Incidence of Dysplasia and Carcinoma of the Uterine Cervix in an Appalachian Population

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Abstract
Background : Cervical cancer mortality rates in the Appalachian population of southeastern Kentucky have been shown to be unusually high. To better understand the high cervical cancer death rate in this area, we developed a population based cervical disease registry. Purpose : This study describes the incidence of cervical dysplasia, carcinoma in situ, and invasive cervical cancer in 1986 and 1987 among White women in a 36 county area of Appalachian Kentucky based on histologic diagnoses. Methods : We compared average annual age adjusted incidence rates for carcinoma in situ and invasive cervical cancer in the study area with those for women in the Surveillance, Epidemiology, and End Results (SEER) Program. Results : The incidence rate of invasive cervical cancer for women in the study area (14·9 per 100000) was nearly twice that for White women in the SEER population (7·8 per 100000), but it was similar to that for Black women in the SEER population (15·3 per 100000). The incidence of carcinoma in situ for women in the study population (38·2 per 100000) was 21% higher than that for White women (31·5 per 100000) or for Black women (31·2 per 100000) in the SEER population. The average annual age adjusted incidence rate for all grades of dysplasia among women in the study population was 194·6 per 100000. No comparable population based incidence rates for dysplasia could be identified. Conclusions : Cervical cancer incidence rates are higher in Appalachian Kentucky than in the SEER population. Poverty appears to be a factor associated with these rates. Implications : Lowdensity populations such as those in rural Appalachia deserve greater attention in cancer control research. The population based cervical dysplasia rates reported here may be useful for comparisons in future investigations. [J Natl Cancer Inst 84:1030–1032, 1992]

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