title: 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 1968-2006 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 1978-2003 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.
authors.affiliation: 2nd Department of Oncology, Comenius university, Faculty of Medicine, National Cancer Institute, Bratislava, Slovak Republic. martina.ondrusova@savba.sk
authors.forename: M
authors.initials: M
authors.lastname: Ondrusova
authors.forename: P
authors.initials: P
authors.lastname: Zubor
authors.forename: D
authors.initials: D
authors.lastname: Ondrus
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007390:International Agencies; D008403:Mass Screening; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018154:Slovakia / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult