Clinical and demographic predictors of late-stage cervical cancer

Background: Despite increasingly widespread use of the Papanicolaou smear, almost half of all women with invasive cervical cancer are diagnosed at a l ate stage (regional or distant). Little is known about factors associated w ith late-stage diagnosis of cervical cancer. Objective: To examine the relationship of age, race, education level, incom e level, smoking, marital status, health insurance type, comorbidity, and r esidence in an urban or rural setting to late stage at diagnosis of cervica l cancer. Methods: Incident cases of invasive cervical cancer occurring in 1994 in Fl orida were identified from the state tumor registry (N = 852). Cases were l inked with state dis charge abstracts and the 1990 US census. Multiple logi stic regression was used to determine the relationship between predictor va riables (age, race or ethnicity, marital status, smoking status, education level, income level, insurance type, comorbidity, and urban vs rural reside nce) and the odds of late-stage diagnosis. Results: Age, marital status, and insurance type were associated with late- stage diagnosis. Each additional year of age was associated with a 3% incre ased odds of late-stage diagnosis (odds ratio [OR], 1.03; 95% confidence in terval [CI], 1.02-1.05; P<.001). Being unmarried was associated with a 63% increased odds of late-stage diagnosis (OR, 1.63; 95% CI, 1.18-2.25; P=.003 ). Being uninsured was associated with a 60% increased odds of late-stage d iagnosis (OR, 1.60; 95% CI, 1.01-2.38, P=.02). Having commercial health mai ntenance organization insurance was associated with a 46% decreased odds of late-stage disease (OR, 0.54; 95% CI, 0.30-0.96; P=.04). Race, education l evel, income level, smoking status, comorbidity, and urban residence were n ot associated with stage at diagnosis. Conclusions: Women with cervical cancer who are elderly, unmarried, and uni nsured are more likely to be diagnosed at a late stage. These women should be targeted for cervical cancer education and screening programs.