Rural US counties see an increase in cervical cancer rates

Cervical cancer diagnoses among rural U.S. women have been increasing since 2012, after years of decreases, according to new research from MUSC Hollings Cancer Center and The University of Texas MD Anderson Cancer Center.

The increases come at the same time as diagnoses have plateaued among urban U.S. women, leading to even greater disparities between the groups.

“The rate of cervical cancer incidence is 25% higher in rural areas, and the rate of cervical cancer deaths is 42% higher,” said Trisha Amboree, Ph.D., a Hollings researcher who led the study, published today in JAMA Network Open.

This paper looked at annual data between 2001 and 2019. In the early 2000s, cervical cancer was on the decline everywhere in the country.

“In rural counties, incidence was decreasing, as was every other cervical cancer trend for the past several decades. But around 2012, rates started to increase,” Amboree said. “When you break that down by race and ethnicity, the rise is even more pronounced. We found increasing incidence among rural non-Hispanic white women.”

"More support and preventive care is needed in rural areas."

Trisha Amboree, Ph.D.

This study also documented widening disparities in the death rate.

“We found that mortality was 42% higher in rural counties versus urban counties. When you look by race and ethnicity, it's consistent across the board: Mortality rates are 33% higher among rural Hispanic women, 58% higher among rural non-Hispanic Black women and 54% higher among rural non-Hispanic white women compared with their urban counterparts,” Amboree said.

For researchers, this type of news is particularly disheartening as cervical cancer is largely preventable.

"It’s troubling to see that both cervical cancer incidence and mortality have been higher in rural counties in recent years. While the underlying factors are multifactorial and complex, we believe they likely reflect heightened barriers to cervical cancer prevention and treatment experienced by residents of rural areas,” said senior author Jane R. Montealegre, Ph.D., associate professor of behavioral science at The University of Texas MD Anderson Cancer Center.

Nearly all cases of cervical cancer are caused by the human papillomavirus (HPV), and a safe, effective vaccine against HPV has been available since 2006. Routine screening can provide early warning; the Pap test looks for precancerous cell changes, and the HPV test looks for high-risk types of HPV.

Amboree said that better access to preventive care is needed in rural U.S. areas.

“More support and preventive care is needed in rural areas. There needs to be more resource allocation, more funding and more health care providers, as there are documented health care shortages in rural areas. There are likely also other barriers that may hinder those who live in rural areas from accessing necessary preventive care,” she said.

Montealegre agreed.

"There’s a critical need to address health care shortages in rural areas that are contributing to suboptimal cervical cancer screening and care. Mobile clinics, self-collected screening tests, and other innovations hold promise as potential solutions that need to be explored,” she said.

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