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Grand Rounds

How Have Distant Stage Cervical Cancer Trends in the US Changed Over the Past 18 Years?

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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?

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Related ObG Topics:

Guidance Update: Professional Organizations Align on Cervical Cancer Screening
Has the Pandemic Impacted Cervical Cancer Diagnoses?
What is the Most Efficient Method for Cervical Cancer Screening?
Classifying Cervical Cancer: A Genomic and Molecular Approach
Why Have Cervical Cancer Screening Rates Decreased Over the Past Decade in the US?

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