Cervical cancer incidence in Denmark: Disentangling determinants of time trend

Elsebeth Lynge; Jeppe Bennekou Schroll; Berit Andersen; Kirubakaran Balasubramaniam; Anna Poulsgaard Frandsen; Else Helene Ibfelt; Kirsten Marie Jochumsen; Maja Ulrikka Bruun Laustsen; Susanne Nielsen; Rouzbeh Salmani; Doris Schledermann; Petra Birgitta Hall Viborg; Marianne Waldstrøm; George Napolitano; Reza Serizawa

doi:10.1002/ijc.35081

Cervical cancer incidence in Denmark: Disentangling determinants of time trend

Elsebeth Lynge^*, Jeppe Bennekou Schroll, Berit Andersen, Kirubakaran Balasubramaniam, Anna Poulsgaard Frandsen, Else Helene Ibfelt, Kirsten Marie Jochumsen, Maja Ulrikka Bruun Laustsen, Susanne Nielsen, Rouzbeh Salmani, Doris Schledermann, Petra Birgitta Hall Viborg, Marianne Waldstrøm, George Napolitano, Reza Serizawa

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

1 Citation (Scopus)

Abstract

Cervical cancer is a preventable disease. Nevertheless, stagnation has been seen in incidence rates also in countries with well-functioning healthcare. On this basis, we investigated associations between control interventions and changes in cervical cancer incidence in Denmark from 2009 to 2022. Data on human papillomavirus (HPV)-vaccination were retrieved from Staten's Serum Institute; on screening recommendations from Danish Health Authority, on screening performance from Danish Quality Database for Cervical Screening; and on cervical cancer incidence from Nordcan and Danish Cancer Register. We reported coverage with HPV vaccination (1+ dose); coverage with cervical cell samples; number of women with primary HPV tests; proportion of non-normal cell samples without timely follow-up; number of conizations; and cervical cancer incidence rates. In 2022, all women aged ≤29 had been offered childhood HPV vaccination with coverage of 80%–90%. By 2020–2022, the cervical cancer incidence rate in women aged 20–29 was 3 per 100,000; at level of disease elimination. In 2017, women aged 70+ were offered a one-time HPV screening, and by 2020–2022, the old-age peak in cervical cancer incidence had largely disappeared. From 2009 to 2022, proportion of non-normal cell samples without timely follow-up decreased from 20% to 10%, and conventional cytology was largely replaced by SurePath liquid-based cytology; these factors could explain the steady decrease in cervical cancer incidence rate. Implementation of primary HPV screening in women aged 30–59 in 2021 was reflected in a, probably temporary, increase in the 2022 cervical cancer incidence rate. In conclusion, combined interventions with childhood HPV vaccination; one-time HPV screening of elderly women; and better management of screening broke previous stagnation in cervical cancer incidence rate.

Original language	English
Journal	International Journal of Cancer
Volume	155
Issue	10
Pages (from-to)	1769-1779
Number of pages	11
ISSN	0020-7136
DOIs	https://doi.org/10.1002/ijc.35081
Publication status	Published - 15 Nov 2024

Keywords

cancer incidence rate
cervical cancer
human papillomavirus vaccination
screening time trend

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10.1002/ijc.35081Licence: CC BY-NC-ND

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Lynge, E., Bennekou Schroll, J., Andersen, B., Balasubramaniam, K., Poulsgaard Frandsen, A., Ibfelt, E. H., Jochumsen, K. M., Bruun Laustsen, M. U., Nielsen, S., Salmani, R., Schledermann, D., Hall Viborg, P. B., Waldstrøm, M., Napolitano, G., & Serizawa, R. (2024). Cervical cancer incidence in Denmark: Disentangling determinants of time trend. International Journal of Cancer, 155(10), 1769-1779. https://doi.org/10.1002/ijc.35081

