Cervical cancer incidence in Denmark: Disentangling determinants of time trend

Research output: Contribution to journalJournal articleResearchpeer-review

  • Elsebeth Lynge
  • Jeppe Bennekou Schroll
  • Berit Andersen
  • Kirubakaran Balasubramaniam
  • Anna Poulsgaard Frandsen
  • Else Helene Ibfelt
  • Kirsten Marie Jochumsen
  • Maja Ulrikka Bruun Laustsen
  • Susanne Nielsen
  • Rouzbeh Salmani
  • Doris Schledermann
  • Petra Birgitta Hall Viborg
  • Marianne Waldstrøm
  • Napolitano, George
  • Reza Serizawa

Cervical cancer is a preventable disease. Nevertheless, stagnation has been seen in incidence rates also in countries with well-functioning healthcare. On this basis, we investigated associations between control interventions and changes in cervical cancer incidence in Denmark from 2009 to 2022. Data on human papillomavirus (HPV)-vaccination were retrieved from Staten's Serum Institute; on screening recommendations from Danish Health Authority, on screening performance from Danish Quality Database for Cervical Screening; and on cervical cancer incidence from Nordcan and Danish Cancer Register. We reported coverage with HPV vaccination (1+ dose); coverage with cervical cell samples; number of women with primary HPV tests; proportion of non-normal cell samples without timely follow-up; number of conizations; and cervical cancer incidence rates. In 2022, all women aged ≤29 had been offered childhood HPV vaccination with coverage of 80%-90%. By 2020-2022, the cervical cancer incidence rate in women aged 20-29 was 3 per 100,000; at level of disease elimination. In 2017, women aged 70+ were offered a one-time HPV screening, and by 2020-2022, the old-age peak in cervical cancer incidence had largely disappeared. From 2009 to 2022, proportion of non-normal cell samples without timely follow-up decreased from 20% to 10%, and conventional cytology was largely replaced by SurePath liquid-based cytology; these factors could explain the steady decrease in cervical cancer incidence rate. Implementation of primary HPV screening in women aged 30-59 in 2021 was reflected in a, probably temporary, increase in the 2022 cervical cancer incidence rate. In conclusion, combined interventions with childhood HPV vaccination; one-time HPV screening of elderly women; and better management of screening broke previous stagnation in cervical cancer incidence rate.

Original languageEnglish
JournalInternational Journal of Cancer
ISSN0020-7136
DOIs
Publication statusE-pub ahead of print - 2024

Bibliographical note

© 2024 The Author(s). International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

ID: 398353355