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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
National Screening Unit (2010) National Screening Unit Strategic Plan 2010 to 2015. National Screening Unit. https://www.nsu.govt.nz/system/files/page/nsu_strategic_plan_2010-2015.pdf
Lewis H (2005) Cervical screening in New Zealand: a brief statistical review of the first decade. Ministry of Health, Wellington. https://www.nsu.govt.nz/system/files/resources/ncsp-statistical-review.pdf
Smith M, Walker R, Simms K, Canfell K (2014) National Cervical Screening Programme Annual Report 2012. Wellington
Brewer N, McKenzie F, Wong KC, Ellison-Loschmann L (2008) National Cervical Screening Programme Annual Report 2007. Centre for Public Health Research Massey University. https://www.nsu.govt.nz/system/files/page/annual_report_2007_revised_final.pdf. Accessed 6 June 2016
Smith M, Edwards S, Canfell K (2016) National Cervical Screening Programme Annual Report 2013. Wellington
Smith M, Walker R, Canfell K (2014) National Cervical Screening Programme Monitoring Report Number 40. National Screening Unit, Wellington
Blakely T, Shaw C, Atkinson J, Tobias M, Bastiampillai N, Sloane K, Sarfati D, Cunningham R (2010) Trends in Cancer Incidence by Ethnic and Socioeconomic Group, New Zealand 1981–2004. University of Otago and the Ministry of Health. http://www.health.govt.nz/publication/trends-cancer-incidence-ethnic-and-socioeconomic-group-new-zealand-1981-2004
McLeod M, Harris R, Purdie G, Cormack D, Robson B, Sykes P, Crengle S, Iupati D, Walker N (2010) Improving survival disparities in cervical cancer between Maori and non-Maori women in New Zealand: a national retrospective cohort study. Aust N Z J Public Health 34(2):193–199. doi:10.1111/j.1753-6405.2010.00506.x
National Screening Unit (2016) Primary HPV Screening. Ministry of Health. https://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/primary-hpv-screening. Accessed 6 June 2016
Smith M, Canfell K (2016) Impact of the Australian National Cervical Screening Program in women of different ages. Med J Aust 205(8):359–364
Sasieni P, Castanon A, Cuzick J (2009) Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 339:b2968
Canadian Task Force on Preventive Health Care, Dickinson J, Tsakonas E, Conner Gorber S, Lewin G, Shaw E, Singh H, Joffres M, Birtwhistle R, Tonelli M, Mai V, McLachlin M (2013) Recommendations on screening for cervical cancer. CMAJ 185(1):35–45. doi:10.1503/cmaj.121505
Cancer Council Australia Cervical Cancer Prevention Guidelines Working Party (2016) Draft clinical management guidelines for the prevention of cervical cancer. Cancer Council Australia. http://wiki.cancer.org.au/australia/Guidelines:Cervical_cancer/Prevention. Accessed 18 February 2016
Advisory committee on cervical screening (2009) Extraordinary Meeting to re-examine current policy on cervical screening for women aged 20–24 years taking account of any new evidence and to make recommendations to the National Cancer Director and Ministers. http://webarchive.nationalarchives.gov.uk/20150506150512/http://www.cancerscreening.nhs.uk/cervical/cervical-review-minutes-20090519.pdf
Public Health England Current UK NSC recommendations: cervical cancer consultation Q&A. http://legacy.screening.nhs.uk/cervicalcancer-qa. Accessed 5 May 2016
Jeronimo J, Castle PE, Temin S, Denny L, Gupta V, Kim JJ, Luciani S, Murokora D, Ngoma T, Qiao Y, Quinn M, Sankaranarayanan R, Sasieni P, Schmeler KM, Shastri SS (2016) Secondary prevention of cervical cancer: ASCO resource-stratified clinical practice guideline. J Glob Oncol. doi:10.1200/jgo.2016.006577
International Agency for Research on Cancer (2005) IARC handbooks of cancer prevention volume 10: cervix cancer screening, vol 10. IARC Press, Lyon
Bergstrom R, Sparen P, Adami HO (1999) Trends in cancer of the cervix uteri in Sweden following cytological screening. Br J Cancer 81(1):159–166
