The earlier decline in cervical cancer incidence is beginning to reverse in low-income US counties and stagnate in high-income counties


Newswise – The incidence of cervical cancer is beginning to rise in low-income U.S. counties and has plateaued in recent years after years of decline in high-income counties, according to a new study led by researchers at the University of Texas Health Science Center in Houston ( UTHealth Houston) and published in JNCI Cancer Spectrum.

Cervical cancer is one of six major cancers associated with the human papillomavirus (HPV) and the only one currently preventable through screening. The other types of HPV-associated cancers are oropharyngeal, anal, penile, vaginal, and vulvar cancer. According to the Centers for Disease Control and Prevention, more than 46,000 HPV-related cancers are diagnosed in the United States each year — over 25,000 in women and 20,000 in men.

Researchers led by Ashish A. Deshmukh, PhD, MPH, Associate Professor in the Department of Management, Policy and Community Health at the UTHealth School of Public Health, conducted a retrospective study of men and women in the United States beginning in 2000, diagnosed with HPV-associated cancers through 2018 across the 21 Surveillance, Epidemiology, and End Results program registries. They estimated incidence trends using county-level household income and smoking prevalence. 252,648 cases of HPV-associated cancer were included in the analysis.

In the lowest-income counties, the annual percentage increase for cervical cancer was 1.6% between 2011 and 2018, while no change (0% per year) was observed in the highest-income counties over the same period, the researchers reported.

The study found that people living in counties with low household incomes or high smoking rates had rapid increases in oropharyngeal, anal and vulvar cancers compared to their counterparts. Low household income and high smoking rates were not associated with changes in the incidence of vaginal or penile cancer.

“Our finding that cervical cancer rates are rising again in disadvantaged counties is sobering,” Deshmukh said. “We have two evidence-based interventions for cervical cancer. Cervical cancer screening and HPV vaccination could eliminate almost all HPV-associated cancers. Rapid and targeted improvements in HPV vaccine delivery, uptake of cervical cancer screening, and adherence to screening guidelines and follow-up are urgently needed to address the growing disparity,” he added.

“Smoking is an important risk factor for HPV-associated cancers. Our study underscores the importance of increasing the emphasis on smoking cessation efforts to curb the rising burden of these cancers,” said Yueh-Yun Lin, MS, the study’s first author and a graduate student at the UTHealth School of Public Health.

UTHealth co-authors include Haluk Damgacioglu, PhD; Ryan Suk, PhD; Yenan Zhu, MS; and Kalyani Sonawane, PhD. Chi-Fang Wu, PhD, from the University of Texas MD Anderson Cancer Center; Ana P. Ortiz, PhD, MPH, from the University of Puerto Rico Comprehensive Cancer Center; and Sehej Kaur Hara, MPH, BDS, of the City of Houston Health Department, also contributed to the study.

Deshmukh is associate director of the Center for Health Services Research and co-director of the Clinical Analytics and Decision Science Lab at the UTHealth School of Public Health.

The study, entitled Trends in the incidence of human papillomavirus-associated cancers by County-Level Income and Smoking Prevalence in the United States, 2000-2018, was recognized by the National Cancer Institute Awards (R01CA232888 and U54CA096300) and the National Institute on Minority Health Supports and Health Disparities (K01MD016440).

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