Decline in cervical cancer incidence and mortality in New South Wales in relation to control activities (Australia).
BACKGROUND
To examine time trends in cervical cancer incidence and mortality in NSW women aged yen20 years in relation to important health service initiatives and programs.


METHODS
Data on cervical cancer incidence and mortality were obtained from the NSW Central Cancer Registry for 1972-2001, and corresponding annual populations obtained from the Australian Bureau of Statistics. Direct age-standardised rates in the yen20 year population were calculated using the 2001 NSW census population as standard. Proportional reductions in incidence and mortality since 1972-1974 were also calculated and related to key health service factors and to published NSW 5-year cervical cancer relative survival for similar periods.


RESULTS
Declines in cervical cancer incidence (-10%) and mortality (-20%), and increased degree-of-spread specific survival following the introduction of universal health care in 1975 suggest effects of greater access to Pap screening, earlier access to diagnosis and treatment services, and improved effectiveness of treatment. Incidence plateaued during the 1980s, but mortality fell further (-7%) due to an increased proportion of localised cancers (without change to degree-of-spread specific survival). The 1980s mortality reduction was a consequence of earlier diagnosis and/or secondary prevention, not improved treatment effectiveness or reduced incidence. A marked and sustained incidence decline to 2001 (-35%) occurred after the introduction of the NSW Cervical Screening Program in 1992. This was followed 3 years later by a sustained mortality decline (-20%). During the 1990s survival across all degrees of spread remained unchanged and the mortality reduction was due entirely to reduction in incidence.


CONCLUSIONS
The substantial reduction of cervical cancer incidence and mortality in NSW over the last 3 decades is associated with important health service interventions that relate to control of cervical cancer, particularly the implementation of a population-based organised cervical screening program.
NSW Cervical Screening Program, Cumberland Hospital, Sydney, Australia.
Richard
R
Taylor
Stephen
S
Morrell
Hassan
H
Mamoon
Gerard
G
Wain
Jayne
J
Ross
D001315:Australia; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D009313:National Health Programs; D009517:New South Wales / Q000453:epidemiology; D011159:Population Surveillance; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000401:mortality; D014626:Vaginal Smears