Population-Level Shifts in Cervical Cancer Stage Distribution in the United States Following Human Papillomavirus (HPV) Vaccine Implementation.
- 1Radiation Oncology, University of Chicago, Chicago, USA.
Abstract
Objective
To assess whether human papillomavirus (HPV) vaccine introduction is associated with shifts in stage at cervical cancer diagnosis and to examine whether sociodemographic disparities and evolving imaging practices have influenced these observed trends.Methods
We analyzed 103,831 cervical cancer cases diagnosed between January 2004 and December 2022 from the Surveillance, Epidemiology, and End Results (SEER) database. Stage at diagnosis was classified as non-distant or distant disease and compared across sociodemographic subgroups, including age group at diagnosis (<40 vs. ≥40 years), race/ethnicity, income, and urban-rural status. Temporal trends in distant-stage disease were evaluated using a linear probability model including year of diagnosis, age group, and an age group-by-year interaction term.Results
Across the entire cohort (N = 103,831), 14,622 patients (14.1%) presented with distant-stage disease. Among patients <40 years, distant disease increased from 5.6% in 2004 to 9.2% in 2022, corresponding to an annual increase of 0.18 percentage points per year (95% CI 0.12-0.23, p < 0.001). Among patients ≥40 years, distant disease increased from 12.6% in 2004 to 20.4% in 2022, corresponding to an annual increase of 0.39 percentage points per year (95% CI 0.34-0.44, p < 0.001). The annual increase was 0.21 percentage points greater among patients ≥40 years (95% CI 0.14-0.29, interaction p < 0.001).Conclusion
Over the past two decades, distant-stage cervical cancer increased in the United States, with a significantly steeper increase among women ≥40 years than among women <40 years. The comparatively smaller increase among younger women is consistent with a possible contribution of HPV vaccination at the population level; however, individual vaccination status was unavailable, and a causal relationship cannot be established. Persistent racial, socioeconomic, and geographic disparities in distant-stage presentation emphasize the ongoing need for equitable access to vaccination and screening.
Related
- Prevalence, genotype distribution and associated factors of high-risk human papillomavirus among pregnant women in Eastern Ethiopia: a cross-sectional analysis nested within a population-based cohort study
- Follow-up after fertility-sparing surgery for cervical cancer: should human papillomavirus testing be used routinely? A narrative review
- 2022 WHO estimates for overall and human papillomavirus test-based cervical cancer screening coverage worldwide: a review and synthetic analysis
- Cervical cancer mortality trends following HPV vaccination in England, 2001–24: an analysis of population-based mortality data
- An 11-Year Comprehensive Retrospective Study on the Prevalence and Genotype Distribution of Human Papillomavirus (HPV) in Women and Men in Türkiye and Northern Cyprus
BibTeX
@article{koshy2026populationlevel,
title = {{Population-Level Shifts in Cervical Cancer Stage Distribution in the United States Following Human Papillomavirus (HPV) Vaccine Implementation.}},
author = {Eva Koshy and Christina Son},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.118618},
url = {https://europepmc.org/article/MED/42936161},
note = {CC BY},
}
RIS
TY - JOUR
TI - Population-Level Shifts in Cervical Cancer Stage Distribution in the United States Following Human Papillomavirus (HPV) Vaccine Implementation.
AU - Eva Koshy
AU - Christina Son
PY - 2026
DA - 2026/10/26
JO - Cureus
DO - 10.7759/cureus.118618
UR - https://europepmc.org/article/MED/42936161
AB - Objective To assess whether human papillomavirus (HPV) vaccine introduction is associated with shifts in stage at cervical cancer diagnosis and to examine whether sociodemographic disparities and evolving imaging practices have influenced these observed trends.Methods We analyzed 103,831 cervical cancer cases diagnosed between January 2004 and December 2022 from the Surveillance, Epidemiology, and End Results (SEER) database. Stage at diagnosis was classified as non-distant or distant disease and compared across sociodemographic subgroups, including age group at diagnosis (<40 vs. ≥40 years), race/ethnicity, income, and urban-rural status. Temporal trends in distant-stage disease were evaluated using a linear probability model including year of diagnosis, age group, and an age group-by-year interaction term.Results Across the entire cohort (N = 103,831), 14,622 patients (14.1%) presented with distant-stage disease. Among patients <40 years, distant disease increased from 5.6% in 2004 to 9.2% in 2022, corresponding to an annual increase of 0.18 percentage points per year (95% CI 0.12-0.23, p < 0.001). Among patients ≥40 years, distant disease increased from 12.6% in 2004 to 20.4% in 2022, corresponding to an annual increase of 0.39 percentage points per year (95% CI 0.34-0.44, p < 0.001). The annual increase was 0.21 percentage points greater among patients ≥40 years (95% CI 0.14-0.29, interaction p < 0.001).Conclusion Over the past two decades, distant-stage cervical cancer increased in the United States, with a significantly steeper increase among women ≥40 years than among women <40 years. The comparatively smaller increase among younger women is consistent with a possible contribution of HPV vaccination at the population level; however, individual vaccination status was unavailable, and a causal relationship cannot be established. Persistent racial, socioeconomic, and geographic disparities in distant-stage presentation emphasize the ongoing need for equitable access to vaccination and screening.
SN - 2168-8184
ER -