Cervical cancer is the most common gynecologic cancer in women worldwide. Most of these cancers stem from infection with the human papillomavirus (HPV), although other host factors affect neoplastic progression following initial infection. Compared with other gynecologic malignancies, cervical cancer develops in a younger population. Thus, screening for this neoplasia typically begins in young adulthood.
Most early cancers are asymptomatic. Thus, diagnosis usually follows histologic evaluation of biopsies taken during colposcopic examination or from a grossly abnormal cervix. This cancer is staged clinically, and this in turn directs treatment. In general, early-stage disease is effectively eradicated surgically. For advanced disease, chemoradiation is primarily selected. As expected, disease prognosis differs with tumor stage, and stage is the most important indicator of long-term survival.
Prevention lies mainly in identifying and treating women with high-grade dysplasia, and in HPV vaccination. Accordingly, as detailed in Chapter 29, regular screening is recommended and HPV vaccination is encouraged to lower rates of cervical cancer in the future.
Worldwide, cervical cancer is common, and it ranks fourth among all malignancies for women (World Health Organization, 2012). In general, higher incidences are found in developing countries, and these countries contribute 85 percent of reported cases annually. Mortality rates are similarly higher in these populations (Torre, 2015). This incidence and survival disparity highlights successes achieved by long-term cervical cancer screening programs.
In the United States, cervical cancer is the third most common gynecologic cancer and the 11th most common solid malignant neoplasm among women. Women have a 1 in 132 lifetime risk of developing this cancer. In 2015, the American Cancer Society estimated 12,900 new cases and 4100 deaths from this malignancy (Siegel, 2015). Of U.S. women, black women and those in lower socioeconomic groups have the highest age-adjusted cervical cancer death rates, and Hispanic women have the highest incidence rates (Table 30-1). This trend is thought to stem mainly from financial and cultural characteristics affecting access to screening and treatment. The age at which cervical cancer develops is in general earlier than that of other gynecologic malignancies, and the median age at diagnosis is 49 years (Howlader, 2014).
TABLE 30-1Cervical Cancer Age-Adjusted Incidence and Death Rates (per 100,000 women per year) ||Download (.pdf) TABLE 30-1 Cervical Cancer Age-Adjusted Incidence and Death Rates (per 100,000 women per year)
| ||All Races ||White ||Black ||Asian American & Pacific Islander ||American Indian & Alaskan Native ||Hispanic |
|Incidence ||7.8 ||7.8 ||9.4 ||6.4 ||7.6 ||10.2 |
|Death ||2.3 ||2.1 ||4.1 ||1.8 ||3.4 || 2.8 |