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Geographic Variations in Advanced Stage Cervical Cancers in California, 2009-2013

In 2013, 1,401 Californians were diagnosed with invasive cancers of the cervix, and 492 deaths due to the disease occurred. With regular cervical cancer screening in the form of Pap tests, early detection and prevention of cervical cancer is possible. If caught in the early stages, the survival rate of localized cervical cancer (when the cancer is confined to the cervix) is 92.5 percent. Unfortunately, in 2013, 55.5 percent of all invasive cervical cancers diagnosed in California were diagnosed at an advanced stage; after the disease spread beyond the cervix to other parts of the body. In 2013, only 79 percent of women ages 21 and older reported having a pap test within the past three years.1 Greater awareness of cervical cancer screening and accessibility to primary health care is needed to improve the early detection of cervical cancers.

Methods

Case Selection

  • The number of cervical cancers occurring in California was based on new cases of invasive cervical cancers diagnosed among California women aged 20 years and older between January 1, 2009 and December 31, 2013 and reported to the California Cancer Registry (CCR) as of December 2015.
  • This analysis was based on 6,710 incidents or new cases.

Geographic Units of Analysis (e.g. Communities)

  • The California Office of Statewide Health Planning and Development (OSHPD) has defined 542 Medical Service Study Areas (MSSAs) in California, which are groups of census tracts that make up "rational service areas" for primary health care and are used to identify medically underserved areas.
  • All cases were geocoded to a census tract based on the county and street address at time of diagnosis.
  • A MSSA code was assigned to each case based upon its census tract.
  • OSHPD defines Primary Care Shortage Areas (PCSAs) as areas “having a shortage of health care providers on the basis of availability of primary care physicians.“2
  • Qualifying MSSAs are designated as a PCSA based on high population to primary care physicians and lack of access to health care in surrounding areas.

Definition of Advanced Stage

  • Using Surveillance Epidemiology and End Results (SEER) summary stage criteria, cases were classified as early stage (in situ and localized) or advanced stage (regional, distant, or unknown stage). For more detailed information on SEER summary stage criteria go to www.seer.cancer.gov.3

Comparison group

The comparison group selected was non-Hispanic white persons residing in high socioeconomic status (SES) neighborhoods. (A person's SES status was ascertained using census indicators of income, employment, and education for the census block group or tract of residence at diagnosis). Non-Hispanic white persons in high SES neighborhoods were chosen as the comparison group because they had the lowest proportion of advanced (51 percent) compared to other race/ethnicity and income groups.

Analysis

  • The proportion of cervical cancers diagnosed at advanced stage in each MSSA was compared to the proportion of cervical cancers diagnosed at advanced stage in the comparison group. Differences in the sex and age distributions of the two groups were taken into consideration.
  • For mapping, communities with a significantly higher proportion of advanced stage cervical cancer cases were divided into three groups: those where 75 percent or more of all cervical cancer cases were diagnosed at advanced stage, those where 70-74 percent were diagnosed at advanced stage, and 53-69 percent were diagnosed at advanced stage.
  • Percentages of advanced stage cervical cancers were only mapped in MSSAs that had at least 15 cervical cancers cases diagnosed among women aged 20 years and older during the study period.

Results

The proportion of cervical cancers cases diagnosed at advanced stage was significantly elevated in 95 of the 542 MSSAs. Of those, ten MSSAs had 75 percent or more of all cervical cancers cases diagnosed at advanced stage, eight MSSAs had 70-74 percent of all cervical cancers cases diagnosed at advanced stage and 77 MSSAs had 53-69 percent of all and cervical cancers cases diagnosed at advanced stage. In 137 MSSAs the proportion of cervical cancer cases diagnosed at advanced stage was not significantly different than the comparison group. Results were not calculated for 310 MSSAs where less than 15 cervical cancer cases were reported over the five-year period.

 

Conclusion

Geocoded registry data have been mapped to show communities with an excess of cervical cancer cases diagnosed at advanced stage. These maps are now available on the California Cancer Registry website. Each map shows the MSSAs within the county and the percentage of advanced stage cervical cancers in the MSSAs. Accompanying each map is a table that details the study results and the demographic information for each MSSA. Below is a summary table displaying the MSSAs with statistically higher proportions of advanced stage cervical cancers.

