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Cervical Cancer Incidence in Ontario Women: Differing Sociodemographic Gradients by Morphologic Type (Adenocarcinoma Versus Squamous Cell)

Prummel, Maegan V. MPH*; Young, Stephanie W. MPH*; Candido, Elisa MPH*; Nishri, Diane MSc*; Elit, Laurie MD, MSc, FRCS(C); Marrett, Loraine D. PhD*‡

International Journal of Gynecological Cancer: September 2014 - Volume 24 - Issue 7 - p 1341–1346
doi: 10.1097/IGC.0000000000000217
Cervical Cancer

Objective Identify patterns in cervical cancer incidence in Ontario according to neighborhood sociodemographic characteristics over time and by morphologic type.

Methods Incident cases of cervical cancer diagnosed from 1991 to 2009 were obtained from the Ontario Cancer Registry. Population data and data on neighborhood sociodemographic characteristics were obtained from the Canadian Census. Age-standardized incidence rates (ASIR) and rate ratios (RRs) with 95% confidence intervals (CIs) were calculated for each sociodemographic characteristic, stratified by morphologic type (squamous cell carcinoma and adenocarcinoma) and time period of diagnosis.

Results Incidence was 51% higher in the poorest neighborhoods compared with the richest (RR, 1.51; 95% CI, 1.42–1.61) and 7% higher in rural areas compared with urban (RR, 1.07; 95% CI, 1.01–1.13). Incidence of squamous cell carcinoma was significantly higher in the poorest neighborhoods compared with the richest (RR, 1.74; 95% CI, 1.61–1.88), a trend observed for all time periods, and in rural areas compared with urban (RR, 1.10; 95% CI, 1.02–1.18). For adenocarcinoma, ASIRs in the earlier time period (1991–1998) were higher in the poorest neighborhoods compared with richest (RR, 1.26; 95% CI, 1.01–1.57), whereas for the more recent time period (1999–2009), ASIRs were lower for women living in the poorest neighborhoods compared with the richest (RR, 0.82; 95% CI, 0.68–0.99).

Conclusions This study identified significantly higher incidence of cervical cancer in low-income neighborhoods in Ontario. The association was especially pronounced for squamous cell carcinoma and varied by time period for adenocarcinoma. Improvements to screening and prevention efforts against oncogenic human papillomavirus strains would increase the detection of cervical cancer, adenocarcinoma especially, and may further reduce cervical cancer incidence.

*Cancer Care Ontario, Toronto; †Division of Gynecologic Oncology, Juravinski Cancer Center, Hamilton; and ‡Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Loraine D. Marrett, PhD, Cancer Care Ontario, 505 University Ave, 14th Floor, Toronto, Ontario, Canada M5G 1X3. E-mail:

The authors declare no conflicts of interest.

Received April 17, 2014

Received in revised form June 15, 2014

Accepted June 15, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.