Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2022

Open Access 01-12-2022 | Vulvar Cancer | Research

Cervical, vaginal and vulvar cancer incidence and survival trends in Denmark, Finland, Norway and Sweden with implications to treatment

Authors: Kari Hemminki, Anna Kanerva, Asta Försti, Akseli Hemminki

Published in: BMC Cancer | Issue 1/2022

Login to get access

Abstract

Background

Incidence of cervical cancer has been reduced by organized screening while for vaginal and vulvar cancers no systematic screening has been implemented. All these cancers are associated with human papilloma virus (HPV) infection. We wanted to analyze incidence trends and relative survival in these cancers with specific questions about the possible covariation of incidence, survival changes coinciding with incidence changes and the role of treatment in survival. We used nationwide cancer registry data for Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE) to address these questions.

Methods

We use the NORDCAN database for the analyses: incidence data were available from 1943 in DK, 1953 in FI and NO and 1960 in SE, through 2016. Survival data were available from 1967 through 2016. World standard population was used in age standardization.

Results

In each country the incidence of cervical cancer declined subsequent to rolling out of screening activities. The attained plateau incidence was lowest at 4/100,000 in FI and highest at 10/100,000 in DK and NO. The incidence of vaginal and vulvar cancer remained relatively constant at about 2/100,000. Relative 1-year survival in cervical cancer improved in all countries from low 80%s to high 80%s in the 50-year period, and 5-year survival improved also but at 20% units lower level. Survival gains were found only in patients diagnosed before age 60 years. Survival in vaginal and vulvar cancer followed the same patterns but at a few % units lower level.

