Objective

The implementation of human papillomavirus-based screening in the early 2000s and advancements in targeted therapies and immunotherapy have necessitated updated insights into the incidence and survival trends of cervical cancer in the U.S.

Methods

This retrospective cohort study used Surveillance, Epidemiology, and End Results (SEER) 17 data on patients diagnosed with primary invasive cervical cancer from 2000 to 2021. Age-adjusted incidence rates were calculated in SEER*Stat software. Trends of incidence were analyzed using Joinpoint regression models to calculate annual percent changes and identify the best-fitting joinpoints. Cox proportional hazards regression was used to evaluate risk factors associated with overall survival (OS).

Results

From 2000 to 2021, the incidence of International Federation of Gynecology and Obstetrics (FIGO) IA/IB declined annually by 1.9% and 0.7%, respectively, while the incidence of FIGO IV increased by 0.9% per year. Unadjusted OS declined slightly over the study period (hazard ratio [HR]=1.010; p<0.001), with 5-year OS decreasing from 70.3% in 2000 to 66.4% in 2016. However, after adjusting for age and stage, OS improved significantly (adjusted HR=0.996; p=0.002). Survival gains were primarily observed in patients with FIGO II-IV, whereas outcomes for FIGO I patients remained unchanged. Non-Hispanic Black patients continued to experience disparities in treatment access, including lower rates of postoperative radiotherapy and brachytherapy use.

Conclusion

The decline in OS from 2000 to 2021 were associated with a shift toward more advanced-stage diagnoses and older age at diagnosis. Poorer outcomes among non-Hispanic Black patients were partly due to unequal access to optimal care.