The end of the decline in cervical cancer mortality in Spain: Trends across the period 1981-2012

Abstract

Background: In Spain, cervical cancer prevention is based on opportunistic screening, due to the disease's traditionally low incidence and mortality rates. Changes in sexual behaviour, tourism and migration have, however, modified the probability of exposure to human papilloma virus among Spaniards. This study thus sought to evaluate recent cervical cancer mortality trends in Spain. Methods: We used annual female population figures and individual records of deaths certified as cancer of cervix, reclassifying deaths recorded as unspecified uterine cancer to correct coding quality problems. Joinpoint models were fitted to estimate change points in trends, as well as the annual (APC) and average annual percentage change. Log-linear Poisson models were also used to study age-period-cohort effects on mortality trends and their change points. Results: 1981 marked the beginning of a decline in cervical cancer mortality (APC1981-2003: -3.2; 95% CI:-3.4;-3.0) that ended in 2003, with rates reaching a plateau in the last decade (APC2003-2012: 0.1; 95% CI:-0.9; 1.2). This trend, which was observable among women aged 45-46 years (APC2003-2012: 1.4; 95% CI:-0.1;2.9) and over 65 years (APC2003-2012: -0.1; 95% CI:-1.9;1.7), was clearest in Spain's Mediterranean and Southern regions. Conclusions: The positive influence of opportunistic screening is not strong enough to further reduce cervical cancer mortality rates in the country. Our results suggest that the Spanish Health Authorities should reform current prevention programmes and surveillance strategies in order to confront the challenges posed by cervical cancer.