BACKGROUND AND PURPOSE:

• Incidence of cervical cancer may have plateaued between 2012 and 2017
• A decline in cancer screening uptake has been reported, particularly among younger women
• Shahmoradi et al. (JAMA, 2022) evaluated calendar trends in cervical cancer incidence by age at diagnosis 

METHODS:

• Time series data analysis
• Data
  • National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) from 2001 to 2019
• Population
  • Cervical cancer cases
• Study design
  • Hysterectomy-corrected incidence trends were assessed by removing the proportion of women with hysterectomy from the denominator
  • For age groups with increasing incidence, trends were examined by race and ethnicity, stage, and histology
• Primary outcome
  • Incidence rates of cervical cancer
  • Trends in cases
  • Annual percentage changes (APCs) by 5-year age group

RESULTS:

• 227,062 reported cervical cancer cases
• Overall, hysterectomy-corrected cervical cancer incidence declined
  • 2001: 12.39 per 100,000
  • 2019: 9.80 per 100,000
  • APC −1.2% (95% CI, −1.6 to −0.9)
• Among women aged 30 to 34 years, after an initial decline from 2001 to 2012, incidence increased after 2012
  • 2001: 12.77 per 100,000
  • 2012: 10.14 per 100,000
  • 2019: 11.60 per 100,000
  • 2001 to 2012: APC −2.3% (95% CI, −2.8 to −1.7)
  • 2012 to 2019: APC 2.5% (95% CI, 1.4 to 3.6)
• Among this age group, hysterectomy-corrected cervical cancer incidence increased significantly for
  • Hispanic
    • APC 3.0% (95% CI, 0.3 to 5.7)
  • Non-Hispanic White
    • APC 2.8% (95% CI, 0.6 to 5.0)
  • Other racial and ethnic groups
    • APC 5.0% (95% CI, 2.7 to 7.4)
• The APC for Black women was relatively stable from 2012 to 2019
  • APC −0.8% (95% CI, −2.8 to 1.2)
• Increases occurred for
  • Localized stage cervical cancer
    • APC 2.8% (95% CI, 1.3 to 4.3)
  • Regional stage cervical cancer
    • APC 1.9% (95% CI, 0.7 to 3.1)
  • Squamous cell carcinoma
    • APC 2.6% (95% CI, 1.0 to 4.2)
  • Adenocarcinoma
    • APC 3.0% (95% CI, 0.9 to 5.1)

CONCLUSION:

• Cervical cancer rates declined or were stable from 2012 to 2019, except among women aged 30 to 34
  • Among this age group the incidence increased by 2.5% per year after 2012

Possible Explanations for the Increased Incidence Include Guideline Changes in 2012

• Co-testing (HPV and cytology): Could lead to increased detection of early-stage cancers 
• Increased screening interval: The authors state

In 2012, the US Preventive Services Task Force recommended an increase in screening interval in 21- to 65-year-old women with cytology every 3 years or in 30- to 65-year-old women with a combination of cytology and human papillomavirus testing every 5 years

Beginning in 2013, declines in screening participation among 21- to 29-year-old women were observed

Future studies are needed to assess factors that underlie the increase in cervical cancer incidence among 30- to 34-year-old women

Learn More – Primary Sources:

Cervical Cancer Incidence Among US Women, 2001-2019