Cervical cancer is preventable, yet rising number of women in poor regions are getting it

Women in low-income regions of the U.S. are experiencing a steep increase in diagnosis and death from cervical cancer despite medical improvements that experts say make the disease preventable, a new study showed.

Screening and early detection and the widely prescribed vaccination against human papillomavirus (HPV), the disease that causes cervical cancer, have helped health providers better protect women. But the reach of these methods, the study found, was uneven.

Since 2000, the rate of cervical cancer declined in high-income areas, however, cases jumped in low-income portions of the country, according to findings published Thursday in the International Journal of Cancer.

White women in low-income areas saw the greatest increase in late-stage cervical cancer. Black women had the greatest increase in cervical mortality in low-income counties. Hispanic women in poor areas had the highest rate of cervical cancer.

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“We have everything we need to not have cervix cancer be the problem that it is,” Jane Montealegre, an associate professor of behavioral science and an epidemiologist at the University of Texas MD Anderson Cancer Center, in Houston, told USA TODAY. “In the U.S., where we have all of these tools, it’s really, undeniably, about access.” 

Montealegre, a study author, said the lack of adequate access to vaccination, screening and treatment in low-income communities is linked to the alarming findings of women with late-stage cancers, when the cancer cells spread beyond the cervix, and death. Increases in these cancers were highest in the South and toward the Southwest, she said.

Researchers reviewed data from the National Cancer Institute’s registry between 2000 and 2019, looking into more than 119,000 cervical cancer cases nationally. They then analyzed the cases based on the race and ethnicity of patients cross-referenced with county-level median household incomes, which, ranged from $19,330 to $38,820. 

Low-income counties had a higher rate of people who had their uterus and cervix removed after diagnosis, 14.1 people per 100,000, compared with 9.5 in high-income areas.

White women saw the largest jump in late-stage cancer, although the increase in deaths was not statistically significant. Conversely, non-Hispanic Black women in low-income counties saw declines in cervical cancer cases but have experienced a 2.9% increase in mortality each year since 2013, according to the study.

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“It would suggest that people are either not being screened at all or they are falling through the cracks,” said Dr. Barbara Goff, chair of obstetrics and gynecology at the University of Washington School of Medicine, who was not affiliated with the paper. “Both of those things are disturbing because it’s not like some cancers where you can’t prevent them.”

“This is a 100% preventable disease,” added Goff, who is also a physician at Fred Hutchinson Cancer Center in Seattle. She pointed to primary prevention of the HPV vaccine, followed by regular intervals of screening, which includes Pap smear testing every three years between 21 to 29. After 30, this includes HPV or HPV and Pap smear testing every five years.

The study may not entirely reflect the advent of vaccines for HPV, the most common sexually transmitted infection in the U.S., since 2006. The vaccine is typically administered in adolescence. HPV contributes to most cervical cancers. The Centers for Disease Control and Prevention estimating about 4,000 women die from this form of cancer annually. The average age for being diagnosed with cervical cancer is 50, according to the American Cancer Society, so adolescents vaccinated in the period studied may not be reflected in the data.

Authors note there were limits with data showing the stage of diagnosis, those were available starting from 2004. There were also delays with case counts in later years. In addition, county-level data doesn’t account for variation within a county.

Dr. Sarah Dilley, an assistant professor of gynecologic oncology at Emory University’s Winship Cancer Institute, said differentiating wealthy or poor areas may not fully account for racial disparities within communities. For example, incidence and mortality from cervical cancer for Black and Native American women are still higher. There wasn’t data on Native women in the study.

Poor counties tend to have fewer doctors, especially specialized practitioners such as gynecologists, Dilley said.

“Those patients really suffer because they don’t have access to the people who are going to be doing both the preventative care and the treatment,” she said.

Informing the public about treatment was also top of mind Thursday as the White House hosted a forum on cervical cancer, as part of the Biden administration’s cancer moonshot initiative, which aims to prevent more than 4 million cancer deaths by 2047. Dr. Kimryn Rathmell, the National Cancer Institute director, announced the availability of new at-home HPV testing. The trial program is set to begin in the second quarter of 2024 with 25 health institutions across the U.S.

Eduardo Cuevas covers health and breaking news for USA TODAY. He can be reached at EMCuevas1@usatoday.com.