Trends in cervical cancer and its precursor forms to evaluate screening policies in a mid-sized Northeastern Brazilian city.

Érika De Abreu Costa Brito,Hianga Fayssa Fernandes Siqueira,Marceli De Oliveira Santos,Angela Maria Da Silva,Marcela Sampaio Lima,Marcia Maria Macedo Lima,Carlos Anselmo Lima,Rosana Cipolotti,Gabriel A Picone,Hugo Leite De Farias Brito,Marco Antonio Prado Nunes

doi:10.1371/journal.pone.0233354

Abstract

Cervical cancer is a health issue that disproportionately affects developing countries, where the Papanicolaou test (Pap smear) remains an important screening tool. Brazilian government recommendations have focused screening on the female population aged from 25 to 64 years old. In this study, we examined the incidence and mortality rates of invasive cervical cancer lesions and the incidence rates of in situ precancerous cervical lesions, aiming to calculate their respective statistics over time in a mid-sized Brazilian city, Aracaju. The 1996-2015 database from the Aracaju Cancer Registry and Mortality Information System was used to calculate age standardized rates for all invasive cervical tumors (International code of diseases, ICD-10: C53) and preinvasive cervical lesions (ICD-10: D06) in the following patient age ranges; ≤ 24, 25-34, 35-44, 45-54, 55-64 and ≥ 65 years old. We identified 1,030 cancer cases, 1,871 in situ lesions and 334 deaths. Using the Joinpoint Regression Program, we calculated the annual percentage incidence changes and our analyses show that cervical cancer incidence decreased up to 2008, increased up to 2012 and decreased again thereafter, a significant trend in all age groups from 25 years. The incidence of precursor lesions increased from 1996 to 2005 and has since decreased, a result significant in all age groups until 64 years. Cervical cancer mortality has decreased by 3.8% annually and trend analysis indicates that Pap smears have been effective in decreasing cancer incidence and mortality. However, recent trends shown here show a decreasing incidence of in situ lesions and may indicate either a real decrease or incomplete catchment. Thus, we suggest health policies should be re-considered and include sufficient screening and HPV vaccination strategies to avoid cervical cancer resurgence in the population.

Highlights

Cervical cancer still has high rates of incidence and mortality, despite the epidemiological transition having occurred in many countries
The annual percentage change (AAPC) for incidence of invasive neoplasms over the whole period was −6.2
Our analyses did not fit any joinpoints in the model and the annual percentage change (APC) was determined as −7.1

Summary

Introduction

Cervical cancer still has high rates of incidence and mortality, despite the epidemiological transition having occurred in many countries. Statistics show regional variation and are dependent on the human development index of the area[1]. The main causative agent of cervical cancer is Human Papilloma Virus (HPV) types 16 and 18. It has been inferred that HPV vaccination, together with screening using the Papanicolaou test (Pap smear) and HPV DNA identification[2][3][4], is important to reduce incidence and mortality rates. The two major histological subtypes of cervical cancer, squamous cell carcinoma and adenocarcinoma, are dependent on HPV infection and the diagnosis and treatment of their preinvasive forms is crucial to blocking transformation into invasive carcinoma[5]

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