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The impact of a two- versus three-yearly cervical screening interval recommendation on cervical cancer incidence and mortality: an analysis of trends in Australia, New Zealand, and England

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An Erratum to this article was published on 31 August 2013

Abstract

Objectives

To assess the impact of cervical screening interval recommendations on cervical cancer incidence and mortality during periods of organized and opportunistic screening in Australia (2-yearly screening interval for organized screening), New Zealand (3 yearly interval for organized screening), and England (3/5 yearly interval for organized screening).

Methods

Changes in cervical cancer rates over two 10-year periods were assessed in each country among women aged 20–69 years using a standardized rate ratio (SRR). The SRR for opportunistic screening was calculated from 1973–1977 to 1983–1987 (mortality only), and for organized screening from 1993–1997 to 2003–2007 (mortality and incidence).

Results

During  the period of opportunistic cervical screening, mortality reduced by 24 % in Australia and 10 % in England and Wales [Australia: SRR 0.76 (95 % CI 0.71–0.83); England and Wales: SRR 0.90 (95 % CI 0.87–0.93)]; no statistically significant reduction was observed in New Zealand [SRR 0.95 (95 % CI 0.82–1.11)]. After the introduction of organized screening, mortality reduced 39–45 % in each country [Australia: SRR 0.56 (95 % CI 0.51–0.62); New Zealand: SRR 0.53 (95 % CI 0.44–0.63); England and Wales: SRR 0.61 (95 % CI 0.58–0.64)], while incidence reduced 19–38 % [New Zealand: SRR 0.62 (95 % CI 0.56–0.69); Australia: SRR 0.64 (95 % CI 0.61–0.72); England: SRR 0.81 (95 % CI 0.78–0.83)].

Conclusion

In the era of opportunistic screening, some reductions were observed in cervical cancer mortality rates, but these were relatively modest and seen inconsistently between countries. After the introduction of organized cervical screening, cervical cancer mortality rates fell by a similar amount (~40 % or more) in all countries, and incidence fell by more than a third in Australia and New Zealand and by approximately one-fifth in England. Although several factors are likely to have influenced these observed reductions in cervical cancer rates, these findings do not support the more frequent 2-yearly cervical screening interval recommendation in Australia.

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References

  1. National Screening Unit (2011) National Cervical Screening Programme. New Zealand Government National Screening Unit. http://www.nsu.govt.nz/current-nsu-programmes/908.asp. Accessed 5th Feb 2011

  2. Australian Government Department of Health and Ageing (2009) National Cervical Screening Program. Australian Government Department of Health and Ageing. http://www.cervicalscreen.health.gov.au/internet/screening/publishing.nsf/Content/cervical-about. Accessed 5th Feb 2011

  3. Patnick J (2000) Cervical cancer screening in England. Eur J cancer (Oxford, England: 1990) 36(17):2205–2208

    Article  CAS  Google Scholar 

  4. ACIM (Australian Cancer Incidence and Mortality) Books (2010) AIHW. http://www.aihw.gov.au/cancer/data/acim_books/index.cfm. Accessed 7th Feb 2011

  5. Ministry of health data and statistics cancer: historical summary 1948–2007. Ministry of Health. http://www.moh.govt.nz/moh.nsf/indexmh/dataandstatistics-subjects-cancer-historicalsummary-1948-2007. Accessed Feb 2011

  6. Office of National Statistics (2009) Cancer Statistics Registrations: registrations of cancer diagnosed in 2007, England. Series MB1 No. 38. Office of National Statistics, London, UK

  7. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10 [Internet] (2010) International agency for research on cancer. http://globocan.iarc.fr. Accessed 8th Aug 2010

  8. IARC Working Group on Evaluation of Cervical Cancer Screening Programmes (1986) Screening for squamous cervical cancer: duration of low risk after negative results of cervical cytology and its implication for screening policies. IARC Working Group on evaluation of cervical cancer screening programmes. Br Med J (Clin Res Ed) 293 (6548):659–664

    Google Scholar 

  9. Cervix cancer screening/IARC Working Group on the Evaluation of Cancer Preventive Strategies (2005) Chapters 5–8: effectiveness of screening in populations; Summary; Evaluation; Recommendations. In, vol 10. IARC Press, Lyon, France, pp 201–241

