M. P. Patel1, S. Jhavar2, G. Gomber3, A. Hubbard4, A. H. Klopp5, A. M. Farach6, and M. S. Ludwig7; 1Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, 2Baylor College of Medicine, Houston, TX, 3University of Texas at Austin, Austin, TX, 4American Society for Radiation Oncology, Arlington, VA, 5Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 6Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, 7Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
Purpose/Objective(s): Brachytherapy is a critical component of definitive cervical cancer treatment. Timely access to treatment has shown an improved survival benefit. Texas is the second largest state by size and population in the US. Here we explore the geographic availability of brachytherapy (BT) centers in the state.Materials/
Methods: We queried publicly available data on cervical cancer incidence and mortality between 2010-2020 from the Texas Cancer Registry. Available BT centers were compiled from the Texas Department of State Health Services (DSHS) Radiation Control Program and verified by direct contact with each treating institution. Number of BT units per 1,000 new cases was calculated as an index of BT availability. Results: The state currently has 48 institutions actively treating cervical cancer with definitive tandem & ring/ovoid intracavitary BT. Texas DSHS geographically divided the state into 11 public health regions (PHR) to support and coordinate the local health needs of the entire state. PHR 8 located in the south-central region has the lowest availability of centers (1.23 centers/1,000 new cases), while PHR 1 in the north region has the highest availability (8.73 centers/1,000 new cases). The overall Texas incidence rate, mortality rate, and BT availability is 9.4 per 100,000 (US rate 7.7), 2.8 per 100,000 (US rate 2.6), and 3.43 per 1,000 new cases, respectively. In Texas, it is estimated that 45% of cases are diagnosed with locally advanced disease. The overall state locally advanced incidence rate is 4.2 cases per 100,000 population, which is 55% higher than the national locally advanced incidence rate of 2.7. Annually, roughly 31% of all cervical cancer patients diagnosed in Texas die from the disease, as compared to only 10% nationally. On the county level, Henderson County has the highest mortality rate (5.8 deaths per 100,000 population) and no BT availability. Hidalgo County located on the southern border has the highest incidence (500) and deaths (157) of rural counties. Fort Bend County has the highest absolute incidence (263) and deaths (90) for a county without any BT centers. Angelina County has the highest incidence rate (15.9 per 100,000) with a non-zero death rate (3.9 per 100,000). Conclusion: Compared to national rates, Texas has a higher overall incidence rate of cervical cancer overall and locally advanced cervical cancer highlighting the need for widespread access to BT services across the state. Herein, we review cervical cancer incidence rates, mortality rates, and access to intracavitary BT centers by county and PHR to identify BT deserts across the state. This analysis identifies the highest at-risk populations and opportunities for improved BT access. There is an existing need for expanded geographic access to high-quality BT centers and well-trained brachytherapists across Texas.
