Long-term trends in cervical cancer: Incidence rates and impact of human papillomavirus testing and vaccination in the United States (343)

Abstract

<b>Objectives:</b> Human papillomavirus (HPV) infection is associated with the development of most cervical cancers (CCs). HPV testing and vaccination have been available since 2003 and 2006, respectively, in the United States (US). In this study, we investigate the long-term trends of CC annual incidence rates in relation to the introduction of HPV testing and HPV vaccination in the US. <b>Methods:</b> This study analyzed data in the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. Age-adjusted annual CC incidence rates were calculated for the overall population or for each race from 1992 to 2017. Additionally, we calculated incidence rates stratified by age group for three stage levels. Joinpoint log-linear regression analysis was used to assess temporal trends in annual CC incidence rates. The average annual percentage change (APC) in incidence was calculated using the weighted least-squares method. <b>Results:</b> In patients aged 30-64 years, we found a statistically significant decrease in the incidence rate of CC between 1992 and 2017 (APC: -2.57% [1992-2006]; APC: -0.95% [2006-2017]; p<0.05; decreased from 17.6 to 11.1 per 100,000 population). We also found a significant decrease in the incidence of localized CC (APC: -4.66% [1998-2004]; APC: -1.11% [2004-2017]; p<0.05; decreased from 8.8 to 6.2 per 100,000 population). The incidence of regional CC decreased at a much slower pace (APC: -1.58%; p<0.05; decreased from 6.5 to 3.8 per 100,000 population), and the incidence of distant CC did not change significantly (APC: 0.54%; p>0.05; increased from 1.3 to 1.5 per 100,000 population). The incidence of CC decreased in all races for which data were available, with the sharpest decrease among the populations with the greatest incidence in 1992: the Black population (APC: -3.37%, p<0.05; decreased from 19.8 to 8.5 between 1992 and 2017) and the Asian or Pacific Islander population (APC: -4.57%, p<0.05; decreased from 17.1 to 8.8 between 1992 and 2008). <b>Conclusions:</b> The overall decrease in APC could be explained partially by the effectiveness of HPV testing, which enables early treatment of HPV infection to prevent tumor development, as well as HPV vaccines, which prevent infection. The decrease is more evident in localized CC stages.