Abstract
BackgroundWe compared women with incident cervical cancer under the age of 30 with older women with regard to stage, morphology, screening history and cervical cancer mortality in a population-based cohort study.MethodsWe included data from the Cancer Registry of Norway. Incidence rates (per 100,000 women-years) were calculated and joinpoint regression was used to analyse trends. The Nelson-Aalen cumulative hazard function for risk of cervical cancer death during a 15-year follow-up was displayed. The hazard ratios (HRs) of cervical cancer mortality with 95% confidence intervals (CIs) were derived from Cox regression models.ResultsThe incidence of cervical cancer in women under the age of 30 has almost tripled since the 1950s, with the steepest increase during 1955–80 (with an annual percentage change (APC) of 7.1% (95%CI 4.4–9.8)) and also an increase after 2004 (3.8% (95%CI -1.3–9.2)). Out of 21,160 women with cervical cancer (1953–2013), 5.3% were younger than 30 years. A lower proportion of younger women were diagnosed at more advanced stages and a slightly higher proportion were diagnosed with adenocarcinoma and adenosquamous carcinoma comparing women above 30 years. The cumulative risk of cervical cancer death was lower for patients under the age of 30. However, the difference between the age groups decreased over time. The overall adjusted HR of cervical cancer mortality was 0.69 (95% CI 0.58–0.82) in women diagnosed under the age of 30 compared to older women.ConclusionThere has been an increase in cervical cancer incidence in women under the age of 30. Cervical cancer in younger women was not more advanced at diagnosis compared to older women, and the cervical cancer mortality was lower.
Highlights
We compared women with incident cervical cancer under the age of 30 with older women with regard to stage, morphology, screening history and cervical cancer mortality in a population-based cohort study
After a peak in the 1970s (APC in incidence was 7.1% during 1955–80), the incidence slightly decreased in 1980–2005 (APC in incidence was -2% (95%Confidence interval (CI) -3.5–0.0)) and increased slightly again after 2004 (APC in incidence was 3.8% during 2005–14)
Cancers in younger women were of earlier stage, and only a slightly higher proportion of women had adenocarcinoma and adenosquamous carcinoma compared to women above 30 years of age
Summary
We compared women with incident cervical cancer under the age of 30 with older women with regard to stage, morphology, screening history and cervical cancer mortality in a population-based cohort study. Cervical cancer is the fourth most common cancer in women globally and affects women of all ages [1]. A nationwide cervical cancer screening programme was introduced in Norway in 1995 [3]. Gravdal et al BMC Women’s Health (2021) 21:110 implementation of HPV primary screening in women aged 34–69 commenced in four counties in Norway, replacing cytology [8]. Since 2019, HPV primary screening is gradually being introduced in the remaining Norwegian counties. In Norway, a reduction of 68% in total cervical cancer incidence due to screening has been estimated [9]. There has been an increase in cervical cancer incidence in women under 30 years over the past 20–25 years in Norway and other European countries, such as the UK [7, 10]. The reasons for the increase are unclear but may include changes in sexual behavior and the burden of associated sexually transmitted infections, including HPV [10, 11]
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