New Zealand is an example of a country with a well-established cytology-based screening program. New Zealand’s National Cervical Screening Programme (NCSP) commenced in 1990, and recommends three-yearly cytology-based screening for women aged 20–69 years. In 2018, the NCSP will transition to five-yearly HPV-based screening for women aged 25–69 years. The aim of this study was to assess the impact of the program to date in different groups, to provide a benchmark for the new program.
Analysis of cervical cancer trends in New Zealand by age and ethnicity over the period 1985–2013, and by morphology over the period 1997–2013, using data from the New Zealand Cancer Registry was conducted.
The overall incidence of cervical cancer was 56% (95% CI 51–60%) lower in 2009–2013 than in 1985–1989, and significant reductions were observed in women aged 25–49, 50–69, and 70 + years. Relative reductions in cervical cancer were very similar for Māori and non-Māori women aged 25–49 (50% in Māori; 52% in non-Māori) and 50–69 years (65% in Māori; 69% in non-Māori). In contrast, incidence appeared to increase after around 1996 in women aged 20–24. The increasing trend was significant for women aged 20–24 overall and for non-Māori women (p < 0.01 in both cases).
There have been substantial reductions in cervical cancer among women aged 25 + years in New Zealand since the inception of the NCSP, and these reductions are similar in Māori and non-Māori women. Cervical cancer incidence among women 20–24 years has not declined since the NCSP began, and appears to be increasing.
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We thank Sam Egger (Cancer Council NSW) for advice on appropriate adjustments between the de facto and resident populations; Ivan Rowe (National Screening Unit, NZ Ministry of Health) for extracting cancer registrations data; Harold Neal for providing information on cancer registrations prior to the inception of the NZCR; and Donna Cormack and Diana Sarfati for providing valuable comments on an earlier draft of this manuscript.
This study was commissioned and funded by the National Screening Unit, New Zealand. MAS, SE, and KC have performed other contracted work for the National Screening Unit, New Zealand. KC receives salary support from NHMRC Australia (Career Development Fellowship APP1082989).
Conflict of interest
KC is co-PI of an investigator-initiated trial of cytology and primary HPV screening in Australia (“Compass”) (ACTRN12613001207707 and NCT02328872). The organization conducting the trial, the VCS Inc, received equipment and a funding contribution from Roche Molecular Systems and Ventana, USA. KC is also a PI on Compass in New Zealand, (“Compass NZ”; ACTRN12614000714684). The organization conducting the trial, DML, received an equipment and a funding contribution from Roche Molecular Systems. However, neither KC nor her institution (Cancer Council NSW) on her behalf received funding from industry for Compass Australia or NZ or any other project.
Ethics approval was not required for the study, as only aggregated non-identifiable data were analyzed.
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Smith, M.A., Edwards, S. & Canfell, K. Impact of the National Cervical Screening Programme in New Zealand by age: analysis of cervical cancer trends 1985–2013 in all women and in Māori women. Cancer Causes Control 28, 1393–1404 (2017). https://doi.org/10.1007/s10552-017-0967-y
- Cervical cancer
- Cancer trends
- New Zealand
- Health disparities