AGE, SUBSTANCE-ABUSE, AND SURVIVAL OF PATIENTS WITH CERVICAL-CARCINOMA

Background. The poor survival of young patients with cervical cancer i n a low income, disadvantaged community stimulated an investigation of pathologic and behavioral risk factors. Methods. The records of 1173 patients with cervical cancer diagnosed in 1967-1988 were evaluated wi th respect to age, stage, histology, and presenting symptoms. Histopat hologic risk factors were evaluated in 196 patients with Stage IB dise ase treated by initial hysterectomy. Substance abuse behaviors were ev aluated for 332 symptomatic patients with Stages IB-III disease diagno sed from 1976 to 1988. Results. There were no significant age-related differences in survival for patients without squamous cell carcinoma o r those with Stage IA and asymptomatic Stage IB squamous cell carcinom a. Women age 70 years and older had a poorer survival rate than did yo unger women with Stages IB-III disease. Symptomatic patients with squa mous cell carcinoma younger than age 50 years had a poorer survival th an did patients age 50-69 years with Stages IB/IIA, IIB, and III disea se. For patients with symptomatic Stage IB tumors, poor prognostic his topathologic factors were distributed equally among women younger than age 50 and those aged 50-69 years. Substance abuse was significantly more prevalent among younger patients, and patients who smoked or abus ed alcohol or drugs had significantly poorer survival than did nonsubs tance abusers. However, in a multivariate analysis of age, stage, and substance abuse, young age remained a significantly poor prognostic fa ctor. Conclusions. Substance abuse may contribute to poor outcome of y oung patients with symptomatic squamous cell carcinoma but does not ex plain adequately their poor survival.