Time trends in cervical cancer epidemiology in the Slovak Republic: reflection on the non-implementation of screening with international comparisons

Abstract

Cervical cancer is a serious public health problem with high geographical variations in incidence, mainly due to historical patterns of risk factors and the influence of screening activities. To reduce both cervical cancer incidence and mortality is the primary objective of organized screening and annual reports of high quality utilising accepted interventional measures. Currently, the time-trends in overall incidence and mortality from cervical cancer in the Slovak Republic are implacable. The high incidence values of this condition that have stabilized long term without any signs of a significant decrease rank us among the "developing countries" in Europe. Moreover, the continuing low accessibility of vaccinations for the population lowers the potential effect of an improvement in the incidence of pre-malignant lesions of cervical cancer. Without a basic analysis of the cervical cancer epidemiological data it is not possible to discover the causes of this unfavorable situation and thus condition changes at the level of screening and early diagnostics.Following this, we aimed to analyse the incidence and mortality of cervical cancer over the period and to point out the necessity for the early introduction of interventional measures in accordance with organized screening in the Slovak Republic. There was recorded a stabilized trend in incidence with an estimated average annual change -0.008/100.000 (95% CI = -0.048 to 0,032, p =0.689) and a moderately increasing trend in mortality with average annual increase 0.049/100,000 (95% CI = 0.033 to 0.065, p < 0.0001). In 2003-2006, the cumulative risk of disease (0-74 years) averaged 1.5 %, the cumulative risk of death reached 0.5%. The analyses of clinical stages during the period showed that the number of cases in clinical stage I increased, the stage II rate declined, and the numbers of cases in stages III and IV were still high with, moreover, a rising tendency. In comparison with other European countries these trends are unfavorable and our results have confirmed the necessity of an immediate introduction of organized screening in the SR.

Current possibilities of cervical precancerous lesions screening in Slovakia: prevalence of high risk human papillomavirus in patients with cytological diagnoses of atypical squamous cells of unknown significance

“…Long-time incidence and mortality trends in Slovakia are similar to developing countries (1). Although Slovakia is ranked among the economically more advanced countries, up to now it has not succeeded in reducing mortality of cervical cancer due to the lack of interest of women in screening for the disease and the opportunistic character of its organisation.…”

“…Based on the results it can be assumed, that HPV infection in women of around 40 years of age is more likely to persist and precancerous lesion occurs. The hypothesis was indirectly confi rmed also by the fact, that development of cervical cancer lasts approximately 10 -12 years and the highest age specifi c incidence of cervical cancer in Slovakia is in 45 -50 years of age (1).…”

“…[2003][2004][2005][2006] show, that cervical cancer did not occur before the age of 20. It started to increase after the age 25 with the highest incidence in the age group of 45-49 years (1). Persistent infection with HR-HPV is a necessary step in the development of cervical cancer and other anogenital carcinomas (3,4).…”

Knowledge, attitudes and practices of cervical cancer prevention

“…According to Rob [7], the vaccination against HPV infection in women has the highest effect before the beginning of sexual life when it is proved to have 100% protection against types 16 and 18. In some countries with long-standing organized screening a decline of disease by 80% was observed if the population of immunization against HPV infection, increased up to 94% [8,9]. We assume that the low rating of HPV vaccination is associated with the beginnings of HPV vaccination since 2007 in Slovakia and no experience with the vaccine as it is more suitable for young virginal girls and also because of the high price of the vaccines.…”

Cervical Carcinoma in the European Union

“…Mortality is 4.8 per 100,000 women, and the incidence is rising among young women. 34 The HPV test was introduced as triage in 2009. 18 Slovenia has a modern health care system that is comparable to those of the richer nations and offers a remarkable example of the effects of a wellorganized and well-run program.…”