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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. Between 1955 and 1992, however, both incidence and mortality rates declined dramatically due to the introduction and implementation of Pap test screening. Currently, cancer of the uterine cervix 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 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. Currently, the lifetime risk of developing cervical cancer among U.S. women is approximately 1 in 147.3

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 69% of all cervical cancers are of this type.4
  • Adenocarcinoma develops from mucus-producing gland cells in the endocervix. It accounts for about 25% of all cervical cancers.4
  • Other rarer types comprise the remaining 6%.

Key Statistics:

  • In 2012, an estimated 12,170 new cases of invasive cervical cancer will be diagnosed in U.S. women.5
       
  • In 2012, an estimated 4,220 U.S. women will die from the disease.5
  • Most women with cervical cancer are diagnosed before the age of 50; the median age is 48.3 However, older women remain at risk. More than 20% of new cases are diagnosed in women over 65. Cervical cancer in women younger than 20 is rare.5
     
  • In the U.S., Hispanic women have the highest rate of cervical cancer, followed by African American, Caucasian, American Indian/Alaska Native, and Asian American/Pacific Islander women. 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. It has since stabilized. The overall decline is mainly attributed to the increased use of the Pap test.5
     
  • When detected at its earliest stage, cervical cancer has a 5-year relative survival rate of approximately 91%. For regional disease, it is nearly 57%. If the cancer has spread to distant organs, 5-year survival drops to approximately 16%. In general, the prognosis is affected by the extent of disease at the time of diagnosis.3
  • As of January 2009, there were approximately 250,000 cervical cancer survivors living in the U.S.3

 

Risk Factors:   

Human papilomavirus

  • Virtually all (99.7%)4 cervical cancers are caused by persistent infection with a high-risk type of human papilomavirus (HPV). There are approximately 15 high-risk (oncogenic) types of HPV, with just two high-risk types, 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.5
  • More than half of all sexually active people will be infected with HPV at some point during their lives.7 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%, including infections with high-risk types, resolve within 2 to 5 years. In young women, an average episode lasts from 8 to 13 months.8
  • 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 25.8
  • 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.9

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; 4 and failure to use a condom.

Weakened 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.5

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. Smoking does not appear to be a risk factor for adenocarcinoma of the cervix.4

First full-term pregnancy at a young age: A first full-term pregnancy in women younger than 17 years old nearly doubles the risk of developing cervical cancer later in life, as compared with women who had their first full-term pregnancy at 25 years and older.5

Multiple full-term pregnancies: Women with 3 or more full-term pregnancies have an increased risk of developing cervical cancer. Studies have pointed to hormonal changes or weaker immune systems during pregnancy as possibly allowing for HPV infection and cancer growth.5

Family history of cervical cancer: A women with a mother or sister with cervical cancer has 2 to 3 times the risk of women without this family history.5

Oral contraceptives: The long-term use (5 or more years) of oral contraceptives has been shown to increase the risk of developing cervical cancer. 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.10 Clinicians are encouraged to discuss with their patients whether the benefits of fertility management outweigh the potential risks.

Diet and weight: Some studies have shown that diets low in fruits and vegetables, as well as being overweight, may place women at increased risk for developing cervical cancer.5

Chlamydia infection: Some studies have found a higher risk of cervical cancer in women with past or current chlamydia infections.5

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.5 (DES was given to some pregnant women in the United States from 1940 to 1971.)

 

Risk Reduction:     

  • Women have a choice between two FDA-approved vaccines (brand names, Gardasil and Cervarix). Gardasil protects against infection by HPV types 6, 11, 16 and 18 and Cervarix protects against types 16 and 18.
  • Vaccination is not a substitute for screening with Pap tests. Even in women who have been vaccinated, cervical cancer is still possible. Nearly all cervical cancer can be prevented with routine screening and by limiting exposure to risk factors.

 

Screening Guidelines:

There are minor differences in the U.S. screening guidelines for women with average risk. The following table compares the current (2012) recommendations of two different groups: the U.S. Preventive Services Task Force (USPSTF) and a multidisciplinary partnership among the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP).511

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

Ages 21-29:
Cytology alone every 3 years

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

OR

Cytology alone every 3 years

When to Stop

Women older than age 65following adequate negative prior screening

(Women with a history of CIN2 or a more severe diagnosis should continue routine screening for at least 20 years after diagnosis )

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 co-tests within 10 years before cessation of screening, with the most recent occurring in the past 5 years)

Post Total
Hysterectomy
Women who have had a total hysterectomy (with removal of the cervix) should not be screened unless there is a history of CIN2 or more severe diagnosis in the past 20 years, or a history of cervical cancer ever Women who have had a total hysterectomy (with removal of the cervix) should not be screened unless there is a history of high-grade precancer or cervical cancer

For additional information on cervical cancer screening and diagnosis, please visit:

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 administered by California Department of Health Care Services. EWC receives funding from the Centers for Disease Control and Prevention (CDC), National Breast and Cervical Cancer Early Detection Program (NBCCEDP), Proposition 99, one cent of a two-cent tax on tobacco products (mandated by the California Breast Cancer Act of 1993), and general funds.

Women who would like to find out if they qualify for the program may call 1-800-511-2300 Monday - Friday, from 8:30 AM to 5 PM. 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.

References:

1American Cancer Society (ACS). (2012). Cancer facts & figures 2012. Accessed Aug. 14, 2012, from http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012

2 National Cancer Institute (NCI). (2012). Cancer advances in focus: cervical cancer. Accessed Aug. 14, 2012, from http://www.cancer.gov/cancertopics/factsheet/cancer-advances-in-focus/cervical

3Surveillance Epidemiological and End Results (SEER). (2012). SEER stat fact sheets: cervix uteri. Accessed Jul. 16, 2012, from http://seer.cancer.gov/statfacts/html/cervix.html

4Frumovitz, M. (2011, Sep.). Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis. Accessed Jul. 30, 2012 from http://www.uptodate.com/contents/invasive-cervical-cancer-epidemiology-risk-factors-clinical-manifestations-and-diagnosis?source=search_result&search=cervical+cancer&selectedTitle=1~150

5American Cancer Society (ACS). (2012). Cervical cancer: detailed guide. Accessed Jul. 17, 2012, from http://www.cancer.org/Cancer/CervicalCancer/DetailedGuide/index

6Centers for Disease Control and Prevention (CDC). (2012). Cervical cancer rates by race ethnicity. Accessed Jul. 24, 2012, from http://www.cdc.gov/cancer/cervical/statistics/race.htm

7National Cancer Institute (NCI). (2012). Fact sheet: HPV and cancer. Accessed Jul. 30, 2012, from http://www.cancer.gov/cancertopics/factsheet/Risk/HPV

8Holschneider, M. (2012, Jun.). Cervical intraepithelial neoplasia: Definition, incidence, and pathogenesis. Accessed Aug. 5, 2012 from http://www.uptodate.com/contents/cervical-intraepithelial-neoplasia-definition-incidence-and-pathogenesis

9Hariri, S., Dunne, E., Saraiya, M., et al. (2011). Manual for the surveillance of vaccine-preventable diseases (5th ed.). Accessed Aug. 1, 2012, from http://www.cdc.gov/vaccines/pubs/surv-manual/chpt05-hpv.html

10Appleby 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.

11USPSTF. (2012). Screening for cervical cancer. Accessed Jul. 30, 2012, from http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm

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Updated: August 15, 2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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