Cervical cancer screening
Women between the ages of 30-60 years are invited by personal letter to take part in cervical cancer screening every five years. Some municipalities also invite women aged 25 and 65 for screening.
About 70% of those invited participate in the screening. A follow-up text, or cervical scan, is given to about 1% of the participants. Additionally, about 5% are invited for a re-check before the next screening invitation (1.). One of the three women who regularly participate in screening has an abnormal screening finding at lease once requiring follow-up (2.).
Cervical Cancer Screening detects cancer precursors in addition to the actual cancer. Over 600 precursors and early stage cancers are found in the screening programme a year. These can all be cured. It has been estimated that screening avoids more than 250 cancer deaths each year (3. Hristova et al., 1997).
Screening for over 60-year-olds also reduces the incidence of cervical cancer and mortality caused by it (4.). For this reason, we are also considering extending the screening programme to over 60s.
Cervical cancer has become less common thanks to screening. The rate of new cancers found annually in the population and the deaths resulting from them have decreased to a fifth of that of the 1960s (Figure). At present, about 160 new cases of cervical cancer are diagnosed in Finland each year, and about 55 women die of cervical cancer annually.
Incidence of cervical cancer by age group in 1961, 1991 and 2013. Screening was started in 1963 and extended to the country as a whole in the early 1970s.
SCREENING TESTS FREQUENTLY USED
The customary cervical screening test used in Finland has been the so-called Pap test, where a cell sample taken from the neck of the uterus is studied using a light microscope. Along with the Pap test, the HPV test is also suitable for cervical cancer screening for women over the age of 35 (5. ). The HPV test uses a cell sample from the cervix of the uterus to detect the DNA of the human papilloma virus (HPV). The aim is to detect so-called high-risk types of HPV, such as HPV 16 and 18.
Both HPV and Pap samples are taken from participants in HPV screening. Following a positive HPV test, the Pap sample is also analysed, after which further measures are taken.
The screening HPV test must meet the requirements of the IARC and WHO. Before being put into use, the validity of new HPV tests must always be verified by comparing them with the most studied HC2 or PCR GP5 + / 6 + tests Current Care Guidelines.
HPV VACCINATION PROGRAMME
In 2013 HPV vaccine for preventing human papilloma viral infections was started as part of the national vaccine programme (6.) . HPV vaccination is given to girls aged 11 to 12 through school health care. The goal of the vaccine programme is to reduce the prevalence of HPV viruses and the prevalence of illnesses related to them in the female population. So far, the vaccination programme has not reduced the need for screening for cervical cancer prevention.
Pankakoski M, Heinävaara S, Sarkeala T, Anttila A. High lifetime probability of screen-detected cervical abnormalities. J Med Screen 2017; Jan 1:969141316685740. doi: 10.1177/0969141316685740
Hristova L, Hakama M. Effect of screening for cancer in the Nordic countries on deaths, costs and quality of life up to the year 2017. Acta Oncologica 1997; 36 (Suppl 9): 1–60.
Lönnberg S, Anttila A, Luostarinen T, Nieminen P. Age-specific effectiveness of the Finnish cervical cancer screening programme. Cancer Epidemiol Biomarkers Prev 2012; 21: 1354–61.
Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, Wiener H, Herbert A, von Karsa L. European guidelines for quality assurance in cervical cancer screening. Second edition – summary document. Ann Oncol. 2010; 21: 448–58.