The effect of mass screening on incidence and mortality of squamous and adenocarcinoma of cervix uteri

Nieminen, Pekka; Kallio, Mervi; Hakama, Matti

doi:10.1016/0029-7844(95)00063-w

Cited by 169 publications

(113 citation statements)

References 12 publications

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“…4,18 This was true also in our material: only one interval cancer of squamous type (sensitivity 98%) was diagnosed in the HPV arm. The type specific results do not change our conclusion but rather make it more credible: the sensitivity was high in both arms.…”

Section: Discussionsupporting

confidence: 80%

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The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland

Malila

Leinonen

Kotaniemi-Talonen

et al. 2012

Intl Journal of Cancer

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We compared test sensitivity (in terms of prevented cancers) and overdiagnosis (in terms of non-progressive pre-invasive lesions) between the human papillomavirus test (HPV test, Hybrid Capture 2) and the traditional Pap test in routine screening for cervical cancer. The design was a randomised (1:1) health services study in Finland with intake between 2003 and 2007. We estimated sensitivity by the incidence method within one screening round. Overdiagnosis was based on the rate of cervical intraepithelial Grade 3 (CIN3) lesions diagnosed at screen and during the following interval. Out of 203,788 randomised women 132,298 attended (65% in both study arms) and 600,753 person-years accumulated among attenders up to the end of 2010. In all attenders, 34 invasive cervical cancers and 288 CIN3 lesions were diagnosed at screen or during the following interval. The interval cancer incidence was 2.5/10 5 person-years (sensitivity 0.87) and 1.4 (sensitivity 0.93) in the HPV arm and Pap test arm, respectively. The rate of CIN3 lesions was 57.1 and 38.8, respectively. In conclusion, sensitivity of HPV testing was similar to that of Pap testing but caused more overdiagnosis. Therefore, implementation of HPV testing needs to be reconsidered especially in countries with well organised programmes.Recommendations concerning new screening tests for cervical cancer are mostly based on cross-sectional studies and on detection rates of pre-invasive lesions. 1-5 The few follow-up studies have focused on pre-invasive lesions and on the length of reassurance that a negative test provides. 6-10 Only few studies have had emphasis on public health aspects. 11,12 The purpose of screening is to prevent invasive cervical cancer and the demonstration of this effect requires follow-up for incident invasive cancers after the screen. In fact, detection (at screen) of pre-invasive lesions results in both benefit and harm; benefit through preventing some of the lesions from progressing to invasive cancer, and harm by detecting also such pre-invasive lesions that would never have progressed to invasive cancers. These two types of pre-invasive lesions cannot be separated and thus, both types have to be treated if diagnosed.Sensitivity measures a screening test's ability to correctly identify unrecognised disease. It can be estimated in several ways. The most common way is called the detection method 4 which is based on screen detected lesions, both pre-invasive and invasive ones. However, the sensitivity estimate is usually biased and too big (closer to one) due to overdiagnosis of the detection of pre-invasive lesions. Sensitivity can also be estimated by the incidence method 13 that is based on failures of screening.The purpose of the present study was to compare the human papillomavirus (HPV) test to the traditional Pap test in cervical cancer screening in terms of sensitivity (detection of progressive lesions) and overdiagnosis (detection of nonprogressive lesions). Material and methodsIn Finland, women between 30 and 60 years of age (sometimes ...

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Section: Discussionsupporting

confidence: 80%

“…4,15,16 The risk of cervical adenocarcinoma was less than 3 per 100,000 person-years in the 1960s, and it has stayed quite stable over time. 17,18 Therefore, the expected incidence without screening (P 0 ) for squamous cell carcinoma was estimated at 17/10 5 person years.…”

Section: Methodsmentioning

confidence: 99%

The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland

Malila

Leinonen

Kotaniemi-Talonen

et al. 2012

Intl Journal of Cancer

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“…Others report that AC incidence might not be influenced by screening (Nieminen et al, 1995;Bergstrom et al, 1999). The decrease of ACIS in the age group 45 -59 and of AC over age 60 years in this study may reflect detection of ACIS lesions in the screened population, but further studies will be required over long time periods.…”

Section: Discussionmentioning

confidence: 59%

“…Studies have shown that Pap smears are less sensitive in detecting precursor lesions of AC than those of SCC (Etherington and Luesley, 2001;Schoolland et al, 2002;Kalir et al, 2005). This makes the incidence of AC less likely to be influenced by screening (Nieminen et al, 1995;Bergstrom et al, 1999).…”

mentioning

confidence: 99%

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

et al. 2008

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“…Previous studies have reported that cervical adenocarcinoma and its preinvasive stages are diagnosed less efficiently by Pap smear screening than squamous cell lesions (Mitchell et al, 1995;Stockton et al, 1997). In some countries, not only the absence of a decrease in incidence (Sigurdsson, 1993;Nieminen et al, 1995), but also increases in the incidence of cervical adenocarcinoma have been described in the presence of a screening programme (Bergstrom et al, 1999;Hemminki et al, 2001;Liu et al, 2001). One study even suggested an increase in incidence especially in younger women (Anttila et al, 1999), whereas older women were not affected by increases in the incidence rate of cervical cancer.…”

Section: Incidence and Survival Of Cervical Cancer S Bulk Et Almentioning

confidence: 99%

Incidence and survival rate of women with cervical cancer in the Greater Amsterdam area

et al. 2003

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To evaluate the effect of population-based cervical cancer screening on the occurrence of cervical cancer in The Netherlands, we investigated the incidence and survival of cervical cancer registered by a cancer registry in the Greater Amsterdam area. The incidence rate of squamous cell carcinoma decreased significantly from 9.2/100 000 women in 1988 to 5.9/100 000 in 2000 (Po0.001). The incidence rate of adenocarcinomas remained stable. After adjustment for age, stage and lymph node involvement, the relative risk of death was 1.6 times higher for patients with adenocarcinomas than for patients with squamous cell carcinoma (95% CI 1.2 -2.1). The decreased survival was related to histological type, as the effect remained significant after correction for confounding factors. Over time, the prognosis of women with squamous cell carcinoma improved significantly. No significant change was observed for women diagnosed with adenocarcinoma. These results suggest that the screening programme in The Netherlands as executed in the Greater Amsterdam area is associated with a decreased incidence and increased survival of patients with squamous cell carcinoma, but fails to detect (pre)malignant lesions of adenocarcinoma. Since more than 92% of adenocarcinomas and its precursors contain high-risk HPV, adding HPV testing to cytologic screening might improve the present screening programme in detecting adenocarcinoma and its precursor lesions.

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The effect of mass screening on incidence and mortality of squamous and adenocarcinoma of cervix uteri

Abstract: The Finnish mass screening program has been effective and its continuation is of utmost importance. In the future more attention should be given to glandular cell atypias in cervical smears. Thus, it might be possible to decrease the incidence of cervical adenocarcinoma.

Cited by 169 publications

References 12 publications

The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland

The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland

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

Incidence and survival rate of women with cervical cancer in the Greater Amsterdam area

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