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. 1999 Apr 3;318(7188):904-8.
doi: 10.1136/bmj.318.7188.904.

Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics

M Quinn  1 , P Babb, J Jones, E Allen
Affiliations

Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics

M Quinn et al. BMJ. .

Abstract

Objective: To assess the impact of screening on the incidence of and mortality from cervical cancer.

Design: Comparison of age specific incidence and mortality before and after the introduction of the national call and recall system in 1988.

Setting: England.

Subjects: Women aged over 19 years.

Results: From the mid-1960s, the number of smears taken rose continuously to 4.5 million at the end of the 1980s. Between 1988 and 1994, coverage of the target group doubled to around 85%. Registrations of in situ disease increased broadly in parallel with the numbers of smears taken. The overall incidence of invasive disease remained stable up to the end of the 1980s, although there were strong cohort effects; from 1990 incidence fell continuously and in 1995 was 35% lower than in the 1980s. The fall in overall mortality since 1950 accelerated at the end of the 1980s; there were strong cohort effects. Mortality in women under 55 was much lower in the 1990s than would have been expected.

Conclusions: The national call and recall system and incentive payments to general practitioners increased coverage to around 85%. This resulted in falls in incidence of invasive disease in all regions of England and in all age groups from 30 to 74. The falls in mortality in older women were largely unrelated to screening, but without screening there might have been 800 more deaths from cervical cancer in women under 55 in 1997.

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Figures

Figure 1
Figure 1
Number of cervical smears and directly age standardised rate of in situ cervical cancer, England, 1965-95
Figure 2
Figure 2
Age specific registrations of in situ cervical cancer in women aged 20-49, England, 1971-95
Figure 3
Figure 3
Age standardised incidence of invasive cervical cancer and coverage of screening, England, 1971-95
Figure 4
Figure 4
Age specific incidence of invasive cervical cancer in England for 1971, 1980, 1990 and 1995
Figure 5
Figure 5
Age standardised mortality from cervical cancer, England, 1950-97
Figure 6
Figure 6
Age specific mortality from cervical cancer, England, 1950-97
See this image and copyright information in PMC

Comment in

References

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