Article Text

Download PDFPDF
The increasing incidence of stage IV cervical cancer in the USA: what factors are related?
  1. Alex Andrea Francoeur1,
  2. Cheng-I Liao2,
  3. Michelle Ann Caesar3,
  4. Ava Chan4,
  5. Daniel S Kapp5,
  6. Joshua G Cohen1,
  7. Ritu Salani1 and
  8. John K Chan6
  1. 1Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA
  2. 2Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  3. 3Department of Pediatrics, University of California San Diego, San Diego, California, USA
  4. 4Department of Obstetrics and Gynecology, California Pacific Medical Center Research Institute, San Francisco, California, USA
  5. 5Stanford University School of Medicine, Palo Alto, California, USA
  6. 6California Pacific Palo Alto Medical Foundation; Sutter Cancer Research Institute, San Francisco, California, USA
  1. Correspondence to Dr Alex Andrea Francoeur, Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, USA; afrancoeur{at}


Objective Cervical cancer (International Federation of Gynecology and Obstetrics (FIGO)) stage IVA-B (distant stage) is a rare diagnosis with an approximate 5 year survival rate of 17% and with limited treatment options. The objective of this study was to determine the trends in distant stage cervical cancer in the USA and identify possible factors related to these trends.

Methods Data were obtained from the United States Cancer Statistics program from 2001 to 2018. Rates of cervical cancer screening and vaccination were evaluated using the Behavioral Risk Factor Surveillance System and TeenVaxView. SEER*Stat and Joinpoint regression program were used to calculate incidence trends.

Results Over the last 18 years, 29 715 women were diagnosed with distant stage cervical carcinoma. Black women have disproportionately higher rates at 1.55/100 000 versus 0.92/100 000 in White women (p<0.001). When examining the trends over time, there has been an annual increase in distant stage cervical cancer at a rate of 1.3% per year (p<0.001). The largest increase is seen in cervical adenocarcinoma with an average annual percent change of 2.9% (p<0.001). When performing an intersection analysis of race, region and age, White women in the South aged 40–44 have the highest rise in distant cervical cancer at a rate of 4.5% annually (p<0.001). Using the Behavioral Risk Factor Surveillance System and TeenVax data, compared with Black women, we found that White women have a nearly two-fold higher rate of missed or lack of guideline screening, 26.6% vs 13.8%. White teenagers (13–17 years) have the lowest human papillomavirus vaccination rate at 66.1% compared with others at 75.3%.

Conclusions Black women have a higher incidence of distant stage disease compared with White women. However, White women have a greater annual increase, particularly in adenocarcinomas. Compared with Black women, White women also have lower rates of guideline screening and vaccination.

  • adenocarcinoma
  • cervix uteri

Data availability statement

Data are available in a public, open access repository.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available in a public, open access repository.

View Full Text


  • Twitter @JCohenMD

  • Presented at These data will be presented at the 2022 annual Society of Gynecologic Oncologist (SGO) meeting in Phoenix Arizona.

  • Correction notice This article has been corrected since it was first published due to errors in tables 1, S3, S4, and S5. Please see the correction notice for further details.

  • Contributors AAF: writing - original draft, conceptualization. CIL: data curation, formal analysis, methodology. MAC: project administration. AC: data curation. DSK: writing - review and editing, conceptualization. JGC: writing - review and editing. RS: writing - review and editing. JKC: writing - review and editing, conceptualization, methodology, funding acquisition, guarantor of study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Linked Articles