Invasive cancer of the uterine cervix was reported diagnosed in 221 women in the SRRHIS region during the years 1991 through 1993. Rates are similar for white women in the Georgia and South Carolina counties, and similar to the Atlanta and all SEER rates. The incidence rate for black women in the SRRHIS area is over twice as high as the rate for white women (SRRHIS black women 18.6 per 100,000; white women: 7.2; Figure 7). While the rate for black women is generally higher than for whites, the SRRHIS rates among black women greatly exceed the Atlanta and all SEER rates (Atlanta: 13.0; All SEER: 12.7). Although both the Georgia and South Carolina rates are quite high, closer examination indicates rates are most elevated in the rural counties (24.8) than in the Savannah and Augusta regions (13.2)(not shown). The high rate of invasive cervical cancer among black women in the rural counties of both Georgia and South Carolina is probably a reflection of inadequate screening in this population.

Cervical cancer is a disease that proceeds from dysplasia to carcinoma in situ to invasive cancer over many years. In many poor underdeveloped countries it is the most common invasive cancer among women. In the United States it is 8th overall, 5th among black women and even more common among other ethnic groups. Since the introduction of the Pap smear for screening for cervical disease the incidence of in situ cases has increased to represent about four times as many cases as invasive disease, and the occurrence of invasive cervical cancer and its related mortality have dramatically decreased. In situ and locally invasive cervical cancers are considered successfully treatable cancers (Miller, 93). The SRRHIS registry does not collect information on in situ cancers of the cervix, so we cannot evaluate rates of preinvasive disease in this population.

In examining the distribution of invasive cervical cancer by stage at diagnosis, black and white women show similar proportions of cases diagnosed while still localized (black: 50.4%; white: 47.3%; Figure 8). However, all invasive cervical cancer cases should be considered preventable with appropriate education and screening programs available.

Five year relative survival rates for invasive cervical cancer are 68 percent for all stages, and almost 91 percent for women with localized disease at diagnosis (Kosary, 95).

Cervical cancer is traditionally more common among lower socioeconomic groups and this probably relates to risk factors as well as screening behaviors. An important cause of cervical cancer is believed to be infection with human papilloma virus (HPV), transmitted through sexual intercourse in early adulthood. HPV infection correlates with the traditional risk factors of early age of initiation of sexual activity and multiple partners. Other factors such as cigarette smoking, other sexually transmitted diseases and immunologic function also appear involved in the progression of dysplasia to cervical cancer.