Reduced cervical cancer incidence and mortality in Canada: national data from 1932 to 2006

BACKGROUND: High levels of participation in cervical screening are reported in Canada from the 1970's as a result of early uptake of the Pap smear and universal Medicare. Despite recommendations to the contrary, the programs have featured early age of initiation of screening and frequent screening intervals. Other countries have achieved successful outcomes without such features. We analyzed national data to better understand mortality and incidence trends, and their relationships to screening. METHODS: The Canadian Cancer Registry, National Cancer Incidence Reporting System, and the Canadian Vital Statistics Database were used to measure mortality and incidence rates. Cases and deaths from invasive cervical cancer were classified by 5 year age groups at diagnosis and death (15 to 19 years through to 80 to 84 years), year of diagnosis (1972 to 2006), and year of death (1932 to 2006). Probabilities of developing and dying from cervical cancer were calculated for age-specific mortality and incidence. The proportion of women reporting a timely Pap test was estimated for 1978 to 2006. RESULTS: Cervical cancer mortality has declined steadily from a peak of 13.5 to 2.2 per 100,000 (83%,) between 1952 and 2006, and 71% between 1972 and 2006. Incidence of invasive cervical cancer has declined by 58% since 1972. These declines have occurred more among older age groups than younger. Invasive cervical cancer incidence and mortality is less in each successive birth cohort of women. Participation rates in screening are high especially in women under age 50. CONCLUSIONS: Despite increasing risk factors for cervical cancer, both incidence and mortality have declined over time, across age groups, and across birth cohorts. Earlier increasing mortality (1932 - 1950) was likely related to improved classification of cancers and the early subsequent reduction (1950 - 1970) to improved treatment. Recent improvements in incidence and mortality are likely due to high rates of screening. For women under age 30 years there are low rates of disease but lesser improvement related to screening.