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Cervical Cancer Facts and Stats

Cervical cancer was once a leading cause of cancer death for women in the United States. Currently, it ranks 3rd in frequency for both diagnosis and cause of death among the gynecologic cancers1 and 14th for all cancers affecting U.S. women.2 Between 1955 and 1992, both incidence and mortality rates declined dramatically due to the introduction and implementation of Pap test screening. Most invasive cervical cancers are found in women who have never been screened or have not had a Pap test within the past 5 years.3 Based on 2008-2010 data, approximately 0.7% of women will be diagnosed with cervical cancer in their lifetime.4

There are two major types of cervical cancer: squamous cell carcinoma and adenocarcinoma.

  • Squamous cell carcinoma arises in the squamous (flattened) epithelial cells that line the cervix. About 66% of all cervical cancers are of this type.
  • Adenocarcinoma develops from mucus-producing gland cells in the endocervix. It accounts for about 28% of all cervical cancers.
  • Other rarer types comprise the remaining 6%.5

Key Statistics:

  • In 2014, an estimated 12,360 new cases of invasive cervical cancer will be diagnosed in U.S. women.3
       
  • In 2014, an estimated 4,020 U.S. women will die from the disease.3
  • Most women with cervical cancer are diagnosed before the age of 50; from 2006-2010, the median age was 49.4 However, older women remain at risk. More than 20% of new cases are diagnosed in women over 65. Cervical cancer in women younger than age 20 is rare.3
     
  • In the U.S., African-American women have the highest rate of cervical cancer, followed by Hispanics, Caucasians, American Indian/Alaska Natives, and Asian American/Pacific Islanders. Mortality rates are highest for African American women.6
     
  • Between 1955 and 1992, the rate of cervical cancer deaths in the U.S. declined by nearly 70%. It continued declining more gradually to 2003 before stabilizing. The overall decline is mainly attributed to the increased use of the Pap test.3 This screening method is able to find changes in the cervix before cancer has a chance to develop.
     
  • When detected at its earliest stage, cervical cancer has a 5-year relative survival rate of approximately 91%. For regional disease, it is approximately 57%. If cancer has spread to distant organs, 5-year survival drops to approximately 16%.4 In general, the prognosis is affected by the extent of disease at the time of diagnosis.
  • As of January 2010, there were approximately 250,000 cervical cancer survivors living in the U.S.4

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Risk Factors:   

Human papillomavirus (HPV)

  • Virtually all (99.7%) cervical cancers are caused by persistent infection with a high-risk type of human papillomavirus (HPV). There are approximately 15 high-risk (oncogenic) types of HPV, with just two of these, 16 and 18, responsible for about 70% of all cervical cancers.7
  • Although HPV is most commonly spread from one person to another through sexual activity, it can also be spread without sex, by skin-to-skin contact with an area of the body infected with HPV.3
  • More than half of all sexually active people will be infected with one or more HPV types at some point during their lives.8 However, the vast majority of HPV infections do not lead to cervical cancer. For cervical cancer to develop, a high-risk infection must also be persistent.
  • Most HPV infections are transient. Up to 90% resolve within 2 to 5 years. On average, a newly diagnosed HPV infection in young women lasts from 8 to 13 months.9
  • Aging is a risk factor for persistent infection. The rate of persistent high-risk infection for women older than age 55 is 50%, compared with a persistence rate of 20% in women younger than age 25.9
  • While long-term infection is necessary for cervical cancer to develop, the vast majority of women with persistent high-risk infection do not develop cervical cancer.10

Other factors

Other factors have been found to increase the risk of developing cervical cancer, either by increasing the risk of HPV infection or by increasing the chances of developing cervical neoplasia following a high-risk infection. These other factors are as follows:

Sexual activity: The main risk factors for HPV infection through sexual activity are early onset of sexual activity, multiple sexual partners, high-risk sexual partners,7 and failure to use a condom.8

Suppressed immune system: A weakened immune system, such as that caused by HIV or by drugs used for suppressing immune response, places women at higher risk for HPV infection and also for cervical cancer.3

Smoking: The risk of squamous cell cervical cancer is increased for women who smoke. Smoking not only exposes the body to cancer-causing chemicals but also weakens the immune system.3 Smoking does not appear to increase risk for adenocarcinoma of the cervix.7

First full-term pregnancy at a young age: A first full-term pregnancy in women younger than age 17 nearly doubles the risk of developing cervical cancer later in life, as compared with women who had their first full-term pregnancy at age 25 and older.3

