Benign hysterectomy rates have an important effect on the population who are truly at risk of cervical cancer. Cervical cancer incidence rates that take into account hysterectomy prevalence have been shown to be much higher than those which are not hysterectomy-adjusted, especially for older women. These findings can affect conclusions about optimal cervical screening policies, especially decisions about when older women can exit screening. Policy evaluation models require estimates of hysterectomy incidence (not prevalence) in the population, but some routine data under-report hysterectomy incidence by excluding outpatient procedures. Additionally, in the USA hysterectomy procedures are still considered to be over-utilized and alternatives to hysterectomy underutilized; as alternative procedures become more widely used, hysterectomy rates may continue to decline, which will impact future rates of cancer incidence.
We performed a systematic search of Medline, Embase, Premedline, and Cochrane Central databases for articles on incidence, prevalence and trends in hysterectomy in United States. Data sources and references in retrieved articles were searched for further relevant data. Data were extracted by age, year, hysterectomy type (total or subtotal), and procedure setting (inpatient or outpatient). State- or insurance-based data were used to estimate the fraction of hysterectomies performed as an outpatient procedure over time.
Using these identified data sources, we re-estimated hysterectomy prevalence and incidence in the USA, taking into account hysterectomies performed as an outpatient procedure that are omitted from national datasets such as the National Inpatient Sample and National Hospital Discharge Survey. Resulting hysterectomy prevalence estimates were validated by comparing with self-reported survey data from the Behavioral Risk Factor Surveillance System. We then projected hysterectomy incidence rates into the future assuming 1) rates are unchanged from current observed rates and 2) rates continue to decline as cervix-preserving alternatives to hysterectomies become more commonplace. These re-estimates of hysterectomy prevalence were also used to re-estimate cervical cancer incidence by age and over time, including projections of cervical cancer rates out to 2050.
These estimates and future projections of hysterectomy incidence will be important in informing optimal cervical cancer prevention policies. Declining hysterectomy rates have implications for cervical cancer prevention over the coming decades as hysterectomy procedures become replaced with less invasive alternatives.