Cervical cancer trends in Hispanic subgroups: who is most at risk?

Abstract

<h3>Objectives:</h3> Although the incidence of cervical cancer in the United States has decreased, it is unclear if this trend applies across all racial/ethnic groups, particularly after adjusting for hysterectomy rates. We proposed to determine the incidence and trends of cervical cancer in non-Black Hispanic subgroups. <h3>Methods:</h3> Data was extracted from the U.S. Cancer Statistics Public Use Database, November 2018 submission (2001-2016). Behavioral Risk Factor Surveillance System (BRFSS) was used to correct for hysterectomy. Chi squared and Joinpoint analyses were used for statistical methods. <h3>Results:</h3> Over the 15-year study period, 166,326 patients were diagnosed with cervical cancer. Of these, 32,954 were classified as non-Black Hispanic with 23.9% identifying as Mexican-American, 4.6% as Puerto Rican-American, 2.4% as Cuban-American and 10.8% as South or Central American. Forty two percent were of Hispanic origin with unknown subgroup. Overall, 46.0% (15,204) presented with local disease, 36.0% (11,897) with regional disease and 10.5% (3,457) with distant disease. The remaining 7.5% presented at unknown stage. In 2016, the overall incidence of cervical cancer was 12.38 in Hispanic compared to 9.27 per 100,000 in White patients. Over the entire study period, cervical cancer incidence in Hispanic women decreased from 20.83 to 12.38 per 100,000 with an average annual percent (AAPC) decrease of 3.3% (p<0.001). The incidence of squamous cell carcinoma also decreased over this time period (AAPC -4.3%, p<0.001). The crude incidence of adenocarcinoma in Hispanic women aged 45-49 years remained unchanged despite a decreasing incidence in the other age and racial groups. Hispanic subgroups (specifically, those identified as Mexican, Cuban, Puerto Rican and South or Central American) were then analyzed separately. Notably, Cuban and Puerto Rican patients did not see a decrease in overall cervical cancer cases. Additionally, the number of adenocarcinoma cases in Mexican patients increased 1.7% annually over the study period. <h3>Conclusions:</h3> Compared to White patients, Hispanic patients have a 30% higher incidence of cervical cancer in the United States. While cases are decreasing in Hispanic patients as a whole, Cuban and Puerto Rican subgroups did not see a decrease in overall cervical cancer cases over this study period. Additionally, cases of cervical adenocarcinoma in Mexican patients have increased over the last 15 years. Efforts at emphasizing HPV vaccination and establishing and maintaining screening programs serving Hispanic patients should continue to be prioritized, particularly for pre-menopausal women.