EXECUTIVE SUMMARY
New research from the Johns Hopkins Bloomberg School of Public Health indicates that U.S. black women are dying from cervical cancer at a rate 77% higher than previously thought, while white women are dying at a rate 47% higher.
- The new figures reflect a change in how mortality rates are calculated, according to the researchers. By excluding women who have had hysterectomies, the researchers say these data give a more accurate indication of who is contracting cervical cancer and how providers can help better prevent it.
- According to 2017 estimates from the American Cancer Society, an estimated 12,820 new cases of invasive cervical cancer will be diagnosed, while some 4,210 women will die from cervical cancer.
New research from the Johns Hopkins Bloomberg School of Public Health indicates that U.S. black women are dying from cervical cancer at a rate 77% higher than previously thought, while white women are dying at a rate 47% higher.1 The new figures reflect a change in how mortality rates are calculated, according to the researchers. By excluding women who have received hysterectomies, the researchers say these data give a more accurate indication of who is contracting cervical cancer and how providers can better prevent it.1
Estimates from the American Cancer Society indicate that in 2017, about 12,820 new cases of invasive cervical cancer will be diagnosed, while some 4,210 women will die from cervical cancer.2 While cervical cancer was once one of the most common causes of cancer death for U.S. women, the cervical cancer death rate has gone down by more than 50% during the past 40 years. The main reason for this change lies in the increased use of the Pap test, which can find changes in the cervix before cancer develops.2
Cervical cancer is a preventable disease, and women should not be getting it or dying from it, says study leader Anne Rositch, PhD, MSPH, an assistant professor in the Department of Epidemiology at the Bloomberg School.
“Since the goal of a screening program is to ultimately reduce mortality from cervical cancer, then you must have accurate estimates within the population targeted by those programs — adult women with a cervix,” Rositch said in a statement accompanying the study’s publication. “These findings motivate us to better understand why, despite the wide availability of screening and treatment, older and black women are still dying from cervical cancer at such high rates in the United States.”
Review the Findings
To conduct the study, researchers used estimates for deaths due to cervical cancer, stratified by age, state, year, and race, derived from the National Center for Health Statistics 2000-2012 county mortality data. Equivalently stratified data on the prevalence of hysterectomy for women 20 years of age or older from the Behavioral Risk Factor Surveillance System survey were used to remove women who were not at risk from the denominator. Age-specific and age-standardized mortality rates were computed, and trends in mortality rates were analyzed with Joinpoint regression.
The analysis indicated a rate of cervical cancer mortality among black women older than 20 years of age at 5.7 per 100,000 each year and 3.2 per 100,000 each year in white women. When adjusted for hysterectomy, the rate in black women increased to 10.1 per 100,000 per year, a rate similar to less developed nations, and to 4.7 per 100,000 per year for white women.1
Black women are more likely to undergo hysterectomy surgery, and at younger ages, compared to white women, largely because black women are more susceptible to fibroids, which can require surgery to remove.3 Placing all women in calculations of mortality underestimated the racial difference in death rates between black and white women by 44%, researchers estimated.1
“While trends over time show that the racial disparities gap has been closing somewhat, these data emphasize that it should remain a priority area,” Rositch said. “Black women are dying of cervical cancer at twice the rate as white women in the United States and we need to put in place measures to reverse the trend.”
Take Steps Toward Prevention
Virtually all cervical cancers are caused by infection with certain types of the human papillomavirus (HPV). Here are the American Cancer Society guidelines to help find cervical cancer early, and also to help find pre-cancers, which can be treated to keep cervical cancer from forming.
- All women should begin cervical cancer screening at age 21. Women younger than age 21 should not be screened regardless of the age of sexual initiation or other risk factors.
- Women between 21 and 29 years of age should receive a Pap test every three years. They should not be tested for HPV, unless it is needed after an abnormal Pap test result.
- Women 30-65 years of age should receive both a Pap test and an HPV test every five years. While this is the preferred approach, the American Cancer Society indicates it is acceptable to undergo a Pap test alone every three years.
- Women older than 65 years of age who have undergone regular screenings with normal results should not be screened for cervical cancer. Women who have been diagnosed with cervical cancer or pre-cancer should continue to be screened according to the recommendations of their doctor.
- Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer should not be screened.
- Women who have received the HPV vaccine still should follow the screening recommendations for their age group.
Women who are at high risk for cervical cancer may need to receive screenings more frequently. High-risk indicators include those infected with HIV, those who have received an organ transplant, or those who have been exposed to the drug DES.5
One simple way to prevent cervical cancer is to receive the HPV vaccine. To get the best benefit from the HPV vaccine, it should be administered at an early age. The American Cancer Society recommends that the vaccine series be started at 11 or 12 years of age, although it can be administered to girls and women up to 26 years of age. The CDC recommends that 11- to 12-year-olds receive two doses of HPV vaccine at least six months apart, rather than the previously recommended three doses.4 Teens and young adults who start the series later, at 15-26 years of age, will continue to need three doses of HPV vaccine to protect against cancer-causing HPV infection.
REFERENCES
- Beavis AL, Gravitt PE, Rositch AF. Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States. Cancer 2017; doi: 10.1002/cncr.30507.
- American Cancer Society. What Are the Key Statistics About Cervical Cancer? Available at: http://bit.ly/2kUcifg. Accessed on Feb. 20, 2017.
- Bower JK, Schreiner PJ, Sternfeld B, Lewis CE. Black-White differences in hysterectomy prevalence: The CARDIA study. Am J Public Health 2009;99:300-307.
- Iversen OE, Miranda MJ, Ulied A, et al. Immunogenicity of the 9-valent HPV vaccine using 2-dose regimens in girls and boys vs a 3-dose regimen in women. JAMA 2016;316:2411-2421.
- American Cancer Society. What You Need to Know About Testing for Cervical Cancer. Available at: http://bit.ly/2lidoBl. Accessed Feb. 21, 2017.
Recent findings may push healthcare providers to broaden and accelerate prevention efforts.
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