‘Surprising’ rise in distant-stage cervical cancer rates driven by white and younger women
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Key findings:
- Distant-stage cervical cancer increased at a rate of 1.3% per year from 2001 to 2018.
- The highest number of cases occurred in the South, followed by the Midwest, the Northeast and the West.
- White women had the highest rates of nonguideline screening and lowest rates of HPV vaccination.
Rates of early-stage cervical cancer decreased as rates of distant-stage disease increased among certain women in the U.S. between 2001 and 2018, according to study results.
The findings, published in International Journal of Gynecological Cancer, showed that although Black women had higher rates of distant-stage disease, white women had the sharpest annual increase in incidence, especially in adenocarcinomas, as well as lower guideline screening and vaccination rates.
The results highlight the importance of proper cervical cancer screening and HPV vaccination, Alex Andrea Francoeur, MD, researcher in the department of obstetrics and gynecology at University of California, Los Angeles, told Healio.
Rationale and methods
“Previous research has shown an overall decrease in the rate of cervical cancer in the U.S. However, the rate of distant-stage cervical cancer appears to be increasing,” Francoeur said. “The objective of our study was to determine the trends in distant-stage cervical cancer in the United States and identify possible factors related to those trends.”
Researchers gathered data from the U.S. Cancer Statistics program and used the Behavioral Risk Factor Surveillance System and TeenVaxView to evaluate the rates of cervical cancer screening and vaccination between 2001 and 2018. They additionally used SEER*Stat 8.3.8.9.2 and Joinpoint regression program 4.9.0.0 to calculate trends in incidence.
Key findings
Overall, 29,715 women received a diagnosis of distant-stage cervical carcinoma during the study period. After adjusting for age, researchers found Black women had disproportionately higher rates than white women (1.55 per 100,000 population vs. 0.92 per 100,000 population; P < .001).
Results additionally showed an overall annual increase of 1.3% in distant-stage disease, with the largest increase observed in cervical adenocarcinoma, for an average annual percent change of 2.9% (P < . 001).
Researchers observed the highest number of cases in the South (1.17 per 100,000 population), followed by the Midwest (0.93 per 100,000), the Northeast (0.87 per 100,000 population) and the West (0.82 per 100,000).
Although the highest increase in distant-stage disease occurred in the South among white women aged between 40 and 44 years (annual rate, 4.5%; P < .001), researchers found Black women aged between 55 and 59 years residing in the South at highest risk (2.61 per 100,000 population) — nearly twice that of their white counterparts (1.39 per 100,000 population).
Moreover, researchers observed a nearly twofold higher rate of missed or lack of guideline screening among white women compared with Black women (26.6% vs. 13.8%). Of note, white adolescents aged 13 to 17 years had the lowest HPV vaccination rate compared with all others (66.1% vs. 75.3%). Conversely, researchers observed the steepest annual increase in vaccination rates (7%) among Black teens.
“We observed the largest rate of increase in distant-stage cervical cancer among white women and younger women; however, Black women overall appeared to have the highest rate of disease,” Francoeur said. “We also found that white women had the highest rates of nonguideline screening — defined as a Pap test more than 5 years ago — and the lowest rates of HPV vaccination. These findings were surprising because we recently published exciting findings that rates of cervical cancer had overall declined during the previous 18 years. It was surprising then to find that while early-stage disease is decreasing, distant-stage disease is increasing. This was surprising also in the context of increased HPV vaccination rates and expansion of Medicaid under the Affordable Care Act.”
Implications
The study findings provide an update on trends of distant-stage cervical cancer in the United States and identify a continued problem with increasing rates of distant-stage cervical cancer, a diagnosis with a poor 5-year survival rate and typically no cure, Francoeur said.
“The findings also emphasize the continued importance of vaccination, especially among young girls,” she continued. “With changes in recommended guideline Pap test screening, this indicates that we may be missing certain populations of women who are at high risk, as the study also showed that more women are not receiving guideline-recommended screening.”
Future research should explore why rates of adenocarcinoma are increasing so much in young women and examine continued HPV vaccination hesitancy, as well as drivers for increasing rates of nonguideline Pap test screening, Francoeur added.
“This could take the form of large database studies or qualitative research. Since this database was from 2001 to 2018, these trends may have worsened with barriers accessing health care due to the COVID-19 pandemic,” she said.
References:
- Francoeur AA, et al. Int J Gynecol Cancer. 2022;doi:10.1136/ijgc-2022-003728.
- Steepest annual rise in advanced cervical cancer in U.S. among white women (press release). Available at: medicalxpress.com/news/2022-08-steepest-annual-advanced-cervical-cancer.html. Published Aug. 18, 2022. Accessed Aug. 18, 2022.
For more information:
Alex Andrea Francoeur, MD, can be reached at afrancoeur@mednet.ucla.edu.
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