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Cervical cancer is preventable and
curable if detected early. The main cause of cervical cancer, which accounts for
approximately 95% of all cases, is sexual exposure to the human papilloma virus, HPV
(IARC, 1995; Franco et al., 1999). Three indicators are
presented to reflect variation in cervical cancer care across OECD countries: cervical
cancer screening rates in women aged 20-69 years, five-year relative survival rates, and
mortality rates.
The primary prevention of cervical
cancer attributable to human papilloma virus types 16 and 18 by prophylactic vaccines has
been shown to be highly effective and recommended in many countries worldwide (Shefer
et al., 2008; Koulova et al., 2008). The secondary prevention of cervical cancer by the Pap-smear
and HPV DNA testing increases the probability of detecting premalignant lesions which can
be effectively treated. Population-based cancer screening programmes have been promoted by
the Council of the European Union and the European Commission (European Union, 2003;
European Commission, 2008c), but the periodicity and target groups vary among member
states. There has been much discussion whether cervical cancer screening needs to be
reevaluated and the cost-effectiveness investigated after introduction of HPV vaccination
programmes (Goldhaber-Fiebert et al., 2008; Wheeler
et al., 2009).
In 2009, screening rates for cervical
cancer were the highest in the United States, at 86% (Figure 5.8.1). The United Kingdom, Norway and Sweden also achieved high
coverage, with close to 80% of the target population. Screening rates were the lowest in
the Slovak Republic and Hungary, although in Hungary a high proportion of screening
activity takes place outside organised screening settings, resulting in underreporting. In
several countries (Canada, Finland, Hungary, Iceland, Norway, the Slovak Republic, the
United Kingdom and the United States), screening rates have declined at least slightly
between 2000 and 2009.
Survival rates are one of the key
measures of the effectiveness of health care systems and are commonly used to track
progress in treating a disease over time. They reflect both how early the cancer was
detected and the effectiveness of the treatment. Over the periods 1997-2002 and 2004-09,
the five-year relative survival rates improved in most countries due to improved
effectiveness of screening and treatment (Figure 5.8.2). In the most
recent period (2004-09), survival rates continued to be the lowest in Ireland and the
United Kingdom, while they were the highest in Norway and Korea.
Mortality rates reflect the effect of
cancer care in past years and improved diagnosis of early-stage cancers with a better
prognosis, as typically happens when screening is widespread. The mortality rates for
cervical cancer declined for most OECD countries between 2000 and 2009, apart from
Luxembourg, Ireland, Israel, Portugal and Greece (Figure 5.8.3). Mexico has experienced a sharp decrease in cervical cancer
mortality from 14.5 per 100 000 females to 9.6, although it still has the highest rate
among OECD countries.
Definition and comparability
Screening rates for cervical
cancer reflect the proportion of women who are eligible for a screening test and
actually receive the test. As policies regarding screening periodicity and target
population differ across countries, the rates are based on each country's specific
policy. An important consideration is that some countries ascertain screening based on
surveys and other based on encounter data, which may influence the results.
Survey-based results may be affected by recall bias. If a country has an organised
screening programme, but women receive care outside the programme, rates may be
underreported.
Relative cancer survival rates
reflect the proportion of patients with a certain type of cancer who are still alive
after a specified time period (commonly five years) compared to those still alive in
absence of the disease. Relative survival rates capture the excess mortality that can
be attributed to the diagnosis. For example, a relative survival rate of 80% does not
mean that 80% of the cancer patients are still alive after five years, but that 80% of
the patients that were expected to be alive after five years, given their age at
diagnosis and sex, are in fact still alive. All the survival rates presented here have
been age-standardised using the International Cancer Survival Standard (ICSS)
population. The survival rates are not adjusted for tumour stage at diagnosis,
hampering assessment of the relative impact of early detection and better
treatment.
See Indicator 1.4
"Mortality from cancer" for definition, source and
methodology underlying the cancer mortality rates.
Information on data for Israel:
http://dx.doi.org/10.1787/888932315602.
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| Indicator in PDF |
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| 5.8.1 Cervical cancer screening, percentage women screened
aged 20-69, 2000 to 2009 (or nearest year) |
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| 5.8.2 Cervical cancer five-year relative survival rate,
1997-2002 and 2004-09 (or nearest period) |
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| 5.8.3 Cervical cancer mortality, females, 2000 to 2009 (or
nearest year) |
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