Article Figures & Data
Figures
- Figure 1.
Cervical SCC incidence trends, Slovakia 1968-1997, with age reference type I (dashed line), type II (dotted), and type I/II (solid) imposed. Age is on a rate scale. Reference points for period and cohort rate ratios are marked.
- Figure 2.
Regular trend over the whole study period and in the last two periods: cervical SCC incidence in 13 European countries for women ages 30-64, sorted by magnitude of overall trend, expressed as the mean annual percentage change.
- Figure 3.
Cervical SCC incidence trends in 13 European countries for women ages 30-64: (A) northern European countries, (B) eastern European countries, (C) southern European countries, and (D) western European countries. Age is on a rate per 100,000 scale. Reference points for period and cohort rate ratios are marked.
- Figure 4.
Scatterplot comparison of the net drift and the contribution of the period slope alone. Both are generated from the full APC model and expressed as the mean annual percentage change in cervical SCC incidence in each country.
Tables
- Table 1
Populations included in the analysis (A-E), estimated percentage change in the regular trend (F-G), model characteristics (H-L), and summary of the identifiable attributes of the period and cohort trends (M-N) by country
A B C D E F G H I J K L M N European area Country Period* Incidence† Person-years†,‡ Overall trend [%§ (95% CI)] Recent trend [%∥ (95% CI)] APC model¶ Residual deviance** df** P** Reference type†† Direction (midyear) period trend‡‡ Direction (midyear) cohort trend§§ Northern Denmark 1979-1998 (4) 225 1,216,706 −2.4 (−2.8 to −2.0) −3.3 (−4.6 to −1.9) APC 12.7 10 0.24 I − (*) + (1949) Estonia 1971-2000 (6) 99 337,550 −0.6 (−1.0 to −0.2) 2.8 (0.0 to 5.8) AC 34.6 24 0.07 II 0 (*) + (1936) Finland 1955-1999 (9) 65 1,225,829 −4.7 (−4.8 to −4.5) 8.2 (3.8 to 13.4) APC 78.2 35 <0.05 I − (1967) + (1945) Norway 1953-1997 (9) 185 933,595 −1.1 (−1.2 to −0.9) −1.2 (−2.9 to 0.6) APC 69.3 35 <0.05 I − (1975) 0 (1943) Sweden‡ 1964-1998 (7) 215 1,943,275 −4.2 (−4.3 to −4.0) −0.8 (−2.3 to 0.9) APC 71.4 25 <0.05 I − (*) 0 (1934), 0 (1954) United Kingdom∥ 1978-1997 (4) 1360 11,982,152 −2.3 (−2.5 to −2.2) −5.6 (−6.0 to −5.1) APC 51.2 10 <0.05 I − (1985) + (1933) Eastern Czech Republic 1985-1999 (3) 651 2,366,652 −0.6 (−1.1 to −0.2) −2.0 (−2.8 to −1.1) APC 9.5 5 0.09 I 0 (*) 0 (1945) Slovakia 1968-1997 (6) 384 1,180,261 1.5 (1.2 to 1.8) 1.1 (−0.2 to 2.6) APC 38.9 20 <0.05 I/II − (1985) + (1938) Southern Italy∥∥ 1983-1997 (3) 119 1,118,959 −1.4 (−2.5 to −0.2) −0.8 (−2.9 to 1.7) AD 14.5 13 0.34 I/II − (*) + (1948) Slovenia 1985-1999 (3) 126 475,358 3.5 (2.1 to 5.0) 5.3 (2.5 to 8.5) AC 5.4 6 0.49 I/II 0 (*) + (1940) Spain¶¶ 1983-1997 (3) 72 692,076 0.7 (−0.8 to 2.4) 1.0 (−1.8 to 4.2) AC 9.0 6 0.18 II 0 (*) + (1938) Western Francea 1978-1997 (4) 115 896,132 −4.2 (−4.8 to −3.7) −3.8 (−5.5 to −1.9) APC 24.1 10 <0.05 I − (*) 0 (1938) Switzerlandb 1983-1997 (3) 73 702,021 −3.7 (−4.8 to −2.5) −0.5 (−3.1 to 2.4) AP 20.5 12 0.06 I − (*) 0 (1948) ↵* Data available according to period of diagnosis; figure in parentheses represent number of 5-year periods available in the analysis.
