Risk Factors

Sexual behavior is the major known risk factor for cervical carcinoma In situ and invasive cervical cancer including early age at first intercourse, multiple sex partners, and sex partners who have had many sex partners. Women of low socioeconomic status are at increased risk. Sexually-transmitted viruses, especially the human papilloma virus which causes genital warts, have recently been studied as a cause of cervical cancer. Also being studied are co-factors that may operate with the human papilloma virus to cause cervical cancer. Possible co-factors are herpes viruses, hormonal and dietary factors, and smoking. Cigarette smoking, particularly among long-term or many-packs-a-day smokers, has been associated with cervical cancer in many studies. Barrier type birth control methods such as condoms and diaphragms lower the risk of cervical cancer, probably by reducing the chances of transmission of infectious diseases. Oral contraceptives and multiple births increase the risk of cervical cancer, perhaps through hormones. A diet low in vitamin C, beta carotene, and vitamin B may increase the risk of cervical cancer.

Prevention and Control

Behavioral changes such as delaying sexual intercourse until a later age, limiting the number of sexual partners, avoiding sexually transmitted diseases, and not smoking will reduce the risk of cervical cancer. Use of barrier or spermicidal birth control methods and a diet rich in foods with vitamin C, beta carotene, and vitamin B may also decrease the chances of cervical cancer.

Early detection is very important with cervical cancer. The Pap test should be performed annually with a pelvic exam in all women who have been sexually active or are 18 years of age or older. Increased screening with the Pap test is the main reason for the decreases in incidence and mortality due to cervical cancer. Please see Appendix I for additional recommendations on the Pap test from the American Cancer Society.

Incidence and Mortality in the U.S.

About 13,700 new cases of invasive cancer of the uterine cervix (cervical cancer) are expected to occur among U.S. women in 1998. The incidence rate of cervical cancer has decreased steadily over the past three decades in the U.S. During a woman's lifetime, the incidence increases sharply until age 45 and peaks between the ages of 45 to 55. Black women have incidence rates of cervical cancer that are nearly twice those of white women. In recent years, diagnosis of cervical carcinoma In situ has become more common than invasive cervical cancer due to Pap screening. About 95 percent of carcinoma In situ of the cervix is curable. Eighty- nine percent of women with invasive cervical cancer survive one year after diagnosis and 69 percent survive five years. Invasive cervical cancer detected at the earliest stage (localized) has a five-year relative survival rate of 91 percent. (See the Glossary for definintions of In situ and invasive.)

An estimated 4,900 cervical cancer deaths are expected in 1998 in the U.S. Death rates from cervical cancer have declined in the past three decades. However, the mortality rate for black women remains twice that among white women.

Incidence in New Jersey - 1986-1996

Tables 13 through 15 show the incidence data for invasive cervical cancer by county for the years 1986 through 1996. Figure 7 shows the statewide trends in cervical cancer. Statewide, black women had rates about twice the rates of white women (see Figure 7). This held true for each county (see Table 15). In general, the statewide rates declined for black women over the years, but remained about the same for white women (see Figure 7).

Conclusion

To continue the decline in cervical cancer, the behavioral changes relating to sexual behavior and avoiding smoking should continue. Additionally, increased use of the Pap test to detect cervical cancer in its earliest stage (In situ) will reduce the incidence of cervical cancer in the later stages.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	19	16.2	20	18.2	16	14.6	16	12.0	21	18.9	21	18.5	10	8.2	15	12.4	17	14.7	11	9.6	17	15.1
Bergen	25	4.7	37	7.3	38	7.3	45	8.4	49	9.2	47	9.2	35	6.8	55	10.3	47	9.4	34	7.0	43	8.9
Burlington	13	6.7	17	8.2	16	8.2	17	8.1	11	5.3	10	4.3	23	10.7	16	8.1	10	5.2	12	5.9	17	8.3
Camden	16	6.0	24	9.3	27	10.8	29	11.5	34	14.4	15	5.8	12	4.2	27	11.4	22	8.2	18	6.6	17	6.3
Cape May	---	---	5	5.5	13	20.2	9	15.0	7	13.3	9	14.1	8	11.5	---	---	8	13.0	---	---	8	14.7
Cumberland	7	9.5	12	17.5	11	15.4	15	21.2	9	14.5	11	14.0	17	25.0	19	29.6	10	15.5	8	11.1	18	31.8
Essex	42	12.9	32	9.9	26	8.7	32	10.4	37	13.2	35	12.3	36	13.9	32	10.7	26	10.0	31	12.1	24	8.8
Gloucester	14	12.3	8	7.1	10	8.2	13	10.4	14	11.2	9	7.0	17	14.8	---	---	8	6.8	8	6.3	11	7.7
Hudson	38	13.3	33	11.8	44	15.7	33	12.2	40	14.2	42	15.9	45	15.2	39	13.5	42	14.9	30	10.1	26	8.5
Mercer	19	11.9	10	5.7	16	9.6	10	6.8	13	8.0	13	8.8	12	6.5	15	9.1	11	7.0	11	6.8	14	8.9
Middlesex	31	8.7	22	6.1	30	8.0	31	8.5	26	7.6	40	10.9	30	8.4	32	8.7	32	8.8	29	7.5	31	8.2
Monmouth	32	10.6	28	8.3	32	9.9	23	6.7	33	10.1	26	8.4	20	6.0	34	10.5	24	6.8	28	8.4	29	8.8
Morris	15	6.3	19	7.3	21	7.6	20	7.8	20	7.2	20	6.9	18	6.9	9	3.8	26	9.2	20	7.3	25	9.5
Ocean	26	11.1	25	9.0	28	10.2	35	13.2	41	13.9	24	8.1	24	9.2	30	11.9	26	8.0	32	10.5	18	6.6
Passaic	23	10.0	27	12.0	27	11.7	19	8.2	31	12.9	28	12.3	21	9.2	26	10.6	24	10.9	26	11.6	29	12.2
Somerset	7	5.3	8	6.2	10	7.1	13	9.4	16	11.1	12	8.4	9	6.8	11	7.9	7	4.4	13	7.8	---	---
Sussex	---	---	---	---	---	---	5	7.2	7	8.8	---	---	9	13.9	12	16.4	6	8.5	10	14.3	7	8.6
Union	21	7.6	29	10.8	24	9.3	31	10.0	14	4.8	15	6.0	18	7.6	19	7.1	26	9.7	29	11.1	25	8.6
Warren	---	---	---	---	5	7.7	8	14.8	12	20.6	10	15.5	5	7.9	6	7.9	---	---	---	---	6	9.3
STATE	362	8.7	369	8.8	404	9.6	415	9.8	444	10.6	398	9.5	380	9.1	410	9.7	387	9.2	368	8.6	381	9.0

¹In situ cervical cancer is not included. Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Hunterdon and Salem counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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