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 1,651 cervical cancer cases diagnosed 2005 to 2009 from the Danish Gynaecological Cancer Database. Date of diagnosis, clinical cancer stage, tumor 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 analyze 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.