Something

Last literature review version 18.3: septiembre 2010 | This topic last updated: noviembre 24, 2008 (More)

INTRODUCTION — In the United States (US) in 2008, there were estimated to be 11,070 new cases of invasive cervical cancer, and 3870 cancer-related deaths are expected; this represents approximately 1 percent of cancer deaths in women [1]. Incidence and mortality associated with cervical cancer are higher among minorities, as illustrated by 2006 to 2008 American Cancer Society Statistics [2,3]. As an example, the incidence of cervical cancer for Hispanics (14.2/100,000) is almost double that for non-Hispanic whites (7.3/100,000), and 3 percent of cancer deaths in Hispanics are due to cervical cancer. The incidence of cervical cancer is about 30 percent higher in African Americans (11.5 /100,000) than in whites, with about twice the mortality (5.0 versus 2.4 /100,000), representing 2 percent of cancer deaths in African American women.

Global incidence and mortality rates are even more disparate. There has been a 75 percent decrease in the incidence and mortality of cervical cancer over the past 50 years in developed countries. In contrast, cervical cancer is the second most common cause of cancer-related morbidity and mortality among women in developing countries. In 2002, in developing countries, 493,243 new cases were observed and 273,606 deaths, corresponding to a 55 percent mortality rate. Eighty-three percent of all cases of cervical cancer worldwide occur in developing countries; this results in a cumulative risk of 1.5 percent for developing cervical cancer by age 65 years [4].

This discrepancy is largely due to the widespread institution of cervical cancer prevention programs in developed countries, which are essentially non-existent in many developing countries. Based on a recent meta-analysis of process of care failures in the prevention of cervical cancer, poor screening history was the primary factor: 54 percent of invasive cervical cancer patients had inadequate screening histories and 42 percent were never screened [5]. In addition, while cervical cytology tests are excellent screening tools for preinvasive disease, the false negative rate for patients with invasive cancer is relatively high: 11 to 33 percent in a series of Northern European and US studies [5]. Thus, a negative cervical cytology smear cannot be relied upon to exclude disease in a patient with signs or symptoms of cervical cancer.

The epidemiology, clinical manifestations, and diagnosis of invasive cervical cancer will be reviewed here. Screening and prevention and the management of invasive and noninvasive cervical cancer are discussed separately. (See "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing" and "Invasive cervical cancer: Staging" and "Invasive cervical cancer: Management of early stage disease (FIGO IA, IB1, nonbulky IIA1) and special circumstances" and "Invasive cervical cancer: Management of stages IB2, bulky IIA2, and locally advanced disease" and "Cervical intraepithelial neoplasia: Management".)

INCIDENCE — The occurrence of invasive cervical cancer is related to age, with a mean age at diagnosis of 47 years in the United States. From 1995 to 1999, the US incidence of cervical cancer in girls under age 20 is reported to be 0/100,000/year, rising to 1.7/100,000/year in women aged 20 to 24

...