Risk of cervical cancer may dramatically increase in older women, study states

According to a new study published in The Lancet Public Health, the incidence of cervical cancer in older women may drastically increase; however, it is expected to reduce by 75% in young women by 2040. Women between the age group of 50–64 will suffer a 62% increase in incidence, leading to a rise in mortality by 143% (183 in 2015 to 449 in 2040).

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Scientists at Queen Mary University, London, have developed a new model in order to explore the incidence of cervical cancer in England up to 2040, which included the effects of changing cervical screening coverage, and introduction of both HPV primary screening and the 9-valent human papillomavirus (HPV) vaccine.

According to the model, cervical cancer will shift dramatically by 2040 from its status as the most common cancer in women under 35 in the UK, given the burden of the disease moving to older women. The eradication of the cancer among younger women, born after 1991, who have benefited from the HPV vaccination program in 2008, is firmly on the horizon.

The study findings predicted a 50% increase of incidence in women 50–54 years old, 54% increase in 60-64 year olds, and 109% mortality in women 60–64 years old. For 25-44 year olds, more effective vaccination and screening test could result in a greater than 50% incidence reduction.

Screening attendance has gradually decreased every year, with a 3.4% drop in England since 2012. The incidence and mortality among 60–64 year olds would increase by 71% and 128% respectively, if the screening attendance were to decrease to 66% from the current value of 72%.

The study findings also highlighted the significance of vaccination uptake, which would show an increase in incidence of 38% in women 25–44 years old, if the uptake were to drop to 40%.

We used a novel method to estimate cervical cancer incidence rates up to 2040. It combines three levels of modelling making it very flexible. In contrast to a microsimulation model, our model can take into account how year of birth affects risk of cervical cancer throughout a woman's life.

In addition, the model is flexible in that we can change the screening coverage, the screening test and the vaccine type and observe their effect on cancer incidence. This study shows how the age-specific incidence of cervical cancer will change over the next 20 years. Women currently aged between 25 and 40 will remain at high risk of cervical cancer throughout their lives, whilst women younger than 25 will see their risk decrease by around 50%. This has implications for the way we invest in and target screening."

Dr Alejandra Castanon, Queen Mary University

Scientists want the study to be considered a wake-up call , and to stress the need for action. It underlines the importance of primary HPV screening in reducing risk of the disease among women born before 1991.

They also warn that delays in rolling it out will only worsen the burden of disease among this age group, and expanding screening coverage continues to be a critical challenge and priority.

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