Disparities between Blacks and Whites in risk of second primary malignancies among patients with cervical cancer: analysis of Surveillance, Epidemiology, and End Results Database

Int J Gynecol Cancer. 2026 Mar 13;36(5):104637. doi: 10.1016/j.ijgc.2026.104637. Online ahead of print.

ABSTRACT

OBJECTIVE: Cervical cancer is the fourth most common female cancer worldwide. As improved cancer survivorship rates continue, understanding any increased risk for subsequent cancers is vital for surveillance. This study investigates the risk of developing second primary malignancies among women with cervical cancer, along with racial disparities in this risk between non-Hispanic Blacks (Blacks) and non-Hispanic Whites (Whites).

METHODS: Using Surveillance, Epidemiology, and End Results data, we identified Black and White women diagnosed with stage I to IV cervical cancer from 2000 to 2021. Risk of second primary malignancy was calculated using standardized incidence ratios, which represent the observed number of cases divided by the expected number of cases after adjusting for age, race, and year of diagnosis. Likelihood ratio tests were used to determine statistical significance in standardized incidence ratios across race and by anatomic and exposure-related group sites. Multi-variate Cox regression and Kaplan-Meier methods were used to compare demographics and clinical factors across race and second primary malignancy status.

RESULTS: Among 36,702 patients with cervical cancer, 2639 (7.2%) developed a second primary (524 Blacks and 2115 Whites). Both groups had elevated standardized incidence ratios, with Blacks showing significantly higher standardized incidence ratios than Whites (1.7 vs 1.3, p <.001). Anatomic- and exposure-related sites with the highest overall standardized incidence ratios were (human papillomavirus) HPV-related (6.4), respiratory (2.5), urinary (2.1), smoking-related (2.0), genital (1.9), and radiation-related (1.7) (all p <.05). HPV-related sites had the highest standardized incidence ratios and were significantly higher in Blacks than Whites (13.5 vs 5.3, p <.001). At 10 years, second primary malignancy-free survival (89% vs 91%), overall survival (52% vs 65%), and cancer-specific survival (63% vs 72%) were all lower in Blacks (all p <.001).

CONCLUSIONS: Cervical cancer survivors face an elevated risk of second primary malignancies, disproportionately affecting Black patients and HPV-related sites, emphasizing the need for enhanced surveillance and targeted follow-up to address persistent disparities.

PMID:41967417 | DOI:10.1016/j.ijgc.2026.104637