Multiple full-term pregnancies: Women with 3 or more full-term pregnancies have an increased risk of developing cervical cancer. Hormonal changes or weaker immune systems during pregnancy are possible reasons.3

Family history of cervical cancer: A woman with a mother or sister with cervical cancer has 2 to 3 times the risk of women without this family history.7

Oral contraceptives: The long-term use (5 or more years) of oral contraceptives has been shown to increase the risk of developing cervical cancer.3 A collaborative analysis of data from 24 epidemiological studies found that risk increases with duration and declines after use ceases. After 10 or more years of cessation, risk appears to return to that of normal.11 Clinicians are encouraged to discuss with their patients whether the benefits of fertility management outweigh the potential risks.

Chlamydia infection: Some studies have shown higher relative risk in women whose blood test results show evidence of either past or current chlamydia infection.3

Diet and weight: A diet low in fruits and vegetables, as well as being overweight, may place women at increased risk for developing cervical cancer.3

Diethylstilbestrol (DES): DES may increase the risk of a rare form of cervical cancer in women whose mothers took DES when pregnant. About 1 case of this rare form occurs in every 1,000 DES daughters.3 (DES was given to some pregnant women in the United States from 1940 to 1971.)

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Risk Reduction:

HPV Vaccines: Two FDA-approved vaccines (brand names, Gardasil and Cervarix) are highly effective in preventing infection with the types of HPV they target. Gardasil targets HPV types 6, 11, 16 and 18 and Cervarix targets against types 16 and 18 (16 and 18 are responsible for about 70% of all cervical cancers). The FDA has approved Gardasil for use in females (and males) ages 9 to 26 and Cervarix for use in females ages 9 to 25.12

Patients should be vaccinated before becoming sexually active; that is, before they may be exposed to HPV. However, even for persons who have been infected with one or more HPV types, the vaccine can still prevent infection from HPV types not yet acquired.13

Screening: Vaccination is not a substitute for screening with Pap tests. Even in women who have been vaccinated, cervical cancer can still occur. Screening is the most effective means for finding changes in the cervix before cancer has a chance to develop.

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Screening Guidelines:

There are minor differences in the U.S. screening guidelines for women with average risk. The following table compares the current recommendations of three different groups: a multidisciplinary partnership among the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP), The United States Preventive Services Task Force (USPSTF), and the American College of Obstetricians and Gynecologists (ACOG).141516

Comparison of ACS/ASCCP/ASCP, USPSTF, and ACOG Screening Guidelines
  ACS/ASCCP/ASCP USPSTF ACOG
Recommendations apply to both conventional and liquid-based cytology.
When to Start Age 21 Age 21 Age 21
Intervals

Ages 21-29:
Cytology alone every 3 years

Ages 30-65:
HPV and cytology “cotesting” every 5 years is preferred

OR

Cytology alone every 3 years is acceptable

Ages 21-29 years:
Cytology alone every 3 years

Ages 30-65:
HPV and cytology “cotesting” every 5 years for women who want to extend their screening interval

OR

Cytology alone every 3 years

Ages 21-29:
Cytology alone every 3 years

Ages 30-65:
HPV and cytology "cotesting" every 5 years is preferred

OR

Cytology alone every 3 years is acceptable
When to Stop

Women older than age 65 following adequate negative prior screening and no history of CIN2 or higher within the last 20 years

Women older than age 65 who have had adequate negative prior screening (as defined below) and who are not otherwise at high risk

(Adequate negative prior screening is defined as 3 consecutive negative cytology results or 2 negative cotests within 10 years before cessation of screening, with the most recent occurring in the past 5 years)

Women older than age 65 with evidence of adequate negative prior screening results and no history of CIN2 or higher
Post Total
Hysterectomy
Women who have had a total hysterectomy (with removal of the cervix) should not be screened unless the hysterectomy was done as a treatment for pre-cancer or cancer Women who have had a total hysterectomy (with removal of the cervix) and no history of CIN2 or higher in the past 20 years should not be screened Women who have had a hysterectomy with removal of the cervix and have never had CIN2 or higher should discontinue routine cytology screening and HPV testing and should not restart for any reason
Alternative Screening Modalities None None Ages 25-65
FDA-approved primary HPV screening no more than every 3 years can be considered as an alternative. If used, should be performed per ASCCP and SGO guidelines

For information on cancer screening services for medically underserved women:

Breast and cervical cancer screening services are available to medically underserved women living in the United States through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This national program is sponsored by the Centers for Disease Control and Prevention (CDC) and provides access to free or low-cost screening for eligible women.