Oh C-M, Jung K-W, Won Y-J, Shin A, Kong H-J, Jun JK, Park S-Y (2013) Trends in the incidence of in situ and invasive cervical cancer by age group and histological type in Korea from 1993 to 2009. PLoS ONE 8(8):e72012. doi:10.1371/journal.pone.0072012
Bray F, Loos AH, McCarron P, Weiderpass E, Arbyn M, Moller H, Hakama M, Parkin DM (2005) Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomark Prev 14(3):677–686
Bray F, Carstensen B, Moller H, Zappa M, Zakelj MP, Lawrence G, Hakama M, Weiderpass E (2005) Incidence trends of adenocarcinoma of the cervix in 13 European countries. Cancer Epidemiol Biomark Prev 14(9):2191–2199. doi:10.1158/1055-9965.epi-05-0231
Australian Institute of Health and Welfare (2014) Cervical screening in Australia 2011–2012. Cancer series no.82. Cat. no. CAN 79. AIHW, Canberra
Hodgen E, Tobias M, Cheung J (2002) Cancer in New Zealand: trends and projections. New Zealand Ministry of Health, Wellington
Statistics New Zealand (2015) Estimated resident population by age and sex (1991+) (Annual-Dec) [via Infoshare]. http://www.stats.govt.nz/infoshare/Default.aspx. Accessed 11 Jan 2016
Statistics New Zealand (2012) Estimated de facto population by age and sex (1936–1995) (Annual-Dec) [via Infoshare]. http://www.stats.govt.nz/infoshare/Default.aspx. Accessed 11 Jan 2016
Statistics New Zealand (2015) Māori Population Estimates: Mean year ended 31 December 1991–2014. Statistics New Zealand. http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/MaoriPopulationEstimates_HOTPMnYrDec14.aspx. Accessed 11 Jan 2016
Boyle P, Parkin DM (1991) Chap. 11: statistical methods for registries. In: Jensen OM, Parkin DM, MacLennan R, Muir CS, Skeet RG (eds) Cancer registration: principles and methods. IARC Press, Lyon, pp 126–158
Dickinson JA, Stankiewicz A, Popadiuk C, Pogany L, Onysko J, Miller AB (2012) Reduced cervical cancer incidence and mortality in Canada: national data from 1932 to 2006. BMC Public Health 12(1):1–13. doi:10.1186/1471-2458-12-992
Adegoke O, Kulasingam S, Virnig B (2012) Cervical cancer trends in the United States: A 35-year population-based analysis. J Women’s Health 21(10):1031–1037. doi:10.1089/jwh.2011.3385
Smith M, Yap S, Canfell K (2017) National Cervical Screening Programme Monitoring Report Number 44 (1 July–31 December 2015). Ministry of Health, Wellington
National Screening Unit (2017) National Cervical Screening Programme: Independent monitoring reports. https://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/independent-monitoring-reports. Accessed 2 June 2017
Wang SS, Sherman ME, Hildesheim A, Lacey JV, Devesa S (2004) Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for 1976–2000. Cancer 100(5):1035–1044
Swan J, Breen N, Coates RJ, Rimer BK, Lee NC (2003) Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 97(6):1528–1540. doi:10.1002/cncr.11208
Hiatt RA, Klabunde C, Breen N, Swan J, Ballard-Barbash R (2002) Cancer screening practices from National Health Interview Surveys: past, present, and future. J Natl Cancer Inst 94(24):1837–1846. doi:10.1093/jnci/94.24.1837
Selvin E, Brett KM (2003) Breast and cervical cancer screening: sociodemographic predictors among White, Black, and Hispanic women. Am J Public Health 93(4):618–623
Parliamentary Review Committee (2015) Report of the Parliamentary Review Committee regarding the New Zealand Cervical Screening Programme, June 2015. Wellington
Smith MA, Hall M, Lew J-B, Canfell K (2017) Potential for HPV vaccination and primary HPV screening to reduce cervical cancer disparities: example from New Zealand. Paper presented at the 31st International Papillomavirus Society Conference (HPV2017), Cape Town, 28 February–4 March
Verdoodt F, Jentschke M, Hillemanns P, Racey CS, Snijders PJ, Arbyn M (2015) Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. Eur J Cancer 51(16):2375–2385. doi:10.1016/j.ejca.2015.07.006
