BACKGROUND AND PURPOSE:

• Amboree et al. (JAMA Network Open, 2025) assessed rural-urban disparities in cervical cancer incidence and mortality

METHODS:

• Cross-sectional study
• Population
  • Cervical cancer cases in National Program of Cancer Registries and Surveillance, Epidemiology, and End Results (NPCR-SEER) database
  • Between 2001 and 2019
• Exposures
  • Rurality
• Study design
  • Cervical cancer rates were corrected to account for hysterectomy prevalence
  • Joinpoint regression was used to calculate trends in incidence and derive annual percentage change (APC)
• Primary outcome
  • Annual incidence
  • Age-adjusted 5-year mortality rates per 100,000 women

RESULTS:

• Cervical cancer cases: 222,425
  • From urban counties: 84.3% | Non-Hispanic White: 59.9%
• Hysterectomy-corrected incidence rates
  • Rural counties: 11.9 per 100,000 women
  • Urban counties: 10.0 per 100,000 women
• After decreasing from 2001 to 2012, incidence increased in rural counties between 2012 to 2019
  • 2012 to 2019: APC 0.85% (95% CI, 0.08 to 2.05)
• Incidence also decreased in urban counties between 2001 and 2013, but plateaued from 2013 to 2019
  • 2013 to 2019: APC –0.03% (95% CI, –0.89 to 2.00)
• The gap between rural and urban incidence rates widened from 2013 to 2019
  • 2013: rate ratio 1.16 (95% CI, 1.10 to 1.22)
  • 2019: rate ratio 1.25 (95% CI, 1.19 to 1.31)
• During 2012 to 2019, among rural White women, cervical cancer incidence increased
  • 1.05% per year (95% CI, 0.24 to 2.33)
• Incidence also increased among non-Hispanic Black women, but this was not statistically significant
  • 9.07 (95% CI, –2.84 to 17.84)
• Incidence declined among rural Hispanic women
• Incidence declined or plateaued for all women in urban counties
• Mortality was higher in rural vs urban counties during 2015 to 2019
  • 1.42 (95% CI, 1.33 to 1.51)
• Compared with their urban counterparts, mortality among rural women was higher
  • Hispanic women: rate ratio 1.33 (59% CI, 1.12 to 1.58)
  • Black women: rate ratio 1.58 (95% CI, 1.32 to 1.90)
  • White women: rate ratio 1.54 (95% CI, 1.43 to 1.67)

CONCLUSION:

• The incidence of cervical cancer cases has recently risen by 0.85% per year among rural women, especially rural White women
• Both incidence and mortality were higher among rural vs urban counties
• The authors state

The increase in incidence and mortality in rural US counties may reflect lower screening coverage and lower utilization of diagnostic and therapeutic care, likely resulting from heightened access barriers experienced in rural areas

Additionally, if unaddressed, lower human papillomavirus (HPV) vaccine uptake in rural areas may contribute to further widening disparities in the future

Learn More – Primary Sources:

Rural-Urban Disparities in Cervical Cancer Incidence and Mortality Among US Women