Cervical Cancer Incidence & Mortality Expected to Soar by 2050

Cervical cancer is one of the most preventable cancers worldwide. Despite this being the case, it still remains the fourth leading cause of cancer morbidity and mortality among women. A new study evaluated data on the current state of affairs in cervical cancer based on the target set forth by the World Health Organization (WHO) to address this public health concern. As it stands, cervical cancer is the second most common cancer when it comes to incidence and mortality in women of reproductive age. The burden of cervical cancer runs exceptionally high in countries with the lowest human development index (HDI). Chronic human papillomavirus (HPV) infection remains the primary cause of cervical cancer, and a combination of HPV types 16 and 18 is responsible for nearly a quarter of all cancers worldwide (71%). The scientific community has a rather thorough understanding of cervical cancer pathogenesis stemming from HPV infection, precancerous progression, and cancerous invasion. In addition, other factors can contribute to the onset of cervical cancer. These include smoking, HIV infection, early sexual debut, oral hormonal contraceptives, and multiple sexual partners. Due to their modifiable nature, these factors make cervical cancer a largely preventable disease. Previous randomized controlled trials and various population-based observational studies have repeatedly indicated that screening methods can help reduce incidence and mortality rates associated with cervical cancer significantly. These include conventional or liquid-based cytology, visual inspection with acetic acid, and high-risk HPV genotyping, among other screening methods. It is also worth noting that HDI is the most commonly used method to evaluate the average socioeconomic development index, an indicator assessed based on factors such as education. Study Parameters In this study, researchers based their estimates of new cases and deaths resulting from cervical cancer by age 18 on data from 18 groups spanning 185 countries from the GLOBOCAN 2022 database released by the International Agency for Research on Cancer (IARC) under the WHO. The authors aggregated and combined all country-level raw data regarding the cervical cancer burden by the IARC based on uniform standards assessing completeness, comparability, validity, accuracy, and timeliness to ensure quality of current estimates. They also used high-quality incidence data pulled from the Cancer Incidents in 5 Continents (a database published by the IARC) and mortality data from the WHO mortality database. This information helped the study investigators describe temporal trends. Regarding the cervical cancer burden, investigators based the demographics on a composite of projected cases and deaths, which helped researchers to prove the present forecast, future regional and national incidents, and mortality of cervical cancer up to the year 2050. Data & Future Projections Based on the United Nations Development Programme's Human Development Report 2021-2022, each country was classified into one of four HDI levels according to life expectancy and gross national income. These were low (HDI<0.55), medium (HDI=0.55-70), medium high (HDI=0.70-0.79), and very high (HDI≥0.80). In addition, the authors noted the terminology “transitioning countries” was used synonymously for countries with low or medium HDI. Meanwhile, “transitioned countries” was the phrase applied to those with high or very high HDI on global assessment. Researchers estimated that 662,044 cases (age-standardized incidents rate: 14.12 per 100,000) and 348,709 deaths (age-standardized mortality rate [ASMR]: 7.08 per 100,000) from cervical cancer occurred in 2022. These statistics correlate to cervical cancer as the fourth-leading cancer morbidity and mortality in women. Moreover, the vast majority of new cervical cancer cases (<85% of new cases and 90% of deaths globally) occurred in women aged 40 and older, and overwhelmingly comprised the incidence and mortality rates of late-onset cancer. These rates were approximately 10-fold and 20-fold higher than those observed in women with early-onset cervical cancer across both age groups. The findings highlight the global burden of cervical cancer in both younger and older women. Similarly, the data showed as much as a 10-fold variation between the United Nations regions, with Eastern African populations having the highest instant rates of cervical cancer (40.42 per 100,000), followed by Southern Africa (34.89 per 100,000), Middle Africa (31.12 per 100,000), and Melanesia (27.59 per 100,000). Meanwhile, Western Asia had the lowest incident rate, at 4.1 per 100,000. Eswatini had the highest country-specific age-standardized incident rate at 95.9 per 100,000. Zambia came in second place with 71.58 incidents per 100,000 women, followed by Malawi at 70.9 cases per 100,000. Melanesia had the highest incidents of early-onset cervical cancer, coming in at 10.44 per 100,000, followed by Malawi at 23.7 per 100,000. This also included country-specific incident rates. Eastern Africa had the highest late-onset cervical cancer rates, coming in at 110.91 per 100,000. Similar results were found when exploring the ASMRs of cervical cancer, with Eastern Africa claiming the highest mortality rate at 28.87 per 100,000, followed by Middle Africa at 22.86 per 100,000, Southern Africa at 20.36 per 100,000, and Melanesia at 19.33 per 100,000. Meanwhile, Australia/New Zealand had the lowest mortality rate at 1.44 per 100,000 women. Eswatini had the highest national cervical cancer mortality rate (64.3 per 100,000), followed by Malawi at 51.1 per 100,000, and Zambia at 49.4 per 100,000. Researchers observed the highest mortality rate of early-onset and late-onset cervical cancer in Melanesia, at 44.95 per 100,000, and in Eastern Africa with 8.3 per 100,000 