Advanced stage cervical cancer: Who is at risk and is it related to screening and vaccination practices? (441)

Abstract

<b>Objectives:</b> Advanced-stage cervical cancer is challenging to treat and is usually a terminal diagnosis focusing on palliation, not cure. We aimed to examine the trends in advanced-stage cervical cancer and explore the groups where this diagnosis is increasing. We also looked at changes in cervical cancer screening and vaccination patterns to understand if there is a correlation between these trends. <b>Methods:</b> Data on cervical carcinoma incidence and rates were obtained from the U.S. Cancer Statistics program from 2001 to 2018. Rates of cervical cancer screening and HPV vaccination were evaluated using the Behavioral Risk Factor Surveillance System and TeenVaxView (BRFSS: 2001-2016, TeenVaxView: 2008-2016, 13-17 years olds). SEER*Stat 8.3.8 and Joinpoint regression program 4.8.0.1 were used to calculate incidence trends. Since all the data used in this study were derived from de-identified files, no institutional review board approval was required for this study. <b>Results:</b> The incidence of advanced cervical cancer was 0.94/100,000 in 2018. Non-Hispanic Black (NHB) women had the highest incidence of cervical cancer at 1.33/100,000. Between the years 2001 and 2018, advanced-stage cervical cancer had been on the rise in all women with an average annual percent change (AAPC) of 1.24% (p<0.001). When examining race, rates were stable in all groups except Non-Hispanic White (NHW) women, where there was an increase of 1.67% per year (p<0.001). The South had the largest increase of all regions in the US with an AAPC of 2.11% (p<0.001). NHW women in the South had the largest increase with an AAPC of 2.79% (p<0.001). Dividing age into five years age groups, 85% of the increasing rate were found in patients younger than 60 years. More specifically, those within the age range of 30-34 years had a 3.27% increase per year. When examining age, rates were increasing in most younger age groups less than 60 years, with the largest increase in the 30-34 years old age group at 3.27% (p<0.001). When performing an intersection analysis, NHW in the South aged 40-44 had the highest rise in advanced cervical cancer at a rate of 4.56% annually (p<0.001). Using the BRFSS data, we found that NHW women had the highest rates of non-guideline screening (last pap smear > 5 years ago) at 26.65%, almost double compared to NHB women at 13.79%. The suboptimal screening had been increasing in all racial groups at 6.1% annually (p<0.001). When looking at vaccination, NHB women had the highest vaccination rate at 17.07%; however, vaccination rates were rising most quickly in NHW at an AAPC of 24.8% (p<0.001). When looking specifically at the teenage population, NHW girls aged 13-17 had the lowest vaccination rate at 66.10% compared to Hispanic girls at 75.30%. Rates of vaccination were rising the most in NHB girls at 6.9% annually (p<0.001). <b>Conclusions:</b> Disparities exist among diagnoses of advanced-stage cervical cancer, with rates disproportionately affecting minorities. However, advanced-stage cervical cancer is on the rise in the United States, especially in younger NHW women. Upon examining the screening and vaccination practices, NHW were more likely to be non- compliant with pap smear screening, and young NHW girls, for whom the vaccine was recommended, had the lowest vaccination rates. These factors could contribute to a rise in more advanced stage diagnosis.