Cervical cancer incidence in the United States by area of residence, 1998-2001

OBJECTIVES: To examine differences in cervical cancer incidence rates among women in rural, suburban, and metropolitan areas of the United States. METHODS: This study examined invasive cervical cancer incidence among women in United States counties classified as rural, suburban, and metropolitan for the period 1998-2001. We examined differences in incidence by age, race, Hispanic ethnicity, stage at diagnosis, and poverty level, using the Center for Disease Control and Prevention National Program of Cancer Registries, National Cancer Institute's Surveillance, Epidemiology, and End Results Program and 2000 U.S. Census data. RESULTS: A total of 39,946 cases of cervical cancer were included. Overall, the rates increased among younger women, peaked at ages 40-44 years, remained relatively constant in middle age, and decreased after age 69 years. Incidence rates were lower among residents of metropolitan areas than residents of rural areas, both overall and across groups defined by race, ethnicity, (localized) stage, and poverty level. CONCLUSION: Rural women in the United States have higher cervical cancer incidence rates. Among older women (aged 45-80 years) in whom half of cervical cancers occur, geographic differences largely disappear after controlling for poverty and race. LEVEL OF EVIDENCE: III.