Rare gynecologic cancers represent 3.4% of all cancers of women in the US and may disproportionately affect specific demographic groups due to access to healthcare. In California, the gynecologic cancers that meet the NCI criteria of rare cancer are ovarian, cervical, vulvar, vaginal, and other gynecologic cancers. The influence of race/ethnicity and measures of healthcare access on incidence, risk of late stage at diagnosis, and 5-year cancer site-specific survival rates for all rare gynecologic cancers were examined in the large and racially diverse population of the California Cancer Registry from 1988-2009. Factors of healthcare access were measured by SES, health insurance status, and US-born status.

We found that the association between healthcare access and rare gynecologic cancer outcomes varied by cancer site, cancer outcome, race/ethnicity and the particular measure of healthcare access. Proportional incidence of HPV-related cancers were increased for women with low SES, especially NH Whites. Private insurance and US birthplace status decreased proportional incidence by race/ethnicity for all rare gynecologic cancer sites. Risk of late stage at diagnosis for HPV-related cancers varied by measures of healthcare access. Race/ethnicity and insurance status were the most important predictors of ovarian cancer late-stage risk while private insurance was associated with lower risk of late stage at diagnosis for other female genital organ cancers. Cervical and ovarian cancer survival were associated with race/ethnicity, SES and insurance status. The risk of death for all rare gynecologic cancers, except other gynecologic cancers, was reduced for women born outside the US.