Cervical cancer incidence, mortality rises sharply in America's poorest counties
Click Here to Manage Email Alerts
A study led by researchers at The University of Texas MD Anderson Cancer Center revealed an alarming increase in cervical cancer incidence and mortality among women living in America’s lowest-income counties.
“Cervical cancer is almost entirely preventable, yet it remains a major public health problem among certain subpopulations globally and nationally,” Trisha L. Amboree, PhD, MPH, postdoctoral fellow in the department of behavioral science at MD Anderson, told Healio. “More specifically, it remains an issue in the U.S. among our most marginalized communities. There’s a great need to enhance and scale up prevention efforts so we can combat these concerning trends in the communities that are most affected.”
Healio spoke with Amboree about the study’s key findings, possible explanations for these trends, and what can be done to address the disparities investigators identified.
Healio: Why did you conduct this study?
Amboree: Cervical cancer is largely preventable through vaccination against HPV, as well as through screening for early detection and treatment of precancerous lesions. With widespread implementation of Pap smears in the U.S. over the last several decades, we have seen major declines in cervical cancer incidence and mortality. We recently became deeply concerned with some studies reporting the reversal of previously declining cervical cancer incidence among certain subpopulations. We wanted to look more closely at this to see if incidence was continuing to rise and, if so, which groups were experiencing these increases.
Healio: How did you conduct this study?
Amboree: We used NCI’s SEER-22 database, which combines data from different cancer registries across the U.S. We used these data to analyze trends in incidence and mortality from 2000 to 2019.
Healio: What did you find?
Amboree: In short, we found an increasing trend in annual cervical cancer incidence, particularly in advanced-stage distant disease among women living in low-income U.S. counties. We also found an upward trend, though not statistically significant, in cervical cancer mortality among non-Hispanic white women and non-Hispanic Black women living in low-income counties.
Healio: Why are these trends concerning?
Amboree: We found it concerning to see differing trends across racial and ethnic groups, as well as differences by county-level income. This suggests some widening health disparities.
Healio: Do you have any potential explanations for these findings?
Amboree: One commonly accepted justification for why we’re seeing more cervical cancer cases is the recent shift toward recommending primary HPV testing as the preferred method for cervical cancer screening. Primary HPV testing is a more sensitive screening test that may result in greater detection of earlier-stage cancers. However, in our study, we saw an increase in distant-stage cancers, not early-stage cancers. This implies there is potential disruption along the screening and treatment continuum that is specifically impacting women in low-income U.S. counties. More research is needed, but we would hypothesize that these findings may reflect lower screening uptake, which has been well documented in the U.S.
In terms of mortality trends we saw among non-Hispanic white women, this may be a consequence of rising incidence, which we did see in that group. Among non-Hispanic Black women, however, we are unclear on what is happening. Over recent decades, the incidence observed in that group has decreased, so the mortality trends could reflect a delay in timely or appropriate care.
Healio: What can be done to address this issue?
Amboree: Cervical cancer is one of the few cancers that has both primary and secondary prevention. So, an immediate call to action is the need to scale up targeted prevention efforts, specifically among women living in low-income U.S. counties, but also overall.
In my future research, I plan to look deeper into what the potential disruptions may be in the screening and treatment continuum — specifically in marginalized communities and lower-resource settings — so we can adequately target whatever is happening there. I am also working with our research group on what it will look like to begin scaling up prevention and screening in lower-resource settings.
Reference:
For more information:
Trisha L. Amboree, PhD, MPH, can be reached at The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1515 Holcombe Blvd., Unit 1330, Houston TX 77030; email: tlamboree@mdanderson.org.
Collapse
Healio Interviews
Click Here to Manage Email Alerts