Cervical cancer incidence and mortality have significantly increased from 2009 to 2019 in Appalachian Kentucky, according to a recent study published in JAMA Network Open.
Takeaways
- Cervical cancer incidence and mortality rates increased significantly in Appalachian Kentucky from 2009 to 2019, as revealed in a study published in JAMA Network Open.
- Kentucky had the highest incidence of cervical cancer in the United States from 2015 to 2019, and this issue was especially prominent in the central Appalachian region due to economic distress, health inequity, poverty, isolation, transportation difficulties, and healthcare shortages.
- The study emphasized the importance of county-level data in highlighting disparities in cervical cancer care, which could help guide public health interventions to address the issue.
- Over the 2 decades covered by the study (2000-2019), there was an initial decline in cervical cancer rates in Appalachian Kentucky, followed by a significant increase in incidence and mortality, while non-Appalachian regions experienced a decrease in rates.
- The findings suggest a critical need for further research and improved prevention strategies to address the growing disparities in cervical cancer outcomes in these regions
From 2015 to 2019, the greatest incidence of cervical cancer in the United States was observed in Kentucky. Cervical cancer screening and care is especially lacking in the central Appalachian region, where high economic distress, health inequity, and persistent poverty cause isolation, lack of transportation, and health care shortages.
Public health interventions may be supported by data on county-level trends which highlight disparities in care. To evaluate trends in cervical cancer incidence and mortality in Appalachian and non-Appalachian Kentucky counties, investigators conducted a cross-sectional study.
Surveillance Epidemiology and End Results data from 2000 to 2019 was evaluated, with malignant cervical cancer cases determined using the International Classification of Diseases for Oncology, Third Edition site codes C53.0-C53.9 and histology codes 8010 to 8671 and 8940 to 8941.
State at diagnosis was used to calculate incidence rates, with measures including state-wide and Appalachian and non-Appalachian regions. Incidence was compared between Appalachian and non-Appalachian regions using piecewise log-linear trends and annual percentage changes (APCs) and rate ratios (RRs).
Hysterectomy-corrected cervical cancer mortality rates were also measured. Statistical analysis was performed from February 10 to April 17, 2023.
There were 4110 cases of cervical cancer reported between January 1, 2000, and December 31, 2019, in Kentucky. Of these cases, 32.6% were in Appalachian and 67.7% in non-Appalachian regions. Eighty-eight percent of patients were non-Hispanic White, 8% non-Hispanic Black, 2% Hispanic, and 1.5% non-Hispanic other.
An annual cervical cancer incidence increase of 2.9% was observed in Appalachian Kentucky between 2009 and 2019. This occurred following an initial decline, with an APC of -4% from 2000 to 2019. In comparison, rates decreased overall in non-Appalachian regions, with an APC of -1.3% from 2000 to 2019.
Of 563 reported cervical cancer mortalities from 2010 to 2019, 33.9% were in Appalachian and 66.1% in non-Appalachian regions. Cervical cancer mortality in Appalachian Kentucky had an APC of 4.5%, vs -3.2% for non-Appalachian Kentucky.
Between 2017 and 2019, cervical cancer mortality increased 2-fold in Appalachian Kentucky vs nationally, at 6.4 vs 3.1 per 100,000 and with an RR of 2.1.
These results indicated significant increases in cervical cancer incidence and mortality in Appalachian Kentucky from 2009 to 2019. Investigators recommended further research and improvement in prevention to combat disparities in cervical cancer outcomes in these regions.
Reference
Damgacioglu H, Burus T, Sonawane K, Hill E, Lang Kuhs KA, Deshmukh AA. County-level trends in cervical cancer incidence, stage at diagnosis, and mortality in Kentucky. JAMA Netw Open. 2023;6(10):e2338333. doi:10.1001/jamanetworkopen.2023.38333
