De acordo com dados da Organização Mundial da Saúde, o câncer cervical foi a quarta neoplasia maligna mais comum em mulheres em todo o mundo em 2020, com uma estimativa de 604,000 novos casos e 342,000 mortes.[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
Na Europa, estima-se que ocorreram 30,447 novos casos de câncer cervical em 2020, com uma estimativa de 13,437 mortes.[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
O câncer cervical está em 11o lugar entre os cânceres mais comuns em mulheres. A incidência e a mortalidade variam significativamente na Europa. Essa grande variação pode ser explicada por diferenças na prevalência do papilomavírus humano e pelas políticas de vacinação e rastreamento.[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
Nos EUA, a incidência e as taxas de mortalidade do câncer cervical estão diminuindo gradualmente.[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
Em 2024 houve uma estimativa de 13,820 novos casos (0.7% de todos os novos diagnósticos de câncer) e 4360 mortes.[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
A maior incidência ocorre nas mulheres hispânicas (9.8 por 100,000, com base em dados de 2017 a 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
A taxa de mortalidade é mais elevada nas mulheres negras não-hispânicas (3.2 por 100,000 pessoas); a mortalidade global é de 2.2 por 100,000 (com base em dados de 2018 a 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
O câncer cervical é mais comumente diagnosticado na meia-idade (mais frequentemente em mulheres de 35 a 44 anos); a idade mediana ao diagnóstico é de 50 anos.[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
O papilomavírus humano (HPV) é o fator etiológico mais importante. A incidência do câncer cervical está relacionada com o início precoce da atividade sexual, vários parceiros sexuais, tabagismo, imunossupressão (por exemplo, infecção por HIV, receptores de transplante), nível socioeconômico baixo, desnutrição e uso de contraceptivos orais.[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
O rastreamento eficaz nos países desenvolvidos reduziu consideravelmente a incidência e a mortalidade do câncer cervical.[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
Aproximadamente 50% dos diagnósticos no mundo desenvolvido ocorrem em mulheres que nunca realizaram rastreamento ou que não foram examinadas nos 5 anos anteriores ao diagnóstico.[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
Reduções adicionais na incidência foram relatadas em países com programas de vacinação contra o HPV estabelecidos.[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
Quase 90% das mortes globais por câncer cervical ocorrem em países de renda baixa e média. Sem a vacinação, o número estimado de casos de câncer cervical entre meninas nascidas entre 2005 e 2014 é de 11.6 milhões, com aproximadamente 75% da carga em 25 países, a maioria na África e na Ásia.[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
Muitos desses países têm alta prevalência de infecção por HIV, o que aumenta o risco de câncer cervical.[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
A Organização Mundial da Saúde lançou uma estratégia global para eliminar o câncer cervical, com o objetivo de melhorar o acesso à vacinação, rastreamento e tratamento.[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