In California, the Every Woman Counts (EWC) program assists low income, uninsured, underserved women in obtaining high quality breast and cervical cancer screening and follow-up services. The program is funded through the California Department of Health Care Services(DHCS), from federal grant monies, and State of California funds: The Breast Cancer Control Account (BCCA), Proposition 99, and the General Fund.

Women who would like to find a provider in their area may call the automated 24-hour consumer line at 1-800-511-2300. The EWC representative for your area may know of other low-cost screening programs that might be available to you. Regional Contractors are also your link to support groups, advocacy groups and the latest information on what's happening in your community.

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References:

1American Cancer Society (ACS). (2014). Cancer facts & figures 2013. Accessed Jul. 8, 2014, from http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2014

2National Cancer Institute (NCI). (2010, Nov. Last reviewed). Cancer advances in focus: cervical cancer. Accessed Jul. 3, 2014, from http://www.cancer.gov/cancertopics/factsheet/cancer-advances-in-focus/cervical

3American Cancer Society (ACS). (2014, Jan. - Last revised).Cervical cancer: detailed guide. Accessed Jul. 3, 2014, from http://www.cancer.org/cancer/cervicalcancer/detailedguide

4Surveillance Epidemiological and End Results (SEER). (2014). SEER stat fact sheets: cervix uteri. Accessed Jul. 3,2014, from http://seer.cancer.gov/statfacts/html/cervix.html

5Howlder N., Noone, A.M., Krapcho, M., Garshell, J., Miller, D., Altekruse, S.F.,...Cronin, K.A. (eds). SEER cancer statistics review, 1975-201., National Cancer Institute, Bethesda, MD, based on November 2013 SEER data submission, posted to the SEER web site, April 2014. Accessed on Jul.3 , 2014, from http://seer.cancer.gov/csr/1975_2011.html

6Centers for Disease Control and Prevention (CDC). (2013). Cervical cancer rates by race ethnicity. Accessed Jul. 8, 2014, from http://www.cdc.gov/cancer/cervical/statistics/race.htm

7Frumovitz, M. (2013, Jan. - Last updated). Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis. Accessed Jul. 3, 2014, from http://www.uptodate.com/contents/invasive-cervical-cancer-epidemiology-risk-factors-clinical-manifestations-and-diagnosis

8National Cancer Institute (NCI). (2012, Mar. - Last reviewed). Fact sheet: HPV and cancer. Accessed Jul. 3, 2014, from http://www.cancer.gov/cancertopics/factsheet/Risk/HPV

9Wright, JD. (2014, May. - Last updated). Cervical intraepithelial neoplasia: Terminology, incidence, pathogenesis, and prevention. Accessed Jul. 3,2014, from http://www.uptodate.com/contents/cervical-intraepithelial-neoplasia-terminology-incidence-pathogenesis-and-prevention

10Hariri, S., Dunne, E., Saraiya, M., et al. (2011). Manual for the surveillance of vaccine-preventable diseases (5th ed.). Accessed Jul. 3, 2014, from http://www.cdc.gov/vaccines/pubs/surv-manual/chpt05-hpv.html

11Appleby P., Beral V., Berrington de González, A., et al. (2007). Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet, 370 (9599):1609-21.

12National Cancer Institute (NCI). (2011, Dec. - Last reviewed). Fact sheet: human papillomavirus (HPV) vaccines. Accessed Jul. 3, 2014, from http://www.cancer.gov/cancertopics/factsheet/Prevention/HPV-vaccine

13Centers for Disease Control and Prevention (CDC). (2012, Jul. - Last updated). HPV vaccine information for clinicians - fact sheet. Accessed Jul. 3, 2014, from http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-hcp.htm

14USPSTF. (2012). Screening for cervical cancer. Accessed Jul. 3, 2014, from http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm

15Saslow, D., Solomon, D., Herschel, W., et al. (2011). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Accessed Jul. 3, 2014, from http://journals.lww.com/jlgtd/PublishingImages/ASCCP%20Guidelines.pdf

16American College of Obstetricians and Gynecologists (2016). ACOG practice bulletin No. 157: Cervical cancer screening and prevention. Obstet Gynecol, 127(1), e1-e20. doi: 10.1097/AOG.0000000000001263

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Last updated: July 15, 2014

 

 

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