JAMA's latest research confirms that the incidence of cervical cancer in millennial women is rising rapidly

On November 21, Dr. Ashish Deshmukh, a researcher from the Hollins Cancer Center of South Carolina Medical University (MUSC), published his latest research results in the Journal of the American Medical Association (JAMA), indicating that the incidence rate of cervical cancer among women in their early 30s in the United States is rising sharply.

Cervical cancer is mostly related to human papillomavirus (HPV). At present, cervical cancer is the only cancer with a clear cause. HPV screening can prevent this cancer to a certain extent. However, it is estimated that more than 14000 cases of cervical cancer will be diagnosed in the United States this year, and more than 4000 people will die from cervical cancer.

"HPV is a virus group composed of more than 200 viruses, of which at least 14 high-risk HPV types can cause several types of cancer, including cervical cancer, anal cancer and head and neck cancer. In the era of overall decline in cancer incidence, cancer caused by HPV is unfortunately rising," said Deshmukh, associate professor of MUSC Department of Public Health Sciences.

Deshmukh joined Hollins Cancer Center in August and served as the co leader of the cancer control project. He focused on cancer epidemiology and etiology research, provided evidence basis for cancer prevention, and cooperated with stakeholders and policy makers to formulate public health policies and inform practice.

As an expert focusing on HPV related malignant tumors, Deshmukh has been focusing on the incidence rate of cervical cancer in the United States for many years. Previously, he found that screening recommendations based on research evidence contributed to the decline in the incidence rate of cervical cancer since the 1970s. However, since 2012, the incidence rate of cervical cancer in the United States has stabilized and no longer declined significantly.

"In the past two years, we have been trying to understand why the continuous decline in the incidence of cervical cancer ended abruptly in 2012, and why we have reached a critical turning point." Deshmukh said.

In order to better understand this situation, Deshmukh and his colleagues began to use the data from the National Cancer Registry (NPCR) and Surveillance Epidemiology and End Results (SEER) dataset from 2001 to 2019 to analyze the incidence rate of cervical cancer by age. This data set includes cancer incidence rate data of all 50 states in the United States, covering more than 98% of the population of the United States. Deshmukh said: "Taking five years as a dividing line, we found that among women aged 30 to 34, the decline in the incidence rate of cervical cancer was reversed for the first time." In other words, the incidence of cervical cancer among women in their early 30s has increased every year since 2012, about 3%.

"It is very surprising that the incidence rate of non Hispanic white women, Hispanic women and other ethnic groups has increased, but the incidence rate of non Hispanic black women has not increased." Deshmukh said.

Researchers found that local and regional canceration is increasing, and the incidence rate of squamous cell cervical cancer and cervical adenocarcinoma is increasing. Deshmukh said that squamous cell carcinoma was largely found through screening, so the public health policy implication of this discovery is that we need to improve the screening rate.

The screening rate of cervical cancer in the United States has dropped sharply recently, especially among young women aged 21-29. "It is crucial to determine whether the increase in the incidence rate of cervical cancer in young women is due to the decline in screening rates among women aged 21 to 29 years or the introduction of more effective HPV testing in recent years. We need to thoroughly understand this problem through research." Deshmukh said.

He said that the United States urgently needs national campaigns and innovative methods to improve women's acceptance and persistence of cervical cancer screening. He plans to continue to study the reasons for the recent rise in the incidence rate of cervical cancer.

As part of the Hollins Cancer Control Program, research like this can help inform and raise awareness about cancer epidemiology and public health policies. As a general guideline, it is recommended that women aged 21 to 29 should have Pap smear examination every three years, and women aged 30 to 65 should continue to have Pap smear examination every three years or be transferred to HPV testing or joint testing, that is, Pap smear and HPV testing should be conducted every five years. If the patient's previous examination results are not normal, the doctor may recommend routine examinations after the age of 65.

The promotion of HPV vaccine and routine screening are important strategies to reduce the number of deaths related to cervical cancer. "Hollins Cancer Center has done outstanding work in providing life-saving screening and vaccination for people throughout South Carolina. I expect more HPV vaccination vehicles and mobile medical units targeting rural communities to improve the vaccination and screening rate in underserved areas, which will change the HPV related cancer burden in South Carolina in the coming decades," Deshmukh said.