Trends in cervical cancer incidence and mortality in the United States, 1975-2018: a population-based study

Abstract

Background: Cervical cancer incidence and mortality rates in the United States have substantially declined over recent decades, primarily driven by reductions in squamous cell carcinoma cases. However, the trend in recent years remains unclear. This study aimed to explore the trends in cervical cancer incidence and mortality, stratified by demographic and tumor characteristics from 1975 to 2018.

Methods: The age-adjusted incidence, incidence-based mortality, and relative survival of cervical cancer were calculated using the Surveillance, Epidemiology, and End Results (SEER)-9 database. Trend analyses with annual percent change (APC) and average annual percent change (AAPC) calculations were performed using Joinpoint Regression Software (Version 4.9.1.0, National Cancer Institute).

Results: During 1975-2018, 49,658 cervical cancer cases were diagnosed, with 17,099 recorded deaths occurring between 1995 and 2018. Squamous cell carcinoma was the most common histological type, with 34,169 cases and 11,859 deaths. Over the study period, the cervical cancer incidence rate decreased by an average of 1.9% (95% CI: -2.3% to -1.6%) per year, with the APCs decreased in recent years (-0.5% [95% CI: -1.1 to 0.1%] in 2006-2018). Squamous cell carcinoma incidence trends closely paralleled overall cervical cancer patterns, but the incidence of squamous cell carcinoma in the distant stage increased significantly (1.1% [95% CI: 0.4 to 1.8%] in 1990-2018). From 1995 to 2018, the overall cervical cancer mortality rate decreased by 1.0% (95% CI: -1.2% to -0.8%) per year. But for distant-stage squamous cell carcinoma, the mortality rate increased by 1.2% (95% CI: 0.3 to 2.1%) per year.

Conclusion: For cervical cancer cases diagnosed in the United States from 1975 to 2018, the overall incidence and mortality rates decreased significantly. However, there was an increase in the incidence and mortality of advanced-stage squamous cell carcinoma. These epidemiological patterns offer critical insights for refining cervical cancer screening protocols and developing targeted interventions for advanced-stage cases.

Keywords: age-adjusted incidence; cervical cancer; incidence-based mortality; relative survival; trends.

Figure 1

Trends in cervical cancer age-adjusted incidence rates. Panel (A) shows overall cervical cancer incidence and incidence by histologic type in 1975–2018. Panel (B) shows squamous cell carcinoma incidence by tumor stage in 1975–2018. Panel (C) shows squamous cell carcinoma incidence by tumor size in 1983–2018. All rates were age-adjusted to the 2000 US standard population. The dots represent annual incidence rates and the lines represent incidence trends from joinpoint analysis.

Figure 2

Trends in cervical cancer incidence-based mortality rates. Panel (A) shows observed US cervical cancer mortality (1995–2018), SEER-9 cervical cancer incidence-based mortality overall (1995–2018) and by histologic type. Panel (B) shows squamous cell carcinoma mortality by tumor stage. Panel (C) shows squamous cell carcinoma mortality by tumor size. All rates were age-adjusted to the 2000 US standard population. The dots represent annual mortality rates and the lines represent mortality trends from joinpoint analysis.