Increase in cervical cancer mortality in Spain, 1951-1991

Abstract

Background-The trend in cervical cancer mortality in Spain from 1951 to 1991 is examined. Methods-Analysis of national mortality statistics calculating age standardised mortality rates and an age-period cohort analysis. A fit to the Gompertz function was made to estimate the influence of the environmental factors on the mortality rates evolution. Main results-The age standardised mortality rate in Spain is lower than in other developed countries (USA or Estonia) and equal to Norwegian and Finland rates; but whereas in these countries the trend is to decrease, the Spanish rate has increased during this period, because of a cohort eVect. A misclassification bias could be responsible for the trend in women aged 40 and older but the increasing trend in younger women could not be interpreted as espurious. The Gompertzian analysis suggests an increase in environmental factors causing cervical cancer. Conclusions-Cervical cancer mortality rates are increasing in Spain because of environmental factors. (J Epidemiol Community Health 1999;53:408-411) Cervical cancer mortality has been decreasing in developed countries for several decades.

Trends in cervical cancer mortality

“…The latter has proved to be eVective in reducing incidence and mortality of cervical cancer and in addition provides information on the coverage (percentage of women in the age groups complying with the proposed screening scheme) oVered by the preventive action. In the absence of epidemiologically sound screening programmes, interpretation of time trends is diYcult, particularly if an increase in mortality is claimed to exist as indicated by Llorca et al 1 Cervical cancer mortality data from regions in Spain have been analysed before. Sanchez Garrido et al 2 published in 1996 a study in which death certificates including three rubrics (cervix (ICD-O 180), uterus (ICD-O 182), and uterus not otherwise specified -NOS-ICD-O 179)) were jointly analysed for the interval between 1975 and 1992.…”

Trends in Cervical Squamous Cell Carcinoma Incidence in 13 European Countries: Changing Risk and the Effects of Screening

“…A recent evaluation by IARC concluded that there is sufficient evidence that screening women ages 35 to 64 for cervical cancer precursors by conventional cytology every 3 to 5 years within high-quality programs reduces incidence of invasive cervical cancer by at least 80% among those screened (3). There are however large variations in current screening policies in Europe and in organizational aspects of established programs (4, 5); whereas cervical cancer incidence and mortality has been declining in many European populations in the last few decades (6, 7), upward trends have been reported in younger women in several countries (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Time trend studies at the population level are therefore a critical element in evaluating the effectiveness of cervical screening against a backdrop of changes in risk.…”

Buren of Hospital Admissions for Cervical Cancer in Spain During 1999-2002

“…Moreover, published data show that the mortality for cervical cancer in Spain increased from 0.32 in 1951 to 1.69 deaths per 100,000 women in 1991. 7 As in other industrialized countries, cervical cancer represents more than 3% of all cancers among Spanish women and it is the seventh most frequent cancer, in terms of incidence, after breast, colon and rectum, corpus uteri, ovary etc, stomach and non-Hodgkin lymphoma. 6 Cervical cancer screening programs were established in Spain in the 1980's.…”