UK Cervical Cancer incidence statistics

This section presents cervical cancer statistics and information regarding pre-invasive lesions, invasive cervical carcinomas, age and stage, trends, cervical cancer worldwide and histology The ICD code for cervical cancer is ICD9 180 and ICD10 C53.

Pre-invasive lesions and cervical cancer

It is widely accepted that invasive carcinoma of the cervix is preceded by pre- malignant lesions which are benign. There are three systems used to classify these cervical abnormalities 1.

1. The World Health Organisation classifies cervical dysplasia as mild, moderate, or severe as well as a separate category for carcinoma in situ (CIS).
2. The term Cervical intraepithelial neoplasia (CIN) (CIN) was introduced by Richart: CIN1 represents mild to moderate dysplasia; CIN2 is an intermediate grade; and CIN3, severe dysplasia or CIS.
3. In the Bethesda system a low-grade squamous intraepithelial lesion (LSIL) corresponds to CIN1 and a high grade SIL (HSIL) encompasses both CIN2 and CIN3.

For statistical registration purposes, since 1984 the International Classification of Diseases code for carcinoma in situ of the cervix uteri includes CIN3 with or without mention of severe dysplasia (the International Classification of Diseases tenth revision (ICD10) code for carcinoma in situ of the cervix is D06). Virtually all cases of CIN are detected through smear tests.

In 2003 there were 24,105 new registrations of carcinoma in situ of the cervix uteri in the UK 2-,5. Most (22,033) (91%) cases are registered in women under 45, with peak incidence in the 25-29 age group.

Invasive carcinoma of the cervix

In 2006, 2,873 new cases of cervical cancer were diagnosed in the UK, making it the twelfth most common cancer in women and accounting for around 2% of all female cancers. ( Table 1.1). It has been estimated that the lifetime risk of a female of developing cervical cancer cancer is 1 in 136 in the UK. This was calculated on February 2009 using incidence and mortality data for 2001-2005. 14

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In 2006, the age-standardised (European) annual incidence rate of cervical cancer in the UK is 8.5 per 100,000 females. Cervical cancer is the second most common cancer after breast cancer in the under 35s females, with 686 new cases diagnosed in the UK in 2006.

Cervical cancer incidence by age and stage

In contrast to carcinoma in situ, the occurrence of invasive cervical cancer is fairly evenly spread across age groups over 25 (see Figure 1.1). Incidence rate for cervical cancer is highest for those aged 30-40 reaching around 17 per 100,000 women. Although rates decrease for the following age-groups, a similar peak is reached at the early 80s.

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Both peaks reflect a cohort effect: women born in the 1920s are known to have high rates of invasive carcinoma of the cervix throughout their lives. Data for 1979 incidence show a peak for women in their late fifties to late sixties. This effect is explained more fully in the mortality section.

Cervical cancer is divided into stages:

• Stage 1 is often divided into 1a and 1b and means the cancer remains within the cervix
• In Stage 2 the cancer has begun to spread around the cervix into the surrounding tissues, this stage can also be divided into 2a and 2b
• In Stage 3 the cancer has spread into the pelvis
• By Stage 4 the cancer is advanced and has spread into other body organs

The West Midlands Cancer Intelligence Unit 6 has information on stage for over 80% of its cervical cancer registrations - between 1991 and 1995 the Unit recorded the distribution of cervical cancer by stage and age for 1,898 tumours.

Stage 1 accounts for nearly two thirds of the staged tumours. The stage breakdown varies across the age groups, with older women being diagnosed with progressively later stage disease. Cervical cancer survival rates vary with stage at diagnosis.

Further analyses of the cervical cancer cases with an unknown stage demonstrate that, although older women have a larger proportion of cases with an unknown stage compared to younger women, a similar association between age and stage also exists in women where the stage is not known, e.g. younger women with unknown stage have good cervical cancer survival (indicating early stage disease) while older women with an unknown stage have poor survival (indicating late stage disease).

