50 years of screening in the Nordic countries: quantifying the effects on cervical cancer incidence

• Published in: British journal of cancer Vol. 111; no. 5; pp. 965 - 969
• Main Authors: Vaccarella, S, Franceschi, S, Engholm, G, Lönnberg, S, Khan, S, Bray, F
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 26.08.2014; Nature Publishing Group
• Subjects: 692/699/67/1517/1371; 692/699/67/2322; 692/699/67/2324; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cervical cancer; Drug Resistance; Early Detection of Cancer - methods; Epidemiology; Female; Female genital diseases; Finland - epidemiology; Gynecology. Andrology. Obstetrics; Human papillomavirus; Humans; Incidence; Mass Screening - methods; Medical sciences; Molecular Medicine; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Oncology; Papillomavirus Infections - epidemiology; Scandinavian and Nordic Countries - epidemiology; Short Communication; Tumors; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - virology; Scandinavia; Europe; Scandinavian and Nordic Countries; Finland; Denmark; Sweden; Norway; screening; age-period-cohort models; cervical cancer; incidence; Malignant tumor; Medical screening; Epidemiology; Female genital diseases; Incidence; Cancerology; Statistical model; Uterine cervix diseases; Cervical cancer; Cancer; Quantitative analysis
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2014.362

Background: Nordic countries’ data offer a unique possibility to evaluate the long-term benefit of cervical cancer screening in a context of increasing risk of human papillomavirus infection. Methods: Ad hoc -refined age-period-cohort models were applied to the last 50-year incidence data from Denmark, Finland, Norway and Sweden to project expected cervical cancer cases in a no-screening scenario. Results: In the absence of screening, projected incidence rates for 2006–2010 in Nordic countries would have been between 3 and 5 times higher than observed rates. Over 60 000 cases or between 41 and 49% of the expected cases of cervical cancer may have been prevented by the introduction of screening in the late 1960 s and early 1970 s. Conclusions: Our study suggests that screening programmes might have prevented a HPV-driven epidemic of cervical cancer in Nordic countries. According to extrapolations from cohort effects, cervical cancer incidence rates in the Nordic countries would have been otherwise comparable to the highest incidence rates currently detected in low-income countries.