Population-Level Shifts in Cervical Cancer Stage Distribution in the United States Following Human Papillomavirus (HPV) Vaccine Implementation

OBJECTIVE: To assess whether human papillomavirus (HPV) vaccine introduction is associated with shifts in stage at cervical cancer diagnosis and to examine whether sociodemographic disparities and evolving imaging practices have influenced these observed trends. METHODS: We analyzed 103,831 cervical cancer cases diagnosed between January 2004 and December 2022 from the Surveillance, Epidemiology, and End Results (SEER) database. Stage at diagnosis was classified as non-distant or distant disease and compared across sociodemographic subgroups, including age group at diagnosis (<40 vs. ≥40 years), race/ethnicity, income, and urban-rural status. Temporal trends in distant-stage disease were evaluated using a linear probability model including year of diagnosis, age group, and an age group-by-year interaction term. RESULTS: Across the entire cohort (N = 103,831), 14,622 patients (14.1%) presented with distant-stage disease. Among patients <40 years, distant disease increased from 5.6% in 2004 to 9.2% in 2022, corresponding to an annual increase of 0.18 percentage points per year (95% CI 0.12-0.23, p < 0.001). Among patients ≥40 years, distant disease increased from 12.6% in 2004 to 20.4% in 2022, corresponding to an annual increase of 0.39 percentage points per year (95% CI 0.34-0.44, p < 0.001). The annual increase was 0.21 percentage points greater among patients ≥40 years (95% CI 0.14-0.29, interaction p < 0.001). CONCLUSION: Over the past two decades, distant-stage cervical cancer increased in the United States, with a significantly steeper increase among women ≥40 years than among women <40 years. The comparatively smaller increase among younger women is consistent with a possible contribution of HPV vaccination at the population level; however, individual vaccination status was unavailable, and a causal relationship cannot be established. Persistent racial, socioeconomic, and geographic disparities in distant-stage presentation emphasize the ongoing need for equitable access to vaccination and screening.