Effect of organised screening on cervical cancer incidence and mortality in Finland, 1963-1995: Recent increase in cervical cancer incidence

A nation-wide screening programme for cervical cancer started in Finland gr adually from 1963 onwards. By the beginning of the 1990s, there had been a decrease of 80% both in the age-adjusted incidence of and mortality from ce rvical cancer. To describe the recent patterns in cervical cancer incidence and mortality and evaluate their differentials in relation with the organi sed screening activities, we have updated the material on the cervical canc er incidence and mortality as well as mass-screening activities up to the y ear 1995. Based on the files of the Finnish Cancer Registry, there is a str iking increase of about 60% in the incidence of cervical cancer during the last 4 years of the study period among women below 55 years of age. The mor tality rates are still decreasing. There is no overall decrease over recent years in the coverage of the programme invitations or smears taken. Incide nce of invasive cancer and of moderate and severe dysplasia as detected in mass screening have increased. As to the interpretation, changes in the ris k factors, such as in sexual behaviour and smoking habits, over the decades might partly explain increasing trends in cervical cancer incidence. As th e change in incidence was relatively abrupt, inadequacies or changes in the effectiveness in the screening programme, particularly among young women, may also have contributed. Expanding the coverage of and attendance in the pap-screening programme among women in young target ages would still be eff ective. Increasing emphasis on quality assessment in screening is also need ed. (C) 1999 Wiley-Liss, Inc.