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title = "Cervical cancer incidence in Denmark: Disentangling determinants of time trend",

abstract = "Cervical cancer is a preventable disease. Nevertheless, stagnation has been seen in incidence rates also in countries with well-functioning healthcare. On this basis, we investigated associations between control interventions and changes in cervical cancer incidence in Denmark from 2009 to 2022. Data on human papillomavirus (HPV)-vaccination were retrieved from Staten's Serum Institute; on screening recommendations from Danish Health Authority, on screening performance from Danish Quality Database for Cervical Screening; and on cervical cancer incidence from Nordcan and Danish Cancer Register. We reported coverage with HPV vaccination (1+ dose); coverage with cervical cell samples; number of women with primary HPV tests; proportion of non-normal cell samples without timely follow-up; number of conizations; and cervical cancer incidence rates. In 2022, all women aged ≤29 had been offered childhood HPV vaccination with coverage of 80%–90%. By 2020–2022, the cervical cancer incidence rate in women aged 20–29 was 3 per 100,000; at level of disease elimination. In 2017, women aged 70+ were offered a one-time HPV screening, and by 2020–2022, the old-age peak in cervical cancer incidence had largely disappeared. From 2009 to 2022, proportion of non-normal cell samples without timely follow-up decreased from 20% to 10%, and conventional cytology was largely replaced by SurePath liquid-based cytology; these factors could explain the steady decrease in cervical cancer incidence rate. Implementation of primary HPV screening in women aged 30–59 in 2021 was reflected in a, probably temporary, increase in the 2022 cervical cancer incidence rate. In conclusion, combined interventions with childhood HPV vaccination; one-time HPV screening of elderly women; and better management of screening broke previous stagnation in cervical cancer incidence rate.",

keywords = "cancer incidence rate, cervical cancer, human papillomavirus vaccination, screening time trend",

author = "Elsebeth Lynge and {Bennekou Schroll}, Jeppe and Berit Andersen and Kirubakaran Balasubramaniam and {Poulsgaard Frandsen}, Anna and Ibfelt, {Else Helene} and Jochumsen, {Kirsten Marie} and {Bruun Laustsen}, {Maja Ulrikka} and Susanne Nielsen and Rouzbeh Salmani and Doris Schledermann and {Hall Viborg}, {Petra Birgitta} and Marianne Waldstr{\o}m and George Napolitano and Reza Serizawa",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.",

year = "2024",

month = nov,

day = "15",

doi = "10.1002/ijc.35081",

language = "English",

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journal = "International Journal of Cancer",

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Lynge, E, Bennekou Schroll, J, Andersen, B, Balasubramaniam, K, Poulsgaard Frandsen, A, Ibfelt, EH, Jochumsen, KM, Bruun Laustsen, MU, Nielsen, S, Salmani, R, Schledermann, D, Hall Viborg, PB, Waldstrøm, M, Napolitano, G & Serizawa, R 2024, 'Cervical cancer incidence in Denmark: Disentangling determinants of time trend', International Journal of Cancer, vol. 155, no. 10, pp. 1769-1779. https://doi.org/10.1002/ijc.35081

Cervical cancer incidence in Denmark: Disentangling determinants of time trend. / Lynge, Elsebeth; Bennekou Schroll, Jeppe; Andersen, Berit et al.
In: International Journal of Cancer, Vol. 155, No. 10, 15.11.2024, p. 1769-1779.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Cervical cancer incidence in Denmark

