County-Level Cervical Cancer Screening Coverage and Differences in Incidence and Mortality
Menée aux Etats-Unis à partir de données des registres américains des cancers et des certificats de décès, cette étude examine, en fonction du niveau de couverture du programme de dépistage des cancers du col de l'utérus, l'incidence de la maladie et la mortalité chez les femmes âgées de 20 ans ou plus
Introduction : Recent research shows that cervical cancer incidence and mortality are 67% and 108% higher, respectively, in low-resourced US counties.1 County-level screening disparities may contribute to these differences,2 yet this remains unexplored. This study examines differences in cervical cancer incidence and mortality by county-level screening.
Methods : For this cross-sectional study, we identified cervical cancer cases among women aged 20 years or older using the Surveillance, Epidemiology, and End Results (SEER)–22 database.3 Cervical cancer mortality was based on death certificate data ascertained by the National Center for Health Statistics. County-level cervical cancer screening was derived from SEER’s small area estimates4 for 1086 counties. Counties were considered to have repeatedly low vs high screening if they had less than 70% vs 80% or greater coverage during the 2011 to 2016 period and at least 1 earlier period (2008-2010 or 2004-2007). Counties not meeting these criteria were categorized as other. The less-than-70% threshold reflects coverage nearly 10 percentage points below the national target (79.2%) and below the current national average (74%-78%). The 80%-or-greater threshold exceeds both benchmarks, indicating consistently high coverage. Using SEER*Stat version 8.4.4 (National Cancer Institute), we estimated age-adjusted 5-year incidence and mortality rates for years 2016 to 2021 (excluding 2020 due to potential reporting biases from the COVID-19 pandemic5) and derived rate ratios (RRs) and 95% CIs to quantify differences in rates. County-level median household income (derived from American Community Survey 2017-2021 estimates) and metropolitan status (derived from 2013 Rural-Urban Continuum Codes, with 1-3 indicating urban and 4-9 indicating rural) were described.
This study followed the STROBE reporting guideline for cross-sectional studies. It was deemed exempt from review and the requirement for informed consent by the institutional review board at The Medical University of South Carolina because the data are deidentified and publicly available.
Results : A total of 70 counties were identified as repeat low coverage, 141 as repeat high coverage, and 875 as other. Most repeat low coverage counties were rural (61 [87.1%]), and all had a median household income of less than $75 000, while most repeat high coverage counties were urban (119 [84.4%]), and 72 (51.1%) had a median household income of $75 000 or greater. Most repeat low coverage counties were from Texas (33 [47.1%]), Idaho (12 [17.1%]), and New Mexico (12 [17.1%]) (Figure 1).
JAMA Network Open , article en libre accès, 2025