Sultana F, English DR, Simpson JA, Drennan KT, Mullins R, Brotherton JM, Wrede CD, Heley S, Saville M, Gertig DM (2016) Home-based HPV self-sampling improves participation by never- and under-screened women: results from a large randomised trial (iPap) in Australia. Int J Cancer 139(2):281–290. doi:10.1002/ijc.30031
Rositch AF, Nowak RG, Gravitt PE (2014) Increased age and race-specific incidence of cervical cancer after correction for hysterectomy prevalence in the United States from 2000 to 2009. Cancer 120:2032–2038
Dharmalingam A, Pool I, Dickson J (2000) Biosocial determinants of hysterectomy in New Zealand. Am J Public Health 90(9):1455–1458
Gray A (2011) Methodology for estimating hysterectomy prevalence in women 20–69. Wellington, New Zealand
Health, Unit Disability, Midland Health (1997) Sexual and reproductive health in the Midland health region. Midland Health. http://www.moh.govt.nz/notebook/nbbooks.nsf/0/2839C293913505864C2565D70018B3A8/$file/sexual%20and%20reproductive%20health.pdf
Adolescent Health Research Group (2003) A health profile of New Zealand youth who attend secondary school. N Z Med J 116(1171):U380
Hodges I, Maskill C, Coulson J, Christie S, Quigley R (1998) Our Children’s Health: Key findings on the health of New Zealand children. Ministry of Health, Wellington
Kyrgiou M, Mitra A, Arbyn M, Stasinou SM, Martin-Hirsch P, Bennett P, Paraskevaidis E (2014) Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis. BMJ 349:g6192. doi:10.1136/bmj.g6192
Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E (2006) Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. The Lancet 367(9509):489–498
Arbyn M, Kyrgiou M, Simoens C, Raifu AO, Koliopoulos G, Martin-Hirsch P, Prendiville W, Paraskevaidis E (2008) Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 337:a1284
Litmus (2013) HPV Immunisation Programme Implementation Evaluation Volume 1: Final Report. http://www.health.govt.nz/system/files/documents/publications/hpv-immunisation-programme-evaluation-v2.pdf
Sykes P, Gopala K, Tan AL, Kenwright D, Petrich S, Molijn A, Chen J (2014) Type distribution of human papillomavirus among adult women diagnosed with invasive cervical cancer (stage 1b or higher) in New Zealand. BMC Infect Dis 14:374. doi:10.1186/1471-2334-14-374
Ministry of Health (2014) HPV immunisation coverage by ethnicity, vaccination and eligible birth cohort - All DHBs (2014). http://www.health.govt.nz/system/files/documents/pages/hpv_immunisation_coverage_by_ethnicity_vaccination_and_eligibile_birth_cohort-feb2014.xlsx. Accessed 12 Jan 2015
Ministry of Health (2015) Immunisation Coverage—HPV—2001 Cohort—All DHBs (September 2015)
Oliphant J, Perkins N (2011) Impact of the human papillomavirus (HPV) vaccine on genital wart diagnoses at Auckland Sexual Health Services. N Z Med J 124(1339):51–58
The Institute of Environmental Science and Research Ltd (2014) Sexually transmitted infections in New Zealand: Annual Surveillance Report 2013. Porirua, New Zealand
Wilson N, Morgan J, Baker MG (2014) Evidence for effectiveness of a national HPV vaccination programme: national prescription data from New Zealand. Sex Transm Infect 90(2):103. doi:10.1136/sextrans-2013-051037
Smith M, Edwards S, Canfell K (2016) National Cervical Screening Programme Monitoring Report Number 42 (1 July–31 December 2014). Wellington
National Screening Advisory Committee (2016) Meeting minutes 6 July 2016. https://www.nsu.govt.nz/system/files/page/nsac_minutes_6_july_2016.docx. Accessed 9 March 2017
Cormack D, Harris R (2009) Issues in monitoring Māori health and ethnic disparities: an update. Te Ropu Rangahau Hauora a Eru Pomare, Wellington
Cormack D, McLeod M (2010) Improving and maintaining quality in ethnicity data collections in the health and disability sector. University of Otago, Wellington
Shaw C, Atkinson J, Blakely T (2009) (Mis)classification of ethnicity on the New Zealand Cancer Registry: 1981–2004. N Z Med J 122(1294):10–22
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.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
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