Cervical cancer incidence trends

Since the late 1980s there has been an increase in the incidence rates of carcinoma in situ for women in England and Wales under 30. For women aged 30-34 there has been an increase since 1992, but there have been no apparent increases for women over 34 7,8.

Incidence rates of invasive cervical cancer, in contrast, have generally shown a downward trend since 1990. 2,4,9. The Great Britain age-standardised (European) incidence rate for cervical cancer has decreased by around 44% since 1975, although it presented a slight increase in the 1980s.(see Figure 1.2).

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The slight increase in the overall cervical cancer incidence rate in the 1980s hides the varying incidence trends for different age groups

In those aged 35-44 incidence rates peaked in the mid 1980’s and have since declined, returning to similar rates seen in the mid 1970’s. Incidence rates in women aged 25-34 also declined since the mid 1980’s but remain elevated relative to the rates of the mid 1970’s.

In women aged 45+ incidence rates have declined significantly since the mid 1970’s. The most significant decline is found in women in their sixties. In comparison to the other age groups, incidence rates for women under 25 have remained largely stable.

In the UK the age-standardised (European) incidence rate for cervical cancer has decreased by 16% since 1997 ( Figure 1.3).

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Cervical cancer incidence worldwide

One in ten female cancers diagnosed worldwide are cancers of the cervix and it is the most commonly diagnosed cancer among women in Southern Africa and Central America. There is a seven-fold variation in the incidence of cervical cancer between the different regions of the world ( Figure 1.413).

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Human papillomavirus (HPV) is the most important cause of cervical cancer and much of the international variation in rates of cervical cancer may relate to population prevalence of HPV and other co-factors that modify the risk in women infected with HPV such as the Pill and smoking. Cervical cancer incidence and mortality rates have declined substantially in Western countries with screening programmes, such as the UK where incidence rates rank 141st of the 172 countries worldwide and the mortality rate ranks 148th.

Histology of cervical cancer

Around two thirds of cervical cancers are squamous cell carcinoma (SCC). Adenocarcinoma is the next most common histology (around 15%); a further 15% are poorly specified carcinomas 7.

One study 10,11 reported an increase in adenocarcinoma and a downward trend in SCC in many countries worldwide. It is possible that some of this increase is due to increased awareness and referrals for diagnosis of abnormal glandular cells of unknown significance.

Analysis of Swedish data has shown that the early age peak of cervical cancer incidence at 35-39 years is apparent for both SCC and adenocarcinoma, but different birth cohort trends have been observed for the two histologies 12.

UK Cervical Cancer mortality statistics

This page presents cervical cancer mortality statistics including by age, trends over time and cervical cancer mortality worldwide.

Overall cervical cancer mortality in the UK

In 2007, there were 941 deaths from cervical cancer in the UK 1-,4 giving a European age-standardised death rate of 2.4 per 100,000 females and a crude rate of 3.0 per 100,000 (see Table 2.1).

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Cervical cancer mortality by age

Cervical cancer mortality rates generally increase with age, with the highest number of deaths occurring in women in their late seventies (see Figure 2.1). Only about 7% of cervical cancer deaths occur in women under 35.

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Cervical cancer mortality trends

Cervical cancer mortality rates in 2007 (2.4 per 100,000 females) are nearly 70% lower than they were 30 years earlier (7.4 per 100,000 females in 1977)( Figure 2.2).

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A more detailed look at the cervical cancer age-specific trends over a longer time period shows a more complex pattern (see Figure 2.3).

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The differing cervical cancer mortality trends by age can be explained by birth cohort analysis rather than analysis by year of death. A birth cohort effect is evident when a cohort experiences different disease patterns compared to people born immediately earlier or later than the cohort.

For example, for women born at the end of the nineteenth century and around 1920 cervical cancer mortality was higher throughout their lives than for previous and subsequent birth cohorts. These two cohorts of women (with increased risk) would have become sexually active around the times of World War I and World War II.

