The Alarming Trend in Advanced Cervical Cancer
Recent research has shown a steep increase in new cases of advanced cervical cancer among white Southern women, as well as a disproportionately high burden of late-stage cases among Black Southern women. This is particularly concerning, as early detection of cervical cancer through routine screening can lead to successful treatment and cure. In the United States, the five-year survival rate for early-stage cervical cancer is approximately 92%, whereas it is only 17% for late-stage cervical cancer.
Human Papillomavirus (HPV) and Its Link to Cervical Cancer
Human papillomavirus (HPV) is responsible for causing nine out of ten cervical cancers. It is estimated that in 2023, 13,960 women in the US will be diagnosed with cervical cancer, and 4,310 will succumb to the disease. Pap test screening plays a crucial role in early detection of cervical cancer, making it easier to treat. HPV testing has also been approved as an additional screening method for cervical cancer, either to be used alone or in conjunction with a Pap test.
Key Findings from the Recent Study
The study in question was published in the International Journal of Gynecological Cancer. Researchers analyzed cervical cancer data from the United States Cancer Statistics program, spanning from 2001 to 2018, along with national survey findings on Pap screening and HPV vaccination. During this period, nearly 30,000 women were diagnosed with late-stage cervical cancer, which had spread to other parts of the abdomen and body.
While early-stage cervical cancer cases have been decreasing for most groups in the US in recent years, advanced cervical cancer cases have not shown any decline across racial, ethnic, or age groups over the last 18 years. New diagnoses of advanced disease increased by 1.3% annually during the study period. Southern white women aged 40-44 experienced a 4.5% annual rise in advanced cases, while Southern Black women aged 55-59 had nearly twice as many early and advanced cases as their white counterparts.
Unraveling the Factors Behind the Rise in Late-Stage Cervical Cancer
The study revealed that women living in the South are less likely to be vaccinated against HPV or to undergo screening for cervical cancer. However, lower screening rates do not fully explain the increase in late-stage cases in that region. Dr. Ursula Matulonis, chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute, suggests that the rise in cases involving a more aggressive cell type called adenocarcinoma could be a contributing factor. This cell type, often found higher up in the cervical canal, is more difficult to detect with a Pap smear.
Older women are particularly vulnerable to late-stage cervical cancer, as rates are higher and survival rates lower among women aged 65 and older compared to younger women. This could be due to a lack of recommended screening tests with normal results before they stopped having Pap smears, as explained by Dr. Sarah Feldman, a gynecologic oncologist at Brigham and Women's Hospital.
The Protective Role of HPV Vaccination against Cervical Cancer
The HPV vaccine is FDA-approved for use in females aged 9 through 26. The first group of vaccinated adolescents, now in their 20s, have shown clear benefits: invasive cervical cancer rates among women aged 20 to 24 dropped by 3% each year from 1998 through 2012.
That's pretty impressive, and those decreases span race and ethnicity, which isn't always the case in women's cancers.
Dr. Ursula Matulonis
Proactive Steps to Guard Against Cervical Cancer
Dr. Feldman provides the following guidance for cervical cancer prevention and detection:
- HPV vaccination: All children should be vaccinated against HPV between the ages of 9 and 12, well before sexual activity begins. "The most important thing for future generations in cervical cancer prevention is vaccinating that generation," Dr. Feldman says.
- Routine screening: Regardless of vaccination status or whether they are sexually active, women should begin screening tests for cervical cancer in their 20s and continue through age 65. Consult with your doctor to determine the appropriate intervals for screening. Current guidelines, which take into account when you start screening and whether test results are normal, include:
- If you start at 21: Have a Pap test every three years until 30.
- If you start at 25: Seek an HPV test first.
- At age 30: If all screening tests so far have been normal, have HPV testing every five years. Continue this screening until age 65.
- Don't stop screening at 65 unless all test results are normal, including at least two results in the last 10 years and one in the last five years.
- If any testing led to abnormal results, you may need to continue screening beyond age 65.
An HPV infection, rather than sexual activity alone, is the factor that places people at risk for cervical cancer, according to Dr. Feldman.
A lot of older women may have a new sexual partner in their 50s. A new HPV infection raises the risk for cervical cancer roughly 20 years later, if HPV test results are persistently negative through age 65, the risk of developing cervical cancer in your 70s is low.
Dr. Sarah Feldman, MD
In conclusion, the rise in late-stage cervical cancer is a concerning trend that warrants attention. By understanding the contributing factors, such as HPV infection and inadequate screening, individuals can take proactive steps to protect themselves. Ensuring that children receive the HPV vaccine, adhering to routine screening guidelines, and maintaining open communication with healthcare providers are crucial measures to safeguard against the growing threat of advanced cervical cancer.
