Estimation of the Duration of the Preclinical Phase of Cervical Adenocarcinoma Suggests That There Is Ample Opportunity for Screening

Significant decrease of adenocarcinoma in situ not reflected in cervical adenocarcinoma incidence in the Netherlands 1989–2003

“…Moreover, the decrease in the incidence of ACIS is mainly caused by ACIS lesions with a concurrent squamous dysplasia. The only two previous studies of AC and ACIS trends, both in the United States, found an increase in the incidence of ACIS without a significant change in AC incidence over a 20-year period (Plaxe and Saltzstein, 1999;Wang et al, 2004). This stable pattern in AC incidence accords with an earlier report from the Netherlands (Bulk et al, 2005).…”

“…We used the same database but extended the analysis to an additional 5 years, making short-term fluctuations in AC incidence less important. This unchanged AC incidence contrasts with the incidence rates reported from other countries where it is rising (Zheng et al, 1996;Vizcaino et al, 1998;Bergstrom et al, 1999;Plaxe and Saltzstein, 1999;Smith et al, 2000;Liu et al, 2001;Sasieni and Adams, 2001;Visioli et al, 2004;Wang et al, 2004;Bray et al, 2005). However, a stable pattern has been reported more often (Vizcaino et al, 1998;Chan et al, 2003;Bulk et al, 2005), although a decreasing incidence has also been recorded (Vizcaino et al, 1998;Bray et al, 2005;Howlett et al, 2007).…”

“…Our study included data from 1989 to 2003, the second study to incorporate years after 2000 (Howlett et al, 2007). The significant decrease of ACIS incidence in this study contrasts with two other studies describing an increase, mainly in patients under age 40 years (Plaxe and Saltzstein, 1999;Wang et al, 2004). In the light of the increasing prevalence of HPV and sexually transmitted infections in young women due to younger ages of first intercourse (http://www.rivm.nl), the decrease in ACIS incidence is rather surprising and contrasts with the increasing incidence of other HPV-related lesions like vulvar intraepithelial neoplasia (Jones et al, 1997;Iversen and Tretli, 1998;Joura et al, 2000).…”

“…The incidences of both have increased during the last three decades, especially in women under the age of 40 years (Zheng et al, 1996;Vizcaino et al, 1998;Bergstrom et al, 1999;Plaxe and Saltzstein, 1999;Smith et al, 2000;Liu et al, 2001;Sasieni and Adams, 2001;Visioli et al, 2004;Wang et al, 2004;Bray et al, 2005). This contrasts with the decrease in squamous cell carcinoma (SCC) since the introduction of screening programmes (Bergstrom et al, 1999;Ronco et al, 2005;Kyndi et al, 2006).…”

Cervical Cancer Screening, Screening Errors and Reporting

“…Particularly advantageous has been the long latency period of the preinvasive stage of cervical carcinoma, close to 18 years for the squamous and 13 for the glandular variety. 23 Cervical cancer screening programs are either organized or opportunistic.…”