Time Trends Analysis of Cervical Cancer Incidence in Cluj County, Romania, Using Data from a Population-Based Cancer Registry.

Radu-Mihai Ignat,Ofelia Șuteu,Patricia Ignat,Radu-Ion Badea,Daniela Coza

doi:10.3390/curroncol28030159

Abstract

(1) Background: Romania has one of the highest cervical cancer incidence rates in Europe. In Cluj County, the first screening program was initiated in 1998. We aimed to investigate the time trends of cervical cancer incidence in women from Cluj County and to evaluate the data quality at the Cancer Registry. (2) Methods: We calculated time trends of standardized incidence rates in the period 1998–2014 and the Annual Percent Change (APC%). To assess data quality, we used the indicators: mortality/incidence ratio (M/I), percentage of cases declared only at death (DOD%), and percentage of cases with pathological confirmation (PC%). (3) Results: The standardized incidence rate increased steadily, from 23.74 cases/100,000 in 1998, to 32/100,000 in 2014, with an APC% of 2.49% (p < 0.05). The rise in incidence affected both squamous cell carcinoma (APC% 2.49%) (p < 0.05) and cervical adenocarcinoma (APC% 10.54%) (p < 0.05). The M/I ratio was 0.29, DOD% 2.66%, and MC% 94.8%. The last two parameters are within the silver standard concerning data quality. (4) Conclusions. Our study revealed an ascending trend of cervical cancer incidence, more consistent for adenocarcinoma, in the context of a newly introduced screening program and partially due to the improvement of the quality of case reporting at the Cancer Registry from Cluj.

Highlights

In the last two decades, Romania constantly recorded the highest incidence and mortality rates of cervical cancer in Europe [1,2,3], ranking 5th in Europe in 2018, according to estimates in the GLOBOCAN Project in the context of a marked downward trend in cervical cancer incidence and mortality worldwide, in countries that have adopted national screening programs [4,5].The unfavorable situation in our country regarding the incidence and mortality of this highly preventable cancer reflects the inefficiency of previous actions and measures of secondary cancer prevention
We aimed to investigate the trends of cervical cancer incidence in Cluj County, in the period 1998–2014 and to evaluate the data quality at the cancer registry, for an objective assessment of cervical cancer incidence trends
We identified time change points, and we estimated the Annual Percent Change (APC%), assuming that the rates change with a constant percentage on a logarithmic scale for each time segment [19]

Summary

Introduction

The unfavorable situation in our country regarding the incidence and mortality of this highly preventable cancer reflects the inefficiency of previous actions and measures of secondary cancer prevention. These consisted exclusively of opportunistic screening, performed in recent decades, with insufficient coverage of the target female population according to unanimously accepted international standards [1,6,7]. In the decades, screening combined with vaccination are expected to eliminate cervical cancer in low- and middle-income countries, which hold the greatest burden of this cancer [9,10,11,12]

Objectives

Findings

Discussion

Conclusion