T2 - Disentangling determinants of time trend

AU - Lynge, Elsebeth

AU - Bennekou Schroll, Jeppe

AU - Andersen, Berit

AU - Balasubramaniam, Kirubakaran

AU - Poulsgaard Frandsen, Anna

AU - Ibfelt, Else Helene

AU - Jochumsen, Kirsten Marie

AU - Bruun Laustsen, Maja Ulrikka

AU - Nielsen, Susanne

AU - Salmani, Rouzbeh

AU - Schledermann, Doris

AU - Hall Viborg, Petra Birgitta

AU - Waldstrøm, Marianne

AU - Napolitano, George

AU - Serizawa, Reza

PY - 2024/11/15

Y1 - 2024/11/15

N2 - Cervical cancer is a preventable disease. Nevertheless, stagnation has been seen in incidence rates also in countries with well-functioning healthcare. On this basis, we investigated associations between control interventions and changes in cervical cancer incidence in Denmark from 2009 to 2022. Data on human papillomavirus (HPV)-vaccination were retrieved from Staten's Serum Institute; on screening recommendations from Danish Health Authority, on screening performance from Danish Quality Database for Cervical Screening; and on cervical cancer incidence from Nordcan and Danish Cancer Register. We reported coverage with HPV vaccination (1+ dose); coverage with cervical cell samples; number of women with primary HPV tests; proportion of non-normal cell samples without timely follow-up; number of conizations; and cervical cancer incidence rates. In 2022, all women aged ≤29 had been offered childhood HPV vaccination with coverage of 80%–90%. By 2020–2022, the cervical cancer incidence rate in women aged 20–29 was 3 per 100,000; at level of disease elimination. In 2017, women aged 70+ were offered a one-time HPV screening, and by 2020–2022, the old-age peak in cervical cancer incidence had largely disappeared. From 2009 to 2022, proportion of non-normal cell samples without timely follow-up decreased from 20% to 10%, and conventional cytology was largely replaced by SurePath liquid-based cytology; these factors could explain the steady decrease in cervical cancer incidence rate. Implementation of primary HPV screening in women aged 30–59 in 2021 was reflected in a, probably temporary, increase in the 2022 cervical cancer incidence rate. In conclusion, combined interventions with childhood HPV vaccination; one-time HPV screening of elderly women; and better management of screening broke previous stagnation in cervical cancer incidence rate.

AB - Cervical cancer is a preventable disease. Nevertheless, stagnation has been seen in incidence rates also in countries with well-functioning healthcare. On this basis, we investigated associations between control interventions and changes in cervical cancer incidence in Denmark from 2009 to 2022. Data on human papillomavirus (HPV)-vaccination were retrieved from Staten's Serum Institute; on screening recommendations from Danish Health Authority, on screening performance from Danish Quality Database for Cervical Screening; and on cervical cancer incidence from Nordcan and Danish Cancer Register. We reported coverage with HPV vaccination (1+ dose); coverage with cervical cell samples; number of women with primary HPV tests; proportion of non-normal cell samples without timely follow-up; number of conizations; and cervical cancer incidence rates. In 2022, all women aged ≤29 had been offered childhood HPV vaccination with coverage of 80%–90%. By 2020–2022, the cervical cancer incidence rate in women aged 20–29 was 3 per 100,000; at level of disease elimination. In 2017, women aged 70+ were offered a one-time HPV screening, and by 2020–2022, the old-age peak in cervical cancer incidence had largely disappeared. From 2009 to 2022, proportion of non-normal cell samples without timely follow-up decreased from 20% to 10%, and conventional cytology was largely replaced by SurePath liquid-based cytology; these factors could explain the steady decrease in cervical cancer incidence rate. Implementation of primary HPV screening in women aged 30–59 in 2021 was reflected in a, probably temporary, increase in the 2022 cervical cancer incidence rate. In conclusion, combined interventions with childhood HPV vaccination; one-time HPV screening of elderly women; and better management of screening broke previous stagnation in cervical cancer incidence rate.

KW - cancer incidence rate

KW - cervical cancer

KW - human papillomavirus vaccination

KW - screening time trend

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U2 - 10.1002/ijc.35081

DO - 10.1002/ijc.35081

M3 - Journal article

C2 - 39003657

AN - SCOPUS:85198563860

SN - 0020-7136

VL - 155

SP - 1769

EP - 1779

JO - International Journal of Cancer

JF - International Journal of Cancer

IS - 10

ER -

Cervical cancer incidence in Denmark: Disentangling determinants of time trend

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