Trends in Cervical Cancer Incidence and Mortality in the United States, 1975-2018. A Population-Based Study

Abstract

Abstract Background: Cervical cancer incidence and mortality have declined substantially in the U.S. over many years, largely due to the decline in squamous cell carcinoma. However, the trend change in recent years is not clear. This study aimed to explore trends in cervical cancer incidence and mortality stratified by demographic and tumor characteristics during 1975-2018. Methods: Cervical cancer age-adjusted incidence, incidence-based mortality, and relative survival were calculated using the Surveillance, Epidemiology, and End Results-9 database. Trends and the calculation of annual percent change (APC) and average annual percent change (AAPC) were realized by joinpoint software. Results: A total of 49,658 cases were diagnosed with cervical cancer between 1975-2018 and 17,099 patients died between 1995-2018. Among them, squamous cell carcinoma was the most common histological type (34,169 cases and 11,859 deaths). Cervical cancer incidence rate declined by an average of 1.9% (95% CI, -2.3% to -1.6%) per year over the study period, with the APCs decreased in recent years (-0.5% [95% CI, -1.1% to 0.1%] in 2006-2018). The incidence trend of squamous cell carcinoma was basically consistent with that of the general population, but the incidence of squamous cell carcinoma in distant stage was increasing significantly (1.1% [95% CI, 0.4% to 1.8%] in 1990-2018). During 1995-2018, cervical cancer mortality rate decreased by 1.0% (95% CI, -1.2% to -0.8%) per year overall, but increased by 1.2% (95% CI, 0.3% to 2.1%) per year for distant stage squamous cell carcinoma. Conclusion: For cases diagnosed with cervical cancer in the United States from 1975 to 2018, the overall incidence and mortality rates decreased significantly, with increase in the incidence and mortality of advanced-stage squamous cell carcinoma. These findings will provide a scientific basis for cervical cancer prevention and management.