BACKGROUND AND PURPOSE:

• Stage IVA-B (distant stage) cervical cancer has poor long-term outcomes and related trends are generally not well studied
• Francoeur et al. (International Journal of Gynecologic Cancer, 2022) sought to determine the trends for distant stage cervical cancer in the US and identify possible related factors

METHODS:

• Population cohort study
• Population
  • US Cancer Statistics program from 2001 to 2018
• Study design
  • Rates of cervical cancer screening and vaccination were evaluated using the Behavioral Risk Factor Surveillance System and TeenVax data
  • Regression analysis was used to calculate incidence trends
• Primary outcome
  • Trends of distant stage cervical cancer rates over the last 18 years

RESULTS:

• 31 million cancer cases during the study period
• Diagnoses of distant stage cervical cancer: 29,715 women
• Black vs White women have disproportionately higher rates of distant stage diagnoses (P<0.001)
  • Black women: 1.55 per 100,000 cases
  • White women: 0.92 per 100,000 cases
• There has been an annual increase in distant stage cervical cancer
  • Increase of 1.03% per years (P<0.001)
• The largest increase is seen in cervical adenocarcinoma
  • Average annual percent change: 2.9% (P<0.001)
• When performing an intersection analysis of race, region and age
  • White women in the South, 40 to 44 years of age, had the highest rise in distant cervical cancer
  • Annual increase: 4.5% (P<0.001)
• White vs Black women have a nearly two-fold higher rate of missed or lack of guideline screening
  • White women: 26.6%
  • Black women: 13.8%
• White teenagers (13 to 17 years) have the lowest HPV vaccination rate vs other groups
  • White teenagers: 66.1%
  • Others: 75.3%

CONCLUSION:

• Over the past 18 years, Black women experienced the highest incidence of distant stage cervical cancer
• However, White women experienced the greatest annual increase in distant stage diagnoses, especially in adenocarcinomas
• White women also had lower rates of screening adherence, and HPV vaccination, compared to Black women
• The authors state

While rates of early-stage cervical cancer have fallen, distant stage cancer is on the rise in White and Black women, a finding most pronounced in adenocarcinoma subtypes. 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 

Learn More – Primary Sources:

The increasing incidence of stage IV cervical cancer in the USA: what factors are related?