US hysterectomy prevalence by age, race and ethnicity from BRFSS and NHIS: implications for analyses of cervical and uterine cancer rates

Adam, Emily; White, Mary C.; Saraiya, Mona

doi:10.1007/s10552-021-01496-0

Cited by 19 publications

(8 citation statements)

References 18 publications

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“…Fifth, hysterectomy prevalence among certain smaller subpopulations may not accurately reflect population approximations 22 . However, we do not anticipate this to have significantly impacted our findings as BRFSS is known to provide a robust representation of various subgroups and is acknowledged as the most reliable data for estimating hysterectomy prevalence within smaller subpopulations 23 . Finally, we did not include a “Non‐Hispanic other” racial/ethnic group given the sparse number of annual cervical cancer cases in this group and the large variation in cervical cancer incidence that was observed when this group was disaggregated 24 .…”

Section: Discussionmentioning

confidence: 99%

“…However, it is not clear why cervical cancer mortality rates among Non- 22 However, we do not anticipate this to have significantly impacted our findings as BRFSS is known to provide a robust representation of various subgroups and is acknowledged as the most reliable data for estimating hysterectomy prevalence within smaller subpopulations. 23 Finally, we did not include a "Non-Hispanic other" racial/ethnic group given the sparse number of annual cervical cancer cases in this group and the large variation in cervical cancer incidence that was observed when this group was disaggregated. 24 Despite these limitations, our study's principal strength is the use of highquality, population-based registries which allowed us to provide a comprehensive description of disparities in cervical cancer incidence by county-level income and race/ethnicity.…”

Section: Factors Underlying Increased Cervical Cancer Incidence Amongmentioning

confidence: 99%

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Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county‐level income in the United States, 2000–2019

Amboree,

Damgacioglu,

Sonawane

et al. 2024

Intl Journal of Cancer

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Early evidence suggests that declining cervical cancer incidence reversed in low‐income regions in the United States in recent years; however, it is unclear whether there are distinct patterns by race/ethnicity and stage at diagnosis and if the increase has translated into rising mortality. Using Surveillance, Epidemiology, and End Results data, we evaluated trends in hysterectomy‐corrected cervical cancer incidence rates (2000–2019) and mortality rates (2005–2019) by county‐level income and race/ethnicity, with further stratification of incidence by stage at diagnosis. Following a period of decline, hysterectomy‐corrected cervical cancer incidence increased 1.0%/year (95% CI = 0.1% to 4.5%) among Non‐Hispanic White women in low‐income counties. Particularly, a statistically significant 4.4%/year (95% CI = 1.7% to 7.5%) increase in distant‐stage cancer occurred in this group. Additionally, recent increases in cervical cancer mortality (1.1%/year [95% CI = −1.4% to 3.7%]) were observed among this group and Non‐Hispanic Black women in low‐income counties (2.9%/year [95% CI = −2.3% to 18.2%]), but trends were not statistically significant. Among Hispanic women in low‐income counties, distant‐stage cervical cancer incidence increased 1.5%/year (95% CI = −0.6% to 4.1%), albeit not statistically significant. The increasing incidence of distant‐stage cervical cancer and mortality in specific racial/ethnic groups suggests that the recent introduction of higher sensitivity screening tests may not explain increasing trends in low‐income counties. Our findings suggest that the observed rise in cervical cancer incidence may reflect disruptions along the screening and treatment continuum. Future research to further comprehend these trends and continued enhancements in prevention are crucial to combat rising cervical cancer incidence and mortality in low‐income counties in the United States.