 

Summary of MSSAs with Statistically Significantly* Higher Proportions of Advanced Stage Cervical Cancers, 2009-2013

County

MSSA Identification Number

MSSA Name

Percent Advanced Stage

Orange

116l

Anaheim Central

86

Fresno

35c

Fresno West Central

79

Sacramento

139f

Florin/Fruitridge/Oak Park/Parkway/South Sacramento

78

Stanislaus

215a

Modesto West

78

Los Angeles

78.2h

Boyle Heights Central/City Terrace West

78

Stanislaus

212.1

Denair/Turlock

76

Los Angeles

78.2ff

Glassell Park/Glendale Southeast/Silverlake North

76

Los Angeles

78.2pp

Hacienda Heights/Industry Central

76

San Joaquin

164.1

Lathrop/Manteca

75

Los Angeles

77.1b

Desert View Highlands/Lancaster West/Palmdale Northwest/Quartz Hill

75

San Diego

161u

Bostonia/Glenview/Granite Hills/Hillsdale/Johnstown/Lakeside/Riverview/ Winter Gardens

73

San Bernardino

151c

Montclair/Ontario Northwest/Upland South

72

San Joaquin

169b

French Camp/Stockton South/Stockton Southeast

71

Los Angeles

78.2jjj

Long Beach West Central

71

Los Angeles

78.2l

Exposition Park/Leimert Park

71

Sacramento

139k

Freeport/Meadowview

70

Fresno

31

Auberry/Calwa/Centerville/Clovis East/Del Rey/Fowler/Friant/Sanger/Shaver Lake

70

Los Angeles

78.2zzz

Baldwin Park/Irwindale

70

Orange

116b

Santa Ana Central

69

Riverside

135a

Eastside/Fairmont Park/Riverside Downtown/Rubidoux/University

69

Kern

66b

Bakersfield East/Lakeview/La Loma

69

Los Angeles

78.2qq

Asuza/Charter Oak/Covina

69

Los Angeles

78.2qqq

Rosemead/San Gabriel South/South El Monte West/Temple City West

69

Los Angeles

78.2vvv

Diamond Bar/Industry East/Phillips Ranch/Pomona West/Walnut

69

Sacramento

139a

Elverta/Natomas/North Highlands/Rio Linda

68

Los Angeles

78.2bbb

Compton East

68

Los Angeles

78.2eeee

Alhambra/El Sereno South/San Gabriel Central

68

Los Angeles

78.2iiii

Gardena Southeast/Harbor Gateway Central/Lawndale South/Moneta/Redondo Beach North/Torrance North

68

Los Angeles

78.2jjjj

Norwalk/Studebaker

68

Los Angeles

78.2lll

Bixby Knolls/Long Beach Central

68

Los Angeles

78.2uuu

Athens/Gardena Northeast/Harbor Gateway North

68

Orange

116f

Fullerton Central and South

67

Riverside

128

Arabia/Coachella/Desert Beach/Flowing Wells/Indio South/La Quinta East/Mecca/Oasis/Thermal

67

San Bernardino

151j

Mentone/Redlands South/Yucaipa

67

San Diego

161e

College Heights/Hillcrest Southeast/Kensington/Rolando North/University Heights

67

San Joaquin

169a

Stockton North Central/Stockton Northeast

67

Solano

202b

Fairfield

67

Tulare

233

Farmersville/Goshen/Visalia

67

Los Angeles

78.2eee

Downey Northeast

67

San Bernardino

151h

Fontana Central/Rialto Central

66

San Diego

156a

Encinitas Central/Leucadia/Oceanside North and West/San Luis Rey/South Oceanside

66

Riverside

135b

Edgemont/Orange Crest/Woodcrest

65

San Diego

161k

Chula Vista Central and Northwest/National City West

65

San Diego

161s

Cockatoo Grove/Eastlake Greens/Otay Mesa

65

Alameda

2n

Hayward Central

65

Los Angeles

78.2m

Bellflower/Paramount South

65

Los Angeles

78.2rr

Glendale Northeast/La Canada-Flintridge/La Crescenta/Montrose/Sunland/Tujunga/Verdugo City