  10. Sasieni P, Adams J, Cuzick J (2003) Benefit of cervical screening at different ages: evidence from the UK audit of screening histories. Br J Cancer 89(1):88–93

    Article  PubMed  CAS  Google Scholar 

  11. Anttila A, Ronco G, (2009) Working Group on the Registration and Monitoring of Cervical Cancer Screening Programmes in the European Union within the European Network for Information on Cancer (EUNICE) Description of the national situation of cervical cancer screening in the member states of the European Union. Eur J cancer (Oxford, England: 1990) 45(15): 2685–2708

  12. Anttila A, von Karsa L, Aasmaa A, Fender M, Patnick J, Rebolj M, Nicula F, Vass L, Valerianova Z, Voti L, Sauvaget C, Ronco G (2009) Cervical cancer screening policies and coverage in Europe. Eur J cancer (Oxford, England: 1990) 45(15):2649–2658

    Article  Google Scholar 

  13. Australian Government: Department of Health and Ageing (2012) National Cervical Screening Program Renewal. Australian Government: Department of Health and Ageing. Accessed 2012

  14. Canfell K, Sitas F, Beral V (2006) Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust 185(9):482–486

    PubMed  Google Scholar 

  15. Creighton P, Lew JB, Clements M, Smith M, Howard K, Dyer S, Lord S, Canfell K (2010) Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years. BMC Public Health 10:734

  16. World Health Organization (2010) WHO Mortality Database. WHO Statistical Information System. http://www.who.int/whosis/mort/download/en/index.html. Accessed Feb 2010

  17. Office of National Statistics (1998–2008) Cancer Statistics: Registrations: Registrations of cancer diagnosed in 1992; 1993;1994; 1995-1997; 1998; 1999; 2003; 2004; 2005; 2006, England and Wales. vol Series MB1 No.: 25–30; 34–37 Office of National Statistics

  18. Jakomis N (2010) Cancer incidences ENGLAND 1992–1994. Office of National Statistics, London

    Google Scholar 

  19. Boyle P, Parkin, DM (1991) Chapter 11: Statistical Methods for Registries. In: Jensen OM, Parkin, DM, MacLennan, R., Muir, CS., Skeet, RG. (ed) Cancer Registration: Principles and Methods. IARC Press, Lyon, France

  20. Doll R, Payne P, Waterhouse JAH (1966) Cancer Incidence in five continents, vol I. Union Internationale Contre le Cancer, Geneva

    Book  Google Scholar 

  21. Australian Institute of Health and Welfare (2009) Cervical Screening in Australia 2006–2007. Australian Institute of Health and Welfare Cat. No. CAN 43 Cancer Series Number 47, Canberra

  22. Brewer N, McKenzie F, Wong KC, Ellison-Loschmann L (2009) National cervical screening programme annual monitoring report 2007, vol 26. Centre for Public Health Research, Massey University, NZ, Wellington, New Zealand

    Google Scholar 

  23. Brewer N, McKenzie F, Wong KC, Eillison-Loschmann L (2008) NCSP Annual Monitoring Report 2006, Centre for Public Health Research. Massey University, Wellington, New Zealand

    Google Scholar 

  24. Brewer N, McKenzie F, Wong KC, Eillison-Loschmann L (2007) NCSP annual monitoring report 2005. Centre for Public Health Research, Massey University, Wellington, New Zealand

    Google Scholar 

  25. Brewer N, McKenzie F, Travier N, Jeffreys M (2007) NCSP annual monitoring report 2004. Centre for Public Health Research, Massey University, Wellington, New Zealand

    Google Scholar 

  26. Coppell K (2003) NCSP annual monitoring report 2003. Wellington, New Zealand

    Google Scholar 

  27. Coppell K (2003) NCSP annual monitoring report 2002. Wellington, New Zealand

    Google Scholar 

  28. Coppell K, Cox B (2002) National cervical screening programme October–December 2001. Hugh Adam Cancer Epidemiology Unit University of Otago, Dunedin, New Zealand

    Google Scholar 

  29. Coppell K, Cox B (2001) National Cervical Screening Programme October–December 2000. Hugh Adam Cancer Epidemiology Unit University of Otago, Dunedin, New Zealand

