Cervical Cancer

Cervical Cancer in South Carolina

What is cervical cancer?

Cancer is a disease that causes cells in the body to divide and grow out of control. When cancer starts in the cervix, it is called cervical cancer. The cervix is the lower, narrow end of the uterus (or womb). The cervix connects the vagina (the birth canal) to the lower part of the uterus. Cancer cells in the cervix may grow into surrounding tissues or spread to other parts of the body. All women are at risk for cervical cancer.

South Carolina Quick Facts

  • South Carolina ranked 19th in the nation for cervical cancer incidence from 2010-2014
  • South Carolina ranked 14th in the nation for cervical cancer mortality from 2010-2014
  • White women are less likely to develop cervical cancer than black women.
  • Cervical cancer incidence is 22% higher for black women than it is for white women.
  • Black women are nearly twice as likely to die from cervical cancer as white women.

Risk factors

  • Infection with Human Papilloma Virus (HPV) is the most important risk factor for developing cervical cancer, responsible for about two-thirds of cervical cancer.
  • Not all females infected with HPV develop cervical cancer. Other risk factors such as immunosuppression, multiple births, and cigarette smoking can increase the risk of a woman developing cervical cancer.
  • Long-term use of oral contraceptives is also associated with an increased risk of cervical cancer.

South Carolina Success Story

The Best Chance Network (BCN) provides breast and cervical cancer screening for women between the ages of 30-64 with incomes at or below 200% of the federal poverty level who meet other eligibility guidelines.

Since its inception on January 1, 1991:

  • Over 117,000 women received services
  • Over 173,000 mammograms provided
  • Over 215,000 clinical breast exams performed

Signs and symptoms

Early on, cervical cancer may not cause signs and symptoms. Advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal for you, such as bleeding after sex. If you have any of these signs, see your doctor. They may be caused by something other than cancer, but the only way to know is to see your doctor.

Abnormal vaginal bleeding could be a sign of cervical cancer, such as during intercourse, in between menstrual cycles or bleeding after menopause.

Prevention and early detection

Cervical cancer is the easiest gynecologic cancer to prevent, with regular screening tests and follow-up. Two screening tests can help prevent cervical cancer or find it early.

  • The FDA has approved two vaccines for the prevention of cervical cancer from HPV infections for youth age girls and boys: Gardasil is recommended for use in females 9 to 26 years of age; and Cervarix for females 10 to 25 years of age. BCN does not cover the HPV vaccine. Visit CDC’s HPV Vaccine Recommendations website for more information for both males and females.
  • For adult women, the HPV test looks for the virus (human papillomavirus) that can cause these cell changes.
  • The Pap test is a cervical cancer screening tool that screens for abnormal cells on the cervix. Abnormal (dysplastic) and precancerous cells can develop into cervical cancer if not found and treated. The Pap test can provide early detection of cervical cancer. Treatment is most successful when received early.

The Centers for Disease Control (CDC) recommends:

  • Age 21: begin regular Pap tests for cervical cancer screening.
  • Age 21-29: Pap test every three years.
  • Age 30-65: Pap test plus HPV test every five years or Pap test alone every three years. You may choose to have an HPV test along with the Pap test. Both tests can be performed by your doctor at the same time. When both tests are performed together, it is called co-testing. If your test results are normal, your chance of getting cervical cancer in the next few years is very low. Your doctor may then tell you that you can wait as long as five years for your next screening. But you should still go to the doctor regularly for a checkup.
  • If you are 21 to 65 years old, it is important for you to continue getting a Pap test as directed by your doctor—even if you think you are too old to have a child or are not having sex anymore. If you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids, your doctor may tell you that you do not need to have a Pap test anymore.
  • Age 65+: No screening recommendations for women who have had a regular cervical cancer screening (with normal results) in previous years.
  • Women vaccinated against HPV should follow age-specific recommendations for Pap screening.

Cervical cancer facts in South Carolina

  • South Carolina ranked 19th in the nation for cervical cancer incidence and 14th for cervical cancer mortality from 2011-2015.
  • Cervical cancer incidence and mortality have fallen substantially over the last several decades due to the Pap test screening. Cervical cancer is not one of the top ten cancers for incidence (new cases) or mortality (deaths) for women in South Carolina.
  • Yet the majority of cervical cancer diagnoses is at the late stage for women of all ages in South Carolina. More than half (55.9%) of all invasive cervical cancer in SC and in all regions of the state is diagnosed at advanced stage.