women, respectively. Overall, the data indicate that the greatest concentration of cervical cancer cases and deaths occurred in Asia and Africa. A total of 25.3 percent of cervical cancer cases occurred in Eastern Asia, and South-Central Asia claimed second place at 23.3 percent, followed by Southeastern Asia at 10.6 percent. Periodically, nearly a third of all cervical cancer-related deaths occurred in South-Central Asia (27.5%), followed by Eastern Asia (17.8%) and Eastern Africa (11.3%). Among the young female population, SouthCentral Asians had the greatest number of incidents at 18.8 percent and deaths at 25.9 percent from early-onset cervical cancer in the elderly female population. Eastern Asia, South Central Asia, and Southeastern Asia accounted for the highest numbers of late-onset cervical cancer cases. Researchers observed minimal differences in the estimated number of cervical cancer cases between South Central Asia and Eastern Asia. However, the mortality rate was nearly twice as high among women in South Central Asia. When comparing countries among Eastern Asian women, 42 percent of cervical cancer cases were recorded in China (23%) and India (19%) combined. In addition, nearly half (39%) of deaths occurred in those same countries, with 23 percent of those deaths occurring in China compared to16 percent of deaths occurring in India. Stratified diagnosis revealed that more Chinese women had cases of early-onset cervical cancer (14%) and late-onset cancer (24%). Indian women accounted for 14 percent and 20 percent of these cases, respectively. However, Indian women had more deaths from early-onset (19%) and late-onset (23%) cases than China (7% and 17%, respectively). In terms of case and death burden from cervical cancer globally, India and Brazil had the third- and fourth-greatest burdens, respectively. According to the data from the study, researchers found that more than half of cervical cancer cases diagnosed occurred in countries with very high and high HDI. However, less than half of the women who died from cervical cancer lived in those countries. Meanwhile, the greatest historical cancer case burdens were found in countries exhibiting high HDI, but the greatest death burdens occurred in countries with medium HDI, accounting for 40.1 percent of new cases and 35 percent of global deaths or deaths throughout the world. Employing ASMR, researchers identified increasing trends in some countries. Spain showed the largest estimated annual percentage change (EAPC: 2%) from 1951 to 2017, followed by Bulgaria (EAPC: 1.7% from 1964 to 2018) and Latvia (EAPC: 0.7% from 1980 to 2018). Meanwhile, decreases were identified in Chile (EAPC: −3.8% from 1984 to 2018), Costa Rica (EAPC: −3.5 from 1985 to 2017), and Canada (EAPC: −3.3% from 1950 to 2017). Additional findings suggest that late-onset ASMR is increasing in seven countries. Findings reflect significant variations in vaccination and screening coverage throughout those areas. Furthermore, sensitivity analyses conducted for the same time frame regarding mortality, ranging from 2003 to 2010, revealed that EAPC for cervical cancer ASMR were −1.03 percent overall, 0.57 percent early-onset, and−1.18 percent late-onset owing to what the study's authors define as stable, national changes in population growth and aging. Global Soaring of Cases & Mortality Ultimately, researchers forecast that cervical cancer cases will increase by 56.8 percent from 2022 to 2050, with an estimated 1 million cases occurring in the year 2050. They also forecast approximately 630,000 deaths to occur in 2050, reflecting an increase of 80.7 percent. To that end, the highest absolute increases in cases and deaths with cervical cancers would happen in countries with medium HDI, with one country alone estimated to have 169,124 cases and 120,727 deaths, respectively. Countries with low HDI would experience the largest relative increases in cases and deaths, with as much as 150.6 percent increase in cases and 154.8 percent increase in deaths, respectively. The numbers would increase in countries with low and medium HDI and decrease in countries with very high HDI. In addition to being the fourth most common cause of cancer incidence and mortality among women globally, cervical cancer is the leading cause of death in numerous transitioning countries, notably those in sub-Saharan Africa, South America, and Southeast Asia. In addition, incidence and mortality rates of cervical cancer vary widely throughout the world, with as much as a 10-fold variation among the 20 U.S. states without effective preventive and curative interventions to curtail the growing incidence/cases of cervical cancer. The study authors anticipate that the global burden of cervical cancer will rise in the future, with the greatest impact felt in transitioning countries. Also, they cite certain risk factors as being the culprits behind the large geographic disparities. Among these are sexually transmissible infections, such as human immunodeficiency virus and chlamydia, smoking, higher numbers of childbirths, and long-term use of oral contraceptives. Additionally, inequalities in access to appropriate and sufficient screenings, universal HPV vaccination, and effective cancer treatment facilities further exacerbate these disparities. Until recently, 12 of the 448 known HPV types were classified as Group 1 by the IARC monographs. The study authors point out that without widespread, universal implementation of HPV vaccination, cervical cancer screenings, preventive interventions, and systemic cooperation, the number of cases and mortalities will continue escalating. To that end, they encourage various stakeholders, such as those in the civil society's government and private enterprises, to play a more active role in addressing the disease burden. Frieda Wiley is a contributing writer.

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