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INTRODUCTION

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 relatively 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 worsens with advancing 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. Detailed in Chapter 29 (p. 628), regular screening is recommended and HPV vaccination is encouraged to lower future rates of cervical cancer.

INCIDENCE

Worldwide, cervical cancer is common, and it ranks fourth among all malignancies for women (World Health Organization, 2019). In 2018, global cervical cancer estimates include nearly 570,000 new cases and more than 311,000 deaths. In general, higher incidences are found in developing countries, and these countries contribute 85 percent of reported cases annually. In these populations, mortality rates are similarly higher (Torre, 2015). These incidence and survival disparities highlight 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 2019, the American Cancer Society estimated 13,170 new cases and 4250 deaths from this malignancy (Siegel, 2019). 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 50 years (Howlader, 2019).

TABLE 30-1Cervical Cancer Age-Adjusted Incidence and Death Rates (per 100,000 women per year)

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