Background: Cervical cancer incidence has decreased over time in England particularly after the introduction of organized screening. In Portugal, where opportunistic screening has been widely available with only slightly lower coverage than that of the organized programme in England, rates of cervical cancer have been higher than in England. We compared the burden of cervical cancer, risk factors and preventive interventions over time in both countries, to identify elements hindering the further decline in incidence and mortality in Portugal. Methods: We used joinpoint regression to identify significant changes in rate time-trends. We also analyzed individual-level Portuguese data on sexual behaviour and human papillomavirus prevalence, and recent aggregate data on organized and opportunistic screening coverage. We compared published estimates of survival, risk factors and historical screening coverage for both countries. Results: Despite stable incidence, cervical cancer mortality has declined in both countries in the last decade. The burden has been 4 cases and 1 death per 100 000 women annually higher in Portugal than in England. Differences in human papillomavirus prevalence and risk factors for infection and disease progression do not explain the difference found in cervical cancer incidence. Significant mortality declines in both countries followed the introduction of different screening policies, although England showed a greater decline than Portugal over nearly 2 decades after centralizing organized screening. Conclusion: The higher rates of cervical cancer in Portugal compared to England can be explained by differences in screening quality and coverage.
Bibliographical noteFunding Information:
DM was funded by the Foundation for Science and Technology (individual PhD studentship SFRH/BD/84974/2012) on behalf of the Portuguese Ministry of Education and Science and the Human Potential Operational Programme of the National Strategic Reference Framework, within the European Social Fund of the European Commission’s 7th Framework Programme. MJ was part funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunization at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE) (grant HPRU-2012-10096). The views expressed are those of the authors and not necessarily those of the NHS (England), the NIHR, the Department of Health (England), Public Health England or NIH Portugal.