Socioeconomic position and stage of cervical cancer in Danish women diagnosed 2005-2009
A partir des données du registre danois des cancers gynécologiques portant sur la période 2005-2009, cette étude analyse l'associatin entre le statut socioéconomique des femmes et le stade au diagnostic de leur cancer du col de l'utérus
Background: To reduce social disparities in cervical cancer survival, it is important to understand the mechanisms by which social position influence cancer prognosis. We investigated the relations between socioeconomic factors, comorbidity, time since last Papanicolau smear and stage at diagnosis in Danish women with cervical cancer. Methods: We identified 1651 cervical cancer cases diagnosed 2005-2009 from the Danish Gynaecological Cancer Database. Date of diagnosis, clinical cancer stage, tumour histology and treating hospital were retrieved; Pap smear registrations were obtained from the Danish Pathology Register; data on comorbid conditions from the Danish National Patients Register; and data on education, income and cohabitation from Statistics Denmark. Logistic regression models were used to analyse the relations between socioeconomic factors and cancer stage in a four-step model, with stepwise inclusion of mediators. Results: The risk for advanced (stage II-IV) compared with early stage cancer (stage I) was increased for women with short and medium education (OR = 2.40; 1.67-3.45 and 1.76; 1.44-2.16), women living without a partner (OR = 1.31; 1.10-1.55) and older women (OR = 1.07; 1.06-1.08 increase per year). The relations between socioeconomic factors and cancer stage were partly mediated by time since last Pap smear test and to a lesser extent by comorbidity. Conclusions: Shorter education, living alone and older age were related to advanced stage cervical cancer, due partly to Pap smear testing and less to comorbidity. Impact: It is relevant to further investigate how to decrease delay in cervical cancer diagnosis among disadvantaged groups.