Due to effective screening and dysplasia treatment, death from cervical cancer has dramatically decreased in American patients. Despite improvements in prevention and early detection, an estimated 4310 U.S. patients will lose their lives to cervical cancer in 2023 [19]. Patients of historically disadvantaged racial and ethnic groups suffer an unequal disease burden compared to White patients. Black patients have been shown to receive human papilloma virus (HPV) testing less frequently, less appropriate colposcopic follow up, and have a higher rate of cervical cancer precursor lesions than their white counterparts [1,20]. These failures have serious ramifications since cancer outcomes are better when cervical cancer is diagnosed in early stages through screening, when most patients are asymptomatic [21].

Subsequently, Black patients disproportionately experience and die from cervical cancer. It is also important to understand that race is a socially-based construct, and not biologically based, and thus these disparities should be interpreted as ways in which the environmental, interpersonal and inherited aspects of systemic racism impact Black patients [2]. When rate-adjusted for hysterectomy for benign indications, Black patients had an even higher mortality rate at 10.1 per 100,000 compared to 4.7 per 100,000 deaths in White patients [3]. Black patients have consistently been found to have a higher cancer stage at diagnosis, and Black patients' 5- year survival (5YS) is decreased at all stages [[22], [23], [24], [25]]. The disparity in cervical cancer outcomes has been reduced but not resolved in recent decades [26,27]. Previously-identified reasons for some of these disparities include: a lower receipt of adjuvant radiation and disposition to the improper treatment for stage [4,18]. Differences in insurance status and treatment in Black cervical cancer patients have been found to contribute to disparities [28]. Wu et al. developed the concept of Guideline Concordant Care (GCC) to determine the completeness of a patient's evaluation in a standardized fashion, and found that receipt of GCC mitigated the adverse outcomes associated with insurance disparities [28]. Black patients are less likely to receive minimally invasive hysterectomy (MIS), independent of uterine size [29]. Though better examined in benign gynecology, this disparity likely affects the surgical care of Black women with gynecologic malignancies as well. In 2018, patients enrolled in the Laparoscopic Approach to Cervical Cancer (LACC) trial who received MIS for operable cervical cancer were found to have increased mortality compared with those who had an open approach (HR 1.65 for MIS) [5]. Retrospective analyses corroborated this finding, and a practice-changing shift to open surgery was made [6]. The objective of our research was to evaluate if the disparity in survival by race was mitigated by a higher rate of open hysterectomy procedures in Black patients with operable invasive cervical cancer compared to White patients. Secondary outcomes include investigation of the effect of factors including adverse pathologic risk factors, treatment, or social determinants of health (SDoH) on survival.