Cancer Causes & Control

, Volume 24, Issue 9, pp 1727–1736 | Cite as

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

Original paper

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.

Keywords

Cervical screening Screening interval Australia New Zealand England Incidence Mortality 

Notes

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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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Cancer Epidemiology Research UnitCancer Council NSWWoolloomooloo, SydneyAustralia
  2. 2.School of Public Health, Sydney Medical SchoolUniversity of SydneySydneyAustralia
  3. 3.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  4. 4.Lowy Cancer Research Centre, Prince of Wales Clinical SchoolUniversity of NSWSydneyAustralia

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