A Troubling Spike in Advanced Cervical Cancer Is Likely to Worsen

Andrew M. Kaunitz, MD


September 07, 2022

This transcript has been edited for clarity.

As women's health clinicians, we can be proud of the success that cervical cancer screening has had in reducing the incidence of and mortality from cervical cancer. Likewise, HPV vaccination has reduced the incidence of cervical cancer in countries such as Sweden, where vaccination uptake has been higher than in the United States.

In developed countries including the United States, most cervical cancer is diagnosed early, with corresponding 5-year survival rates > 90%. In contrast, advanced cervical cancer is associated with 5-year survival of only 17%.

In a new study, investigators used national databases to assess 2001-2018 trends in the incidence of invasive cervical cancer among US women, self-reported cervical cancer screening, and rates of HPV vaccination among teens. Advanced cervical cancer was defined as FIGO stage IV disease.

The overall incidence of advanced cervical cancer increased 1.3% each year from 2001 to 2018.

Although Black and Hispanic women were noted to have higher rates of advanced disease, the incidence of advanced cervical cancer increased more than twice as fast among White women, with the most rapid rise noted among White women in their 40s residing in the South. Adenocarcinoma of the cervix increased more rapidly than squamous cancers.

While the proportion of women with non-guideline screening (defined as last Pap more than 5 years ago) increased in all race and ethnic groups, the prevalence of inadequate screening was almost twice as high in White women compared with Black women. While the prevalence of HPV vaccination increased across the board, no group exceeded a vaccination prevalence of 80%.

Compared with squamous tumors, screening is less effective in the early detection of cervical adenocarcinoma, and nulliparity and obesity are known risk factors for this type of tumor. The increasing prevalence of obesity as well as age at first birth among US women may help explain increases in this type of cervical cancer.

White parents are more likely to report HPV vaccination safety concerns as reasons for not vaccinating their children. Along with the higher prevalence of inadequate screening, this likely explains the faster increase in advanced cervical cancer among White women.

One can speculate that the trend of clinicians, particularly primary care providers, performing fewer pelvic examinations might have led to more women falling through the cracks with respect to cervical cancer screening.

Because this study ended in 2018, it did not include the years of the pandemic, during which fewer women have come in for screening. This means that the concerning trends observed in this report have likely worsened in recent years.

As women's health clinicians, we can respond to the increasing incidence of advanced cervical cancer by being proactive in educating women and facilitating both screening and HPV vaccination. I find that a particularly effective time for educating patients regarding the value of HPV vaccination for their children or grandchildren is when I am performing colposcopy.

A last point is that research to improve screening for adenocarcinoma of the cervix is urgently needed.

I am Andrew Kaunitz. Please take care of yourselves and each other.

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