    Google Scholar 

  30. Cervical Screening Programme, England 2009–10 (2010) http://www.ic.nhs.uk/statistics-and-data-collections/screening/cervical-screening/cervical-screening-programme-england-2009-10. Accessed Feb 2011

  31. National Health Service Cancer Screening Programmes (2000) Reducing the risk: cervical screening programme 2000. NHS Cervical Screening Programme, National Health Service, Sheffield

    Google Scholar 

  32. Cervical Screening Programme, England 2004–5 (2005) The Health and Social Care Information Centre,. http://www.ic.nhs.uk/statistics-and-data-collections/screening/cervical-cancer/cervical-screening-programme-england-2004-05. Accessed Feb 2011

  33. National Health Service Cancer Screening Programmes (2002) Building on experience: cervical screening programme 2002. NHS Cervical Screening Programme, National Health Service, Sheffield

    Google Scholar 

  34. Quinn M, Babb P, Jones J, Allen E (1999) Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 318(7188):904–908

    Article  PubMed  CAS  Google Scholar 

  35. Foley G, Alston R, Geraci M, Brabin L, Kitchener H, Birch J (2011) Increasing rates of cervical cancer in young women in England: an analysis of national data 1982–2006. Br J Cancer 105(1):177–184

    Article  PubMed  CAS  Google Scholar 

  36. Arbyn M, Rebolj M, De Kok IM, Fender M, Becker N, O’Reilly M, Andrae B (2009) The challenges of organising cervical screening programmes in the 15 old member states of the European Union. Eur J cancer (Oxford, England: 1990) 45(15):2671–2678

    Article  Google Scholar 

  37. Arbyn M, Raifu AO, Weiderpass E, Bray F, Anttila A (2009) Trends of cervical cancer mortality in the member states of the European Union. Eur J cancer (Oxford, England: 1990) 45(15):2640–2648

    Article  Google Scholar 

  38. Ferlay J, Parkin, DM., Curado, MP., Bray, F., Edwards, B., Shin, HR., Forman, D (2010) Cancer Incidence in Five Continents, Volumes I to IX: IARC CancerBase No. 9. Accessed Feb 2011

  39. Taylor RJ, Morrell SL, Mamoon HA, Wain GV (2001) Effects of screening on cervical cancer incidence and mortality in New South Wales implied by influences of period of diagnosis and birth cohort. J Epidemiol Commun Health 55(11):782–788

    Article  CAS  Google Scholar 

  40. Appleby P, Beral V, Berrington de González A, Colin D, Franceschi S, Goodhill A, Green J, Peto J, Plummer M, Sweetland S, Cancer ICoESoC (2007) Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet 370 (9599):1609–1621

    Google Scholar 

  41. The International Collaboration of Epidemiological Studies of Cervical Cancer (2006) Cervical carcinoma and reproductive factors: collaborative reanalysis of individual data on 16,563 women with cervical carcinoma and 33,542 women without cervical carcinoma from 25 epidemiological studies. Int J Cancer 119(5):1108–1124

    Article  Google Scholar 

  42. Appleby P, Beral V, Berrington de Gonzalez A, Colin D, Franceschi S, Goodill A, Green J, Peto J, Plummer M, Sweetland S (2006) Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer 118(6):1481–1495

    Article  PubMed  CAS  Google Scholar 

  43. The World Bank (2011) The world bank data indicators: contraceptive prevalence (% of women ages 15–49). http://data.worldbank.org/indicator/SP.DYN.CONU.ZS. 2011

  44. United Nations (2008) World Population Prospects: the 2008 revision and World Urbanization Prospects: the 2008 revision. http://esa.un.org/unpp/index.asp?panel=2

  45. The World Bank (2011) The world bank data indicators: fertility rate, total (births per woman). http://data.worldbank.org/indicator/SP.DYN.TFRT.IN. 2011

  46. Australian Institute of Health (2005) statistics on drug use in Australia 2004. Department of health and ageing, drug statistics series no. 15, Canberra

  47. Legood R, Wolstenholme J, Gray A (2009) From cost-effectiveness information to decision-making on liquid-based cytology: mind the gap. Health Policy 89(2):193–200

