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Pace of Cervical Cancer Stage Progression Prior to Radiation Therapy Initiation, an Instrumental Variable Analysis
Preethiya Sekar1, Peter Vulysteke2, Taolo Ntloedibe3
1Massachusetts General Brigham, Boston, USA.
International Journal of Radiation Oncology, Biology, Physics
|August 12, 2026
Summary
Delays in cervical cancer radiation therapy initiation commonly lead to measurable cancer stage progression, potentially reducing survival. Starting treatment within four weeks of diagnosis is crucial to minimize this risk.
Area of Science:
- Oncology
- Radiation Therapy
- Public Health
Background:
- Delays in initiating radiation therapy for cervical cancer are frequent.
- These delays may negatively impact patient outcomes.
- The rate of cervical cancer stage progression is not well understood, hindering quality improvement efforts.
Purpose of the Study:
- To estimate the causal effect of treatment delay on cervical cancer stage progression.
- To determine the time required for cervical cancer stage to advance.
- To examine the association between cancer stage at treatment initiation and overall survival.
Main Methods:
- Prospective cohort study of 763 women with cervical cancer in Botswana (2012-2019).
- Instrumental variable (IV) approach using seasonal variation in treatment access to assess treatment delay's impact.
- Two-stage weighted models to estimate stage progression time and survival association.
Main Results:
- Cervical cancer stage progression was estimated to occur over a mean of 8.6 weeks.
- Time to stage progression varied by HIV status, with faster progression observed in women with HIV (7.6 weeks).
- Increased cancer stage at treatment initiation was linked to a 38% reduction in survival time.
Conclusions:
- Modest treatment delays are associated with cervical cancer progression and reduced survival.
- Initiating radiation therapy within four weeks of diagnosis is recommended to mitigate stage progression risk.
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