Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2018 Jul;97(7):795-807. doi: 10.1111/aogs.13313. Epub 2018 Feb 23.
New technologies such as human papillomavirus (HPV) testing and vaccination necessitate comprehensive policy analyses to optimize cervical cancer prevention. To inform future Scandinavian-specific policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Denmark, Norway and Sweden. We compiled and summarized data on current prevention strategies, population demography and epidemiology (for example, age-specific HPV prevalence and cervical cancer incidence over time) for each Scandinavian country by reviewing published literature and official guidelines, performing registry-based analyses using primary data and having discussions with experts in each country. In Scandinavia, opportunistic screening occurred as early as the 1950s and by 1996, all countries had implemented nationwide organized cytology-based screening. Prior to implementation of widespread screening and during 1960-66, cervical cancer incidence was considerably higher in Denmark than in Norway and Sweden. Decades of cytology-based screening later (i.e. 2010-2014), cervical cancer incidence has been considerably reduced and has converged across the countries since the 1960s, although it still remains lowest in Sweden. Generally, Scandinavian countries face similar cervical cancer burdens and utilize similar prevention approaches; however, important differences remain. Future policy analyses will need to evaluate whether these differences warrant differential prevention policies or whether efforts can be streamlined across Scandinavia.
新技术如人乳头瘤病毒（HPV）检测和疫苗接种需要全面的政策分析，以优化宫颈癌的预防。为了为未来的斯堪的纳维亚特定政策分析提供信息，我们旨在概述丹麦、挪威和瑞典的宫颈癌流行病学和现有预防措施。我们通过查阅文献和官方指南，对每个斯堪的纳维亚国家的当前预防策略、人口统计学和流行病学（例如，特定年龄的 HPV 流行率和随时间推移的宫颈癌发病率）进行了数据汇总和总结，并利用主要数据进行了基于登记的分析，并与每个国家的专家进行了讨论。在斯堪的纳维亚，机会性筛查早在 20 世纪 50 年代就已经开始，到 1996 年，所有国家都已经实施了全国性的细胞学为基础的筛查。在广泛筛查实施之前以及在 1960-66 年期间，丹麦的宫颈癌发病率明显高于挪威和瑞典。几十年的细胞学筛查之后（即 2010-2014 年），宫颈癌发病率已经显著降低，自 20 世纪 60 年代以来，各国的发病率已经趋同，尽管瑞典的发病率仍然最低。一般来说，斯堪的纳维亚国家面临着相似的宫颈癌负担，并且使用相似的预防方法；然而，仍然存在重要的差异。未来的政策分析将需要评估这些差异是否需要差异化的预防政策，或者是否可以在整个斯堪的纳维亚范围内简化努力。
