Pap smear screening and changes in cervical cancer mortality in Sweden

ArticleinInternational Journal of Gynecology & Obstetrics 44(3):267-72 · April 1994with24 Reads
DOI: 10.1016/0020-7292(94)90177-5 · Source: PubMed
Abstract
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.
    • "This is mainly due to a lack of screening programmes [3], which have proven successful in the prevention of cervical cancer. The purpose of cervical screening is to detect and treat asymptomatic pre-invasive lesions at an early stage, and its introduction has led to a decline in cervical cancer inci- dence4567 and mortality [7, 8] both in Sweden and in the rest of Europe. According to the national cancer strategy in Sweden, the recommended overall coverage of cervical screening is 85% [9]. "
    [Show abstract] [Hide abstract] ABSTRACT: Danish and Norwegian immigrant women in Sweden have an increased risk of cervical cancer compared to Swedish-born women. In addition, Danish and Norwegian immigrant women follow the national recommendations for attendance at cervical screening to much lesser extent than Swedish-born women. The aim of this study was to explore how Danish and Norwegian immigrant women in Sweden reason about attending cervical screening, focusing on women's perceptions as to why they and their compatriots do not attend. Eight focus group discussions (FGDs) were conducted with Danish and Norwegian immigrant women living in Stockholm. The women were between 26 and 66 years of age at the time of the FGDs, and were aged between <1 and 48 years old when they immigrated to Sweden. A FGD guide was used, which included questions related to cervical screening, and obstacles and motivators to attend cervical screening. The FGDs were tape recorded and transcribed, and the results analysed according to the principles of qualitative content analysis. The main theme was "Women have a comprehensive rationale for postponing cervical screening, yet do not view themselves as non-attenders". Investigation of women's rationale for non-attendance after being invited to cervical screening revealed some complex reasons related to immigration itself, including competing needs, organisational and structural factors and differences in mentality, but also reasons stemming from other factors. Postponing attendance at cervical screening was the category that linked all these factors as the reasons to why women did not attend to cervical screening according to the recommendations of the authorities. The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend.
    Full-text · Article · Jul 2015
    • "In Stockholm County (the location of the present study), smears are free of charge. Cervical cancer incidence in Sweden has fallen by 67% since the initiation of the organized screening program, although the rate of decline has stagnated somewhat in recent years [4]. Registry-based reports indicate that screening coverage in Sweden in 2012 was 78% for women aged 23–50 years for a 3.5-year time interval and 84% for women aged 51–60 for a 5.5-year time interval. "
    [Show abstract] [Hide abstract] ABSTRACT: This study aims to identify possible barriers to and facilitators of cervical cancer screening by (a) estimating time and travel costs and other direct non-medical costs incurred in attending clinic-based cervical cancer screening, (b) investigating screening compliance and reasons for noncompliance, (c) determining women’s knowledge of human papillomavirus (HPV), its relationship to cervical cancer, and HPV and cervical cancer prevention, and (d) investigating correlates of HPV knowledge and screening compliance.
    Full-text · Article · May 2015
    • "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). "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Dec 2014
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