The increasing incidence of stage IV cervical cancer in the USA: what factors are related?

Abstract

ObjectiveCervical cancer (International Federation of Gynecology and Obstetrics (FIGO)) stage IVA-B (distant stage) is a rare diagnosis with an approximate 5 year survival rate of 17% and with limited treatment options. The objective of this study was to determine the trends in distant stage cervical cancer in the USA and identify possible factors related to these trends.MethodsData were obtained from the United States Cancer Statistics program from 2001 to 2018. Rates of cervical cancer screening and vaccination were evaluated using the Behavioral Risk Factor Surveillance System and TeenVaxView. SEER*Stat 8.3.8.9.2 and Joinpoint regression program 4.9.0.0 were used to calculate incidence trends.ResultsOver the last 18 years, 29 715 women were diagnosed with distant stage cervical carcinoma. Black women have disproportionately higher rates at 1.55/100 000 versus 0.92/100 000 in White women (p<0.001). When examining the trends over time, there has been an annual increase in distant stage cervical cancer at a rate of 1.3% per year (p<0.001). The largest increase is seen in cervical adenocarcinoma with an average annual percent change of 2.9% (p<0.001). When performing an intersection analysis of race, region and age, White women in the South aged 40–44 have the highest rise in distant cervical cancer at a rate of 4.5% annually (p<0.001). Using the Behavioral Risk Factor Surveillance System and TeenVax data, compared with Black women, we found that White women have a nearly two-fold higher rate of missed or lack of guideline screening, 26.6% vs 13.8%. White teenagers (13–17 years) have the lowest human papillomavirus vaccination rate at 66.1% compared with others at 75.3%.ConclusionsBlack women have a higher incidence of distant stage disease compared with White women. However, White women have a greater annual increase, particularly in adenocarcinomas. Compared with Black women, White women also have lower rates of guideline screening and vaccination.

Systematic Reviews to Inform Practice, May/June 2023

“…Over half of new cervical cancers occur in those who have never been screened or were not screened in the last 5 years 3 . In recent years, cervical cancer survival rates have been stagnant, 4 and there has been an annual increase in advanced cervical cancers at time of diagnosis, particularly among White women in the South, although Black women have the highest rate of advanced disease diagnosis 5 . One of the reasons may be the increased rate of women not up to date on their cervical cancer screening, which increased from 14% in 2005 to 23% in 2019 6 .…”

Cervical cancer screening in menopause: when is it safe to exit?

“…The incidence of advanced-stage CC increased in the United States from 2001 to 2018, with higher rates in Black (1.55/100,000) than White (0.92/100,000) women. 10 In a multisite US study, inadequate screening was more common in regional (70.1%) and distant (68.5%) CC than localized (31.0%) CC. 14 Persons 55 years or older at diagnosis in three US states were more likely to have advanced-stage cancer than were younger patients.…”

“…Rates of advanced-stage CC are increasing and often associated with inadequate screening. The incidence of advanced-stage CC increased in the United States from 2001 to 2018, with higher rates in Black (1.55/100,000) than White (0.92/100,000) women 10 . In a multisite US study, inadequate screening was more common in regional (70.1%) and distant (68.5%) CC than localized (31.0%) CC 14 .…”

Pap smear recommendations in older women, does the data support stopping?

“…The increases are higher in older populations (seen primarily over age 44), reflecting a larger increase in adenocarcinoma in this age group. The increases are larger in White women, and they note that they have a higher risk of not having recommended screening and vaccination [6 ▪ ]…”