Previous decline in cervical cancer incidence

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Cervical cancer incidence is starting to rise in low-income U.S. counties and has leveled off in high-income counties in recent years, after years of decline, according to a new study by Center researchers of Health Sciences from the University of Texas at Houston. (UTHealth Houston) and published in JNCI cancer spectrum.

Cervical cancer is one of the six main cancers associated with the human papillomavirus (HPV) and the only one currently preventable by screening. Other types of HPV-associated cancers are oropharyngeal, anal, penile, vaginal, and vulvar. According to the Centers for Disease Control and Prevention, more than 46,000 HPV-associated cancers are diagnosed in the United States each year — more than 25,000 in women and 20,000 in men.

Investigators led by Ashish A. Deshmukh, PhD, MPH, associate professor in the Department of Management, Policy, and Community Health at UTHealth School of Public Health, conducted a retrospective study of men and women diagnosed with cancers associated with HPV in the United States from 2000 through 2018 in the 21 Surveillance, Epidemiology and Endline Program registries. They estimated trends in incidence based on county-level household income and smoking prevalence. There were 252,648 cases of HPV-associated cancers included in the analysis.

In the lowest income counties, the annual percentage increase in cervical cancer was 1.6% between 2011 and 2018, while no change was observed (0% per year) in the highest-income counties over the same period, the researchers reported.

The study found that among people living in counties with low household income or high smoking rates, cancers of the oropharynx, anus and vulva increased rapidly compared to their counterparts. Low household income and high smoking rates were not associated with changes in the incidence of vaginal or penile cancer.

“Our finding that the incidence of cervical cancer is increasing again in deprived counties is sobering,” Deshmukh said. “We have two evidence-based interventions for cervical cancer. Cervical cancer screening and HPV vaccination could eliminate almost all HPV-associated cancers. Rapid and targeted improvements in HPV vaccine delivery, uptake of cervical cancer screening, and adherence to screening and follow-up guidelines are urgently needed to address growing disparities,” he added.

“Smoking is an important risk factor for HPV-associated cancers. Our study underscores the importance of greater emphasis on smoking cessation efforts to reduce the growing burden of these cancers,” said Yueh-Yun Lin, MS, study first author and doctoral student at UTHealth School. of Public Health.

UTHealth co-authors include Haluk Damgacioglu, PhD; Ryan Suk, Ph.D.; Yenan Zhu, MS; and Kalyani Sonawane, PhD. Chi-Fang Wu, PhD, of the University of Texas MD Anderson Cancer Center; Ana P. Ortiz, PhD, MPH, of the University of Puerto Rico Comprehensive Cancer Center; and Sehej Kaur Hara, MPH, BDS, of the City of Houston Department of Health, also contributed to the study.

Deshmukh is associate director of the Center for Health Services Research and co-director of the Clinical Analytics and Decision Science Lab at UTHealth School of Public Health.

The study titled “Trends in Human Papillomavirus-Associated Cancer Incidence by County-Level Income and Smoking Prevalence in the United States, 2000-2018” was supported by the National Cancer Institute Awards (R01CA232888 and U54CA096300) and National Institute on Minority Health and Health Disparities (K01MD016440).

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