Impact of Widespread Cervical Cancer Screening

Abstract

Objectives With recent approval of standalone HPV testing and increasing uptake of HPV vaccination, some have postulated that we are moving towards a “post-Pap” era of cervical cancer prevention. However, the total number cases that have been prevented by Pap smear screening as well as its impact on racial disparities are unknown. Methods We estimated national cervical cancer incidence from 1976 to 2009 using the Surveillance, Epidemiology, and End Result (SEER) database. Screening data were obtained from literature and National Cancer Institute Progress Reports. We examined early, late, and race-specific trends in cancer incidence, and calculated the estimated number of cancers prevented over the past three decades. Results From 1976 to 2009, there was a significant decrease in the incidence of early-stage cervical cancer, from 9.8 to 4.9 cases per 100,000 women (p < .001). Late-stage disease incidence also decreased, from 5.3 to 3.7 cases per 100,000 women (p < .001). The incidence among black women decreased from 26.9 to 9.7 cases per 100,000 women (p < .001), a greater decline compared to that of white women and women of other races. After adjusting for “pre-screening era” rates of cervical cancer, we estimate that Pap smears were associated with a reduction of between 105,000 to 492,000 cases of cervical cancer over the past three decades in the U.S. Conclusions A large number of early and late-stage cervical cancers were prevented and racial disparity in cancer rates were reduced during an era of widespread Pap smear screening.

The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities

“…It is important to note that the impact of missing a cancer screening is not the same for every population [ 92 , 93 ]. Evidence suggests that marginalized individuals such as racial minorities are more likely to benefit from cancer screening [ 94 ]. Research also indicates that cancer screening is more cost-effective for high-risk races and ethnicities, such as Asians ($71,451 per quality-adjusted life year [QALY]), Hispanics ($76,070/QALY), African Americans ($80,278/QALY), compared to non-Hispanic White individuals ($122,428/QALY) [ 95 ].…”

Racial/Ethnic Disparities in Cervical Cancer Screening and Outcomes

“…Minority women with a low socioeconomic status (SES) have much higher rates of ICC, are less likely to have undergone screening, and consequently more likely to present with advanced disease [26]. Increasing SES decreases the odds of delayed- versus early-stage diagnosis among all racial groups [16].…”

Sexual behaviours associated with incident high-risk anal human papillomavirus among gay and bisexual men

“…High-risk human papillomavirus (HRHPV) infection-related cancers, including squamous cell carcinomas of the cervix and anus, accounted for approximately 4.5% of all cancers globally in 2012. 1 While rates of cervical cancer have declined in countries with organised cervical screening programmes, 2 anal cancer incidence has increased in most industrialised countries over the last three decades. 3 Several distinct populations experience anal cancer at markedly higher rates than the general population.…”