MUSC researchers identified a dramatic increase in the incidence of cervical cancer among women in their early 30s

MUSC researchers identified a dramatic increase in the incidence of cervical cancer among women in their early 30s

MUSC Hollings Cancer Center researcher Ashish Deshmukh, Ph.D., noted a dramatic recent increase in the incidence of cervical cancer among women in their early 30s. This work was published November 21 in the Journal of the American Medical Association (JAMA).

Cervical cancer is primarily associated with the human papillomavirus (HPV), and screening has made this cancer preventable. Still, it is estimated that over 14,000 new cases will be diagnosed this year and more than 4,000 deaths will be attributed to cervical cancer.

HPV is a group of over 200 viruses. At least 14 high-risk HPV types can cause multiple types of cancer, including cervical, anal and head and neck cancers. Unfortunately, in an era of overall decline in cancer incidence, cancers caused by HPV are increasing.”

Ashish Deshmukh, Ph.D., Associate Professor, Department of Public Health Sciences at MUSC

Deshmukh, who joined Hollings in August as co-leader of the Cancer Control program, focuses on cancer epidemiology and etiology research, establishing an evidence base for cancer prevention, and collaborating with stakeholders and policymakers to develop public policy and inform practice.

As an expert in HPV-associated malignancies, Deshmukh has been tracking the incidence rate of cervical cancer in the United States for several years. He previously noted that evidence-based screening recommendations have contributed to the decline in cervical cancer since the 1970s. However, as of 2012, national rates of cervical cancer incidence have stabilized.

“Over the last two years, we have been trying to understand why the continued decline in cervical cancer stopped in 2012 and why we have reached a critical turning point,” Deshmukh said.

To gain a better understanding, Deshmukh and colleagues, including Hollings researcher Kalyani Sonawane, Ph.D., began analyzing cervical cancer incidence using the National Program of Cancer Registries (NPCR) from 2001 to 2019 and the Surveillance Epidemiology and End Results (SEER) dataset. "This data set includes cancer incidence data from all 50 states and covers over 98% of the U.S. population. Using five-year cutoffs, we found that the declining incidence rate of cervical cancer reversed for the first time in women ages 30 to 34," Deshmukh said.

A 3% annual increase in cervical cancer incidence among women in their early 30s began in 2012. "What is very surprising is that rates have increased in non-Hispanic white women, Hispanic women and other ethnic groups, but not in non-Hispanic black women," Deshmukh said.

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The researchers' results showed an increase in both localized and regional disease, and the incidence increased for both cervical squamous cell carcinoma and cervical adenocarcinoma. Deshmukh said that squamous cell carcinoma is largely detected through screening, so the public health implication of this finding is that we need to improve screening rates.

Cervical cancer screening rates have recently declined dramatically in the United States, particularly among young women ages 21 to 29. "While it is critical to determine whether the increase in cervical cancer incidence among young women is due to the decline in screening rates among women aged 21 to 29, or whether it is due to the introduction of more effective HPV testing in recent years, we know we need future research to thoroughly understand this issue," Deshmukh said.

The U.S. urgently needs national campaigns and innovative ways to improve cervical cancer screening uptake and adherence among women, Deshmukh said. He plans to continue studying the reasons underlying the recent increase in cervical cancer incidence.

As part of Hollings' Cancer Control Program, research like this helps inform cancer epidemiology and public health policy and raise awareness. As a general guideline, women ages 21 to 29 are recommended to be screened with a Pap smear every three years, and women ages 30 to 65 are recommended to either continue with a Pap smear every three years or progress to an HPV test or co-test, which uses a Pap smear and an HPV test every five years. Doctors may recommend routine testing after age 65 if a patient's previous tests were abnormal.

Promoting HPV vaccination, along with routine screening, is a critical strategy to reduce cervical cancer-related deaths. "Hollings Cancer Center is doing outstanding work providing life-saving screening and vaccinations to people across South Carolina. I expect the HPV vaccination van and mobile health unit, which targets rural communities to increase vaccination and screening rates in underserved areas, to make a difference in South Carolina's HPV-related cancer burden for decades to come," said Deshmukh.

Source:

Medical University of South Carolina

Reference:

Shahmoradi, Z., et al. (2022) Cervical cancer incidence among US women, 2001-2019. JAMA. doi.org/10.1001/jama.2022.17806.

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