For birth cohorts after the mid 1920s until the mid 1940s the cervical cancer death rates are lower. The increased risk in women born after the mid 1940s is consistent with the changing sexual behaviour since the 1960s. In the second half of the twentieth century the death rate from cervical cancer for women aged 55-64 dropped by nearly 80% from 30.0 per 100,000 in 1950-52 to 6.2 per 100,000 in 1998-2000 (see Table 2.2).

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For all age groups some of this fall in cervical cancer mortality is due to increased screening activity. A combined European study of cervix and corpus uteri cancer mortality found that the decline seen in the UK is common to most western European countries. This was also believed to be partly the effect of screening programmes. However, in Spain the mortality of cervical cancer in young women appears to be increasing.The authors believe this is due to a cohort effect and that the trend will not reverse until more women at risk participate in the country’s screening programmes.

Another study found that there had been a rise in cervical cancer mortality for women aged 20-44 in Ireland since the early 1980s.There had also been some increases in mortality in some of the eastern European countries notably Romania and Bulgaria. 5

Cervical cancer mortality worldwide

Worldwide there are more than 273,000 deaths from cervical cancer each year and it accounts for 9% of female cancer deaths. Mortality rates vary seventeen fold between the different regions of the world 6.

Cervical cancer contributes over 2.7 million years of life lost among women between the ages of 25 and 64 worldwide, some 2.4 million of which occur in developing areas and only 0.3 million in developed countries 6.

Cervical Cancer survival statistics

This page presents cervical cancer survival statistics, including one year, five year and ten year survival statistics and survival by age at diagnosis.

Cervical cancer - one year survival rates

Figure 3.1 shows the one-year age-standardised survival rates for women diagnosed with cervical cancer from 1971-1999.

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Cervical cancer - five year survival rates

Five-year survival rates for cervical cancer patients are shown in Figure 3.2

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Cervical cancer - ten year survival rates

Figure 3.3 shows the ten year survival rates for women diagnosed with cervical cancer.

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Cervical cancer survival rates by age at diagnosis

Cervical cancer survival rates, by age at diagnosis, are shown in Figure 3.4.

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Cervical Cancer Risk Factors

This page presents risk factors for cervical cancer including, human papillomavirus, smoking, socioeconomic status and other factors.

Human papillomavirus (HPV) and cervical cancer risk

Members of the HPV family have been detected in cervical tumours worldwide with studies showing the presence of HPV in virtually all cervical tumours tested 1.

The highest risks are associated with HPV types 16 and 18. Most HPV infections will not progress to cervical intraepithelial neoplasia (CIN) . However, it is believed that cervical cancer will not develop without the presence of persistent HPV DNA and it has been proposed as the first ever identified “necessary cause” of a human cancer 2.

Genital HPV is generally sexually transmitted through contact with infected cervical, vaginal, vulvar, penile or anal epithelium. Genital HPV infection may involve areas that are not easily covered by a condom so correct condom use may not protect against infection.

An analysis of studies on the prevalence of HPV infection in the population led to the conclusions that HPV is more common in younger women than older women, that HPV is rarely detected in women with no previous sexual activity and that there are no apparent geographical differences in HPV prevalence.

The percentage of the study populations who were HPV positive varied from 0% to 48% depending on the group studied. Results also show that HPV 16 infection is more common than any other classified type of HPV 3. Risk factors for HPV infection include number of sexual partners, a relatively recent new sexual relationship and a history of previous miscarriage 4.

A study has shown that the main risk factors for CIN 3 among HPV positive women are early age at first intercourse, long duration of the most recent sexual relationship and cigarette smoking. 4

For cigarette smoking there is a strong dose-response relationship. The risk of CIN 3 for women who were HPV positive and smoking 20 or more cigarettes a day was two and a half times that of women who had never smoked. The authors concluded that even though smoking was not a risk factor for HPV, smoking acted with HPV to cause cervical neoplasia (see also Smoking section below).

