A new study finds that cervical cancer linked to HPV is on the rise in some women

A new study finds that cervical cancer linked to HPV is on the rise in some women

After decades of good news in the fight against cervical cancer — marked by decades of steady declines in cases and deaths — a new report suggests that some women have been left behind.

Thanks to early detection and treatment, cervical cancer rates have decreased by more than half over the past fifty years. Rates are falling most rapidly among women in their early 20s, the first generation to benefit from HPV vaccines, which were approved in 2006.

Human papillomavirus, human papillomavirus, causes six types of cancer, including cervical cancer.

Among women ages 20 to 24, the incidence of cervical cancer dropped 65% from 2012 to 2019, according to a report released Wednesday by the American Cancer Society.

“Cervical cancer is one of the best understood cancers,” said Dr. Nicholas Vintzensen, a senior researcher in the Clinical Genetics Branch of the National Cancer Institute, who was not involved in the new report. “We have made amazing progress and it will continue to be a success story.”

However, not all women benefit from this progress.

The overall incidence of cervical cancer among women of all ages has stopped declining.

Is it too old for the HPV vaccination?

Among women in their 30s and early 40s, the incidence has been trending higher. Cervical cancer diagnoses among women ages 30 to 44 years rose approximately 2% annually from 2012 to 2019.

“We need to make sure we don’t forget that generation that was too old to get vaccinated against HPV,” said Jennifer Spencer, an assistant professor at Dell Medical School at the University of Texas-Austin who studies population health.

Fortunately, the cancers discovered in 30- and 40-year-old women were mostly early, curable tumors, said Ahmadin Jamal, senior author of the new report and the Cancer Society’s senior vice president for Surveillance and Health Equity Sciences. About 13,800 American women are diagnosed with cervical cancer each year, and 4,360 die from the disease.

Jamal said that researchers did not delve into the reasons why cervical cancer is more common in some women.

But Spencer, who was not involved in the study, said screening rates may play a role. Screenings allow doctors to find and remove precancerous lesions before they become cancerous. More than half of women diagnosed with cervical cancer have either never been screened or have not been screened in the past five years, according to the Centers for Disease Control and Prevention.

Studies show that fewer women are keeping up with routine cervical cancer screening.

The number of women ages 21 to 65 who are screened according to the latest guidelines has fallen from 87% in 2000 to 72%, according to the National Cancer Institute.

Other research found that women aged 21 to 29 were the least likely to be up to date on their checkups, with 29% of them late. Women were also more likely to be behind schedule if they were nonwhite, uninsured, lived in rural areas or identified as gay, lesbian or bisexual, according to the study.

The U.S. Preventive Services Task Force recommends that women ages 21 to 29 have a Pap smear — which examines cells under a microscope — every three years. Women between the ages of 30 and 65 can be screened either every three years with a Pap smear, every five years with an HPV test, or a combination of the two tests. HPV tests can detect genetic material from HPV.

It’s possible that lower screening rates among women in their 20s may help explain the slightly higher cervical cancer rates among women in their 30s and early 40s, Spencer said.

When women in one of Spencer’s studies were asked why they had not been screened recently, they typically responded that they did not know they needed to be screened or that their health care provider had not recommended it. Only 1% of women ages 21 to 29 said they skipped screening because they had received the HPV vaccine.

“There is clearly a need for more patient education,” said Dr. Betty Suh Bergman, chief of gynecologic oncology at Kaiser Permanente Northern California. Its health care system already reminds women of screenings via postcards, letters and phone calls. This year, Kaiser Permanente will begin texting patients as well, she said.

Spencer said changing guidelines regarding cervical cancer screening may have left women and health providers confused. Until the early 2000s, most doctors examined women annually. The task force has updated its guidelines three times in the past two decades, and is now reviewing them again.

Others say the increase in cervical cancer rates among 30- and 40-year-old women cannot be easily explained.

Cervical polyps tend to grow slowly, Wintzensen said, and it usually takes a decade or more to go from precancerous to cancerous. There may be other factors at play, he said. For example, he wonders whether more women moving to the United States are not screened, putting them at greater risk.

Spencer points out that screening is just the first step to saving lives. Women with abnormal screening results need to undergo additional testing and, if necessary, treatment.

In a study published last year in the American Journal of Preventive Medicine, Spencer and her colleagues found that only 73% of women who had abnormal screening results received follow-up care.

“The health care system has a responsibility to think about who is slipping through the cracks,” Spencer said.

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