Kalyani Sonawane

Magnitude of persistent poverty and cervical cancer incidence, stage at diagnosis, and mortality

Abstract Socioeconomically disadvantaged counties exhibit higher cervical cancer incidence and poorer survival. However, the specific impact of the magnitude of persistent poverty on these outcomes remains largely unexamined. Using national cancer registry data, we observed that women living in persistent poverty counties who have experienced extreme poverty (≥40% poverty) have more than 1.5 times higher cervical cancer incidence and twice the mortality rate as women who lived in nonpersistent poverty counties. Furthermore, stage-specific incidence was consistently higher in persistent poverty counties across localized, regional, and distant diagnoses. Five-year mortality for localized cervical cancer diagnoses was nearly twice as high in extreme poverty counties (11% vs 6%, 2-sided P = .03). These findings highlight substantial disparities in cervical cancer outcomes associated with increasing magnitude of persistent poverty and underscore the need for targeted interventions in economically vulnerable communities to reduce disparities and achieve cervical cancer elimination goals.

The cervical cancer divide: state variation in incidence, mortality, and progress toward elimination in the United States

Abstract Cervical cancer elimination (<4 cases per 100 000) is a critical cancer prevention goal in the United States. Implementation of health policies and allocation of health resources occur at regional and state levels; therefore, understanding region- and state-specific cervical cancer incidence, mortality, and progress toward elimination—and remaining gaps—is essential. We estimated hysterectomy-corrected cervical cancer incidence, mortality, and progress toward elimination across all 50 states, the District of Columbia, and Puerto Rico. In 2021, Massachusetts was the only state nearing (4.3 per 100 000) the elimination threshold. Southeastern and Southwestern states were furthest, with the highest incidence rates in Mississippi (14.8), Louisiana (14.2), and Oklahoma (13.8). The mortality rate ranged from 6.8 (Alabama) to 1.4 (Wisconsin). In most states, cervical cancer incidence and mortality did not change from 2007-2011 to 2017-2021. Identifying and addressing regional- and state-level barriers impeding progress will be key to achieving cervical cancer elimination.

Anal cancer incidence among women with a history of vulvar cancer by histology, age, and time since diagnosis

Abstract Women with a history of vulvar cancer face a high risk of anal cancer; however, incidence according to histology, age-at, and time since vulvar cancer diagnosis remains unexplored. Using data from SEER-8 and SEER-17 registries, we identified 21,230 women with vulvar cancer, with 154,825 person-years follow-up from 1975 to 2021. We observed 95 anal cancer cases, resulting in an incidence of 61.4 per 100,000 person-years (95% CI, 49.6-75.0). Incidence was higher among women with vulvar squamous cell carcinoma (SCC) (78.7; 95% CI, 62.9-97.1) than vulvar non-SCC (19.8; 95% CI, 9.0-37.6). The highest incidence (>100 per 100,000) was observed in women <45 years old with vulvar SCC and those >10 years post-diagnosis. These findings could inform anal cancer screening guidelines, as women with vulvar cancer, particularly those diagnosed with SCC, may substantially benefit from heightened surveillance or targeted screening.