According to figures from the World Health Organization, cervical cancer was the fourth most common malignancy in women worldwide in 2020, with an estimated 604,000 new cases and 342,000 deaths.[2]World Health Organization. Human papillomavirus (HPV) and cervical cancer: fact sheet. Aug 2023 [internet publication].
https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer
In Europe, there were an estimated 30,447 new cases of cervical cancer in 2020 and an estimated 13,437 deaths.[3]European Commission: European Cancer Information System. Cervical cancer burden in EU-27. 2021 [internet publication].
https://ecis.jrc.ec.europa.eu/pdf/factsheets/cervical_cancer_en-Nov_2021.pdf
Cervical cancer ranks 11th among the most frequently occuring cancers in women. Incidence and mortality rates vary across Europe significantly. This wide variation can be explained by differences in human papillomavirus prevalence, and vaccination and screening policies.[3]European Commission: European Cancer Information System. Cervical cancer burden in EU-27. 2021 [internet publication].
https://ecis.jrc.ec.europa.eu/pdf/factsheets/cervical_cancer_en-Nov_2021.pdf
In the US, cervical cancer incidence and mortality rates are gradually declining.[4]National Cancer Institute: Surveillance, Epidemiology, and End Results (SEER) Program. Cancer stat facts: cervical cancer. 2024 [internet publication].
https://seer.cancer.gov/statfacts/html/cervix.html
In 2024, there were an estimated 13,820 new cases (0.7% of all new cancer diagnoses), and 4360 deaths.[4]National Cancer Institute: Surveillance, Epidemiology, and End Results (SEER) Program. Cancer stat facts: cervical cancer. 2024 [internet publication].
https://seer.cancer.gov/statfacts/html/cervix.html
The highest incidence is in Hispanic women (9.8 per 100,000, based on data from 2017 to 2021).[4]National Cancer Institute: Surveillance, Epidemiology, and End Results (SEER) Program. Cancer stat facts: cervical cancer. 2024 [internet publication].
https://seer.cancer.gov/statfacts/html/cervix.html
Mortality rate is highest in non-Hispanic black women (3.2 per 100,000 persons); overall mortality is 2.2 per 100,000 (based on data from 2018 to 2022).[4]National Cancer Institute: Surveillance, Epidemiology, and End Results (SEER) Program. Cancer stat facts: cervical cancer. 2024 [internet publication].
https://seer.cancer.gov/statfacts/html/cervix.html
Cervical cancer is most commonly diagnosed in midlife (most frequently in women aged 35-44 years); median age at diagnosis is 50 years.[4]National Cancer Institute: Surveillance, Epidemiology, and End Results (SEER) Program. Cancer stat facts: cervical cancer. 2024 [internet publication].
https://seer.cancer.gov/statfacts/html/cervix.html
Human papillomavirus (HPV) is the most important aetiological factor. Incidence of cervical cancer correlates with early onset of sexual activity, multiple sexual partners, cigarette smoking, immunosuppression (e.g., HIV infection, transplant recipients), low socioeconomic status, poor nutrition, and oral contraceptive use.[5]Louie KS, de Sanjose S, Diaz M, et al. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer. 2009 Apr 7;100(7):1191-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670004
http://www.ncbi.nlm.nih.gov/pubmed/19277042?tool=bestpractice.com
[6]International Collaboration of Epidemiological Studies of Cervical Cancer. Cervical carcinoma and sexual behavior: collaborative reanalysis of individual data on 15,461 women with cervical carcinoma and 29,164 women without cervical carcinoma from 21 epidemiological studies. Cancer Epidemiol Biomarkers Prev. 2009 Apr;18(4):1060-9.
http://cebp.aacrjournals.org/content/18/4/1060.long
http://www.ncbi.nlm.nih.gov/pubmed/19336546?tool=bestpractice.com
[7]International Collaboration of Epidemiological Studies of Cervical Cancer; Appleby P, Beral V, Berrington de González A, et al. Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer. 2006 Mar 15;118(6):1481-95.
https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.21493
http://www.ncbi.nlm.nih.gov/pubmed/16206285?tool=bestpractice.com
[8]Liu G, Sharma M, Tan N, et al. HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer. AIDS. 2018 Mar 27;32(6):795-808.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854529
http://www.ncbi.nlm.nih.gov/pubmed/29369827?tool=bestpractice.com
[9]Hessol NA, Whittemore H, Vittinghoff E, et al. Incidence of first and second primary cancers diagnosed among people with HIV, 1985-2013: a population-based, registry linkage study. Lancet HIV. 2018 Nov;5(11):e647-55.
http://www.ncbi.nlm.nih.gov/pubmed/30245004?tool=bestpractice.com
[10]Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007 Jul 7;370(9581):59-67.
