Role of screening in reducing invasive cervical cancer registrations in England.

OBJECTIVE

To estimate the effect of screening on invasive cervical cancer registrations in England.

SETTING

The Health of the Nation target for cervical cancer seeks to reduce the incidence of invasive cases (ICD 180) by at least 20% between 1986 and 2000.

METHOD

The available area-level statistics on invasive cervical cancer registrations, screening activity, and socioeconomic and behavioural characteristics for 145 district health authorities in England over the period 1985-91 were collected. A multiple regression analysis sought to explain variations in incidence rates by relating screening and socioeconomic and behavioural variables to registration rates.

RESULTS

Districts with higher unemployment levels and higher numbers of pregnancies in young women had higher registration rates for invasive cervical cancer. The cervical smear rate for women aged 35-64 in a district was positively related to registrations, whereas the relation was negative for the 20-34 age group.

CONCLUSIONS

The higher registration rates for invasive cervical cancer in districts with higher cervical smear rates for women aged 35-64 may reflect historically lower screening cover. The negative relation between the cervical smear rate and invasive cervical cancer registrations in women aged 20-34 is accompanied by high registration rates for preinvasive (CIN III) cervical cancer (ICD 233.1). For the advantages of the Pap test to be fully realised, and for invasive cervical cancer registrations to fall in line with the Health of the Nation targets, a comprehensive screening programme, with a high take up rate is required. The various changes to the screening programme introduced since 1988 should help to achieve this. Public health policy should focus on educating the population about the risk factors for cervical cancer and the significance of screening.