Future Burden Of Cervical Cancer Preventable By Screening In Central And Eastern European Countries

Salvatore VACCARELLA, International Agency for Research on Cancer, France

1 Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
2 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France

Purpose: Cervical cancer (CC) incidence is particularly high in Baltic and Central/Eastern European (BCEE) countries mainly because of the historical absence of mass screening programmes. We estimate the future burden of CC that could theoretically be prevented by 2040 if effective screening programmes were introduced.
Methods: Age-period-cohort models were applied within a Bayesian framework to selected BCEE countries. Projected rates in a scenario where the current status quo of no effective screening will persist were obtained by extrapolating, using spline functions, the two major risk factors affecting CC rates. Cohort-specific effects, reflecting mainly the increasing risk of human papillomavirus (HPV), are rising in many European countries. Conversely, period-specific effects have strongly declined in countries with long-standing screening programmes, e.g., the Nordic countries, but are absent in countries without existing CC prevention strategies, e.g., BCEE. A gradual impact of screening is hypothesized, assuming declines in period-specific effects equal to those observed in Denmark following implementation of screening in the late 1960s. Introduction of screening programmes at different future dates was assessed.
Results: Projected CC rates will continue increasing substantially in many BCEE countries, reaching age-standardized rates of ≥50 cases per 100.000 in all studied countries in 2036-2040. Particularly high rates are expected in Lithuania (88 per 100,000), Latvia (68 per 100,000), Belarus (67 per 100,000) and Estonia (64 per 100,000). Effective screening programmes might, however, change dramatically these figures. The number of CC cases possibly preventable up to 2040 through improvements in screening programmes varies from almost 1,500 in Estonia to over 150,000 in the Russian Federation. The beneficial effects of screening will increase progressively over time reaching reductions of 50-60% of the projected rates in 2040.
Conclusions: The improvement of screening programmes might prevent a HPV-driven CC epidemic in several BCEE countries in the next 25 years.
Funding source: None.