Trends of cervical cancer mortality in the member states of the European Union

Background: Cervical cancer mortality can be avoided to a large extent by screening and treatment of screen-detected cervical lesions. However, in 2004, more than 16,000 women died from cervical cancer in the European Union (EU). In the current paper, we analyse cervical cancer mortality trends in the 27 member states since 1970 and, subsequently, try to explain how screening and other factors have driven changes. Methods: Data on number of deaths from uterine cancers and overall female populations from EU member states were extracted from the World Health Organisation mortality database. Three different reallocation rules were applied to correct cervical cancer mortality for inaccuracies in certification of cause of death of not otherwise specified uterine cancer. Joinpoint regression was used to study annual variation of corrected cervical cancer mortality in all member states. We distinguished the 15 old from the 12 new member states, which acceded to the EU in 2004 or later. For Finland, France and Romania, age-specific trends by calendar period and the standardised cohort mortality ratios by birth cohort were analysed. Results: Corrected age-standardised cervical cancer mortality rates have decreased significantly over the past decades in the old member states. Member states in Eastern Europe and also the Baltic states showed mortality rates that decreased at a lower intensity (Czech Republic, Poland), remained constant at a high rate (Estonia, Slovakia) or even increased (Bulgaria, Latvia, Lithuania, Romania). The standardised cohort mortality ratio indicated that mortality does not decrease further or even increase among women born after 1940. Conclusion: Remarkable contrasts were observed on cervical cancer mortality, in particular, between the old and new member states of the EU, which might probably be explained by differences in preventive strategies. This contrast might increase in the future, unless adequate preventive measures are adopted. (C) 2009 Elsevier Ltd. All rights reserved.