Is elimination of cervical cancer in sight in England?

OBJECTIVE

The age-standardised rate of cervical cancer is 8.5 per 100,000 in England, double the WHO "elimination" goal of 4.0 per 100,000, despite England being close to the target coverage for both HPV vaccination and cervical screening. Our aim was to see whether trends in mortality and incidence rates suggest that England is on the path to elimination.

METHODS

We discuss trends in mortality since 1953 by birth cohort, and cancer and cancer-in-situ incidence since 2000 by age group in relation to screening and vaccination.

RESULTS

Mortality trends suggest a steep decline in HPV prevalence from women born in the 1880s to those born in the 1930s followed by a continuing increase. Cancer incidence and mortality then fell steeply after the introduction of national screening in 1988. Since 2004 women were invited for their first screen at age 25. From 2000-2004 to 2010-2014 invasive cancer incidence at age 25-29 doubled and mortality increased by 77 %. From 2015 to 2022 cervical cancer incidence fell by 90 % below age 25 and by 80 % at age 25-29 following the introduction of HPV vaccination for girls born since 1991.

CONCLUSIONS

Raising the age of starting screening from 20 to 25 transiently increased incidence and mortality in women born 1984-1990. Vaccination may enable the NHS to reach its target for cervical cancer incidence of 4.0 per 100,000 by 2040. Whether the switch from cytology to primary HPV testing in 2019 will reduce rates among unvaccinated women born before 1991 is not yet clear.