Study: Spike in New Annual Cases of Advanced Cervical Cancer Seen Among White Women Less Likely to Have HPV Vaccine

Overall rates of early-stage cervical cancer in the United States have been falling, but cases with advanced disease are continuing to rise.

The most significant increases in new cases of advanced cervical cancer in the United States were observed among White women, who were found significantly less likely to have received a human papillomavirus (HPV) vaccine or to even be screened for the disease.

Further, prevalence of HPV is highest among Black women, especially those in their mid to late 50s and living in the South, with rates nearly twice those of their White peers, according to research published online in the International Journal of Gynecological Cancer.

In the advanced stage of cervical cancer (stage IVA-B), the disease has spread beyond the pelvis to the bladder/rectum and/or other parts of the body. Only approximately 17% of those diagnosed with advanced cervical cancer will survive at least 5 years compared with 92% of those diagnosed with early-stage disease.

The overall rates of early-stage cervical cancer in the United States have been falling, but those with advanced disease have been continuing to rise. The research team used cervical cancer data submitted to the United States Cancer Statistics program and national survey findings on screening and vaccination for 2001-2018.

During this time, 29,715 women were diagnosed with advanced disease. The rate was then adjusted, and the rate of advanced disease was much higher among Black women than among White women (1.55/100,000 of the population compared with 0.92/100,000).

The highest number of cases were diagnosed in the South at 1.17/100,000 followed by the Midwest at 0.93/100,000, the Northeast at 0.87/100,000, and the West at 0.82/100,000. The group most at risk were Black women 55 to 59 years of age living in the South with a rate of 2.61/100,000, which is nearly double the White population in the South.

The examination of trends over time showed that cases of early-stage disease fell by an annual rate of 1.6%, but cases of advanced disease increased by nearly 1.5% annually, with new cases of cervical adenocarcinoma making up just under 3%. The increasing rates of obesity and older age at first birth could be a contributing factor to the rise in this type of cervical cancer, according to the researchers.

The steepest annual rise in cases was among White women 40 to 44 years of age in the South, with a rate of 4.5%. In comparison with Black women, White women were nearly twice as likely not to be screened in line with clinical guidelines and subject to a gap of 5 or more years between Pap smear tests.

HPV vaccination uptake was lowest among White 13- to 17-year-olds, two-thirds of whom were vaccinated compared with three-fourths of those from other ethnic backgrounds. Further, the steepest annual increase in vaccination rates was among Black teens.

The researchers noted that the lack of a national screening and vaccination registry in the United States caused them to rely on multiple sources of data, and inaccuracies may have risen due to the datasets relying on personal recall.

“Even with screening and vaccination, there is not one racial/ethnic group, region in the USA, or age group where distant stage cervical cancer has been decreasing over the last 18 years,” the researchers said in the press release. “Over 90% of cervical cancer is caused by HPV; the lower rate of vaccination in White women, coupled with non-guideline screening in this population could explain the trend toward the higher rate of increase in distant disease in White women. This challenges the idea that Black and Hispanic women have higher rates of distant stage diagnosis due to lower access to screening.”

The research team added that this finding demonstrates the public health movement to vaccinate more young girls and women.

REFERENCE

Steepest annual rise in advanced cervical cancer in US among White women. BMJ. August 22, 2022. Accessed August 22, 2022. https://www.bmj.com/company/newsroom/steepest-annual-rise-in-advanced-cervical-cancer-in-us-among-white-women/