Abstract

Background. Cervical cancer is the third most common cancer among women in the world. Human papillomavirus (HPV) is a necessary but not suffi cient cause of cervical cancer. There are over 100 diff erent HPV types, 13 HPV types are associated with cervical cancer and HPV 16 and 18 are recognised as the most oncogenic HPV types. Since the 1960s the Papanicolau smear has been used to diagnoose cervical pre-invasive changes. In 2003–2006, Estonia launched a national cervical cancer screening programme. Since 2008, the vaccine against HPV types 6, 11, 16 and 18 has been available. In Estonia, however, HPV vaccination coverage is negligible.

Aim. To estimate cervical cancer incidence in Estonia during 1998 to 2008 by age and morphology.

Methods. We selected from the Estonian Cancer Registry all cervical cancer patients diagnosed between 1998 and 2008. According to the morphology codes, the cases were divided into squamous cell carcinomas (SCC), adenocarcinomas (AC) and others. Annual standardized incidence rates and incidence rates (IR/105) by age-groups (20–29, 30–39, 40–49, 50–59, 60–69, 70+) and morphology were estimated. Changes in the incidence were analysed using annual percentage change (APC).

Results. In total, there were 1826 cervical cancer cases: 1555 SCC, 116 AC and 155 others. The mean age of cervical cancer patients was 54.3 years. Age-standardized IR/105 of cervical cancer and cervical SCC ranged between 14.8– 20.6 and 12.7–17.9, respectively. AC incidence doubled during the study period. The highest IR/105 of SCC was observed in the age-group 40–49 years, varying between 29.1 and 45.7. The highest IR/105 of AC was observed among women over 50 years of age. During the study period, we observed statistically significant annual increase of 2.2% for SCC (95% CI 0.8–3.6) and 8.0 % for AC (95% CI 4.9–12.3).

Conclusion. Cervical cancer incidence rates in Estonia are increasing, despite the cervical cancer screening and the possibility to vaccinate against HPV.