- • Cervical cancer mortality is improving in most European countries.
- • Countries with higher quality cervical screening programs had greater improvements.
- • Better trends were identified in countries implemented screening prior 2009.
Cervical cancer is the fourth leading oncological cause of death in women. Variable trends in cervical cancer mortality have been observed across Europe, despite the widespread adoption of screening programs. This variability has previously been attributed to heterogeneity in the quality of screening programs.
Age-standardized cervical cancer death rates for European countries between 1985 and 2014 were analyzed using Joinpoint regression. Countries were dichotomized based on year of implementation and population invitational coverage of national population-based cervical cancer screening programs. National cervical cancer mortality trends during the study period were compared based on this classification.
Decreasing trends in mortality were observed in all European countries with the specific exceptions of Bulgaria, Greece and Latvia. The highest rates of cervical cancer mortality throughout the study period were in Romania (16.0-14.9/100,000) and the lowest rates in Italy (1.4-1.2/100,000). The greatest percentage decline in mortality was observed in the United Kingdom and the greatest absolute reduction in mortality was seen in Hungary. European countries which implemented a national population-based cervical cancer screening program prior to 2009 demonstrated greater improvements in cervical cancer mortality outcomes compared to those that did not (p = 0.016).
Cervical cancer mortality is improving in most European countries; however, substantial variation remains. Trends in mortality were associated with the time of implementation of national population-based cervical screening programs.
Cervical cancer is the fourth leading cause of oncological death amongst women [ ]. Globally, it is the underlying cause for an estimated 235,700 deaths per annum, although age standardized death rates have fallen since 1990 [ ]. Furthermore, cervical cancer is associated with substantial morbidity; estimates suggest that it is responsible for 243,800 years lived with disability and a net loss in excess of 6.9 million disability adjusted life years [ , ]. More than 85 % of the global cervical cancer disease burden occurs in low-to-medium resource countries [ , ].
Individual analyses of data from population-based registries report improving 5-year survival for cervical cancer across a number of European countries; however, these improvements have been modest compared to other common site-specific cancers [ ]. Outcomes remain variable with 5-year survival ranging from 53.0 % in Bulgaria and Poland to 73.1 % in Iceland [ ]. Across the majority of Europe, incidence rates and mortality in cervical cancer have been in decline [ ], likely as a result of successful screening and human papillomavirus (HPV) vaccination programs which have offset the influences of increased female smoking and earlier onset of sexual activity [ ]. Where programs have had poor coverage or poor uptake, stable or worsening trends have also been reported [ ].
In Europe, screening programs are ongoing, piloted or planned in 22 of the 28 member states of the European Union (EU) plus the United Kingdom (UK), covering 72 % of women in the 30−59 year target age group [ ]. However, there is variability in the year of initiation and population coverage of these national screening programs. We aim to provide an updated comparative time trend analysis of cervical cancer mortality in countries within Europe. Further, we attempt to assess the influence of cervical cancer screening programs on mortality from cervical cancers.