Conclusion

Cervical cancer screening appeared to have reached its limits in the Nordic countries by year 2000. Novel treatments, such as immunotherapy, would be needed to improve survival until HPV vaccination will reach population coverage and boost the global fight against these cancers.
Literature
1.
Serrano B, Brotons M, Bosch FX, Bruni L. Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol. 2018;47:14–26.PubMedCrossRef
2.
Bray F, Laversanne M, Weiderpass E, Arbyn M. Geographic and temporal variations in the incidence of vulvar and vaginal cancers. Int J Cancer. 2020;147(10):2764–71.PubMedCrossRef
3.
Preti M, Rotondo JC, Holzinger D, Micheletti L, Gallio N, McKay-Chopin S, et al. Role of human papillomavirus infection in the etiology of vulvar cancer in Italian women. Infect Agent Cancer. 2020;15:20.PubMedPubMedCentralCrossRef
4.
Vaccarella S, Franceschi S, Engholm G, Lönnberg S, Khan S, Bray F. 50 years of screening in the Nordic countries: quantifying the effects on cervical cancer incidence. Br J Cancer. 2014;111(5):965–9.PubMedPubMedCentralCrossRef
5.
Anttila A, Ronco G, Clifford G, Bray F, Hakama M, Arbyn M, et al. Cervical cancer screening programmes and policies in 18 European countries. Br J Cancer. 2004;91(5):935–41.PubMedPubMedCentralCrossRef
6.
Partanen VM, Anttila A, Heinävaara S, Pankakoski M, Sarkeala T, Bzhalava Z, et al. NordScreen - an interactive tool for presenting cervical cancer screening indicators in the Nordic countries. Acta Oncol. 2019;58(9):1199–204.PubMedCrossRef
7.
Klint A, Tryggvadóttir L, Bray F, Gislum M, Hakulinen T, Storm HH, et al. Trends in the survival of patients diagnosed with cancer in female genital organs in the Nordic countries 1964-2003 followed up to the end of 2006. Acta Oncol. 2010;49(5):632–43.PubMedCrossRef
8.
Pukkala E, Martinsen JI, Lynge E, Gunnarsdottir HK, Sparen P, Tryggvadottir L, et al. Occupation and cancer - follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009;48:646–790.PubMedCrossRef
9.
Sasieni P, Castanon A, Cuzick J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ. 2009;339:b2968.PubMedPubMedCentralCrossRef
10.
11.
Hemminki K, Sundquist K, Sundquist J, Försti A, Hemminki A, Li X. Familial risks and proportions describing population landscape of familial Cancer. Cancers (Basel). 2021;13(17):4385.CrossRef
12.
Hortlund M, Arroyo Muhr LS, Storm H, Engholm G, Dillner J, Bzhalava D. Cancer risks after solid organ transplantation and after long-term dialysis. Int J Cancer. 2017;140(5):1091–101.PubMedCrossRef
13.
Zhang L, Hemminki O, Zheng G, Försti A, Sundquist K, Sundquist J, et al. Comparison of familial clustering of Anogenital and skin cancers between in situ and invasive types. Sci Rep. 2019;9(1):16151.PubMedCrossRef
14.
Bao X, Hanson AL, Madeleine MM, Wang SS, Schwartz SM, Newell F, et al. HLA and KIR associations of cervical Neoplasia. J Infect Dis. 2018;218(12):2006–15.PubMedCrossRef
15.
Leo PJ, Madeleine MM, Wang S, Schwartz SM, Newell F, Pettersson-Kymmer U, et al. Defining the genetic susceptibility to cervical neoplasia-A genome-wide association study. PLoS Genet. 2017;13(8):e1006866.PubMedCrossRef
16.
Zhang L, Hemminki O, Chen T, Zheng G, Forsti A, Sundquist K, et al. Familial clustering, second primary cancers and causes of death in penile, vulvar and vaginal cancers. Sci Rep. 2019;9(1):11804.PubMedCrossRef
17.
Cibula D, Pötter R, Planchamp F, Avall-Lundqvist E, Fischerova D, Haie Meder C, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Radiother Oncol. 2018;127(3):404–16.PubMedCrossRef
18.
Bjurberg M, Holmberg E, Borgfeldt C, Flöter-Rådestad A, Dahm-Kähler P, Hjerpe E, et al. Primary treatment patterns and survival of cervical cancer in Sweden: A population-based Swedish gynecologic Cancer group study. Gynecol Oncol. 2019;155(2):229–36.PubMedCrossRef
19.
Nitecki R, Feltmate CM. Human papillomavirus and nonhuman papillomavirus pathways to vulvar squamous cell carcinoma: A review. Curr Probl Cancer. 2018;42(5):476–85.PubMedCrossRef
20.
Borella F, Preti M, Bertero L, Collemi G, Castellano I, Cassoni P, et al. Is there a place for immune checkpoint inhibitors in vulvar neoplasms? A state of the art review. Int J Mol Sci. 2020;22(1):190.CrossRef
21.
Sam A, George J, Mathew B. Less common gynecologic malignancies: an integrative review. Semin Oncol Nurs. 2019;35(2):175–81.PubMedCrossRef
22.
Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977–1010.PubMedCrossRef
23.
Pukkala E, Engholm G, Hojsgaard Schmidt LK, Storm H, Khan S, Lambe M, et al. Nordic Cancer registries - an overview of their procedures and data comparability. Acta Oncol. 2018;57:440–55.PubMedCrossRef
24.
Engholm G, Ferlay J, Christensen N, Bray F, Gjerstorff ML, Klint A, et al. NORDCAN--a Nordic tool for cancer information, planning, quality control and research. Acta Oncol. 2010;49(5):725–36.PubMedCrossRef
25.
Pedersen K, Fogelberg S, Thamsborg LH, Clements M, Nygård M, Kristiansen IS, et al. An overview of cervical cancer epidemiology and prevention in Scandinavia. Acta Obstet Gynecol Scand. 2018;97(7):795–807.PubMedCrossRef
26.
Hussain SK, Sundquist J, Hemminki K. Familial clustering of cancer at human papillomavirus-associated sites according to the Swedish family-Cancer database. Int J Cancer. 2008;122(8):1873–8.PubMedCrossRef
27.
Storm HH, Klint A, Tryggvadóttir L, Gislum M, Engholm G, Bray F, et al. Trends in the survival of patients diagnosed with malignant neoplasms of lymphoid, haematopoietic, and related tissue in the Nordic countries 1964-2003 followed up to the end of 2006. Acta Oncol. 2010;49(5):694–712.PubMedCrossRef
28.
Engholm G, Gislum M, Bray F, Hakulinen T. Trends in the survival of patients diagnosed with cancer in the Nordic countries 1964-2003 followed up to the end of 2006. Material and methods. Acta Oncol. 2010;49(5):545–60.PubMedCrossRef
