The steepest annual rise in new cases of advanced cervical cancer in the United States from 2001 to 2018 was among White patients, who were significantly less likely to receive the preventive human papillomavirus (HPV) vaccine or to be screened for the disease, according to research published by Francoeur et al in the International Journal of Gynecological Cancer. However, the prevalence of the disease was highest among Black patients, especially those in their mid to late 50s and living in the South—for whom the rates were nearly twice those of their White peers, the study findings showed.
Advanced (stage IVA–B) cervical cancer that has spread beyond the pelvis to the bladder/rectum and/or other parts of the body is still relatively rare, but just around 17% of patients diagnosed with it will survive at least 5 years, compared with 92% of those diagnosed with early-stage disease. Although the overall rates of early-stage cervical cancer in the United States have been falling, the rates of advanced disease have been rising. It’s not clear whether specific trends in age, ethnicity, or geographical region could explain these trends.
Study Details and Findings
Researchers drew on cervical cancer data submitted to the U.S. Cancer Statistics program and national survey findings on screening and vaccination for 2001 to 2018. During this period, 29,715 patients were diagnosed with advanced disease. After the investigators adjusted for age, the rate of advanced disease was much higher among Black patients than it was among White patients: 1.55/100,000 of the population compared with 0.92/100,000.
The highest number of cases were diagnosed in the South at 1.17/100,000, followed by the Midwest at 0.93/100,000, the Northeast at 0.87/100 000, and the West at 0.82/100,000.
KEY POINTS
- Stratification of the data by race, geographical region, and age showed that the steepest annual rise in cases was among White 40- to 44-year-old patients in the South, with a rate of 4.5%.
- Compared with Black patients, White patients were nearly twice as likely (26.5% vs 14%) not to be screened at all or not to be screened in line with clinical guidelines, and so subject to a gap of 5 or more years between smear tests.
- HPV vaccination uptake was lowest among White 13- to 17-year-olds, two-thirds of whom were vaccinated compared with three-quarters of those from other ethnic backgrounds. The steepest annual increase in vaccination rates (7%) was among Black teens.
Those most at risk were 55- to 59-year-old Black patients living in the South, with a rate of 2.61/100,000—nearly double that of their White peers in the South (1.39/100,000).
Examination of trends over time showed that the number of cases of early-stage disease fell by an annual 1.6%, but the number of cases of advanced disease increased by nearly 1.5% every year, with new cases of cervical adenocarcinoma making up the bulk of this increase (just under 3%).
Increasing rates of obesity and older age at first birth could be contributing to the rise in this type of cervical cancer, suggested the researchers.
Stratification of the data by race, geographic region, and age showed that the steepest annual rise in cases was among White 40- to 44-year-old patients in the South, with a rate of 4.5%. Compared with Black patients, White patients were nearly twice as likely (26.5% vs 14%) not to be screened at all or not to be screened in line with clinical guidelines, and so they were subject to a gap of 5 or more years between smear tests.
White teenagers (13–17 years) have the lowest HPV vaccination rate at 66.1% compared with others at 75.3%. The steepest annual increase in vaccination rates (7%) was among Black teens.
The researchers acknowledged that the lack of a national screening and vaccination registry in the United States resulted in relying on multiple sources of data, which may have affected the findings. Inaccuracies may also have crept in because these data sets relied on personal recall, they added.
“Even with screening and vaccination, there is not one racial/ethnic group, region, or age group where distant-stage cervical cancer has been decreasing over the last 18 years.”
They explained: “Over 90% of cervical cancer is caused by HPV; the lower rate of vaccination in White [patients], coupled with screening [not concordant with guidelines] in this population, could explain the trend toward the higher rate of increase in distant disease in White [patients]…. This challenges the idea that Black and Hispanic [patients] have higher rates of distant-stage diagnosis due to lower access to screening.”
The study authors concluded: “This finding demonstrates the public health imperative to vaccinate more young girls and women.”
Disclosure: For full disclosures of the study authors, visit ijgc.bmj.com.
