Cervical cancer in the Netherlands 1989-1998: Decrease of squamous cell carcinoma in older women, increase of adenocarcinoma in younger women

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Abstract
Cervical cancer is a preventable disease, occurring in relatively young women. In the Netherlands, population‐based cervical screening aims at women aged 30–60 years. We performed a population‐based study of the incidence of invasive cervical cancer in the Netherlands to evaluate trends, with emphasis on age at time of diagnosis. Histologic diagnosis was retrieved from the Netherlands Cancer Registry for all women residing in the Netherlands with invasive cervical cancer between January 1, 1989, and December 31, 1998. In this 10‐year period, the incidence rate of squamous cell carcinoma decreased significantly from 7.1/100,000 to 6.1/100,000 (p < 0.001), with the greatest decrease in women aged 60–74 (–5.5%). While the overall incidence rate of adenocarcinoma remained stable, it increased in women aged 15–29 (+15.8%) and in women aged 30–44 (+2.5%), though the number of cases was small. For squamous cell carcinoma, the incidence of stage II at diagnosis decreased most (–2.7%). There was no change in stage at diagnosis for adenocarcinoma. Most cases of cervical cancer, 60.5%, were detected between ages 30 and 60 years, i.e., the Dutch screening age interval. Cervical cancer in women below age 30 contributed 5.0% to the total incidence, with 3.0% occurring between ages 27 and 29. Thus, screening for cervical cancer in the Netherlands is associated with a decrease in the incidence of squamous cell carcinoma and adenocarcinoma incidence appears to be increasing in younger women.