Women in Rural Regions Experience Greater Cervical Cancer Incidence/Mortality

Increased incidence and mortality rates for cervical cancer among rural women in the US may result from barriers to access to care.

Cervical cancer incidence and mortality have increased in US rural counties, particularly among White women, according to a cross-sectional study published in JAMA Network Open.¹

Data from the study revealed that the overall incidence of cervical cancer in rural counties increased by 0.85% per year (95% CI, 0.08%-2.05%) from 2012 to 2019 after decreasing from 2001 to 2012, a difference of –1.90% (–2.39% to –1.54%). By contrast, the annual percentage change (APC) among urban counties has leveled off from 2012 to 2019, showing a difference of –0.03% (95% CI, –0.89% to 2.00%) after having decreased from 2001 to 2013. Among urban women, the APC for cervical cancer showed a –4.33% difference (95% CI, –5.74% to 1.62%) from 2001 to 2003 and a –1.43% difference (95% CI, –2.12% to 0.37%) from 2003 to 2013.

“We always had an indication that there were rural-urban disparities [for cervical cancer], but there were not any recent studies, to our knowledge, that assessed annual trends in cervical cancer incidence over time,” study author Trisha Amboree, PhD, MPH, assistant professor of Public Health Sciences at the Medical University of South Carolina Hollings Cancer Center in Charleston, said in a news release.²

Furthermore, the gap between rural and urban incidence rates increased from 2013, where the rate ratio (RR) was 1.16 (95% CI, 1.10-1.22), to 2019, where it was 1.25 (95% CI, 1.19-1.31). Moreover, incidence rate disparities were observed among patient subgroups, with rural White women seeing the highest statistically significant APC increase of 1.05% (95% CI, 0.24%-2.33%) from 2012 to 2019. Black rural women saw the biggest nominal increase of 9.07% per year (95% CI, –2.84% to 17.84%) between 2017 and 2019, but it was not statistically significant.

Mortality in rural counties was 1.42 (95% CI, 1.33-1.51) times higher than in urban counties from 2015 to 2019. Subgroup analysis revealed that mortality was higher among rural Black women (RR, 1.58; 95% CI, 1.32-1.90), rural White women (RR, 1.54; 95% CI, 1.43-1.67), and rural Hispanic women (RR, 1.33; 95% CI, 1.12-1.58) vs their urban counterparts.

The cross-sectional study used the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results (NPCR-SEER) database and death certificates from the National Center for Health Statistics to identify cervical cancer cases and access mortality data, respectively. SEER Stat version 8.4.3 was used to estimate the annual incidence and 5-year mortality rates per 100,000 women age-adjusted based on 2000 US population data. Additionally, the 2013 Rural-Urban Continuum Codes were used to assess rurality.

From 2001 to 2019, 222,425 cervical cancer cases were identified. Of those identified, 84.3% came from urban counties and 59.9% came from White women. In rural and urban counties, the hysterectomy-corrected incidence rates were 11.9 and 10.0 per 100,000, respectively.

“This cross-sectional study found a recent increase in cervical cancer incidence in rural US counties, specifically among White women,” Amboree wrote in the publication with study coinvestigators.¹ “In addition, incidence was 25% higher and mortality was 42% higher in rural vs urban counties in recent years. The increase in incidence and mortality in rural US counties may reflect lower screening coverage and lower utilization of diagnostic and therapeutic care, likely resulting from heightened access barriers experienced in rural areas. Additionally, if unaddressed, lower human papillomavirus (HPV) vaccine uptake in rural areas may contribute to further widening disparities in the future.”

References

1. Amboree TL, Damgacioglu H, Chiao EY, et al. Rural-urban disparities in cervical cancer incidence and mortality among US women. JAMA Netw Open. 2025;8(3):e2462634. doi:10.1001/jamanetworkopen.2024.62634
2. Lawrence L. Study showing cervical cancer’s toll on rural America “should be a call to action,” says expert. Oncology News Central. March 12, 2025. Accessed March 18, 2025. https://tinyurl.com/srypj277