Success of a Cervical Cancer Screening Program: Trends in Incidence in Songkhla, Southern Thailand, 1989-2010, and Prediction of Future Incidences to 2030

Abstract

<b>Background:</b> Cervical cancer has been a leading female cancer in Thailand for decades, and has been secondto breast cancer after 2007. The Ministry of Public Health (MoPH) has provided opportunistic screening withPap smears for more than 30 years. In 2002, the MoPH and the National Health Security Office providedcountrywide systematic screening of cervical cancer to all Thai women aged 35-60 years under universal healthcare coverage insurance scheme at 5-year intervals. <br/><b>Objectives</b>: This study characterized the cervical cancerincidence trends in Songkhla in southern Thailand using joinpoint and age period cohort (APC) analysis toobserve the effect of cervical cancer screening activities in the past decades, and to project cervical cancer ratesin the province, to 2030. Materials and <br/><b>Methods</b>: Invasive and in situ cervical cancer cases were extracted fromthe Songkhla Cancer Registry from 1990 through 2010. Age standardized incidence rates were estimated. Trendsin incidences were evaluated by joinpoint and APC regression models. The Norpred package was modified for Rand was used to project the future trends to 2030 using the power of 5 function and cut trend method. <br/><b>Results</b>:Cervical cancer incidence in Songkhla peaked around 1998-2000 and then dropped by -4.7% per year. APCanalysis demonstrated that in situ tumors caused an increase in incidence in early ages, younger cohorts, and inlater years of diagnosis. <br/><b>Conclusions</b>: Both joinpoint and APC analysis give the same conclusion in continuationof a declining trend of cervical cancer to 2030 but with different rates and the predicted goal of ASR below 10or even 5 per 100,000 women by 2030 would be achieved. Thus, maintenance and improvement of the screeningprogram should be continued. Other population based cancer registries in Thailand should analyze their datato confirm the success of cervical cancer screening policy of Thailand.