Advanced cervical cancer on the rise, study finds: 'No easy explanation'

Late-stage cervical cancer rates are on the rise in the U.S. with the steepest increases in white women, although the prevalence of the disease is still highest in Black women, a new study finds.

An analysis of data from nearly 30,000 women diagnosed with advanced disease revealed that Black women had a prevalence rate nearly 60% higher than white women. Researchers found that advanced adenocarcinoma, the form with the lowest rate of overall survival, has increased at nearly twice the rate in white women as in Black women, according to the report published in the International Journal of Gynecological Cancer: 3.4% per year among white women compared to 1.71%, among Black women.

“Paradoxically, when we look at early stage cancer, we see that it has decreased, but when you look at stage IV metastatic cervical cancer, the opposite is true: The rates have increased,” said the study’s first author, Dr. Alex Francoeur, a fourth year OB-GYN resident at the University of California, Los Angeles.

“Unfortunately, there’s no easy explanation for how this can be improved.”

The steepest increase in the rates of late-stage cervical cancer, 4.5% per year, was in white women from the South, aged 40 to 44 — a group that would have been too old to have been vaccinated against HPV, the virus that can cause cervical cancer.

At least part of the explanation for the steep increase in late-stage cervical cancers in white women could be the lower rates of screening, Francoeur said. She and her colleagues found that compared with Black women, white women were nearly twice as likely to not have been screened at all or to not have been screened in line with clinical guidelines, which resulted in a gap of five or more years between Pap smears.

To take a closer look at trends in the rates of late-stage cervical cancer, Francoeur and her colleagues turned to data from 2001 to 2018 from the Centers for Disease Control and Prevention’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. Data on rates of cervical cancer screening came from the Behavioral Risk Factor Surveillance System, a national system of health-related telephone surveys.

Among the 29,715 women diagnosed with advanced-stage cervical cancer between 2001 and 2018, the prevalence was higher among Black women than white women: 1.55 per 100,000 versus 0.92 per 100, 000. The researchers found that overall there was an increase of 1.3% per year in late-stage cancers. The largest increase was in cervical adenocarcinomas, which rose at an annual percentage rate of 2.9% per year.

While the researchers weren’t able to look at the screening histories of the women who had late-stage cancers, it’s reasonable to assume that lack of screening is to blame, said Dr. Stephanie Blank, a professor at the Icahn School of Medicine at Mount Sinai and director of gynecologic oncology for the Mount Sinai Health System.

“It’s such a shame,” Blank said. “Unfortunately, this is a disease that disproportionately affects under-resourced and under-insured communities. We really need a system to help people to get both the vaccine and screening. Only by improving access to these lifesaving tools can these trends be turned around.”