Suggested co-factors for cervical cancer include age at first intercourse, number of life-time partners, co-infection with herpes simplex virus-2 or chlamydia trachomatis, parity, age at first birth, oral contraceptive use and family history 5,9,25-28. A lower risk has been shown in partners of men who have been circumcised. 29

Smoking and cervical cancer risk

Cigarette smoking has been linked to inactivation in cervical tumours of the fragile histidine triad 6 putative tumour suppressor gene (which is also altered in most tobacco-associated lung cancers).

Smoking may also be associated with a decrease in the number of Langerhans’ immune cells in the cervix epithelium, suggesting a decrease in epithelial cell-mediated immune responses in smokers 7, 8.

A meta-analysis showed that risk of squamous cell cervical cancer was increased by almost 50% in current smokers, although there was no risk increase for adenocarcinomas. 9

Reduction in early cervical lesion size in women who gave up smoking after diagnosis has been reported 10. Also smokers have been found to have a 3-fold increased risk of treatment failure of CIN compared to non-smokers and therefore require more intensive follow-up after treatment 11.

Socio-economic status and cervical cancer risk

In England and Wales 12, incidence and mortality from cervical cancer has been analysed by to Carstairs deprivation category ( Figure 4.1).

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Women living in the most deprived areas have rates more than three times as high as those in the least deprived areas. A strong positive association between cervical cancer and deprivation has also been described for incidence data from Scotland 13.

In addition a link has been demonstrated between social class and cervical cancer. Data from a longitudinal study, representing 1% of the England and Wales population, indicates that cervical cancer incidence is considerably higher among women of working age in manual than in non-manual classes 14.

Other cervical cancer risk factors

As with smoking, the association between oral contraceptive (OC) use and cervical cancer is complicated by possible confounding with sexual behaviour 15. A meta-analysis 9 found risk of both types of cervical cancer was doubled in women using OCs for 10 or more years. There were smaller risk increases for shorter durations of use.

The risk increase is temporary and returns to the level of non-users after 10 years. 17

Other studies 20, 21 have investigated the use of hormone replacement therapy and cervical cancer, but there are no clear conclusions.

A recent meta-analysis showed that women with HIV/AIDS have a six-fold increased risk of cervical cancer and women who have undergone organ transplant have more than double the risk, strongly suggesting that immunosuppression plays a role. 22

Cervical Screening in the UK

This page presents statistics from the NHS cervical screening programme.

Summary statistics from the Cervical Screening Programme in England - 2007-08

• Around 4.3 million women of all ages were invited for screening.
• Around 3.2 million women in the target age-range (25-64) were screened, 2.6 million of these were screened following an invitation to the screening programme.
• Of the 3.2 million women aged 25-64 who were screened and had a result, around 93% were negative.
• Laboratories examined 3.6 million samples.
• Cervical screening can prevent around 75% of cancer cases in women who attend regularly.

One way of examining the effectiveness of the screening programme is to look at the coverage* rate.

In England the proportion of eligible women attending cervical smear tests has improved from just above 40% in 1989 to 82% in 1995. In 2007-08 the coverage rate was 78.6%.

The target age-group and frequency of invite for each country of the UK is shown in ( Table 1.1).

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*The coverage rate is the proportion of resident eligible women who have had a test with a recorded result at least once in the previous 5 years e.g the number of women screened divided by the number of resident eligible population

You can download the full report from the NHS Cervical Screening programme.

In this section you can read about:

• a brief history of the cervical screening programme
• results from the cervical screening programmes in the UK

More information about cervical screening

Find out more about how cervical screening is performed and why it is important.

Our patient information website answers your questions about cervical screening.

Further cervical screening programme statistics can be found on the NHS Cervical Screening Programme website.