Rising Incidence of Cervical Cancer Among Millennial Women
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After decades of decline, cervical cancer is on the rise among millennial women. A study published in JAMA in 2022 revealed that the incidence of the disease since 2012 has risen by an average of 2.5 percent per year among women 30 to 34 years old — an increase experts call dramatic and surprising.
According to the study, which surveyed women in all 50 states between 2001 and 2019, the incidence of cervical cancer rose in millennials — those born between 1981 and 1996 (ages 23–38 in 2019) — while it decreased or stayed the same in all other age groups.
Specifically, the incidence — or the number of newly diagnosed cases during this period of time — fell among the youngest age group (under 24 years) as well as the oldest age group (55 and older) and remained relatively stable among 35- to 54-year-olds. But among women ages 30 to 34, cases have been rising since 2012, ultimately reaching an annual increase of almost 12 percent by 2019.
“The recent increase in cervical cancer among millennial women is a public health concern,” says Ashish Deshmukh, PhD, MPH, the coleader of the cancer control program at Medical University of South Carolina’s Hollings Cancer Center in Charleston and the lead investigator of the study.
Experts Say Lack of Screening Is to Blame for the Rise of Cervical Cancer
While study authors say it’s possible that the increase in cervical cancer among millennial women is due in part to better detection, the more likely explanation is missed screening. “Lack of screening among younger women (younger than 29 years) may have contributed to the rise of cervical cancer in millennials,” Dr. Deshmukh says.
Indeed, Deshmukh’s report comes on the heels of another study, published in JAMA Network Open, which found that of 20,557 U.S. women surveyed between 2005 and 2019, the percentage of those overdue for cervical cancer screening rose from 14 percent in 2005 to 23 percent in 2019. And women ages 21–29 were significantly more likely to be overdue for screening than those between the ages of 30 and 65.
“Cervical cancer is preventable,” says Ryan Suk, PhD, an assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta and the first author of the screening study. “But the incidence of the disease is higher than it should be, in part because a considerable number of women aren’t being screened in a timely manner.”
Indeed, cervical cancer is nearly entirely preventable thanks to the Pap test (or Pap smear). Named for its inventor, George Papanicolaou, the Pap test revolutionized cancer screening when it was introduced in the United States in the 1940s and has been recommended routine care for women since 1960. The test is so effective at spotting changes in cells before they become cancerous that it essentially knocked cervical cancer — long the number-one deadly cancer among women in the United States — so far down the list that it’s currently not even in the top 10.
So why aren’t women getting screened? The most common reason given by participants in the JAMA Network Open study was “lack of knowledge,” which rose from 45 percent to 55 percent during the study period, followed by “not receiving recommendations from healthcare professionals,” which increased from 6 percent to 12 percent.
“The increase in the proportion of women who said they did not know screening was needed or that they did not have a recommendation from a healthcare provider is surprising and concerning,” said Veronica Chollette, RN, of the National Cancer Institute’s (NCI) Health Systems and Interventions Research Branch in an NCI release on the study.
Meanwhile, another unfortunate cervical cancer trend is emerging among millennials, which experts say is also due to lack of screening at earlier ages. Analyzing data from 2001 to 2017, a group of researchers discovered that late-stage cervical cancer is on the rise in the United States, with a particularly high rate of increase among millennials, at 3.4 percent a year.
Strong Link Between HPV and Cervical Cancer
About 99.7 percent of cervical cancers are caused by persistent infection with high-risk human papillomavirus (HPV), which is spread through sexual contact. And while most cases of HPV resolve within a couple of years without causing any health problems, sometimes the virus lingers.
Lingering infection with high-risk HPV can set in motion a series of changes that over time turn healthy cervical cells into abnormal cells. Left unchecked, these abnormal cells can become precancerous and eventually cancerous unless they are surgically removed.
Indeed, the lack of screenings can create missed opportunities for critical follow-up care. “It is also likely that fewer women are receiving necessary follow-up care, including treatment for precancer,” Deshmukh says. According to the Centers for Disease Control and Prevention (CDC), an estimated 196,000 cervical precancer cases occur each year in the United States.
While there is no cure for the HPV virus itself, effective vaccines are available. Research shows that HPV vaccination dramatically reduces the incidence of cervical cancer, particularly when women are vaccinated at a younger age. A study of nearly 1.7 million girls and women published in the New England Journal of Medicine found that the HPV vaccine reduced cervical cancer incidence by nearly 90 percent among women who were vaccinated before age 17.
The CDC recommends that girls and boys receive the HPV vaccine at age 11 or 12, although it can be started at age 9. (The vaccine is recommended for boys because it can prevent infection with HPV types that cause cancers of the mouth, throat, penis, and anus, as well as genital warts.) Teens and young adults through age 26 who are not already vaccinated should get the HPV vaccine as soon as possible, according to the American Cancer Society (ACS).
The HPV vaccine is not typically recommended for adults older than 26, mostly because they have probably already been exposed to HPV. The vaccine — which works best before any exposure to HPV — prevents new HPV infections but doesn’t treat existing infections or disease.
Cervical Cancer Screening Recommendations
As effective as the HPV vaccine is, it’s not perfect, nor is it a reason to skip cervical cancer screening. In addition to the Pap test, the HPV test is another effective cervical cancer screening tool. Both tests involve swabbing cells from the cervix during a routine exam by a healthcare provider. Cells collected for a Pap test are viewed under a microscope for abnormalities that may become precancerous or cancerous. Cells collected for an HPV test are lab-tested to identify strains of HPV with a high cancer-causing risk.
The CDC recommends that women ages 21 to 29 receive cervical cancer screening in the form of a Pap test every three years if results are normal. Women ages 30–65 have three available screening options: a Pap test alone every three years, an HPV test alone every five years, or Pap and HPV tests together (called co-testing) every five years.
In general, women older than 65 do not need routine cervical cancer screening as long as they have had three negative Pap tests or two negative HPV tests (with or without the Pap test), in the past 10 years. In some cases, however, healthcare providers may recommend continued Pap testing.
And while it’s tempting to think that HPV vaccination and screening provide perfect protection against HPV and cervical cancer, that’s not the case. It’s wise to also use condoms properly for any type of sex, which can protect against a variety of sexually transmitted infections in addition to HPV, according to the CDC.
About 14,000 new cases of invasive cervical cancer will be diagnosed, and more than 4,300 women will die from the disease in 2023 alone, according to the ACS. When cervical cancer is diagnosed early, the five-year survival rate is 92 percent.
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