Previous decline in cervical cancer incidence begins to reverse in low-income U.S. counties and stall in high-income counties

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

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

Investigators led by Ashish A. Deshmukh, PhD, MPH, associate professor in the Department of Management, Policy and Community Health at UTHealth School of Public Health, conducted a retrospective study of men and women diagnosed with HPV-associated cancers in the U.S. from 2000 through 2018 in the 21 registries in the Surveillance, Epidemiology, and End Results program. They estimated incidence trends according to county-level household income and smoking prevalence. There were 252,648 cases of HPV-associated cancers 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 was observed (0% per year) in the highest-income counties during the same period, the researchers reported.

The study found that among persons living in counties with low household income or high smoking rates, oropharyngeal, anal, and vulvar cancers rose rapidly 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 incidence is escalating again in disadvantaged counties is sobering,” said Deshmukh. “We have two evidence-based interventions for cervical cancer.  Cervical cancer screening and HPV vaccination could eliminate nearly all HPV-associated cancers. Rapid and targeted improvements in HPV-vaccine administration, cervical cancer screening uptake, and adherence to screening guidelines and follow-up are urgently needed to combat the widening disparities,” he added.       

“Smoking is an important risk factor for HPV-associated cancers. Our study highlights the importance of increased emphasis on smoking cessation efforts to curb the rising burden of these cancers,” said Yueh-Yun Lin, MS, the study’s first author, and doctoral student at 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, of The University of Texas MD Anderson Cancer Center; Ana P. Ortiz, PhD, MPH, of 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 the associate director of the Center for Health Services Research and co-director of the Clinical Analytics and Decision Science Lab at UTHealth School of Public Health.

The study titled “Trends in the incidence of human papillomavirus-associated cancers by county-level income and smoking prevalence in the United States, 2000-2018” was supported by National Cancer Institute Awards (R01CA232888 and U54CA096300) and the National Institute on Minority Health and Health Disparities (K01MD016440).

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