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Screening for cervical neoplasia in Dundee and Angus: 10 years on
W J van Wijngaarden1, I D Duncan, K A Hussain
1Department of Obstetrics and Gynaecology, Queen's Medical Centre, Nottingham, UK.
Objective:
To evaluate the effect of changed cervical screening policies on a steady population with low migratory tendencies.
Design:
A retrospective analysis study.
Setting:
Dundee and Angus, Scotland.
Subjects:
All women who developed cervical carcinoma between 1957 and 1992.
Main Outcome Measures:
The incidence of and mortality from cervical cancer after the introduction of organised cervical screening in 1962, according to age, stage, histology and screening history.
Results:
The initial fall in incidence of cervical cancer seen in women between 35 and 54 years after the introduction of cervical screening was not sustained during the last 10 years of our study and appears to have been transferred to women aged 55 years and older instead. After 1976 an increase in the incidence of cervical cancer was seen in women under 35 years. The reduction in mortality from cervical cancer appears to have reached a plateau since 1976. No effect of cervical screening was seen on the incidence of adenocarcinoma of the cervix.
Conclusions:
The effect of changed cervical screening policies has been shown for a small population for a period of 35 years. The incidence of the higher stages of squamous cervical cancer continues to fall. The increase in incidence of cervical cancer in women under 35 years confirms similar trends seen in other countries. A background mortality rate refractory to further intensification of screening appears to have been reached. Adenocarcinoma of the cervix appears to gain in importance as cervical screening policies are shown to have their effect on its squamous counterpart.