29.
Brenner H, Rachet B. Hybrid analysis for up-to-date long-term survival rates in cancer registries with delayed recording of incident cases. Eur J Cancer. 2004;40(16):2494–501.PubMedCrossRef
30.
Virtanen A, Anttila A, Luostarinen T, Malila N, Nieminen P. Improving cervical cancer screening attendance in Finland. Int J Cancer. 2015;136(6):E677–84.PubMedCrossRef
31.
Hansen BT, Campbell S, Nygård M. Long-term incidence trends of HPV-related cancers, and cases preventable by HPV vaccination: a registry-based study in Norway. BMJ Open. 2018;8(2):e019005.PubMedPubMedCentralCrossRef
32.
Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine. 2012;30(Suppl 5):F88–99.PubMedCrossRef
33.
Wang J, Andrae B, Sundström K, Ploner A, Ström P, Elfström KM, et al. Effectiveness of cervical screening after age 60 years according to screening history: Nationwide cohort study in Sweden. PLoS Med. 2017;14(10):e1002414.PubMedPubMedCentralCrossRef
34.
Lönnberg S, Anttila A, Luostarinen T, Nieminen P. Age-specific effectiveness of the Finnish cervical cancer screening programme. Cancer Epidemiol Biomark Prev. 2012;21(8):1354–61.CrossRef
35.
Lönnberg S, Nieminen P, Luostarinen T, Anttila A. Mortality audit of the Finnish cervical cancer screening program. Int J Cancer. 2013;132(9):2134–40.PubMedCrossRef
36.
Gravdal BH, Lönnberg S, Skare GB, Sulo G, Bjørge T. Cervical cancer in women under 30 years of age in Norway: a population-based cohort study. BMC Womens Health. 2021;21(1):110.PubMedPubMedCentralCrossRef
37.
Broberg G, Strander B, Ellis J, Adolfsson A. Attending cervical cancer screening, opportunities and obstacles: a qualitative study on midwives' experiences telephoning non-attendees in Sweden. Scand J Public Health. 2014;42(7):691–7.PubMedCrossRef
38.
Virtanen A, Nieminen P, Niironen M, Luostarinen T, Anttila A. Self-sampling experiences among non-attendees to cervical screening. Gynecol Oncol. 2014;135(3):487–94.PubMedCrossRef
39.
Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):591–603.PubMedPubMedCentralCrossRef
40.
Lehtinen M, Baussano I, Paavonen J, Vanska S, Dillner J. Eradication of human papillomavirus and elimination of HPV-related diseases - scientific basis for global public health policies. Expert Rev Vaccines. 2019;18(2):153–60.PubMedCrossRef
41.
Falcaro M, Castañon A, Ndlela B, Checchi M, Soldan K, Lopez-Bernal J, et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021;398(10316):2084–92.PubMedCrossRef
42.
Mancini S, Bucchi L, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, et al. Incidence trends of vulvar squamous cell carcinoma in Italy from 1990 to 2015. Gynecol Oncol. 2020;157(3):656–63.PubMedCrossRef
43.
Ellis L, Woods LM, Estève J, Eloranta S, Coleman MP, Rachet B. Cancer incidence, survival and mortality: explaining the concepts. Int J Cancer. 2014;135(8):1774–82.PubMedCrossRef
44.
IARC. Cervical Cancer screening. Lyon: IARC Press; 2005. p. 250.
45.
Dickman PW, Hakulinen T, Luostarinen T, Pukkala E, Sankila R, Söderman B, et al. Survival of cancer patients in Finland 1955-1994. Acta Oncol. 1999;38(Suppl 12):1–103.PubMedCrossRef
46.
Hemminki K, Försti A, Hansson M. Incidence, mortality and survival in multiple myeloma compared to other hematopoietic neoplasms in Sweden up to year 2016. Sci Rep. 2021;11(1):17272.PubMedCrossRef
47.
Hemminki K, Försti A, Hemminki A. Survival in colon and rectal cancers in Finland and Sweden through 50 years. BMJ Open Gastroenterol. 2021;8(1):e000644.PubMedCrossRef
48.
Hemminki K, Försti A, Hemminki A, Ljungberg B, Hemminki O. Progress in survival in renal cell carcinoma through 50 years evaluated in Finland and Sweden. PLoS One. 2021;16(6):e0253236.PubMedPubMedCentralCrossRef
49.
Hellman K, Hellström AC, Pettersson BF. Uterine cervix cancer treatment at Radiumhemmet: 90 years' experience. Time trends of age, stage, and histopathology distribution. Cancer Med. 2014;3(2):284–92.PubMedPubMedCentralCrossRef
50.
Bruni L, Saura-Lázaro A, Montoliu A, Brotons M, Alemany L, Diallo MS, et al. HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010-2019. Prev Med. 2021;144:106399.PubMedCrossRef
51.
Zur HH. The search for infectious causes of human cancers: where and why. Virology. 2009;392:1–10.CrossRef
52.
Walsh RJ, Tan DSP. The role of immunotherapy in the treatment of advanced cervical Cancer: current status and future perspectives. J Clin Med. 2021;10(19):4523.PubMedCrossRef
53.
Mauricio D, Zeybek B, Tymon-Rosario J, Harold J, Santin AD. Immunotherapy in cervical Cancer. Curr Oncol Rep. 2021;23(6):61.PubMedCrossRef
Metadata
Title
Cervical, vaginal and vulvar cancer incidence and survival trends in Denmark, Finland, Norway and Sweden with implications to treatment
Authors
Kari Hemminki
Anna Kanerva
Asta Försti
Akseli Hemminki
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2022
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-022-09582-5

Other articles of this Issue 1/2022

BMC Cancer 1/2022 Go to the issue

Research

Prognostic value and immune relevancy of a combined autophagy-, apoptosis- and necrosis-related gene signature in glioblastoma

Research

Electronic patient-reported monitoring of symptoms during follow-up of ovarian cancer patients: a feasibility study

Research

Beyond standard data collection – the promise and potential of BRAIN (Brain tumour Registry Australia INnovation and translation registry)

Research

MiR-659-3p inhibits osteosarcoma progression and metastasis by inhibiting cell proliferation and invasion via targeting SRPK1

Research

Overexpression of PFKFB3 promotes cell glycolysis and proliferation in renal cell carcinoma

Research

Clinical significance and correlation of PD-L1, B7-H3, B7-H4, and TILs in pancreatic cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits