Higher county densities of PCPs associated with earlier cancer stage at diagnosis
Click Here to Manage Email Alerts
SAN DIEGO — A higher density of primary care physicians was associated with an earlier stage of cervical cancer at diagnosis, according to findings presented at the ACOG Annual Clinical & Scientific Meeting.
“While gynecologists are well-trained in following [gynecologic cancer] guidelines, this study shows that PCPs may play a more significant role in earlier diagnosis, and subsequently increased survival,” Alexandra H. Smick, MD, a third-year resident in OB/GYN at TriHealth in Cincinnati, Ohio, told Healio. “Increasing the training opportunities for our PCPs in screening tests like PAP smears, endometrial biopsies, imaging or tumor markers may continue to make a positive impact on women's health care and improve population-based care for cervical cancer.”
Smick and colleagues analyzed cancer stages at diagnosis of gynecologic cancers, including uterine, ovarian and cervical cancers, using data from the Surveillance, Epidemiology and End Results (SEER) database from 2005 to 2018. They extracted county-level demographics from SEER, population density from the U.S. Census and OB/GYN and PCP densities from the Area Health Resources File. In total, 620 U.S. counties were analyzed, 57% of which were nonmetropolitan.
Among 113,938 patients, 15% had cervical cancer, 60% had uterine cancer and 25% had ovarian cancer. In nonmetropolitan counties, the average OB/GYN density was nine physicians per 100,000 women and the average PCP density was 92 physicians per 100,000 women. In metropolitan areas, the averages were 16 OB/GYNs and 110 PCPs per 100,000 women. Overall, the average densities were 12 OB/GYNs and 99 PCPs per 100,000 women, Smick and colleagues reported.
The higher density of PCPs may help explain why PCPs play a more significant role in cervical cancer screening, Smick said. PCP density was negatively correlated with cancer stage at diagnosis (P < .05) and positively correlated with 5-year survival in cervical cancer (P = .04). Meanwhile, OB/GYN density was not correlated with the cancer stage at diagnosis or survival outcomes from the gynecologic cancers analyzed. The researchers reported that median household income was negatively correlated with cancer stage (P = .01) while education and metropolitan status were positively correlated with 5-year survival (P < .01). For endometrial cancer specifically, identifying as Black was positively correlated with cancer stage at diagnosis (P < .01) and negatively correlated with 5-year survival (P < .01).
“Increasing PCP density has been shown to have a positive impact on other cancers like colorectal and urologic malignancies, and we were not surprised to see a similar trend with cervical cancer outcomes,” Smick said.