Pap smear screening and changes in cervical cancer mortality in Sweden

Institution of Obstetrics/Gynecology, University of Umeå, Sweden.
International Journal of Gynecology & Obstetrics (Impact Factor: 1.54). 04/1994; 44(3):267-72. DOI: 10.1016/0020-7292(94)90177-5
Source: PubMed


Age-adjusted incidence of cervical carcinoma has fallen dramatically in Sweden in recent decades. This investigation is an attempt to evaluate the effectiveness of the gynecologic Pap smear screening program in terms of reduction of mortality from cervical cancer.
Cervical cancer mortality trends in relation to age, calendar period, county and degree of screening activities in the population were analyzed. Multiplicative Poisson regression models were utilized. The reduction of mortality was attributed to the activities of cervical screening.
The analysis gave a calculated 53% reduction in cervical cancer mortality (95% confidence limits 23-72%), attributable to screening.
The study supports the hypothesis that gynecological Pap smear screening has had an important impact on the reduction in cervical cancer mortality.

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    • "Opportunistic screening with a Pap smear was launched in Thailand more than 30 years ago and later VIA was introduced just before 2000. Organized countrywide cytologic cervical cancer screening has been demonstrated in many countries of the benefit in reduction of cervical cancer incidence and mortality (Laara and Hakama, 1987; Mahlck et al., 1994; Dickinson et al., 2012). A longitudinal Swedish study showed the success of the countrywide cytologic screening for cervical cancer in reduction of squamous cell carcinoma (SCC) incidence and mortality but an unapparent effecton adenocarcinoma (AC) (Gunnel et al., 2007). "
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    ABSTRACT: Background: Cervical cancer has been a leading female cancer in Thailand for decades, and has been second to breast cancer after 2007. The Ministry of Public Health (MoPH) has provided opportunistic screening with Pap smears for more than 30 years. In 2002, the MoPH and the National Health Security Office provided countrywide systematic screening of cervical cancer to all Thai women aged 35-60 years under universal health care coverage insurance scheme at 5-year intervals. Objectives: This study characterized the cervical cancer incidence trends in Songkhla in southern Thailand using joinpoint and age period cohort (APC) analysis to observe the effect of cervical cancer screening activities in the past decades, and to project cervical cancer rates in the province, to 2030. Materials and Methods: Invasive and in situ cervical cancer cases were extracted from the Songkhla Cancer Registry from 1990 through 2010. Age standardized incidence rates were estimated. Trends in incidences were evaluated by joinpoint and APC regression models. The Norpred package was modified for R and was used to project the future trends to 2030 using the power of 5 function and cut trend method. Results: Cervical cancer incidence in Songkhla peaked around 1998-2000 and then dropped by -4.7% per year. APC analysis demonstrated that in situ tumors caused an increase in incidence in early ages, younger cohorts, and in later years of diagnosis. Conclusions: Both joinpoint and APC analysis give the same conclusion in continuation of a declining trend of cervical cancer to 2030 but with different rates and the predicted goal of ASR below 10 or even 5 per 100,000 women by 2030 would be achieved. Thus, maintenance and improvement of the screening program should be continued. Other population based cancer registries in Thailand should analyze their data to confirm the success of cervical cancer screening policy of Thailand.
    Asian Pacific journal of cancer prevention: APJCP 12/2014; 15(22):10003-10008. DOI:10.7314/APJCP.2014.15.22.10003 · 2.51 Impact Factor
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    • "The use of visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) is feasible as a primary means of screening for cervical cancer in low-resource settings [3] [4] [5] [6] [7]. In lowincome countries, organized cytologic screening—which used to occur annually but now occurs every 3–5 years—has been successful in reducing the number of deaths from cervical cancer [8] [9]. Owing to lack of resources and poor logistics, cytology-based programs are not feasible in low-resource settings. "
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    ABSTRACT: To evaluate the efficacy of male partner involvement in reducing loss to follow-up among women in Uganda referred for colposcopy after a positive cervical cancer-screening test. In 2 family-planning/postnatal clinics at Mulago Hospital, Kampala, Uganda, 5094 women were screened for cervical lesions. Those who screened positive were referred for colposcopy; half were allocated to the intervention group and half to the control group. In the intervention group, information about the screening findings and a request to assist their partner in attending the next examination were sent to male partners. In the control group, a standard service was provided, which did not include a letter to the male partner. Logistic regression models were applied to calculate the probability of women returning for colposcopy. Of the 834 women referred, 209 (25%) did not return for colposcopy: 143/419 (34%) from the control group and 66/415 (16%) from the intervention group. Women in the intervention group were more likely to return (odds ratio 2.8; 95% confidence interval, 1.9-3.9). Male partner involvement significantly reduced loss to follow-up among women referred for colposcopy.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 09/2009; 107(2):103-6. DOI:10.1016/j.ijgo.2009.07.019 · 1.54 Impact Factor
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    • "Cervical cancer is the second commonest cancer among women in Malaysia. In many developed countries where the screening programmes are effective, reductions in cancer incidence have been seen (Mahlck et al., 1994; Fouquet and Gage, 1996; Riza et al., 2000; Schenck and von Karsa, 2000; Moore and Tajima, 2004) while in Asia the incidence remains high, probably because of ineffective screening (Moore and Tajima, 2004; Patro and Nongkynrih, 2007). It is the most frequent cancer among women in India, Indonesia and Thailand and the second most frequent in Malaysia, the Philippines and Viet Nam. "
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    ABSTRACT: We studied women with cervical cancer to determine whether they had had a Pap smear within the 3 years preceding cancer development and their understanding of screening for this cancer. The study had 2 parts; Pathology Data and Survey Data. For pathology data, all cases of cervical cancer diagnosed in 2000-2006 were retrieved from eight hospitals and Pap smear history was obtained from clinical records. For the Survey data; patients who were still undergoing treatment in some of these hospitals and three others were administered structured questionnaires to determine their awareness about screening. The results showed 1431 cases of cervical cancer in women aged 25-85 were diagnosed in these hospitals. Most had not had a Pap smear within 3 years before cancer development. The percentages of patients who had had Pap smear ranged from 0-12%. Questionnaires were returned by 221 patients; 56.3% had none or only primary education and 61.1% had a household income of RM 1,000 or less. Level of education and the household income were strongly associated (p<0.05) with knowledge and having had a Pap test. The main reasons cited for not having had a Pap smear were "Never heard about it" (36.2%), "Shy" (10.4%), "Afraid to do it" (13.1%), "Think the test is not important" (8.1%) and "No encouragement from family" (4.5%). A large majority (95.9%) of the patients did not know the optimal interval. In conclusion, a large number of cervical cancer patients had not had a Pap smear within 3 years preceding cancer development and most had inadequate knowledge about this screening test.
    Asian Pacific journal of cancer prevention: APJCP 01/2009; 10(4):569-74. · 2.51 Impact Factor
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