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. 2019 Nov 15;145(10):2629-2638.
doi: 10.1002/ijc.32195. Epub 2019 Mar 4.

Recent increase in incidence of cervical precancerous lesions in Norway: Nationwide study from 1992 to 2016

Madleen Orumaa  1 , Maarit K Leinonen  1 , Suzanne Campbell  1 , Bjørn Møller  2 , Tor Åge Myklebust  2   3 , Mari Nygård  1
Affiliations

Recent increase in incidence of cervical precancerous lesions in Norway: Nationwide study from 1992 to 2016

Madleen Orumaa et al. Int J Cancer. .

Abstract

We analysed patterns in the incidence of cervical intraepithelial neoplasia grades 2 and 3 (CIN2, CIN3) and adenocarcinoma in situ (AIS) by age and histology in 1992-2016 in Norway and described changes in screening tests. Incident cases of CIN2, CIN3, AIS and cervical cancer were identified in the Cancer Registry of Norway, as were all women with at least one screening test. The annual percentage change statistic was used to assess point estimates and changes in age-specific and age-standardised incidence rates (IR). Women aged 25-29 years had the highest incidence of cervical precancerous lesions (CIN2: 192.9/10, CIN3: 737.2/10, AIS: 32.5/105 in 2016). The IR of CIN2 increased for all screening ages (25-69 years) from 3.6% to 6.7% per year. CIN3 incidence increased by 1.6% (95% confidence interval [CI] 0.6-2.6) annually. A steep increase in AIS incidence was observed in all age groups (7.1% per year, 95% CI 5.3-8.8). Changes in screening tests and the histological verification of cervical precancerous lesions alone cannot explain the steady increase in incidence we observed over the 25-year study period, and increased exposure to human papillomavirus (HPV) likely plays a role. Age-appropriate treatment of screening-detected cervical precancerous lesions is needed for effective cervical cancer control while avoiding overtreatment and related health risks. In order to perform an appropriate harm-benefit evaluation of cervical cancer control efforts, detailed information on screening technology and background risks, including HPV vaccination status, is needed to create optimal public health policy.

Keywords: cervical cancer screening; cervical precancerous lesions; trend analysis.

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Figures

Figure 1
Figure 1
Cervical intraepithelial neoplasia grade 2 (CIN2), Cervical intraepithelial neoplasia grade 3/adenocarcinoma in situ (CIN3/AIS) and cervical cancer age‐specific incidence rate per 100,000 women and per 100,000 screened women by age in Norway in 2016.
Figure 2
Figure 2
Cervical intraepithelial neoplasia grade 2 (CIN2), cervical intraepithelial neoplasia grade 3 (CIN3), and adenocarcinoma in situ (AIS) incidence rate per 100,000 on the log scale by nine age groups from 1992 to 2016.
Figure 3
Figure 3
Period and cohort analysis for cervical intraepithelial neoplasia grade 2 (CIN2), cervical intraepithelial neoplasia grade 3 (CIN3), and adenocarcinoma in situ (AIS).
Figure 4
Figure 4
Numbers and proportions of different screening test used from 1992 to 2016.
See this image and copyright information in PMC

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