Highlights
- •Declining rates of hysterectomy have important impacts on SEER-reported cervical cancer rates.
- •We estimate hysterectomy rates increased from 2.4 to 10.6 per 1000 women between 1935 and 1975, dropping to 3.9 by 2035.
- •Consequently, holding all else constant, a 9% increase in SEER-reported cervical cancer rates are expected from 2009 to 2035.
- •Declining hysterectomy rates may partially offset expected reductions in cervical cancer after changes in screening.
Abstract
Background
SEER-reported cervical cancer incidence rates reflect the total female population
including women no longer at risk due to hysterectomy. Hysterectomy rates have been
declining in the United States as alternative treatments have become available, which
could result in an apparent increase in SEER-reported cervical cancer rates. We aimed
to obtain nationally representative historical data on hysterectomy rates in USA,
use trends analysis to project rates back to 1935 and forward to 2035, and then predict
the impact of changing hysterectomy rates on SEER-reported cervical cancer rates.
Methods
We performed a systematic search of Medline, Embase, Premedline, Cochrane Central
databases and extracted nationally-representative hysterectomy incidence data from
1965 to 2009, including data on the number of cervix-preserving (subtotal) procedures.
We then projected rates back to 1935, and forward to 2035 based on trends from joinpoint
regression. These rates were then used to estimate hysterectomy prevalence out to
2035, and then to predict the impact of changing hysterectomy rates on SEER-reported
cervical cancer rates to 2035. We examined alternative assumptions regarding projected
hysterectomy incidence rates out to 2035, including a scenario in which rates decline
no further from 2009 rates, and a scenario where rates decline at twice the baseline
rate.
Results
Estimated age-standardized hysterectomy incidence increased from 2.4 to 10.6 per 1000
women between 1935 and 1975. Thereafter, rates are predicted to fall to 3.9 per 1000
by 2035. Subtotal hysterectomy procedures declined from being the predominant method
in 1935 to less than 12% of procedures from 1970 onwards. Consequently, holding all
else constant, an increase in SEER-reported age-standardized cervical cancer incidence
rates (ages 0–85+) of 9% is expected from 2009 to 2035. The predictions were minimally
impacted by alternative scenarios for future hysterectomy rates.
Conclusions
Declining hysterectomy rates have implications for the interpretation of SEER-reported
cervical cancer rates. A background increase in cervical cancer rates due to decreasing
population hysterectomy exposure may partially offset expected decreases from recent
cervical screening changes recommended by the US Preventive Services Task Force. Evaluations
of new cervical cancer prevention opportunities should consider the background impact
of historical and projected hysterectomy rates.
Keywords
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Article info
Publication history
Published online: July 26, 2020
Accepted:
May 16,
2020
Received:
March 19,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
