Cancer Causes & Control

, Volume 17, Issue 3, pp 299–306 | Cite as

Decline in Cervical Cancer Incidence and Mortality in New South Wales in Relation to Control Activities (Australia)

  • Richard Taylor
  • Stephen Morrell
  • Hassan Mamoon
  • Gerard Wain
  • Jayne Ross
Original Paper
Received:
Accepted:

Abstract

Background

To examine time trends in cervical cancer incidence and mortality in NSW women aged ¥20 years in relation to important health service initiatives and programs.

Methods

Data on cervical cancer incidence and mortality were obtained from the NSW Central Cancer Registry for 1972–2001, and corresponding annual populations obtained from the Australian Bureau of Statistics. Direct age-standardised rates in the ¥20 year population were calculated using the 2001 NSW census population as standard. Proportional reductions in incidence and mortality since 1972–1974 were also calculated and related to key health service factors and to published NSW 5-year cervical cancer relative survival for similar periods.

Results

Declines in cervical cancer incidence (−10%) and mortality (−20%), and increased degree-of-spread specific survival following the introduction of universal health care in 1975 suggest effects of greater access to Pap screening, earlier access to diagnosis and treatment services, and improved effectiveness of treatment. Incidence plateaued during the 1980s, but mortality fell further (−7%) due to an increased proportion of localised cancers (without change to degree-of-spread specific survival). The 1980s mortality reduction was a consequence of earlier diagnosis and/or secondary prevention, not improved treatment effectiveness or reduced incidence. A marked and sustained incidence decline to 2001 (−35%) occurred after the introduction of the NSW Cervical Screening Program in 1992. This was followed 3 years later by a sustained mortality decline (−20%). During the 1990s survival across all degrees of spread remained unchanged and the mortality reduction was due entirely to reduction in incidence.

Conclusions

The substantial reduction of cervical cancer incidence and mortality in NSW over the last 3 decades is associated with important health service interventions that relate to control of cervical cancer, particularly the implementation of a population-based organised cervical screening program.

