Trends in cervical cancer incidence in the Netherlands: A join-point and age-period-cohort analysis (1989-2023)

Cervical cancer remains a significant public health issue, ranking as the fourth most common cancer in women globally. In the Netherlands, cervical cancer incidence declined steadily from 1989 to 2001 but increased between 2001 and 2007. This study updates trends in cervical cancer incidence from 1989 to 2023 in the Netherlands and evaluates the impact of screening practices and participation rates in the national population-based screening program. This ecological study uses group-level data from the Netherlands Cancer Registry (1989-2023) to analyze trends across three temporal dimensions-age, period, and cohort-using age-period-cohort analysis and join-point regression to identify significant changes in trends over time. Cervical cancer incidence declined steadily from 1989 to 2003 but increased from 2003 to 2023, particularly among younger birth cohorts (1976-1995). This increase aligns with the decline in screening participation, which dropped from over 77% before 2003 to below 60% in subsequent years, as well as the introduction of primary high-risk human papillomavirus testing in 2017, which has higher sensitivity than cytology, leading to more cases being detected and, consequently, an increase in incidence. Trends in cervical cancer incidence in the Netherlands indicate a positive impact of the screening program, with a steady decline over the years. However, efforts should focus on increasing participation in both screening and vaccination, as this is crucial for achieving the goal of reducing incidence to below 4 per 100,000 women, in line with the global strategy to eliminate cervical cancer.