Cervical cancer is a major cause of morbidity and mortality worldwide. It is the second largest cause of deaths due to cancer in women. The death toll is greatest in populations that lack cervical cancer screening programmes.
Cervical cancer is the leading cause of cancer deaths in women in less developed regions. Every year 530,000 women are diagnosed with cervical cancer and more than 270,000 die from this disease. Incidence rates vary widely; for example, South-Central and South-East Asia have relatively high incidence rates.
If early changes in cervical cells are detected through screening programmes, cervical cancer is curable. However, if undetected until late in its clinical course, it has a high death rate.
Cervical cancer develops slowly and is linked to HPV infection. Pre-cancerous cervical cells may not cause symptoms and by the time symptoms become apparent, it is often too late for treatment – particularly in resource-poor environments. HPV is found in 99% of the cervical cancer cases.
Progression of HPV infection to cancer is slow, generally taking more than 10 years. Although invasive cancer is most commonly seen in women aged over 45 years, the precursor changes are detectable much earlier.
Variation in incidence with age
In a study of international incidence rates prior to the introduction of cervical screening, the first onset of cervical cancer occurred at approximately 25 years of age in most populations.
European countries generally showed an earlier peak age (mean peak age, 46 years) and a more rapid decline after the peak than non-European countries (mean peak age, 59 years).
However, the overall shape of the age-specific incidence curve suggests a similar development of invasive cervical cancer within different populations. Because cervical cancer affects relatively young women in their prime of life, it is an important cause of lost life-years in developing countries. Cervical cancer makes the largest contribution to lost life-years from cancer in South-Central Asia.
Globally, the ratio of mortality rates to incidence rates is 55%. However, mortality rates vary greatly between countries as well as within countries. Incidence and mortality rates also vary with time. For example, a study in China found the mortality rate for cervical cancer to be 10.7/100,000 in the 1970s, but this declined by over 60% to 3.89/100,000 overall in the 1990s.
This decline was not uniform throughout China; in some rural areas in the mid-west (i.e. Wudu in Gansu and Yangcheng in Shanxi), the rate remained high.
The economic costs of cervical cancer consist of both medical costs and costs associated with lost productivity due to premature death. The annual direct medical costs associated with cervical cancer have been estimated at US$300–400 million in the USA. In a recent study designed to determine the costs of lost productivity in the USA due to cervical cancer, it was estimated that 130,377 women would have been alive in 2000 had they not died from cervical cancer. Of these women, 75% died before age 60 and 25% before age 40. With 29% of these women expected to have been working during 2000, the productivity loss due to cervical cancer mortality was estimated at US$1.3 billion in that year.