Abstract
BackgroundIn Spain, cervical cancer prevention is based on opportunistic screening, due to the disease’s traditionally low incidence and mortality rates. Changes in sexual behaviour, tourism and migration have, however, modified the probability of exposure to human papilloma virus among Spaniards. This study thus sought to evaluate recent cervical cancer mortality trends in Spain.MethodsWe used annual female population figures and individual records of deaths certified as cancer of cervix, reclassifying deaths recorded as unspecified uterine cancer to correct coding quality problems. Joinpoint models were fitted to estimate change points in trends, as well as the annual (APC) and average annual percentage change. Log-linear Poisson models were also used to study age-period-cohort effects on mortality trends and their change points.Results1981 marked the beginning of a decline in cervical cancer mortality (APC1981–2003: −3.2; 95% CI:-3.4;-3.0) that ended in 2003, with rates reaching a plateau in the last decade (APC2003–2012: 0.1; 95% CI:-0.9; 1.2). This trend, which was observable among women aged 45–46 years (APC2003–2012: 1.4; 95% CI:-0.1;2.9) and over 65 years (APC2003–2012: −0.1; 95% CI:-1.9;1.7), was clearest in Spain’s Mediterranean and Southern regions.ConclusionsThe positive influence of opportunistic screening is not strong enough to further reduce cervical cancer mortality rates in the country. Our results suggest that the Spanish Health Authorities should reform current prevention programmes and surveillance strategies in order to confront the challenges posed by cervical cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1306-x) contains supplementary material, which is available to authorized users.
Highlights
In Spain, cervical cancer prevention is based on opportunistic screening, due to the disease’s traditionally low incidence and mortality rates
To avoid the bias flowing from these changes, we reclassified Not otherwise specified sites of the uterus (U-NOS) in accordance with IARC strategy [10], to analyse trends in cervical cancer mortality in Spain across the period 1981–2012, both overall and by age group and region, and fitted age-period-cohort models by incorporating a novel approach that enables possible change-points in cohort or period effects to be estimated
They defined 5 age groups (0–39, 40–49, 50–59, 60–69 and ≥70 years), and quantified the annual age-specific proportion of cases registered as cervical cancer among all uterine cancer deaths, excluding U-NOS; these proportions were applied to U-NOS to estimate cervical cancer deaths
Summary
In Spain, cervical cancer prevention is based on opportunistic screening, due to the disease’s traditionally low incidence and mortality rates. The Spanish National Health Service’s fast pace of growth and decentralisation has modified both the coverage and quality of opportunistic cervical cancer screening. These factors, which may well have affected the epidemiology of cervical cancer, taken together with the recent incorporation of HPV vaccination strategies render it necessary for the pertinent. In Spain, deaths coded as not otherwise specified sites of the uterus (U-NOS) represented almost 70% of all uterine cancer deaths in the early 1980s, and less than 25% since 2000 This gradual improvement in data quality, which has not been taken into account in the most recent study on cervical cancer mortality in Spain [9], directly affects and distorts time trends. To avoid the bias flowing from these changes, we reclassified U-NOS in accordance with IARC strategy [10], to analyse trends in cervical cancer mortality in Spain across the period 1981–2012, both overall and by age group and region, and fitted age-period-cohort models by incorporating a novel approach that enables possible change-points in cohort or period effects to be estimated
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