Keywords

Cervix neoplasms Incidence Mortality Survival Time factors Mass screening 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Sigurdsson, K, Hrafnkelsson, J, Geirsson, G,  et al. 1991Screening as a prognostic factor in cervical cancer: analysis of survival and prognostic factors based on Icelandic population data, 1964–1988Gynecol Oncol436470CrossRefPubMedGoogle Scholar
  2. 2.
    Adami, HO, Ponten, J, Sparen, P,  et al. 1994Survival trend after invasive cervical cancer diagnosis in Sweden before and after cytologic screening. 1960–1984Cancer73140147PubMedGoogle Scholar
  3. 3.
    International Agency for Research on Cancer [IARC]1986Screening for squamous cervical cancer: duration of low risk after negative results of cervical cytology and its implications for screening policiesBMJ293659664Google Scholar
  4. 4.
    Johannesson, G, Geirsson, G, Day, N 1978The effect of mass screening in Iceland, 1965–74, on the incidence and mortality of cervical carcinomaInt J Cancer21418425PubMedGoogle Scholar
  5. 5.
    Johannesson, G, Geirsson, G, Day, N,  et al. 1982Screening for cancer of the uterine cervix in Iceland 1965–1978Acta Obstet Gynecol Scand61199203PubMedGoogle Scholar
  6. 6.
    Sigurdsson, K 1993Effect of organized screening on the risk of cervical cancer: evaluation of screening activity in Iceland, 1964–1991Int J Cancer54563570PubMedGoogle Scholar
  7. 7.
    Day, N 1984Effect of cervical cancer screening in ScandinaviaObstet Gynecol63714718PubMedGoogle Scholar
  8. 8.
    Hakama, M, Louhivuori, K 1988A screening programme for cervical cancer that workedCancer Surv7403416PubMedGoogle Scholar
  9. 9.
    Parkin, DM, Nguyen-Dinh, X, Day, NE 1985The impact of screening on the incidence of cervical cancer in England and WalesBr J Obstet Gynaecol92150157PubMedGoogle Scholar
  10. 10.
    Macgregor, JE, Campbell, KM, Mann, EMF, Swanson, KY 1994Screening for cervical intraepithelial neoplasia in north east Scotland shows fall in incidence and mortality from invasive cancer with concomitant rise in preinvasive diseaseBMJ30814071411PubMedGoogle Scholar
  11. 11.
    Gibson, L, Spiegelhalter, DJ, Camilleri-Ferrante, C,  et al. 1997Trends in invasive cervical cancer incidence in East Anglia from 1971 to 1993J Med Screen44448PubMedGoogle Scholar
  12. 12.
    Quinn, M, Babb, P, Jones, J, Allen, A 1999Effect of screening on incidence of and mortality from cancer of the cervix in England: evaluation based on routinely collected statisticBMJ318904908PubMedGoogle Scholar
  13. 13.
    Peto, J, Gilham, C, Fletcher, O, Matthews, FE 2004The cervical cancer epidemic that screening has prevented in the UKLancet364249256CrossRefPubMedGoogle Scholar
  14. 14.
    Liu, S, Semenciw, R, Probert, A, Mao, Y 2001Cervical cancer in Canada: changing patterns in incidence and mortalityInt J Gynecol Cancer112431CrossRefPubMedGoogle Scholar
  15. 15.
    Laara, E, Day, NE, Hakama, M 1987Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmesLancet112471249PubMedGoogle Scholar
  16. 16.
    Aareleid, T, Pukkala, E, Thomson, H,  et al. 1993Cervical cancer incidence and mortality trends in Finland and Estonia: a screened vs. an unscreened populationEur J Cancer29745749CrossRefGoogle Scholar
  17. 17.
    Sigurdsson, K 1999The Icelandic and Nordic cervical screening programs: trends in incidence and mortality rates through 1995Acta Obstet Gynecol Scand78478485PubMedGoogle Scholar
  18. 18.
    McCredie, M, Coates, MS, Ford, JM 1989Trends in invasive cancer of the cervix uteri in New South Wales, 1973–1982Aust NZ J Obstet Gynaecol29335339Google Scholar
  19. 19.
    McCredie, M, Coates, M, Churches, T 1990Cancer of the Cervix Uteri: New South Wales, Australian Capital Territory 1972–1987Cancer Epidemiology Research Unit and NSW Central Cancer Registry, NSW Cancer CouncilSydneyGoogle Scholar
  20. 20.
    Kricker, A, Bell, J, Coates, M, Taylor, R, Armstrong, B 1996Cancer of the Cervix in NSW 1972 to 1992Cancer Epidemiology Research Unit and NSW Central Cancer Registry, NSW Cancer CouncilSydneyGoogle Scholar
  21. 21.
    Taylor, R, Bell, J, Coates, M, Churches, T, Wain, G 1996Cervical cancer in New South Wales women: five-year survival, 1972 to 1991ANZ J Pub Health20413420Google Scholar
  22. 22.
    Australian Institute of Health and Welfare [AIHW] (1998) Breast and cervical cancer screening in Australia 1996–1997. AIHW Cat. No. CAN 3 (Cancer Series Number 8). AIHW CanberraGoogle Scholar
  23. 23.
    New South Wales Cervical Screening Program and NSW Pap Test Register [NSW CSP/PTR] (1999) Cervical cancer screening in New South Wales: First Annual Statistical report 1997. NSW Health Department, Sydney. http://www.csp.nsw.gov.au
  24. 24.
    Coates M, et al. (1992–1998) Cancer in NSW, Incidence and Mortality [1990–1995, annual reports]. NSW Central Cancer Registry and Cancer Control Information Centre, NSW Cancer Council and NSW Health DepartmentGoogle Scholar
  25. 25.
    Tracey E, et al. (2003) Cancer in NSW, Incidence and Mortality 2001 [2001 annual report]. NSW Central Cancer Registry, Cancer Research and Registers Division; NSW Cancer Council; and NSW Health DepartmentGoogle Scholar
  26. 26.
    Taylor, R, Morrell, S, Mamoon, H, Wain, G 2001The effect of screening on cervical cancer incidence and mortality in New South Wales implied by influences of period of diagnosis and birth cohortJ Epi Com Hlth55782788Google Scholar
  27. 27.
    Muir, C, Waterhouse, J, Mack, T,  et al. 1987Cancer Incidence in Five ContinentsInternational Agency for Research on CancerLyon45IARC Publication No 88.Google Scholar
  28. 28.
    Armitage, P, Berry, G 1994Statistical Methods in Medical Research3Blackwell Scientific PublicationsOxfordGoogle Scholar
  29. 29.
    Yu, XQ, O'Connell, DL, Gibberd, RW, Smith, DP, Armstrong, BK 2003Cancer Survival, Incidence and Mortality by Area Health Service in NSW 1994–2000NSW Cancer CouncilSydneyGoogle Scholar
  30. 30.
    New South Wales Cervical Screening Program and NSW Pap Test Register [NSW CSP/PTR] (2003) Cervical cancer screening in New South Wales: Annual Statistical report 2002. NSW Health Department, Sydney. http://www.csp.nsw.gov.au

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Richard Taylor
    • 1
    • 2
  • Stephen Morrell
    • 1
    • 3
    • 5
  • Hassan Mamoon
    • 1
  • Gerard Wain
    • 1
    • 4
  • Jayne Ross
    • 1
  1. 1.NSW Cervical Screening ProgramCumberland HospitalSydneyAustralia
  2. 2.School of Population HealthUniversity of QueenslandBrisbaneAustralia
  3. 3.School of Public HealthUniversity of SydneySydneyAustralia
  4. 4.Department of Obstetrics and GynaecologyUniversity of SydneySydneyAustralia
  5. 5.NSW Cervical Screening ProgramParramattaAustralia

Personalised recommendations