title: The moderate decrease in invasive cervical cancer incidence rates in Spain (1980-2004): limited success of opportunistic screening?
abstract: BACKGROUND
  Despite its low incidence, invasive cervical cancer (ICC) is still a public health concern in Spain, due to its being perceived as an avoidable neoplasm. Social changes in recent decades may have increased the risk of ICC among Spanish females. This study sought to update incidence trends in Spanish registries.
  
  
  METHODS
  We studied the ICC incidence time trend over the period 1980-2004 using data from 13 Spanish population-based cancer registries, analysing all cases and the two main histological types, i.e. squamous cell carcinoma (SCC) and adenocarcinoma (AC). Change-point Poisson regression models were fitted for all women and for the following three age groups: 25-44, 45-64 and > or =65 years. Age-period-cohort models were used to study cohort and period effect.
  
  
  RESULTS
  ICC incidence showed a moderate decrease (annual percentage change: -0.9%; 95% CI -1.3% to -0.5%). Whereas rates among younger women rose sharply by 5.5% until 1990, when they began to descend by 1.2% annually, among women aged > or =45 years they declined by 1.5% per annum. In the last decade of the study period, divergent trends were found for SCC and AC, i.e. downward versus upward, respectively. Risk increased with birth cohort after 1940-45 but the period effect showed opposite trends for the two histological types.
  
  
  CONCLUSIONS
  Cervical cancer incidence rates have decreased moderately in Spain, a trend consistent with the preventive effect of widespread opportunistic screening.
authors.affiliation: Cancer and Environmental Epidemiology Area, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain. bperez@isciii.es
authors.forename: B
authors.initials: B
authors.lastname: Pérez-Gómez
authors.forename: C
authors.initials: C
authors.lastname: Martínez
authors.forename: C
authors.initials: C
authors.lastname: Navarro
authors.forename: P
authors.initials: P
authors.lastname: Franch
authors.forename: J
authors.initials: J
authors.lastname: Galceran
authors.forename: R
authors.initials: R
authors.lastname: Marcos-Gragera
mesh_terms: D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer / Q000639:trends*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology / Q000517:prevention & control; D013030:Spain / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control