Increased cervical cancer incidence in the target age of screening-Variation by mode of detection

Cervical cancer incidence has increased in several high-income countries over the last decades. During the same period, many screening programs have shifted their primary method from cytology to the more sensitive HPV test. To better understand the increasing incidence, we visualized the incidence trends by mode of detection (screen-detected, interval cancers, cancers in non-participants, or cancers in those outside screening target ages) and by cancer morphology type using segmented regression. We also assessed the effects of the primary test method on the risk of screen-detected and interval cancers using Poisson regression. The study population consisted of all individuals diagnosed with cervical cancer (n = 4472) during 1996-2022 in Finland. An increase in cervical cancer incidence was observed during the 2010s, predominantly among individuals within the screening age. A clear upward trend was evident among both screening participants and non-participants. Notably, the incidence of screen-detected cervical cancer rose sharply after approximately 2013. The introduction of HPV-based screening was associated with an increased detection rate of screen-detected cancers (RR = 1.4, 95% CI = 1.1-1.7) compared to cytology testing. Conversely, the risk of interval cervical cancer was reduced when the preceding screening method was an HPV test (RR = 0.29, 95% CI = 0.21-0.38) compared to cytology. Our results imply that the initiation of HPV testing has improved the detection of prevalent cancers, but changes in risk factors also contribute to the rising incidence of cervical cancer.