↵† Average annual number of cases/person-years obtained from most recent 5-year period.
↵‡ Aggregation of England and Scotland.
↵§ Estimated annual percentage change based on the trend variable from the net drift for the whole study period (95% CI).
↵∥ Estimated annual percentage change based on the most recent two 5-year periods (95% CI).
↵¶ Refers to the most parsimonious final model providing a good fit: AD: age + drift; AC: age + drift + cohort; AP: age + drift + period; APC: age + drift + period + cohort.
↵** To determine the goodness-of-fit, the deviance was compared with the 2 distribution on the df determined by the model (see Appendix 1). P < 0.05 denotes that the full APC model does not yield an adequate fit.
↵†† Age curve of reference type used (see Materials and Methods).
↵‡‡ Estimated direction of trends by period of diagnosis (+, positive trends; −, negative trend; 0, stable trend or difficult to interpret). Major changes in the direction noted in parentheses as the midyear of the 5-year period (* denotes change throughout study period).
↵§§ Estimated direction of trends by birth cohort (−, negative trend; 0, stable trend or difficult to interpret). Major changes in the direction noted in parentheses as the midyear of the 10-year birth cohort.
↵∥∥ Aggregation of Florence, Varese Province, Parma Province, Ragusa Province, and Turin.
↵¶¶ Aggregation of Catalonia, Tarragona; Granada, Murcia, Navarra, and Zaragoza.
↵a Aggregation of Bas-Rhin, Calvados, Doubs, Isère, Somme, and Tarn.
↵b Aggregation of Basel, Geneva, Neuchatel, St. Gall-Appenzell, Vaud, Zurich.
- Table 2
Overview of screening policy in countries and regions where cervical SCC incidence trends are presented: reported year of onset, age range targeted, and recommended screening interval
European area Incidence population Year of onset of organized screening program, type of screening system, and area covered Age range targeted (year program began) Recommended screening interval with normal result (y) Northern Denmark 1967 (achieved national coverage recently) 23-59 (1986) 3 (some counties 5 y in >45 or 50) Estonia No screening program No screening program No screening program Finland 1963 (national coverage) 30-60 (1993) 5 Norway 1995, pilot 1992 (program in one county 1959-1977) 25-69 (1992) 3 Sweden 1967-1973 in different counties, Gothenburg 1977 23-60 (1999) 3 in ages 23-50; 5 in ages 51-60 United Kingdom 1988 (national coverage) 20-64 (1988, reviewed 2003) 3-5 (currently 3 in ages 25-49 and 5 in ages 50-64) Eastern Czech Republic Opportunistic since 1966 (screening in two districts, beginning 2004) Not specified (1966) 1 Slovakia — (intention to initiate program) 25-64 (—) 3 Southern Italy Florence (1985) 25-60 (1985); (25-64 from 1995) 3 Parma (1998) 25-64 (1998) 3 Ragusa (no data) 25-64 (no data) 3 Turin (1992) 25-64 (1992) 3 Varese (no data) 25-64 (no data) Slovenia Opportunistic until 2003 20-64 (2003) 3 Spain Catalonia (opportunistic until 1993) 20-64 (1993) 3-5: initially 2 smears 1 y apart and then 3 y in ages 20-34 and 5 y in ages 35-64 Western France Bas-Rhin (1994) 25-65 (1990) 3 Doubs (1993) 20-64 (1993) 3 (after 2 normal exams with 1-y interval) Isére (1990) 50-69 (1990) 3 Switzerland Opportunistic (no data) 18-69 (no data) 3 NOTE: Adapted from the European Cervical Cancer Screening Network questionnaire survey (5).
Volume 14, Issue 3