http://www.ncbi.nlm.nih.gov/pubmed/17617273?tool=bestpractice.com
[11]Parikh S, Brennan P, Boffetta P. Meta-analysis of social inequality and the risk of cervical cancer. Int J Cancer. 2003 Jul 10;105(5):687-91.
https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.11141
http://www.ncbi.nlm.nih.gov/pubmed/12740919?tool=bestpractice.com
[12]González CA, Travier N, Luján-Barroso L, et al. Dietary factors and in situ and invasive cervical cancer risk in the European prospective investigation into cancer and nutrition study. Int J Cancer. 2011 Jul 19;129(2):449-59.
https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.25679
http://www.ncbi.nlm.nih.gov/pubmed/20853322?tool=bestpractice.com
[13]International Collaboration of Epidemiological Studies of Cervical Cancer., Appleby P, Beral V, et al. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet. 2007 Nov 10;370(9599):1609-21.
http://www.ncbi.nlm.nih.gov/pubmed/17993361?tool=bestpractice.com
Effective screening in developed countries has significantly reduced the incidence and mortality of cervical cancer.[14]Landy R, Pesola F, Castañón A, et al. Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case-control study. Br J Cancer. 2016 Oct 25;115(9):1140-6.
https://www.nature.com/articles/bjc2016290
http://www.ncbi.nlm.nih.gov/pubmed/27632376?tool=bestpractice.com
Approximately 50% of diagnoses in the developed world occur in women who have never been screened or have not been screened in the 5 years preceding diagnosis.[15]Vesco KK, Whitlock EP, Eder M, et al. Screening for cervical cancer: a systematic evidence review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality (US); 2011 May.
https://www.ncbi.nlm.nih.gov/books/NBK66099
http://www.ncbi.nlm.nih.gov/pubmed/22132428?tool=bestpractice.com
Further reductions in incidence have been reported in countries with established HPV vaccination programmes.[16]Lei J, Ploner A, Elfström KM, et al. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020 Oct 1;383(14):1340-48.
https://www.nejm.org/doi/10.1056/NEJMoa1917338?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
http://www.ncbi.nlm.nih.gov/pubmed/32997908?tool=bestpractice.com
[17]Kjaer SK, Dehlendorff C, Belmonte F, et al. Real-world effectiveness of human papillomavirus vaccination against cervical cancer. J Natl Cancer Inst. 2021 Oct 1;113(10):1329-35.
https://academic.oup.com/jnci/article/113/10/1329/6227603
http://www.ncbi.nlm.nih.gov/pubmed/33876216?tool=bestpractice.com
[18]Guo F, Cofie LE, Berenson AB. Cervical cancer incidence in young U.S. females after human papillomavirus vaccine introduction. Am J Prev Med. 2018 Aug;55(2):197-204.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054889
http://www.ncbi.nlm.nih.gov/pubmed/29859731?tool=bestpractice.com
[19]Falcaro M, Castañon A, Ndlela B, et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021 Dec 4;398(10316):2084-92.
http://www.ncbi.nlm.nih.gov/pubmed/34741816?tool=bestpractice.com
[20]Liao CI, Francoeur AA, Kapp DS, et al. Trends in human papillomavirus-associated cancers, demographic characteristics, and vaccinations in the US, 2001-2017. JAMA Netw Open. 2022 Mar 1;5(3):e222530.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790165
http://www.ncbi.nlm.nih.gov/pubmed/35294540?tool=bestpractice.com
[21]Rahangdale L, Mungo C, O'Connor S, et al. Human papillomavirus vaccination and cervical cancer risk. BMJ. 2022 Dec 15;379:e070115.
https://www.bmj.com/content/379/bmj-2022-070115.long
http://www.ncbi.nlm.nih.gov/pubmed/36521855?tool=bestpractice.com
Nearly 90% of deaths worldwide from cervical cancer are in low- and middle-income countries. Without vaccination, the expected number of cervical cancer cases among girls born between 2005 and 2014 is estimated to be 11.6 million, with approximately 75% of the burden in 25 countries, mostly in Africa and Asia.[22]Bonjour M, Charvat H, Franco EL, et al. Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis. Lancet Public Health. 2021 Jul;6(7):e510-21.
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00046-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/33864738?tool=bestpractice.com
Many of these countries have a high prevalence of HIV infection, which increases the risk of cervical cancer.[23]Sharma K, Machalek DA, Toh ZQ, et al. No woman left behind: achieving cervical cancer elimination among women living with HIV. Lancet HIV. 2023 Jun;10(6):e412-20.
http://www.ncbi.nlm.nih.gov/pubmed/37182539?tool=bestpractice.com
The World Health Organization has launched a global strategy to eliminate cervical cancer, aiming to improve access to vaccination, screening, and treatment.[24]World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. November 2020 [internet publication].
https://www.who.int/publications/i/item/9789240014107