Epidemiology of cervical cancer.

Cervical cancer is a major public health problem through-out the world, and despite important declines in incidence and mortality observed in developed countries in the last 20 years, those indicators remain almost unchanged in developing countries. In addition, a recent increase in cervical cancer among women under age 50 years is being observed in some areas, particularly for adenocarcinoma, without a clear explanation. Marked socioeconomic and ethnic differences are evident in incidence, mortality, and survival from the disease, with the less affluent groups having a much higher impact. Epidemiologic research has concluded that certain types of human papillomaviruses are the central cause of cervical cancer and its precursors, and this has opened the door to the possibility of developing vaccines. However, many aspects of the epidemiology still need to be elucidated, and the development of clinically applicable vaccines will require a number of years to be achieved. Therefore, renewed efforts at improving screening programs are necessary, particularly among women in the lower socioeconomic regions and groups. In this paper, we present the descriptive epidemiology of invasive cervical cancer, with particular emphasis on the situation in the United States, based on the latest data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (up to 1992). In addition, a brief overview is made of current ideas on the role of human papillomaviruses and other risk factors for the disease.