One-Third of Women With Cervical Cancer in California Present Symptomatically

Cervical cancer can mostly be prevented or detected very early before symptoms develop, yet it persists.

After large declines in incidence and mortality of cervical cancer, rates have plateaued since 2012, with approximately 13,000 diagnoses and 4,200 deaths each year in the United States. However, many women still are diagnosed at advanced stages when survival is poor, despite the ability of screening to detect pre-cancer and early-stage cancer of the cervix. A study published in Cancer Causes and Control takes a closer look.

Highlights:

• Despite effective screening tools and vaccines against the causative agent (HPV), nearly a third of women with cervical cancer in California presented symptomatically in emergency departments (ED) from 2006 to 2017.
• Women presenting in the ED were more likely to have public or no insurance and low socioeconomic status.
• These women were 3 to 5 times more likely to have stage III or IV disease and had worse survival.
• This suggests that many women, especially those with low socioeconomic status, are likely not benefiting from screening and have poor access to healthcare.

Purpose

Through screening and HPV vaccination, cervical cancer can mostly be prevented or detected very early, before symptoms develop. However, cervical cancer persists, and many women are diagnosed at advanced stages. Little is known about the degree to which U.S. women may begin their diagnostic workup for cervical cancer in Emergency Departments (ED). We sought to quantify the proportion of women presenting symptomatically in the ED prior to their diagnosis of cervical cancer and to describe their characteristics and outcomes.

Methods

We identified women diagnosed from 2006 to 2017 with cervical cancer in the California Cancer Registry. We linked this cohort to statewide ED discharge records to determine ED use and symptoms present at the encounter. Multivariable logistic regression models examined associations with ED use, and multivariable Cox proportional hazards regression models examined associations with survival.

Results

Of the more than 16,000 women with cervical cancer in the study cohort, 28% presented symptomatically in the ED prior to diagnosis. Those presenting symptomatically were more likely to have public (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.06-1.27) or no insurance (OR 4.81; CI 4.06-5.71) (vs. private), low socioeconomic status (SES) (OR 1.76; CI 1.52-2.04), late-stage disease (OR 5.29; CI 4.70-5.96), and had a 37% increased risk of death (CI 1.28-1.46).

Conclusion

Nearly one-third of women with cervical cancer presented symptomatically, outside of a primary care setting, suggesting that many women, especially those with low SES, may not be benefiting from screening or healthcare following abnormal results.