Cervical cancer mortality trends in England and Poland

Introduction:
Age-standardised cervical cancer death rates in both Poland and England have been decreasing for many years, but without looking at rates within birth cohorts it is not clear whether these decreases are due to falling HPV rates or effective screening.

Material and methods:
We compare the death rates within birth cohorts in both countries and reflect on the probable reasons behind these apparently parallel trends.

Results:
Birth cohort analysis shows that the cervical cancer death-rate fell sharply in England after the introduction of the national screening programme in 1988. Before 1988 the rate had been rising rapidly in young women presumably due to rising prevalence of HPV, and without screening Britain would have had one of the highest rates of cervical cancer in the world. Mortality is lower in Poland than in England below age 35 due to lower HPV infection rates in young women but continues to rise steeply with age and is higher than in England above age 40, suggesting that screening has had much less impact on Polish mortality rates. In English women born since 1995 cervical cancer has now become very rare due to the highly successful school-based HPV vaccination programme which began in 2008, but vaccination coverage in Polish girls is estimated to be less than 15%.

Conclusions:
The key to reducing mortality from cervical cancer in Poland is achieving high coverage for HPV vaccination in teenagers and for screening in unvaccinated women. Even a single sensitive HPV test has the potential to rapidly reduce the high mortality rate among older Polish women.