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IS RAISING THE THRESHOLD FOR CERVICAL CANCER SCREENING FROM 20 TO 25 YEARS APPROPRIATE FOR THE NORTH WEST? H. Moeller, R. Iddenden, L. Shack, J. Richardson and E.M.I Williams Merseyside and Cheshire Cancer Registry. Structure. Introduction Methods Results Discussion. Biology.

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  1. IS RAISING THE THRESHOLD FOR CERVICAL CANCER SCREENING FROM 20 TO 25 YEARS APPROPRIATE FOR THE NORTH WEST? H. Moeller, R. Iddenden, L. Shack, J. Richardson and E.M.I Williams Merseyside and Cheshire Cancer Registry

  2. Structure • Introduction • Methods • Results • Discussion

  3. Biology Cervical cancer is caused by Human Papillomavirus (HPV) HPV is one of the most common sexually transmitted infections in the world Four specific HPV types (16,18, 31 and 45) cause at least 80% of cervical cancers

  4. Burden of cervical cancer • Ranked second to breast cancer in women worldwide • Per year ~493,000 cases and 273,000 deaths from cervical cancer worldwide • In England cervical cancer ranked 12th in females with 2,418 cases (2001) and 927 deaths (2002)

  5. Cervical Cancer Screening • Aims to reduce the incidence (& mortality) of cervical cancer by detecting cervical pre-cancer i.e. cervical intraepithelial neoplasia (CIN) • From 2005, the threshold for cervical cancer screening has been raised from 20 to 25 years (Department of Health)

  6. Standardised Registration Ratio cervical cancer 1996-2001

  7. Standardised Mortality Ratio cervical cancer 1996-2001

  8. Standardised Registration Ratio CIN III 1996-2001

  9. Structure • Introduction • Methods • Results • Discussion

  10. Study area Study area

  11. Methods • Study group: North West (NW) women diagnosed with cervical cancer and CIN III • Time period: 1996-2001 • Incidence and mortality in NW compared with England • Incidence by socio-economic group using Index of Multiple Deprivation (IMD)

  12. Structure • Introduction • Methods • Results • Discussion

  13. Age specific incidence and mortality of cervical cancer

  14. Age specific incidence of CIN III

  15. Results How does cervical cancer & CIN3 incidence in NW women aged 20-24yrs compare with national incidence in women aged 20-24yrs (old screening threshold) & 25-29yrs (new screening threshold)?

  16. Incidence of cervical cancer

  17. Incidence of cervical cancer

  18. Incidence of CIN III

  19. Incidence of CIN III

  20. Results • Which social group contributes the most cases?

  21. Incidence by socioeconomic group national call and recall introduced

  22. Structure • Introduction • Methods • Results • Discussion

  23. Discussion • NW cervical cancer incidence & mortality rates are above national average & vary significantly within the region • CIN III rates in NW women aged 20-24 years are similar to rates in 25-29 year old women nationally • Biological progression rates from CIN III to cervical cancer are unknown

  24. Increasing the threshold for cervical cancer screening May: • Delay the detection of ~550 cases of CIN III per year in NW women aged 20-24yrs • Have a greater effect on the most deprived groups in society, thereby maintaining or even increasing health inequalities

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