65

Los Angeles

78.2z

Mar Vista/Ocean Park/Santa Monica South/Venice

65

Orange

116i

Garden Grove South/Santa Ana West

64

Riverside

134

Banning/Beaumont/Cabizon/Calimesa/Cherry Valley

64

Sacramento

139j

Capitol Park/Del Paso Heights/Downtown/Gardenland/North Sacramento

64

Los Angeles

77.1c

Lancaster Central/Palmdale North Central

64

Los Angeles

78.2ooo

Paramount North/Willowbrook

64

San Diego

156d

Oceanside East/San Marcos West/Vista

63

San Diego

161h

El Cajon Central and South/Fletcher Hills

63

San Diego

161l

Lemon Grove South/Paradise Hills

63

Santa Barbara

180.1

Orcutt/Santa Maria

63

Santa Clara

183h

San Jose Southeast

63

Sonoma

209.1

Petaluma

63

Ventura

241b

Oxnard North Central

63

Los Angeles

78.2q

Del Aire/Inglewood West/Los Angeles International Airport

63

Merced

94

Dos Palos/Gustine/Los Banos

63

Monterey

109.2

Salinas/Spreckels

62

Orange

116r

Garden Grove North/Stanton

62

San Diego

161c

Downtown/Golden Hill/Logan Heights

62

San Diego

161g

Encanto/Lemon Grove Northwest/Lincoln Acres/National City East/Paradise Hills Southwest

62

Kern

66c

Bakersfield Southwest

62

Riverside

131a

Lake Elsinore/Murrieta West/Sedco Hills/Wildomar

61

San Bernardino

145.1a

Hesperia West/Mountain View Acres/Victorville Central and South

61

San Bernardino

151l

Chino Northeast/Fontana Southwest/Ontario South

61

San Diego

161a

Clairemont/Fiesta Shores/Linda Vista/Mission Beach/Sorrento/University City

61

Contra Costa

18f

Richmond Central/San Pablo Central

61

Los Angeles

78.2k

South Central Northwest

61

Orange

116g

Santa Ana South

60

Orange

116q

Anaheim East/City of Orange North/Placentia Southwest

60

Solano

204

Vallejo

60

Los Angeles

78.2c

Bell Northeast/Bell Gardens/Commerce/Maywood/Montebello South

60

Los Angeles

78.2kk

North Hills/Northridge North

60

Los Angeles

78.2s

South Central Southwest

60

Los Angeles

78.2uu

La Habra Heights/Whittier

60

Los Angeles

78.2yyy

Bassett/Industry West/La Puente

60

Orange

116k

Brea West/Fullerton North/La Habra

59

Sonoma

210.1

Santa Rosa

59

Los Angeles

78.2e

Country Club Park/Koreatown/Mid-City East

59

Los Angeles

78.2ttt

Burbank North/North Hollywood South

59

Los Angeles

78.2ww

Pico Rivera/Santa Fe Springs Northwest

59

Riverside

129.4

Cathedral City Southeast/Palm Desert North/Palm Springs South/Rancho Mirage North

58

San Diego

161d

Chollas Creek/City Heights/East San Diego/North Park/Oak Park/South Park

58

Los Angeles

78.2ll

Arleta/Pacoima West/Panorama City/San Fernando West

58

Los Angeles

78.2mmm

Downtown Southeast/Florence North

58

Riverside

135g

Moreno Valley

57

Shasta

189.2

Redding

57

San Mateo

176b

East Menlo Park/East Palo Alto/North Fair Oaks/Redwood City East

56

Riverside

135e

Corona North/Glen Avon/Jurupa/Norco

55

San Diego

161j

Castle Park/Chula Vista Southwest/Imperial Beach West/Nestor East/Palm City/San Ysidro/South San Diego

53

* Percent of advanced stage cervical cancers is statistically significantly different from the comparison group (p<0.01).Source: California Cancer Registry, California Department of Public Health.

Data: Cervical Cancer: Percent Diagnosed Advanced Stage and Proportional Incidence Ratios for Medical Study Service Areas within California Counties, 2009-2013

 


1. California Behavioral Risk Factor Surveillance Survey, 2013. California Department of Public Health.
2. Office of Statewide Health Planning and Development. Healthcare Workforce Development Division: Dental Health Professional Shortage Area (http://www.oshpd.ca.gov/HWDD/DHPSA.html).

3. Surveillance, Epidemiology, and End Results Program. National Cancer Institute.  

 

 

 
 
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