Cervical Cancer Screening Tied to Stable or Declining Incidence, Mortality

By Lisa Rapaport

August 10, 2021

(Reuters Health) - Many countries with effective cervical cancer vaccination and screening programs have seen incidence and mortality for these malignancies decline in recent years and are on track for this trend to continue, a new study suggests.

Researchers examined databases released by the International Agency for Research on Cancer to assess trends the relationship between cervical cancer incidence and mortality and the Human Development Index (HDI) for 31 countries. The HDI is a summary measure of socioeconomic development that includes life expectancy, education, and gross national income.

Over the 10-year period ending in 2018, cervical cancer incidence and mortality were stable in 12 of 31 countries in the analysis, while incidence decreased in 14 countries and mortality declined in 18 countries. These trends appeared on track to persist for the next 15 years, researchers estimated in the journal Cancer.

Both cervical cancer incidence and mortality were negatively correlated with the HDI (r = 0.56 and 0.69, respectively), the analysis found. These trends were also expected to continue for the next 15 years, the researchers projected.

"Cervical cancer screening has been recommended and promoted by the World Health Organization for many years," said Dr. George Sawaya, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, who wasn't involved in the study.

"Because screening can be resource-intensive, it is not too surprising that countries with high socioeconomic development - and that have funded robust screening programs - have lower cervical cancer incidence and mortality," Dr. Sawaya said by email.

While HPV vaccination is an important part of prevention, it isn't a substitute for screening, Dr. Sawaya said.

"Not only do we need to identify these people and encourage screening, but we must also assure timely follow-up of abnormal test results, treatment of precancerous cervical lesions, and close surveillance after treatment," Dr. Sawaya said.

Over the next 15 years, cervical cancer incidence is on track to remain stable in 10 countries, decline in 9 countries, and rise in 8 countries, the analysis found. Cervical cancer mortality is on track to remain stable in 16 countries, drop in 10 countries, and increase in one country.

One limitation of the analysis, the authors note, is that they were unable to account for advances in cervical prevention or control strategies over time in individual countries.

Senior study author Dr. Mingjuan Jin of Zhejiang University School of Medicine in Hangzhou, China, didn't respond to email seeking comment.

"Deeper dives into incidence and mortality statistics would be likely to show disparities between low- and high-income women within many countries, across the HDI spectrum," said Dr. Joy Melnikow, professor emeritus of family and community medicine at the University of California, Davis.

In the U.S., for example, low-income women and women of color have higher incidence and mortality from cervical cancer than white women and more affluent women, Dr. Melnikow, who wasn't involved in the study, said by email.

"No-cost, population-based screening and good public health information campaigns have the potential to attenuate these disparities," Dr. Melnikow said.

SOURCE: https://bit.ly/3iz2LIg Cancer, online August 9, 2021.