Is the recent increase in cervical cancer in women aged 20-24years in England a cause for concern?

Prev Med. 2018 Feb;107:21-28. doi: 10.1016/j.ypmed.2017.12.002. Epub 2017 Dec 13.

Abstract

The rates of cervical cancer (CxCa) in England among women aged 20-24yrs increased from 2.7 in 2012 to 4.6 per 100,000 in 2014 (p=0.0006). There was concern that the sudden increase was linked to the withdrawal of cervical screening in women aged 20-24 (a policy that affected women born since 1984). We analyse granular data on age and FIGO stage at diagnosis using a generalised linear model to see whether the unprecedented increase in CxCa in young women in 2014 was linked to the change in 2012 to the age at which the first invitation to screening was sent (from 25.0 to 24.5). Annual rates of CxCa per 100,000 women aged 20.0-24.5yrs decreased gradually over time, whereas at age 24.5-25.0yrs they increased from an average of 16 pre-2013 to 49 in 2015. An increase of 20.3 per 100,000 women aged 24.5-25.0yrs (95% CI: 15.2-25.4) was associated with inviting women for screening at age 24.5yrs instead of at age 25.0. At age 25.0-25.5yrs, rates decreased by 23.7 per 100,000 after women were invited at age 24.5yrs (p<0.001). All these changes were limited to stage I CxCa. There was a dramatic increase in diagnoses at age 25yrs in 2009-2011 associated with changing the age at first invitation from 20yrs to 25yrs. No changes were observed at age 26.0-27.0yrs. The increase in CxCa aged 20-24 is attributable to an increase in the proportion of women first screened aged 24.5yrs. The increase was limited to stage I CxCa. There is no evidence of a lack of screening leading to increasing rates.

Keywords: Cancer intelligence; Cancer rates; Cancer trends; Cervical screening; Early diagnosis; Micro-invasion; Overdiagnosis; Screen-detected; Uterine cervical neoplasms; Young women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Early Detection of Cancer / methods*
  • England / epidemiology
  • Female
  • Humans
  • Incidence
  • Mass Screening*
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / epidemiology*
  • Uterine Cervical Neoplasms / prevention & control
  • Young Adult