Cases of late stage cervical cancer are increasing in the United States despite expanded access to health insurance through the Affordable Care Act and the availability of a vaccine designed to protect against the disease.
A new study published in the International Journal of Gynecological Cancer found that while the overall rate of cervical cancer in this country has been declining, advanced-stage cases of the disease are rising among white and Black women.
Overall, there was a 1.3% annual increase in the number of advanced stage cervical cancer cases between 2001 to 2018, according to the study. The most significant uptick was among white women in the south aged 40 to 44 years old. For this specific demographic, the annual increase in the number of advanced cervical cancer cases was 4.5%.
Among Black women, for whom the overall prevalence of cervical cancer remains higher, cases increased 0.67% annually during the 18-year study period.
"While rates of early-stage cervical cancer have fallen, distant stage cancer is on the rise in white and Black women," researchers said. "Even with screening and vaccination, there is not one racial or ethnic group, region in the USA, or age group where distant stage cervical cancer has been decreasing over the last 18 years."
Here's a closer look at the study findings and the signs and symptoms of late stage cervical cancer.
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Advanced Stage Cervical Cancer on the Rise in Black and White Women
In high income countries, advanced stage cervical cancer continues to be a significant challenge. It remains the sixth most common cause of female malignancy and the ninth most common cause of female cancer mortality, according to the newly published study.
This is despite the fact that a vaccine for the human papillomavirus (HPV), which provides protection against 90% of the HPV strains that lead to cervical cancer, was approved by the US Food and Drug Administration (FDA) back in 2006.
The study's findings also come as a surprise given that the expansion of the Affordable Care Act provided more individuals with access to medical care and preventative screenings.
“Cervical cancer should be nearly 100% preventable,” Gary Leiserowitz, MD, interim executive director of UC Davis Medical Group’s department of obstetrics and gynecology, told Health. “For people who are receiving routine preventative care and with use of the HPV vaccine, we can almost entirely eliminate the risk of cervical cancer.”
While early stage cervical cancer is indeed decreasing in the United States, late stage or metastatic cervical cancer is not experiencing similar progress.
Researchers from the University of California Los Angeles Department of Obstetrics and Gynecology, who reviewed data for 29,715 women, found that by 2018, the incidence of distant stage cervical cancer had increased to 0.99 per 100,000 compared with 0.78 per 100,000 back in 2001.
Cases of adenocarcinoma—or cervical cancer that forms in the glandular tissues lining organs—increased most significantly at an average rate or 2.95% annually between 2001 and 2018. Cases of squamous cell carcinoma, increased at a rate of 0.77% annually.
“Adenocarcinomas are more challenging to pick up as they are within tissue in the cervix or high up in the canal,” Cheryl Saenz, MD, a gynecologic oncologist at UC San Diego Health’s Moores Cancer Center, told Health. “That makes it all the more important for women to be aware, as those can be more challenging to detect.”
Adenocarcinoma cases increased most among white women at 3.4% annually, while among Black women there was a 1.71% annual increase. Squamous cell carcinoma is only increasing among white women and is doing so at a rate of 1.4% per year.
When researchers looked at the study data by region, they found that individuals in the South experienced the most significant annual increase of advanced stage cervical disease at 2.1% per year, followed by the Northeast where numbers rose 1.4% annually. And as already noted, white women in the South, aged 40 to 44 experienced the single most significant increase of distant cervical cancer at 4.5% annually.
But even with that specific regional leap in case numbers, Black women overall continue to experience the highest rates of cervical cancer. Prevalence of advanced cervical cancer was 1.55 per 100,000 Black women compared to 0.92 per 100,000 white women, according to the researchers.
Cases Increasing Despite Prevention and Early Detection Methods
There's likely many factors contributing to the rise in advanced stage cervical cancer, say experts.
The study, for instance, points out that white patients have the lowest rate of childhood HPV vaccination and the highest rates of non-guideline screening—meaning they're not engaging in regular cancer screenings as recommended, which could be contributing to the findings.
"Over 90% of cervical cancer is caused by HPV," says the study. "The lower rate of vaccination in white women coupled with non-guideline screening in this population could explain the trend toward the higher rate of increase in distant disease in white women."
The challenge here is two-fold. It's not uncommon for individuals to be suspicious of vaccines or to simply forgo getting vaccinated for HPV.
"Use of the HPV vaccine is highly variable among different groups in the United States and use depends on many demographic factors. People either do not have access to it or are not availing themselves of the vaccine," said Dr. Leiserowitz.
This reality is compounded by the fact that many women, as they age, simply cease getting routine screenings.
"Women tend to stop going to the gynecologist when they stop having babies. And if you're not in the gynecologist's office, then you're not having pap smears," said Dr. Saenz. "A lot of women associate going to the doctor with having babies."
No matter what your age, however, it's incredibly important to continue visiting the gynecologist.
"People need to continue going for their annual checkups. You're never too old to go to the gynecologist," said Dr. Akers. "People think they age out of going to the gynecologist."
The study conclusion also stressed that disparities continue to exist when it comes to accessing screening programs and more generally, accessing healthcare in this country. And this too is likely contributing to the increase in advanced stage cervical cancer among Black and HIspanic women.
"When we see advanced stage disease, it's a pretty clear indication that the patient may not have access to preventative care," said Dr. Leiserowitz. "And that's a strong indicator of the health care inequities in the United States, even with the passage of the Affordable Care Act."
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Signs and Symptoms of Advanced Stage Cervical Cancer
Cervical cancer may not be symptomatic in its earliest stages. According to the American Cancer Society, symptoms often do not emerge until the cancer becomes larger and grows into nearby tissue.
This is one of the primary reasons why routine screenings are critical, as pap smears and HPV testing can detect abnormal cells and diagnose cervical cancer in earlier stages or even when it is still in the precancerous phase of development and the lesions are curable, explained Dr. Saenz.
There are a number of signs and symptoms of late stage cervical cancer to be aware of, according to the American Cancer Society. They include:
- Vaginal bleeding
- Vaginal discharge
- Pain during sex
- Pain in the pelvic region
“A big common symptom is bleeding after intercourse,” Stacey Akers, MD, division director of gynecologic oncology in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, told Health. “But others include weight loss, fatigue, anemia, swelling in the legs and difficulty—or not being able—to void.”
By the time an individual experiences difficulty voiding, or urinating, it is generally because a tumor has grown in the cervix and is blocking the connection between the bladder and the kidney, explained Dr. Akers.
If you experience any of these symptoms, it's important to be seen by a medical professional as soon as possible. "Go right away. It doesn't necessarily mean you have cancer, but if you have any of these symptoms you should be seen," said Dr. Akers.
"People need to make sure they listen to their body," added Dr. Akers. "If something feels out of the ordinary don't be hesitant to have it evaluated."
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