Increased age and race‐specific incidence of cervical cancer after correction for hysterectomy prevalence in the United States from 2000 to 2009

Abstract

BACKGROUND Invasive cervical cancer is thought to decline in women over 65 years old, the age at which cessation of routine cervical cancer screening is recommended. However, national cervical cancer incidence rates do not account for the high prevalence of hysterectomy in the United States. METHODS Using estimates of hysterectomy prevalence from the Behavioral Risk Factor Surveillance System (BRFSS), hysterectomy-corrected age-standardized and age-specific incidence rates of cervical cancer were calculated from the Surveillance, Epidemiology, and End Results (SEER) 18 registry in the United States from 2000 to 2009. Trends in corrected cervical cancer incidence across age were analyzed using Joinpoint regression. RESULTS Unlike the relative decline in uncorrected rates, corrected rates continue to increase after age 35–39 (APCCORRECTED = 10.43) but at a slower rate than in 20–34 years (APCCORRECTED = 161.29). The highest corrected incidence was among 65- to 69-year-old women, with a rate of 27.4 cases per 100,000 women as opposed to the highest uncorrected rate of 15.6 cases per 100,000 aged 40 to 44 years. Correction for hysterectomy had the largest impact on older, black women given their high prevalence of hysterectomy. CONCLUSIONS Correction for hysterectomy resulted in higher age-specific cervical cancer incidence rates, a shift in the peak incidence to older women, and an increase in the disparity in cervical cancer incidence between black and white women. Given the high and nondeclining rate of cervical cancer in women over the age of 60 to 65 years, when women are eligible to exit screening, risk and screening guidelines for cervical cancer in older women may need to be reconsidered.

Prevalence of high-risk human papilloma virus genotypes and associated risk of cervical precancerous lesions in a large U.S. screening population: Data from the ATHENA trial

“…Interestingly, the prevalence of HPV45 in ≥CIN3 was only 2.6% (7 of 274), and there were no cancers. The 6 cancers detected at baseline extrapolate to 14.7/100,000 women which is consistent with the higher U.S. cervical cancer prevalence when corrected for hysterectomy (18.6/ 100,000) [20], a population more similar to the ATHENA cohort where women who had had hysterectomies were excluded from enrollment. All cancers occurred in women aged ≥30 years, with HPV16 responsible for 16.7% (1 of 6), HPV18 for 50% (3 of 6), and HPV31 and HPV39 each for 16.7% (1 of 6) ( Table 3).…”

Tonsillectomy and Risk of Oropharyngeal Cancer: Implications for Research and Prevention

“…This, in turn, involves taking into account the cumulative incidence of tonsillectomy across age/birth cohorts rather than simple age-specific or calendar-year-specific incidence rates of tonsillectomy. Analogous analyses have recently been conducted to account for trends in hysterectomies on cervical cancer incidence trends in the United States (19). These analyses are particularly problematic given the left truncation of information on tonsillectomy.…”

Hot flushes and night sweats symptom profiles over a 17-year period in mid-aged women: The role of hysterectomy with ovarian conservation

“…Between 20 and 40% of women in more economically developed countries have a hysterectomy by the time they are 60 years old [2,3], and this surgery remains one of the most common gynaecological procedures performed worldwide [4]. Women who have a hysterectomy with bilateral oophorectomy (both ovaries removed) are consistently reported to have a higher risk of more frequent and/or severe hot flushes and night sweats, which is thought to be related to the abrupt decline in oestrogen levels post-surgery [5].…”