Key message:

There has been an increase in the incidence of cervical cancer in women aged under 35 since the late 1990’s. Over this time there has also been a steady fall in the coverage of screening in women of this age group; however in the last two years coverage has increased. It is important that this trend continues, so that the number of women who develop cervical cancer may be reduced.

Cervical Cancer Incidence and Screening Coverage

Background

All women in England aged 25 to 64 are regularly invited every three to five years to be screened. This screening aims to detect and treat any abnormalities and pre-invasive disease which may otherwise lead to the development of cervical cancer. This briefing provides national population-based incidence trends in all women and in five-year age groups based on data collected by cancer registries, alongside trends in national screening coverage.

Incidence of Cervical Cancer

Over the last 20 years the incidence of cervical cancer in England has almost halved. In 1988, the year the screening programme was introduced, there were 4,132 women diagnosed with cervical cancer, representing an age-standardised incidence rate (ASIR) of 16.2 per 100,000 female population. This compares to 2,369 women diagnosed in 2008, ASIR of 8.3 per 100,000 (see table).

Trend in cervical cancer incidence over the last 20 years in all women, England. (Source: UK Cancer Information Service).
Year Total cases Age-standardised incidence rate per 100,000 females Confidence interval (95%)
1988 4,132 16.2 15.7 - 16.7
1993 3,141 11.7 11.3 - 12.2
1998 2,620 9.3 9.0 - 9.7
2003 2,386 8.3 8.0 - 8.7
2008 2,369 8.3 8.0 - 8.7

Over the last 10 years there has been a 77% increase in the incidence rate for women age 25-29, with 281 cases in 2008 (see figure). For women aged 30-34 the rate increased by 29%, with 309 cases in 2008. In women aged 20-24 the incidence rate has remained fairly stable, with 39 cases in 2008.

Coverage of Cervical Screening

Coverage of screening has shown a downward trend in younger women since the mid 1990’s (see figure). By 2008, the coverage rate for women aged 25-29 had fallen from a level of 67% in 1995 to 59%. This compares with a rate of 69% in women aged 25-49 years (those called for screening every 3-3.5 years) and 80% in women aged 50-64 years (those called for screening every 5 years), in 2008.

In 2009 a sharp increase in screening coverage of around 3% occurred in women under the age of 35. In 2010 coverage increased in this age group again by around 1.5%. These increases are thought to be a reaction to the high profile death from cervical cancer of the celebrity Jade Goody at the age of 27. It remains to be seen whether this level of coverage will be sustained in women of this age group.

In July 2009, Sasieni et al published a paper in the British Medical Journal (BMJ) that showed that while screening older women leads to a substantial reduction in cervical cancer, screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer at ages 25-29.

Recent trend in cervical cancer incidence ages 20-34 (1995-2008) and coverage of screening ages 25-34 years (1995-2010*), in England

Cervical Cancer Incidence and Screening Coverage

Source: UK Cancer Information Service and The Health and Social Care Information Centre. *Data are as at 31st March (except 2006 - 10th August)

Technical Details

Cervical Screening Coverage

Coverage is defined as the percentage of women in a population eligible for screening at a given point in time, who were screened within a specified period. Women ineligible for screening, and thus not included in the numerator or denominator of the coverage calculation, are those whose recall has been ceased for clinical reasons (most commonly due to hysterectomy).

Further Information

The incidence data in the briefing is based on the ‘National Profile of Cervical Cancer Report: incidence, mortality and survival’. The coverage data is found in the annual reports and statistics from the Cervical Screening Programme and can be downloaded from the NHS Information Centre website.

References

Sasieni P, Castanon A and Cuzick J (2009) Effectiveness of cervical cancer screening with age: population based case-control study of prospectively recorded data. BMJ, 339:b2968

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The National Cancer Intelligence Network (NCIN) is a UK-wide partnership operated by Public Health England. The NCIN coordinates and develops analysis and intelligence to drive improvements in prevention, standards of cancer care and clinical outcomes for cancer patients.