Incidence (rate of new cases):

  • Cervical cancer incidence rates (2011-2015) are slightly higher in South Carolina (7.6) compared to the U.S. 7.5 (per 100,000 women).
  • Cervical cancer incidence is 22% higher for Black women than that of White women.
  • Black women have a 21.9% higher cervical cancer incidence rate than white women (8.9 vs. 7.3, 2011-2015, new cases per 100,000 women, respectively) (Figure 1).
  • In the Low Country, Black women have a 9% higher cervical cancer incidence rate than White women.
  • In the Midlands, Black women have a 7.3% higher cervical cancer incidence rate than White women.

Mortality:

  • Cervical cancer mortality rates (2011-2015) are slightly higher in South Carolina compared to the U.S. (2.5 vs 2.3, respectively).
  • Cervical cancer mortality rates in black women are nearly two times higher than those for white women (3.8 vs. 2.1) (Figure 2).
  • In the Low Country, Black women‘s death rate for cervical cancer is 57% higher than White women’s.
  • In the Midlands, Black women’s death rate for cervical cancer is 27% higher than White women’s. The Midlands has the second highest rates among South Carolina’s regions, higher than the state.

Survival:

  • Cervical cancer is treatable if diagnosed in the early stages of the disease.
  • Nationally, there’s a 92% 5-year relative survival rate for women when diagnosed in the early stages of this disease. Only 44% of cervical cancers were diagnosed in the early stages of the disease in South Carolina (2011-2015).
    • In the Pee Dee, only 38% of cervical cancer was diagnosed at an early stage.
    • In the Upstate, only 44.9% of cervical cancer was diagnosed at an early stage.
    • In the Midlands, only 45.6% of cervical cancer was diagnosed at an early stage.
    • In the Low Country, only 47.1% of cervical cancer was diagnosed at an early stage.
  • More than half of all invasive cervical cancer in South Carolina and in all regions of the state is diagnosed at advanced stage. Overall, 55.9% of cervical cancers were late-stage diagnoses in the state (2011-2015):
    • In the Pee Dee, 62.0% of all invasive cervical cancer was diagnosed at an advanced stage.
    • In the Upstate, 55.1 % of all invasive cervical cancer was diagnosed at an advanced stage.
    • In the Midlands, 54.4% of all invasive cervical cancer was diagnosed at an advanced stage.
    • In the Low Country, 52.9% of all invasive cervical cancer was diagnosed at an advanced stage.

White women with cervical cancer are 29.3% more likely to be diagnosed with early stage disease than black women (47.7% and 35.5%, respectively). Black women, however, are 21% more likely to be diagnosed with cervical cancer at the late stage than white women (64.5% vs. 52.35%) (Figure 3).

Cervical cancer screening:

  • According to the 2016 South Carolina Behavioral Risk Factor Surveillance System data (SC BRFSS), 79.5% of South Carolina women ages 21-65 reported having a Pap test within the past 3 years (U.S. median = 79.8%).
  • Prevalence of receiving a Pap test within the last three years among non-Hispanic Black and non-Hispanic White women ages 21-65 in South Carolina were 83.3% and 78.5%, respectively (Figure 4). Women ages 21-65 with low income (household income less than $15,000) are less likely to have received a Pap test within the last three years than those with high income (household income $50,000+).

Economic burden:

  • Primary diagnoses of cervical cancer for inpatient hospitalizations cost more than $5.9 million dollars in South Carolina during 2016:
  • Inpatient hospitalizations: 121 women
  • Average length of stay: 4.32 days
  • Average charge per stay: $47.230.

Cervical Cancer Incidence Rates by DHEC Regions, All Races, 2011-2015


Figure 1: Rate excludes in situ cases. Data Source: SC Central Cancer Registry

Figure 2: Rate excludes in situ cases. Data Source: SC Central Cancer Registry

Figure 3: Percent excludes in situ cases. Data Source: SC Central Cancer Registry

Figure 4: Data Source: SC BRFSS, Division of Surveillance, Bureau of Health Improvement and Equity

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Cancer Health General Public