    Article  PubMed  Google Scholar 

  48. Cervix cancer screening/IARC Working Group on the Evaluation of Cancer Preventive Strategies (2005) Chapter 2: Screening tests. In. IARC Handbooks of Cancer Prevention, vol 2, 10 edn. IARC Press, pp 59–117

  49. Patel A, Galaal K, Burnley C, Faulkner K, Martin-Hirsch P, Bland MJ, Leeson S, Beer H, Paranjothy S, Sasieni P, Naik R (2012) Cervical cancer incidence in young women: a historical and geographic controlled UK regional population study. Br J Cancer 106(11):1753–1759

    Google Scholar 

  50. Taylor R, Morrell S, Mamoon H, Wain G, Ross J (2006) Decline in cervical cancer incidence and mortality in New South Wales in relation to control activities (Australia). Cancer causes control: CCC 17(3):299–306

    Article  PubMed  Google Scholar 

  51. Wise J (2012) Pilot study will assess whether HPV test should replace smears to screen for cervical cancer. BMJ 344:e3744

    Article  PubMed  Google Scholar 

  52. Kitchener HC, Gilham C, Sargent A, Bailey A, Albrow R, Roberts C, Desai M, Mather J, Turner A, Moss S, Peto J (2011) A comparison of HPV DNA testing and liquid based cytology over three rounds of primary cervical screening: extended follow up in the ARTISTIC trial. Eur J cancer (Oxford, England: 1990) 47(6):864–871

    Article  Google Scholar 

  53. Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, Ratnam S, Coutlee F, Franco EL (2007) Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J med 357(16):1579–1588

    Article  PubMed  CAS  Google Scholar 

  54. Anttila A, Kotaniemi-Talonen L, Leinonen M, Hakama M, Laurila P, Tarkkanen J, Malila N, Nieminen P (2010) Rate of cervical cancer, severe intraepithelial neoplasia, and adenocarcinoma in situ in primary HPV DNA screening with cytology triage: randomised study within organised screening programme. BMJ 340:c1804

    Article  PubMed  Google Scholar 

  55. Bulk S, Bulkmans NW, Berkhof J, Rozendaal L, Boeke AJ, Verheijen RH, Snijders PJ, Meijer CJ (2007) Risk of high-grade cervical intra-epithelial neoplasia based on cytology and high-risk HPV testing at baseline and at 6-months. Int J Cancer 121(2):361–367

    Article  PubMed  CAS  Google Scholar 

  56. Bulkmans NW, Berkhof J, Rozendaal L, van Kemenade FJ, Boeke AJ, Bulk S, Voorhorst FJ, Verheijen RH, van Groningen K, Boon ME, Ruitinga W, van Ballegooijen M, Snijders PJ, Meijer CJ (2007) Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial. Lancet 370(9601):1764–1772

    Article  PubMed  CAS  Google Scholar 

  57. Ronco G, Giorgi-Rossi P, Carozzi F, Confortini M, Dalla Palma P, Del Mistro A, Ghiringhello B, Girlando S, Gillio-Tos A, De Marco L, Naldoni C, Pierotti P, Rizzolo R, Schincaglia P, Zorzi M, Zappa M, Segnan N, Cuzick J (2010) Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial. Lancet oncol 11(3):249–257

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Naomi Jakomis from the Office of National Statistics for provision of data on England incidence data.

Conflict of interest

KC is configuring a new trial of primary HPV screening in Australia which involves partial support from Roche Molecular Diagnostics, USA.

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Author notes

  1. Leonardo Simonella

    Present address: Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, Block MD3, Singapore, 117597, Singapore

  2. Karen Canfell

    Present address: Lowy Cancer Research Centre, Prince of Wales Clinical School, University of NSW, Sydney, Australia

Authors and Affiliations

  1. Cancer Epidemiology Research Unit, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia

    Leonardo Simonella & Karen Canfell

  2. School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia

    Leonardo Simonella & Karen Canfell

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  1. Leonardo Simonella
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  2. Karen Canfell
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Correspondence to Leonardo Simonella.

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Simonella, L., Canfell, K. The impact of a two- versus three-yearly cervical screening interval recommendation on cervical cancer incidence and mortality: an analysis of trends in Australia, New Zealand, and England. Cancer Causes Control 24, 1727–1736 (2013). https://doi.org/10.1007/s10552-013-0250-9

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