Chokniti Khongchum/Pixabay” alt=”The steepest increase in advanced cervical cancer occurs in white women who have not received HPV vaccination and whose screening tests have not been up to date. Photo of Chokniti Khongchum/Pixabay“/>
New research points to a conundrum in cervical cancer: While rates of early-stage disease have fallen in the United States since the human papillomavirus (HPV) vaccine was introduced, advanced cases are on the rise.
Which women are hit the hardest? The steepest increase in advanced cervical cancer occurs in white women who have not received the HPV vaccine and who have not been up to date with their screening tests, a finding that suggests the vaccine works but more women are getting the vaccines have to get.
The HPV vaccine was approved by the US Food and Drug Administration in 2006 and protects against certain strains of HPV, the most common sexually transmitted infection in the United States. HPV has been linked to several types of cancer, including cervical, vaginal, vulvar, head and neck, anal, and penile cancer. Anyone between the ages of 9 and 45 can get the HPV vaccine.
“In previous research, we have seen a greater reduction in cervical cancer in women who would have been vaccine-eligible, indicating a possible association between the vaccine and cervical cancer rates,” said study author Dr. Alex Andrea Francoeur, obstetrician-gynecologist at the University of California, Los Angeles.
But HPV vaccination rates still lag behind other childhood vaccinations, Francoeur noted.
For the study, researchers analyzed data on cervical cancer from the US Cancer Statistics Program and national screening and immunization survey results from 2001 to 2018. During that period, 29,715 women were diagnosed with advanced cervical cancer. Overall, the rate of advanced cervical cancer increased by almost 1.5% each year, the researchers found.
When cervical cancer is advanced and has spread, it is much more difficult to cure. Only about 17% of women diagnosed with it will survive at least five years, compared to 92% of women diagnosed with early-stage cervical cancer, Francoeur noted.
Black women ages 55 to 59 living in the South were the most likely to be diagnosed with advanced cervical cancer, but the largest increase — a rate of 4.5% — was seen in white women ages 40 to 44 from the South , as the results showed.
Compared to black women, white women were almost twice as likely to not be screened for cervical cancer at all or not according to guidelines, the study showed. HPV vaccination rates were lower in these women. The largest increase in cases was in adenocarcinoma, a subtype of cervical cancer.
“We are confident that overall HPV vaccination will reduce the overall incidence of cervical cancer in the United States,” Francoeur said. “I think we need to continue exploring how to study our underinsured, rural and minority populations and continue to educate people about the importance of vaccination.”
The new study was published online Thursday in the International Journal of Gynecological Cancer.
dr Stephanie Blank is Director of Gynecologic Oncology at Mount Sinai Health System in New York City.
When the cervical cancer vaccine known as Gardasil was first introduced, there was slow acceptance, she noted.
“Cervical cancer takes years to develop, so we’re not seeing the full effect of the HPV vaccine here,” Blank explained.
Not enough people are getting vaccinated and those who do get vaccinated are not young enough when they get the shots, she said. Ideally, people should be vaccinated before they are ever exposed to HPV, which most commonly occurs in their late teens and early 20s.
“More vaccinations for all genders and at younger ages should reverse this trend,” Blank said.
Other ways to turn things around include programs to educate people about the HPV vaccine and to ensure systems are in place so people from underserved and underserved communities have access to immunization and cervical cancer screening programs, she said.
The US Centers for Disease Control and Prevention has more on the HPV vaccine.
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