Although the overall rate of cervical cancer is decreasing in the United States, this downward trend is driven by decreasing rates of early stage disease, whereas the rates of advanced disease are increasing.
A new study has shown that Black women have a higher incidence of advanced disease compared with White women, but also found that White women have a greater annual increase. The sharpest increase in advanced disease (of 4.5% annually) was seen among White women in the South aged 40-44 years.
In addition, the study found that White women are less likely to be screened for cervical cancer. Compared with Black women, White women were nearly twice as likely (26.% vs 13.8%) to report no cervical cancer screening in the past 5 years.
"This challenges the idea that Black and Hispanic women have higher rates of distant stage diagnosis due to lower access to screening," the authors write.
Approached for comment, Kyle Bukowski, MD, chief medical officer at Planned Parenthood of Maryland, said the findings suggest that socioeconomic disparities are worsening among White women.
"To me what this is saying is that White women are facing similar socioeconomic impacts in their communities and access to education, vaccination, and screening that historically Black and Brown communities have had based," said Bukowski, who was not involved in the research. "This tells me that socioeconomic disparity is getting worse and it's encompassing even more populations."
"To me, these advanced cases are telling a story that there is still an inherent issue in people having the ability to participate in regular screening," Bukowski said.
"There is something here in the accessibility of that testing…not having a way or system to provide reminders to people not understanding the importance of cervical cancer screening, and that this is a completely preventable disease," he added.
The findings were published recently in the International Journal of Gynecological Cancer.
For the study, researchers analyzed data from the United States Cancer Statistics program from 2001-2018. They identified 29,715 patients diagnosed with advanced-stage cervical cancer during that period (63% were White, 18.3% Black, 13.5% Hispanic, 4.1% were Asian, and the rest were other or unknown).
Overall, there was an increase in advanced cervical cancer of 1.3% per year. This contrasts with the decrease seen in the diagnosis of early stage cervical cancer of 1.6% annually.
Based on region, the South had the largest increase with an annual increase of 2.1%, followed by the Northeast of 1.4%.
The South also had the most women diagnosed with advanced cervical cancer — 40% of all the cases were found here, compared with 21.3% in the West, 20.8% in the Midwest, and 18% in the Northeast.
The team also analyzed data on HPV vaccination, which offers protection against cervical cancer. The researchers found that vaccinations rates were lowest, at 66.1%, among White teenagers aged 13-17 years, compared with Hispanics at 75.3%, Black teenagers at 74.6%, and Asians at 68.1%.
Lead author Alex Francoeur, MD, from the Department of Obstetrics and Gynecology at the University of California Los Angeles, speculated that White teen HPV vaccination rates are lower due to parent misconceptions.
"There's this concept that Caucasian parents are more likely to say 'this vaccine doesn't apply to my child' and so they have the preconceived notion that the HPV vaccine is [needed] if their child is having sex," Francoeur said. "There's also the preconceived notion that Caucasian parents are more likely not to believe in vaccines in general."
No specific funding was declared. The authors report no relevant financial relationships.
Int J Gynecol Cancer. Published online August 18, 2022. Abstract
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Cite this: Advanced Cervical Cancer on the Rise Among White Women in the US - Medscape - Nov 04, 2022.