Pap smear screening and changes in cervical cancer mortality in Sweden

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Abstract
Age-adjusted incidence of cervical carcinoma has fallen dramatically in Sweden in recent decades. This investigation is an attempt to evaluate the effectiveness of the gynecologic Pap smear screening program in terms of reduction of mortality from cervical cancer. Cervical cancer mortality trends in relation to age, calendar period, county and degree of screening activities in the population were analyzed. Multiplicative Poisson regression models were utilized. The reduction of mortality was attributed to the activities of cervical screening. The analysis gave a calculated 53% reduction in cervical cancer mortality (95% confidence limits 23-72%), attributable to screening. The study supports the hypothesis that gynecological Pap smear screening has had an important impact on the reduction in cervical cancer mortality.