚，预后更差。有证据表明，观察到的结果差异是由于治疗不平等或不同的生物学病因。对于宫颈癌，研究表明黑人女性的生存率可能低于患此病的白人女性。尽管有证据表明黑人和白人女性在宫颈癌筛查中使用巴氏涂片的情况相似，但仍会出现这种情况。当考虑到合并症并消除治疗不平等时，这些结果差异可能会变得不那么明显。对于卵巢癌患者，在过去30年中，白人使用当代疗法后生存率有所提高，但黑人提高得较少。这可能是由于初次手术细胞减灭术的可能性存在差异，由于广泛的转移扩散或合并症，一些黑人女性进行这种手术的频率较低。在某些医疗环境中，所有这三种妇科癌症观察到的生存率下降可能都受到患者社会经济地位的影响。为了推动旨在纠正这一重要医疗问题的努力，有必要更好地了解与妇科癌症结果中的种族差异相关的致病因素。
