Cervical cancer is rising among low-income women

According to a new report from the American Cancer Society, cervical cancer incidence among women ages 20 to 24 dropped 65% between 2012 and 2019. However, not all groups experienced this decline, and some even saw their cervical cancer rates increase.

For the study, researchers from the University of Texas MD Anderson Cancer Center analyzed data from the National Cancer Institute on cervical cancer diagnoses and deaths between 2000 and 2019. The researchers also assessed race/ethnicity and county-level median household income. Low-income counties had an income range of $19,330 to $38,820.

Overall, the researchers found that cervical cancer rates were highest among women living in low-income areas of the United States. Among the different racial and ethnic groups, Hispanic women in low-income counties had the highest absolute incidence of cervical cancer.

White women living in low-income counties also saw an increase in cases of cervical cancer that spread to distant parts of the body. Since 2007, there has been a 4.4% annual increase in these types of cancer among this group. Cervical cancer mortality rates have also increased in this group.

Although incidences of cervical cancer among Black women living in low-income counties have declined, they have experienced a 2.9% annual increase in mortality since 2013.

"This is really a reversal of the downward trend that we had previously seen," said Jane Montealegre, associate professor of behavioral science and one of the study's senior authors. "And more disturbingly, the rates aren't necessarily increasing for localized cancer, or even sort of that regional cancer that responds really well to treatment."

"Cervical cancer is almost entirely preventable," Montealegre added. "This continued upward trend calls for scaled-up efforts to eliminate disparities in cervical cancer prevention."

The importance of screenings, HPV vaccination

According to Advisory Board's Ellie Wiles, these findings align with other trends in women's health in recent years, especially regarding incidences of certain health conditions increasing and widening racial and ethnic disparities. These conditions include maternal and reproductive conditions, behavioral health conditions, cardiometabolic conditions, and more.

However, Wiles noted that the study only analyzed pre-pandemic numbers. During the pandemic, low-income communities had an especially hard time accessing primary care, and disruptions to routine preventive measures like screenings and vaccines likely worsened both the overall rate of cervical cases, as well as the disparity in outcomes by income level.

Currently, the U.S. Preventive Services Task Force recommends using Pap smears to screen women ages 21 to 29 for cervical cancer every three years. However, screening rates in the United States, especially among low-income uninsured women, have declined since the early 2000s.

According to CDC, more than half of women diagnosed with cervical cancer have either never been screened or have not been screened in the last five years. "This is really indicating that there are disruptions in terms of screening, and also probably in terms of follow up, after women have a positive screening test, disrupting them actually getting the diagnostic care and the treatment that they need," Montealegre said.

Health experts have also underscored the importance of getting vaccinated against HPV, the source of almost all cervical cancers. Since the vaccine was first approved in 2006, research has shown that it highly effective at preventing cervical cancer. However, only 60% of adolescents ages 13 to 17 in the United States have been vaccinated against HPV.

In a new study published in the Journal of the National Cancer Institute, researchers found that no cases of cervical cancer were detected among women who were born between 1988-1996 and had been fully vaccinated against HPV between the ages of 12 and 13. The study, which was conducted in Scotland, is the first to follow a national cohort of women over a long period of time and find no cases of cervical cancer.

Even women who had been vaccinated at a later age, between 14 and 22, saw benefits. Among this group, the incidence of cervical cancer (3.2 cases per 100,000 women) was 2.5 times lower than the incidence among unvaccinated women (8.4 cases per 100,000 women). The impact of vaccination was also higher among low-income women, who otherwise reported higher incidences of cervical cancer.

"We're really seeing that we need to scale up our efforts for screening, and that's going to be what's going to get us to eliminate cervix cancer as a public health problem faster," Montealegre said. "And then of course, over the long term, the vaccine is going to really ensure that the younger ages don’t have to be worried about a cancer like cervical cancer."

Emily Heuser, Advisory Board's managing director for specialty care and consumer research, also highlighted a need for community partnerships in efforts to improve HPV vaccination rates and cervical cancer outcomes. In this case study, we outline how Northwestern Medicine utilized community outreach and engagement initiatives to reduce cancer disparities. (Reed, Axios, 1/26; Weixel, The Hill, 1/25; Merelli, STAT, 1/25)

Learn how Northwestern Medicine's Chicago Cancer Initiative is reducing disparities and improving health outcomes in the Bronzeville neighborhood of Chicago.