THE RISK OF INVASIVE CERVICAL-CANCER AMONG HISPANICS - EVIDENCE FOR TARGETED PREVENTIVE INTERVENTIONS

Background. Mass screening for cervical cancer has considerably reduce d invasive cancer rates; however, Hispanic Americans have not fully be nefited. This study examined the relationship of demographic, socioeco nomic, and acculturation factors to diagnostic stage prior to preventi ve interventions in a large Hispanic community (San Diego, CA, 1988-19 91). Methods. Age-adjusted incidence rates (IR) were estimated for thr ee subareas: Hispanic community targeted with interventions, compariso n Hispanic community, and remainder of county. Incident cases of cervi cal cancer in the California Cancer Registry were used to calculate in cidence rate ratios (IRR) of in situ to invasive stage cancer and esti mate differences in early detection between Hispanics and white non-Hi spanics. Multiple logistic regression was used to examine the relation ship of cancer stage to census-linked income, education, poverty statu s, foreign birth, and language spoken. Results. The in situ cervical c ancer IR is significantly lower for Hispanics than for white non-Hispa nics in all three regions (P < 0.05). The overall IRR is 3.65 (95% CI 3.19, 4.18) for white non-Hispanics compared with 1.09 (95% CI 0.86, 1 .38) for Hispanics. Hispanics in census tracts in the highest versus r emaining quartiles for percentage of language-isolated households are at greater risk for invasive stage (OR = 2.10, 95% CI 1.27, 3.40). Whi te non-Hispanic women residing in census tracts in the highest versus lowest quartile of adults with less than 12 years education are at gre ater risk for invasive stage (OR = 2.10, 95% CI 1.31, 3.38). Conclusio ns. Results show efforts aimed at cervical cancer early detection for Hispanic women are needed and well targeted. White non-Hispanic women in low-education communities are also at risk. Population-based method s in this study can focus efforts in communities needing preventive in terventions. (C) 1998 American Health Foundation and Academic Press.