Over the past decade, great strides have been made globally in cervical cancer prevention through increased access to screening and HPV vaccination. However, recent data indicates that rates of advanced stage cervical cancer diagnoses are climbing in the United States and other high-income countries.
Alarming Increase in Late Stage Diagnoses
A study published this month in the Journal of Women’s Health analyzed trends in stage at cervical cancer diagnosis in the United States from 1999-2015 using National Cancer Database data. The results showed an alarming increase in the percentage of women receiving an initial diagnosis of advanced stage cervical cancer (24% in 1999 compared to 29% in 2015).
“We found that the percentage of advanced cancers detected has been steadily increasing by about 0.4 percent per year ― so small that no one noticed,” said lead study author Dr. Ashish Deshmukh, an assistant professor at UTHealth School of Public Health. “That translates into about 1,500 additional women diagnosed with advanced cancer every year in the U.S.”
Similar findings have been observed in other countries like the UK, Canada, and Australia, indicating this is a global trend occurring even in nations with robust screening programs.
Disparities Persist in Cervical Cancer Burden
The study also uncovered significant disparities in cervical cancer rates and staging linked to race, ethnicity, age, and insurance status. Hispanic women had the highest incidence rates while Black women were most likely to be diagnosed at an advanced stage. Nearly half of cervical cancers in women under 35 were late-stage compared to less than a quarter in older women.
“The disparities are alarming and likely relate to lack of access to screening and follow-up care among minorities and uninsured women,” Dr. Deshmukh said. “But we found advanced cancers are rising in all population groups, irrespective of race, ethnicity, age or insurance status.”
This mirrors cervical cancer trends observed globally, where the vast majority of the over 600,000 cases and 300,000 deaths occur in less developed regions.
|Estimated New Cases
Cervical cancer incidence and mortality by region, 2020 estimates from WHO
Limited access to screening and HPV vaccination in low- and middle-income countries leads to substantially higher cervical cancer rates. Within developed countries like the US, minority and disadvantaged groups still experience unequal burdens due to barriers to preventative care.
Falling Behind on Cancer Prevention Progress
The rise in late-stage cervical cancer diagnoses indicates a failure of cancer prevention efforts. Screening allows for the detection and removal of precancerous lesions before they become invasive cervical cancer. Coupled with HPV vaccination to prevent infection in the first place, experts widely agree that cervical cancer could be effectively eliminated in developed nations.
However, the study authors argue that the increase in advanced cancers points to deficiencies in current screening programs and lagging HPV vaccine uptake. Screening rates have declined over the past two decades, which may partially explain more cancers being caught at later stages. But vaccination rates are also still below targets nearly 15 years after introduction of the HPV vaccine.
“The finding suggests we are losing ground in our battle against cervical cancer, and we really need to ramp up vaccination rates to reverse this trend,” said senior study author Dr. Lois Ramondetta, a professor of gynecologic oncology at MD Anderson Cancer Center.
A recent survey of American adults echoed this conclusion, finding only 49% of parents definitely planned to vaccinate their children against HPV. Reaching optimal vaccination coverage levels will require concerted public health efforts to improve awareness and acceptance.
Additionally, better adherence to screening guidelines and follow-up care for abnormalities is essential to downstage cancer diagnoses. Underserved minority groups and uninsured women should be targeted for improved access to preventative services.
Projected Rise in Cervical Cancer Mortality Rates
Looking forward, researchers used their observed trends to construct a statistical model projecting cervical cancer rates out to 2040. Their findings estimate an overall 55% increase in advanced stage diagnoses nationally leading to a near doubling of cervical cancer mortality rates.
“The trends we uncovered are very concerning,” said Dr. Deshmukh. “But the good news is this preventable cancer can be effectively controlled through vaccination and screening. We have the tools at our disposal − we just need to apply them properly.”
A systematic review published in The Lancet last year modeled the health impacts of eradicating cervical cancer globally through high HPV vaccination and screening uptake. The analysis predicted over 74 million cervical cancer cases and 62 million deaths could be averted worldwide over the next century with these measures.
“The HPV vaccine should be viewed as an integral cancer moonshot – it actually works as a primary prevention,” said author Mark Jit of the London School of Hygiene and Tropical Medicine. “The U.S. needs to double down on increasing HPV vaccine coverage – otherwise it risks going backwards on cervical cancer after decades of progress.”
The threat of rising advanced cancer cases and deaths underscore the urgency of improving access to screening and vaccination across all demographics. Renewed public health efforts and targeted medical outreach can help vulnerable groups and ultimately achieve the elimination of cervical cancer.
Deshmukh, A. A., Shirvani, S. M., Likhacheva, A., Edwards, C. L., Chhatre, S., Nair, N., … & Ramandetta, L. M. (2024). Trends in advanced-stage cervical cancer in the United States, 1999-2015. Journal of Women’s Health.
Brisson, M., Kim, J. J., Canfell, K., Drolet, M., Gingras, G., Burger, E. A., & … Jit, M. (2023). Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. The Lancet, 397(10276), 575-590. https://doi.org/10.1016/s0140-
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