Rural Residents And Cervical Cancer Rates

HOUSTON — Rates of cervical cancer are higher for women living in rural areas than for those living in cities, Vicki Benard, Ph.D., reported at the annual meeting of the American Society of Preventive Oncology.

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Census county codes were used to categorize residents as rural, suburban, or metropolitan. A total of 39,946 cervical cancer cases were reported. Among metropolitan dwellers, the case rate was 11.8 per 100,000 residents; for those in the suburbs, the rate was 13.2 per 100,000; and for rural residents, the rate was 13.8 per 100,000, Dr. Benard reported.

When broken down demographically, black women had the highest rate of cervical cancer at 17.1 per 100,000 residents, followed by 11.4 per 100,000 for white women, 9.9 per 100,000 for Asian/Pacific Islanders, and 7.2 per 100,000 for American Indian/Alaska Natives. Age also factored into cervical cancer rates: Women aged 45 years or younger living in metro areas had a rate of 14.5 per 100,000, compared with 17.2 per 100,000 for rural women.

Dr. Benard and her colleagues speculated that the disparities are due to income, access to care, or quality of health care, but the study did not measure these factors. The study findings are especially timely, as screening and vaccinations against human papillomavirus become available. “Rural areas may need special education and outreach,” Dr. Benard said.

Having worked in both environments--metro and rural--I can tell you that the findings are in line with my clinical experience, as far as cervical dysplasia is concerned. I was quite surprised at the prevalence of high-grade lesions in my rural patient population (mostly white, young, lower middle class/poor). And, at least in that population, access to care and quality of care were not significant issues.

Cervical cancer drops, but disparities persist

Interesting report on cervical cancer demographics (emphasis mine):

NEW YORK (Reuters Health) - In the United States, rates of invasive cervical cancer declined between 1998 and 2002, although significant racial, ethnic, and geographic differences persisted, according to pre-vaccine surveillance data covering 87 percent the population of women.

Altogether, 59,848 cases of cervical cancer cases were identified during the 5-year study period. The annual number of cases fell from 12,720 in 1998 to 11,071 in 2002.

The incidence rate declined from 10.2 per 100,000 women in 1998 to 8.5 per 100,000 in 2002, report Dr. Mona Saraiya from the Centers for Disease Control and Prevention, Atlanta....

For the period as a whole, the average annual incidence rate was highest among Hispanic women (14.8 per 100,000), followed by African American women (13.5 per 100,000). Rates among Asian or Pacific Islander women and white women were similar (8.9 per 100,000).

"We confirmed that in the United States there is a 50 percent higher incidence of cervical cancer among African-American (compared with white) and 66 percent higher incidence among Hispanic women (compared with non-Hispanic)," note the authors.

Cervical cancer rates rose with age for all groups. Among Hispanic women 40 years or older rates were 26.5 or more per 100,000; among African American women older than 50 years rates were 23.5 or more per 100,000 women.

"Our findings confirm the need to continue screening older women as recommended by guidelines and to find better strategies for access to screening of women of color," Saraiya and colleagues note.

There is evidence that suggests that the difference in cervical cancer incidence among African American, Hispanic, and white women may be due "in substantial measure, to differences, by race, in the follow up of abnormal Pap tests."

There were also geographic differences in cervical cancer rates, with higher rates of squamous cell carcinoma - the most common type of cervical cancer -- seen in the South than in other regions.

"Clearly, our approach to preventing cervical cancer in the United States should include more focused attention on pockets of high risk," the team notes.

Introduction in 2006 of a vaccine for human papillomaviruses (HPV), which cause most cases of cervical cancer, gives doctors "an additional tool" to reduce illness and death from cervical cancer. When administered appropriately, the HPV vaccine can prevent about 70 percent of all cervical cancers in this country and worldwide, they point out.

The surveillance system in place in the U.S., Saraiya's team adds, will provide a consistent means of measuring trends in the incidence of invasive cervical cancer in the post-cervical cancer vaccine era, although the effect of the vaccine may not be seen for two decades.