Women in counties with repeatedly lower cervical cancer screening rates suffer nearly double the rate of cervical cancer diagnoses, particularly of late-stage disease, and death from cervical cancer, according to a new analysis from researchers at MUSC Hollings Cancer Center.
Trisha Amboree, Ph.D., is part of a team of researchers that has previously shown that cervical cancer incidence and death rates are higher in low-income and rural U.S. counties. Those papers analyzed the numbers but couldn't explore the reasons why incidence and death were higher.
"We know that higher screening uptake prevents disease and subsequent mortality," she said.
In the absence of a national screening registry in the U.S., there has been no way to tie individual screening histories to cancer outcomes nationally, so researchers look at county-level metrics to assess this with measurable outcomes.
"In the previous papers, we didn't have any individual-level screening data. This paper helps to contextualize our previous findings to say what we're seeing is at least probably partially a result of repeatedly low screening."
Timely screening can identify precancerous lesions for removal before they develop into cancer and also allows medical providers to diagnose cancer at an early stage, when it is far more likely that someone can be treated successfully. The current paper published in JAMA Network Open looked at county-level screening data from 2004 through 2016, broken into three time periods. The researchers labeled counties as repeatedly low-screening if in at least two of the three time periods fewer than 70% of eligible women in that county were screened. They were labeled as repeatedly high-screening if at least 80% were screened. Nationally, the cervical cancer screening goal is 79.2%.
Most counties fell into the in-between category. But when comparing the repeatedly low-screening counties with the repeatedly high-screening counties, the researchers found that diagnosis of distant-stage cervical cancer was 84% higher in low-screening counties, and deaths were 96% higher in low-screening counties.
The researchers also showed that nearly all the low-screening counties were rural, and all of them had an annual median household income of less than $75,000.
This latest analysis reinforces the need for improved access to screening and treatment, particularly in rural and low-income counties, the researchers said.
Cervical cancer screening in South Carolina
The current paper looks at data from a national database that covers about a third of the U.S. population, including states as varied as California, New York, Texas, Georgia and Idaho.
South Carolina data isn't part of this national database, but it's likely that the trends that the researchers uncovered are observed here as well, Amboree said.
Gynecologists or family physicians generally perform cervical cancer screenings. But the South Carolina Area Health Education Consortium reports that 14 counties in South Carolina have no obstetrician-gynecologists. Several counties have only a handful – or as few as one – family practice physicians.
Hollings supplements this lack of screening options through its Mobile Health Unit, which offers cervical cancer screening and travels to medically underserved areas of the state.
Current screening recommendations from the U.S. Preventive Services Task Force for average-risk women are that those ages 21 to 65 should receive a Pap smear every three years, or those ages 30 to 65 years should receive HPV testing (alone or with a Pap) every five years.
