CERVICAL CANCER SCREENINGIN “WESTERN” EUROPE

ECCARome 2015Hélène Sancho-Garnier

Data sources

Incidence and mortality : Globocan 2012, http:// Globocan.iarc.fr

Screening programmes in Europe : 1. A. Anttila, G. Ronco and the working group on the registration and

monitoring of cervical screening Programmes in the European Union; within EUNICE. Description of the national situation of cervical cancer screening in the member states of the European Unions EJC 2009;45: 2685-2708.

2. A. Garnier, P. Brindel. Les programmes de dépistage organisé du cancer du col de l’Utérus en Europe: Etat des lieux de la situation en 2013. Bull Epidémiol Hebd.2014;(13-14-15):222-7

3. Vkesic, Mpoljak, S Rogovskaya. Cervical cancer burden and prevention activities in Europe.AACRjournals. Cancer Epidemiol Biomarkers Prev 2012; 1423-33

Cervical cancer Incidence in Europe/World

Cervical cancer Incidence in Europe globocan 2012)

<6

6.5-8.5

8.5-13,6

13.7-17

>17.4

Incidence and Morality in Ext.(18) Western Europe (Globocan 2012)

0

5

10

15

20

25

30

Incidence Mortality

2

3

4

5

6

7

8

9

10

11

1980 1990 2000 2010

European RegionEU EU members before May 2004 EU members since 2004 or 2007CISCARK

SDR, cancer of the cervix, all ages, per 100000Source: HFA DB

Time trends of Incidence in EWE% reduction Time (years) Period

Belgium - 28% 8 ( 2004-2012) Estonie + 28% 12 (2000-2012) Netherlands - 9% 24 (1988-2012) Globocan Luxembourg + 29% 24 (1988-2012) Globocan Spain - 2,5% 24 (1988-2012) Globocan Italy - 41% 24 (1988-2012) Globocan Portugal - 51% 24 (1988-2012) Globocan Ireland +54% 24 (1988-2012) Globocan UK - 52% 24 (1988-2012) Globocan Sweden - 17% 24 (1988-2012) Globocan Austria - 50% 24 (1980-2004) France - 67% 25 (1980-2005) Finland - 80% 44 (1962-2006) Germany - 75% 50 (1960-2010) Denmark - 58% 67 (1943 -2012)

Are screening modalities such differences ?

Organized ?

Regional

Periodicity

Coverage ?

Incidence and Type of screening in various European countries

Countries IncidenceType of Screning

PopulationCoverage Year of Start Age

Periodicity(years)

Switzerland 3,6 IS 60% 1960 20-65 2 or 3 (>30y)

Luxembourg 4,9 IS 39% 1962 >15 1

Austria 5,8 IS+ROS 4% 47% 1970/? >19 1

France M, 6,8 IS+ROS 13% 65%/75%* 1960/1994 25-65 3

Netherland 6,8 NOS 77%/65%* 1996 30-60 5

Germany 8,2 IS 80/60/25%** 1971 >20 1

Belgium 8,6 IS+ROS 25% 59%/? I970/ 1993 25-64 3

Finland 4,3 NOS 71% 1963 30-60/25-65 5UK 7,1 NOS 79% 1988/2003 20/25-64 3…5(>50y)

Sweden 7,4 NOS 79% 1967 23-60 3…5(>50y)Norway 9,8 ROS/NOS 75% 1959/1992 25-69 3

Denmark 10,6 IS/ROS/NOS 69% 1962/1996/2006 23-65 3…5 (>50y)Ireland 13,6 ROS/NOS 65% 2000/2008 25-60 3…5 (>45y)Estonie 19,9 ROS/NOS 13% 2003/2006 30-59 5

Lithuania 26,1 “NOS” 9-17% 2004/2008 25-60 3

Italy 6,7 IS/ROS 38%/75% 1982/1998/2006 25-64 3Spain 7,8 IS/ROS 30%/50-69% 1980/1990/2007 25-65 3

Portugal 9 IS/ROS 58%/11% 1990/2005 25-64 3

C.C Incidence and Type of screening(IS/ROS/NOS) in Ext. West.Europe

3,64,9

5,86,7 6,8

9 8,6

4,3

6,8 7,1 7,4

9,810,6

13,6

19,9

26,1

0

5

10

15

20

25

30

Copyright ©1999 BMJ Publishing Group Ltd.Quinn, M. et al. BMJ 1999;318:904

Age standardised incidence of invasive cervical cancer and coverage of screening

(England, 1971-95)

Incidence 2012 and Population coverage

0

5

10

15

20

25

30

Incidence Couverture

Incidence and Screening StartingAge

0

5

10

15

20

25

30

35

Incidence Starting Age

Type of screening test

Conventional: All (18)Pap smear

LBC ± Automation assisted: Dk,Fi,Nd,P,UK

Triage: B,Dk,Fi,Fr, It,Sp,UKHPV-DNA - trials: Fi,Fr, It,Nd,UK

Primary- routine : Sp, Sw

HPV-DNA self sample Trials : Fi,Fr,Nd,Sw

VIA ( In red : Incidence <7)

Incidence 2012 and Screeningstarting Year (IS or NOS)

Switzerland 3,6 Austria 5,8 Italy 6,7 Norway 9 Ireland 13,6Luxembourg 4,9 Germany 8,2 Spain 7,8 Denmark 10,6 Estonie 19,9France-M 6,8 Belgium 8,6 UK 7,1 Netherland 6,8 Lithuanie 26,1Finland 4,3 Sweden 7,4 Portugal 9

1960-65 1967-1971 1980-90 1992-96 >2000

3,6-6,8 5,8-8,6 6,7-9 9-10,6 13,6-26,1 Inc

C.C Incidence modificationsfrom 1988 to 2012

-10

-5

0

5

10

15

20

Incidence2012

Incidence 1988

Difference

Time Trends in CC in some Europeancountries (globocan 2012)

How to increase efficiency?

Targeting the right population

1. High Incidence High coverage

= high decrease

2. Low Incidence High coverage

= = low decrease

The Determinants of high riskpopulation and low participation

are“Country specific”

Age Geographical residency Ethnic groups… Culture Socio-economical level …

Cervical CIN2-3 and Cancer byage in France

0

20

40

60

80

100

120

CIN3+IS

Cancers IN

Incidence x Age and coverageby IS in France

Taux d'activité

13% - 22%23% - 25%26% - 27%28% - 39%

Taux d ’activité de frottis des femmes de 20 à 69 ans: liquidations des actes ( CNAMTS, CANAM, MSA) -Année 2000

INVS 2001 Hétérogénéité géographique

organisé

Incidence élevée

Incidence basse

Coverage by IS and ROS in France (2000)

How to increase screeningefficiency?

Organizing the whole screening process targeting the right population: “High incidence and low participation”

This population must be identified/country:Characteristics and registration

Using the adequate test, diagnosis exams and treatment which comply with the country and population economical resources and cultural background

Monitoring the quality control and the data collection: to know what you are doing…