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Section: Discussionmentioning

confidence: 99%

Section: Factors Underlying Increased Cervical Cancer Incidence Amongmentioning

confidence: 99%

Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county‐level income in the United States, 2000–2019

Amboree,

Damgacioglu,

Sonawane

et al. 2024

Intl Journal of Cancer

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“…Since 1996, the USPSTF has recommended that women who have undergone a hysterectomy with removal of the cervix for benign disease do not need cervical cancer screening . Estimates from self-reported health surveys indicate that about 40% of women report having undergone a hysterectomy by age 65 years, and more than half of women reporting previous hysterectomy for benign reasons also report a Papanicolaou test during the past 3 years . Service use rates are assumed to be higher among women who have not undergone a hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

et al. 2023

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ImportanceSince 1996, the US Preventive Services Task Force has recommended against cervical cancer screening in average-risk women 65 years or older with adequate prior screening. Little is known about the use of cervical cancer screening–associated services in this age group.ObjectiveTo examine annual use trends in cervical cancer screening–associated services, specifically cytology and human papillomavirus (HPV) tests, colposcopy, and cervical procedures (loop electrosurgical excision procedure, cone biopsy, and ablation) in Medicare fee-for-service beneficiaries during January 1, 1999, to December 31, 2019, and estimate expenditures for services performed in 2019.Design, Setting, and ParticipantsThis population-based, cross-sectional analysis included health service use data across 21 years for women aged 65 to 114 years with Medicare fee-for-service coverage (15-16 million women per year). Data analysis was conducted between July 2021 and April 2022.Main Outcomes and MeasuresProportion of testing modalities (cytology alone, cytology plus HPV testing [cotesting], HPV testing alone); annual use rate per 100 000 women of cytology and HPV testing, colposcopy, and cervical procedures from 1999 to 2019; Medicare expenditure for these services in 2019.ResultsThere were 15 323 635 women 65 years and older with Medicare fee-for-service coverage in 1999 and 15 298 656 in 2019. In 2019, the mean (SD) age of study population was 76.2 (8.1) years, 5.1% were Hispanic, 0.5% were non-Hispanic American Indian/Alaska Native, 3.0% were non-Hispanic Asian/Pacific Islander, 7.4% were non-Hispanic Black, and 82.0% were non-Hispanic White. From 1999 to 2019, the percentage of women who received at least 1 cytology or HPV test decreased from 18.9% (2.9 million women) in 1999 to 8.5% (1.3 million women) in 2019, a reduction of 55.3%; use rates of colposcopy and cervical procedures decreased 43.2% and 64.4%, respectively. Trend analyses showed a 4.6% average annual reduction in use of cytology or HPV testing during 1999 to 2019 (P &lt; .001). Use rates of colposcopy and cervical procedures decreased before 2015 then plateaued during 2015 to 2019. The total Medicare expenditure for all services rendered in 2019 was about $83.5 million. About 3% of women older than 80 years received at least 1 service at a cost of $7.4 million in 2019.Conclusions and RelevanceThe results of this cross-sectional study suggest that while annual use of cervical cancer screening–associated services in the Medicare fee-for-service population older than 65 years has decreased during the last 2 decades, more than 1.3 million women received these services in 2019 at substantial costs.

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“…By age 60 years, roughly one of three women has undergone hysterectomy. 3,4 Hysterectomy without oophorectomy is a common clinical practice when it is being performed for benign indications. 5 Therefore, a majority of women who undergo hysterectomy before age 50 years continue to produce estrogen and are premenopausal despite the absence of menses.…”

mentioning

confidence: 99%

“…In the United States, the Centers for Disease Control and Prevention reports that approximately 600,000 hysterectomies are performed in the United States each year. By age 60 years, roughly one of three women has undergone hysterectomy 3,4 . Hysterectomy without oophorectomy is a common clinical practice when it is being performed for benign indications 5 .…”

mentioning

confidence: 99%

Is it time to rethink how menopause is defined?

Streicher

2023

Menopause

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US hysterectomy prevalence by age, race and ethnicity from BRFSS and NHIS: implications for analyses of cervical and uterine cancer rates

Cited by 19 publications

References 18 publications

Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county‐level income in the United States, 2000–2019

Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county‐level income in the United States, 2000–2019

Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

Is it time to rethink how menopause is defined?

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