What’s Behind the Increase in Late-Stage Cervical Cancer? Local Cancer Experts Offer Their Perspective.

A new study has the cancer community concerned, particularly oncologists who specialize in treating gynecologic cancers. The research, published recently in the International Journal of Gynecological Cancer, shows that while early-stage cervical cancer continues to decline in the United States, there has been a surprising spike in advanced stage, or metastatic, cervical cancer diagnoses in recent years.

Researchers collected and analyzed 18 years’ worth of data on deaths and disability due to cervical cancer – work that spanned 204 countries and nearly 30,000 patients with 23 cancer types and 34 risk factors, according to news reports. The data used for the research only went through 2018, before the COVID-19 pandemic.

According to the study, the sharpest rise in advanced stage cervical cancer was among White women, at a rate of 1.69 percent, and in particular among White women in the South aged 40 to 44, who had the highest annual increase of 4.5 percent. Rates also increased among Black women, at a rate of 0.67 percent annually. Overall prevalence of the disease was higher in Black women, too – 1.55 per 100,000 compared to 0.92 per 100,000 for White women.

Resource editors spoke with two local cancer specialists to get their perspectives on the news: John Paul Diaz, M.D., chief of gynecologic oncology at Miami Cancer Institute, and Thomas Morrissey, M.D., director of gynecologic oncology at Lynn Cancer Institute, which is part of Boca Raton Regional Hospital. Both cancer centers are part of Baptist Health and offer some of the most advanced expertise and cancer-fighting technologies available in Florida.

There are multiple reasons for the increase, according to Dr. Diaz, who points to the change in screening guidelines over the years as a possible cause. “We’ve gone from annual screenings to intervals of three or five years, depending on the patient’s risk factors,” he says. “Some women may delay beyond the three- or five-year mark, however.” In addition, many patients paused their screenings during the COVID-19 pandemic. “As a result, these women may have missed an opportunity to catch cervical cancer in its earliest stages, when they have the best chance of having a successful outcome.”

The human papilloma virus (HPV) is one of the greatest risk factors for cervical cancer, Dr. Diaz says, causing an estimated 93 percent of all cervical cancers diagnosed in the U.S. The introduction of an HPV vaccine in 2006 has led to a slow but steady decrease in early-stage cervical cancer over the past 15 years.

However, women who rely on HPV testing without including an annual Pap smear do so at their own risk, cautions Dr. Diaz. “Screening for just HPV and not including a Pap smear can produce a false negative when the patient actually does have cancer,” he says. This is especially true among patients with late-stage tumors, which are the most difficult to treat,” he says.

Dr. Morrissey at Lynn Cancer Institute says there are other factors, too, behind the increase in late-stage cervical cancer. And, like Dr. Diaz, he worries that women may be getting lax about their screenings. “In the U.S. most cases of advanced cervical cancer are seen in patients who have not had a pap smear or a cervical cancer screening for at least five years,” Dr. Morrissey says. “If patients don’t return to the recommended screening intervals, we’ll definitely see a further increase going forward.”

Another factor, according to Dr. Morrissey: Lack of access to health care or lack of health insurance coverage. “Many women who are most at risk for cervical cancer are from underserved populations that typically don’t have adequate health insurance or easy access to cancer screenings and healthcare,” he says.

Dr. Morrissey advises women without health insurance coverage to contact their county health department for assistance in obtaining cancer screening tests like pap smears, mammograms and colon cancer screenings. “Another great resource is The Promise Fund of Florida, an incredible organization which helps patients obtain breast and cervical cancer screenings and also helps patients with those cancers through their cancer treatments,” he says.

Who is most at risk for cervical cancer?

According to the American Cancer Society (ACS), 14,480 women will be diagnosed with cervical cancer this year, and 4,290 will die from the disease. Additionally, the ACS notes that:

• Cervical cancer tends to occur in midlife and is most frequently diagnosed in women between the ages of 35 and 44.
• Women who have never or rarely been screened represent more than 50 percent of new cervical cancer cases.
• Proper screening and getting the human papilloma virus (HPV) vaccine are among factors that can help prevent up to 93 percent of cervical cancers.
• HPV viruses cause the most cervical cancers.

Cervical cancer has few warning signs

Because there are usually no signs or symptoms of early cervical cancer, it’s especially important for women to have regular check-ups and screenings. Dr. Diaz advises checking with your gynecologist if you have any of the following symptoms:

• Vaginal bleeding including bleeding after intercourse
• Unusual vaginal discharge
• Pelvic pain or pain during intercourse

The benefits of screenings and early detection

If found early, cervical cancer is one of the most successfully treatable cancers, according to Dr. Diaz. The American College of Obstetrics & Gynecology (ACOG) encourages women to begin yearly cervical cancer screenings at age 21, and earlier for women younger than 21 who are infected with HIV (human immunodeficiency virus).

Dr. Diaz recommends that women undergo routine cervical cancer screenings consisting of Pap smears and, when appropriate, HPV co-testing. “Cervical cancer is one of the few cancers we can eradicate,” he says. “The combination of the HPV vaccine and routine screening should eliminate this disease. We need to educate our patient population on the benefits of screenings and early detection. It could save their life.”