In a study reported as a research letter in JAMA, Shahmoradi et al found that the incidence of cervical cancer decreased or remained stable in U.S. women between 2001 and 2019, except for an increase in the 30- to 34-year-old age group in more recent years.
As stated by the investigators, “A recent U.S. study reported that previously declining cervical cancer incidence has plateaued between 2012 and 2017. A significant reduction in cervical cancer screening uptake and adherence to guidelines-concordant recommendations has also been reported, particularly among women aged 21 to 29 years. We evaluated calendar trends in cervical cancer incidence by age at diagnosis.”
Study Details
The study involved data from the 2001–2019 National Program of Cancer Registries and Surveillance, Epidemiology, and End Results data set. Annual percentage changes (APCs) in incidence of hysterectomy-corrected cervical cancer were analyzed by 5-year age groups and for women aged < 24 years and ≥ 85 years; analyses showed change from 2001 to 2019 alone for some age groups and for two to three intervals during the study period for others.
Key Findings
During 2001 to 2019, 227,062 cases of cervical cancer were reported. Overall, hysterectomy-corrected cervical cancer incidence decreased from 12.39 cases/100,000 person-years in 2001 to 9.80/100,000 person-years in 2019 (APC = −1.2%, 95% confidence interval [CI] = −1.6% to −0.9%).
Reductions in incidence were observed for the youngest (< 24 years) and oldest (≥ 55 years) age groups, with incidence being relatively stable in recent years among women aged 35 to 54 years. Annual percentage changes were negative for all age groups from 2001 to 2019 or for intervals during this period—except for women aged 30 to 34 years during 2012 to 2019.
Among women aged 30 to 34 years, a decline in incidence from 12.77/100, 000 to 10.14/100,000 person-years (APC = −2.3%, 95% CI = −2.8% to −1.7%) from 2001 to 2012 was followed by an increase from 2012 to 2019 reaching 11.60/100,000 person-years in 2019 (APC = +2.5%, 95% CI = +1.4% to +3.6%).
During 2012 to 2019, incidence in the 30- to 34-year-old age group increased among Hispanic women (APC = +3.0%, 95% CI = +0.3% to +5.7%), non-Hispanic White women (APC = +2.8%, 95% CI = +0.6% to +5.0%), and women of other race/ethnicity (APC = 5.0%, 95% CI = +2.7% to +7.4%), with no apparent increase among Black women (APC = −0.8%, 95% CI = −2.8% to +1.2%). Increases were observed for localized (APC = +2.8%, 95% CI = +1.3% to +4.3%) and regional disease (APC = +1.9%, 95% CI = +0.7% to +3.1%) as well as for squamous cell carcinoma (APC = +2.6%, 95% CI = +1.0% to +4.2%) and adenocarcinoma (APC = +3.0%, 95% CI = +0.9% to +5.1%).
The investigators stated, “Between 2001 and 2019, cervical cancer incidence declined or remained stable among U.S. women except for the 30- to 34-year-old age group, in whom incidence increased 2.5% per year after 2012. The observed increase in incidence among 30- to 34-year-old women could be real as a result of a true increase in cervical cancer incidence or due to increased early detection with a stable disease occurrence. If the increase is real, it could be a result of missed screening opportunities at earlier ages, as suggested by the increase in squamous cell carcinoma and localized disease.”
Ashish A. Deshmukh, 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 article.
Disclosure: The study was supported by grants from the National Cancer Institute and National Institute on Minority Health and Health Disparities. For full disclosures of the study authors, visit jamanetwork.com.
