White Women Lag Behind On Cervical Cancer Screening And HPV Vaccination

A new study has discovered that the steepest annual rise of diagnoses of advanced cervical cancer is in white women. Early-stage cervical cancer diagnoses have been falling by around 1.6% per year, but the number of people diagnosed at advanced stages has been rising by 1.5% a year, puzzling researchers.

Cervical cancer if caught early is quite treatable, with 92% of people surviving five years or more after diagnosis. But a person diagnosed with advanced cervical cancer, which has spread out of the pelvis and to other areas of the body, such as the bladder, stomach or more distant organs, has only around a 17% chance of surviving five years or more after diagnosis.

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Despite the steeper rise in cases of advanced cancer in white women, the study published in the International Journal of Gynecological Cancer found that Black women remain more likely to be diagnosed with the disease, with 1.55 cases per 100,000 people compared to 0.92 cases/100,000 for white women. The research also looked at geographical differences between diagnosis rates, finding that the South had the highest frequency of advanced cervical cancer diagnoses at 1.17/100,000, compared to 0.82-0.93/100,000 in other areas studied.

“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,” note the researchers in their paper.

The typical person at most risk was a 55-59 year-old Black woman living in the South, with a rate of advanced cancer nearly double that of White women in the South. However processing the data taking into account race, geographical region and age showed that the steepest annual rise in cases was among white 40-44 year olds in the South, with a rate of 4.5%.

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The researchers are not able to directly conclude what might be responsible for this increase in the rate of advanced cervical cancer diagnoses in all ethnicities, but they suggest that increasing rates of obesity and older age at first birth could be contributing to the rise in this type of cervical cancer. For white women, a lower uptake of the HPV vaccine and lower adherence to cervical screening recommendations may also be responsible.

The virus HPV is responsible for 9 out of 10 cases of cervical cancer and vaccination campaigns have already resulted in dropping rates in younger women. Additionally, screening including pap smears and tests which look for HPV can lead to early diagnosis and even removal of pre-cancerous cells before they become problematic.

The study found that 26.5% of white women didn’t get cervical cancer screening at all, or did not keep up with recommended clinical guidelines of a pap test every 5 years compared to just 14% of Black women. The lowest uptake of HPV vaccination was in white teens between the age of 13-17 with just two-thirds getting the HPV vaccine, compared to three quarters of non-white teenagers.

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“Over 90% of cervical cancer is caused by HPV; the lower rate of vaccination in white women, coupled with non-guideline screening in this population could explain the trend toward the higher rate of increase in distant disease in white women,” note the researchers in the paper also noting that their findings challenge the idea that Black and Hispanic women have higher rates of distant stage diagnosis due to lower access to screening.

The researchers conclude by urging a higher uptake of the HPV vaccine in girls and women to further drive down cervical cancer diagnoses and deaths.