In a study reported as a research letter in JAMA Network Open, Amboree identified U.S. counties with low or high cervical cancer screening coverage and associated risks of cervical cancer incidence and mortality.
As stated by the investigators, “Recent research shows that cervical cancer incidence and mortality are 67% and 108% higher, respectively, in low-resourced U.S. counties…. County-level screening disparities may contribute to these differences, … yet this remains unexplored.”
Study Details
The study involved data on cervical cancer cases among women aged 20 years or older identified from the Surveillance, Epidemiology, and End Results (SEER)-22 database. Data on cervical cancer mortality were obtained from the National Center for Health Statistics. County-level cervical cancer screening data were obtained from SEER’s small area estimates for 1,086 counties. Counties were considered to have repeatedly low vs high screening rates if they had less than 70% vs 80% or greater coverage during 2011 to 2016 and at least one earlier period (2008–2010 or 2004–2007); counties not meeting these criteria were categorized as “other counties.” Age-adjusted 5-year incidence and mortality rates for years 2016 to 2021 were estimated.
Key Findings
A total of 70 counties were identified as repeat low coverage counties, 141 as repeat high coverage counties, and 875 as other counties. A total of 61 repeat low coverage counties (87.1%) were rural, with all having a median annual household income of less than $75,000. A total of 119 repeat high coverage counties (84.4%) were urban, with 72 (51.1%) having a median annual household income of $75,000 or greater. Most repeat low coverage counties were in Texas (n = 33, 47.1%), Idaho (n = 12, 17.1%), and New Mexico (n = 12, 17.1%).
Compared with repeat high coverage counties, cervical cancer incidence in 2016 to 2021 was significantly higher in repeat low coverage counties (rate ratio [RR] = 1.83, 95% confidence interval [CI] = 1.67–2.00) and other counties (RR = 1.28, 95% CI = 1.25–1.31).
In analysis by stage at diagnosis, incidence was higher in repeat low coverage counties and other counties for localized stage (RR = 1.75, 95% CI = 1.53–2.01; RR = 1.22, 95% CI = 1.17–1.26), regional stage (RR = 1.87, 95% CI = 1.60–2.17; RR = 1.33, 95% CI = 1.27–1.39), and distant stage (RR = 1.84, 95% CI = 1.45–2.32; RR = 1.35, 95% CI = 1.27–1.45) compared with repeat high coverage counties.
Compared with repeat high coverage counties, cervical cancer mortality in 2016 to 2021 was significantly higher in repeat low coverage counties (RR = 1.96, 95% CI = 1.66–2.30) and other counties (RR = 1.42, 95% CI = 1.35–1.50).
The investigators stated: “We report nearly twofold higher cervical cancer incidence, late-stage diagnosis, and mortality in counties with repeatedly low vs high cervical cancer screening coverage. Most counties with repeat low coverage were rural and lower income. These findings help elucidate previously reported differences in cervical cancer incidence and mortality in rural and lower-income counties….”
Trisha L. Amboree, PhD, MPH, of the Department of Public Health Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported by the National Cancer Institute and others. For full disclosures of all study authors, visit jamanetwork.com.
