This section presents cervical cancer statistics and information regarding pre-invasive lesions, invasive cervical carcinomas, age and stage, trends, cervical cancer worldwide and histology The ICD code for cervical cancer is ICD9 180 and ICD10 C53.
It is widely accepted that invasive carcinoma of the cervix is preceded by pre-malignant lesions which are benign. There are three systems used to classify these cervical abnormalities1.
For statistical registration purposes, since 1984 the International Classification of Diseases code for carcinoma in situ of the cervix uteri includes CIN3 with or without mention of severe dysplasia (the International Classification of Diseases tenth revision (ICD10) code for carcinoma in situ of the cervix is D06). Virtually all cases of CIN are detected through smear tests.
In 2003 there were 24,105 new registrations of carcinoma in situ of the cervix uteri in the UK2-5. Most (22,033) (91%) cases are registered in women under 45, with peak incidence in the 25-29 age group.
In 2005, 2,803 new cases of cervical cancer were diagnosed in the UK, making it the twelfth most common cancer in women and accounting for around 2% of all female cancers. (Table 1.1).
In 2005, the age-standardised (European) annual incidence rate of cervical cancer in the UK is 8.4 per 100,000 females. Cervical cancer is the second most common cancer after breast cancer in the under 35s females, with 671 new cases diagnosed in the UK in 2005.
In contrast to carcinoma in situ, the occurrence of invasive cervical cancer is fairly evenly spread across age groups over 25 (see Figure 1.1). Incidence rate for cervical cancer is highest for those aged 30-40 reaching around 17 per 100,000 women. Although rates decrease for the following age-groups, a similar peak is reached at the age of 85+.
Both peaks reflect a cohort effect: women born in the 1920s are known to have high rates of invasive carcinoma of the cervix throughout their lives. Data for 1979 incidence show a peak for women in their late fifties to late sixties. This effect is explained more fully in the mortality section.
Cervical cancer is divided into stages:
The West Midlands Cancer Intelligence Unit6 has information on stage for over 80% of its cervical cancer registrations – between 1991 and 1995 the Unit recorded the distribution of cervical cancer by stage and age for 1,898 tumours.
Stage 1 accounts for nearly two thirds of the staged tumours. The stage breakdown varies across the age groups, with older women being diagnosed with progressively later stage disease. Cervical cancer survival rates vary with stage at diagnosis.
Further analyses of the cervical cancer cases with an unknown stage demonstrate that, although older women have a larger proportion of cases with an unknown stage compared to younger women, a similar association between age and stage also exists in women where the stage is not known, e.g. younger women with unknown stage have good cervical cancer survival (indicating early stage disease) while older women with an unknown stage have poor survival (indicating late stage disease).
Since the late 1980s there has been an increase in the incidence rates of carcinoma in situ for women in England and Wales under 30. For women aged 30-34 there has been an increase since 1992, but there have been no apparent increases for women over 347,8.
Incidence rates of invasive cervical cancer, in contrast, have generally shown a downward trend since 1990. 2,4,9. The Great Britain age-standardised (European) incidence rate for cervical cancer has decreased by around 44% since 1975, although it presented a slight increase in the 1980s.(see Figure 1.2).
The slight increase in the overall cervical cancer incidence rate in the 1980s hides the varying incidence trends for different age groups
In those aged 25-49 incidence rates peaked in the mid 1980’s and have since declined, returning to similar rates seen in the mid 1970’s. Incidence rates in women aged 25-29 also declined since the mid 1980’s but remain elevated relative to the rates of the mid 1970’s.
In women aged 45+ incidence rates have declined significantly since the mid 1970’s. The most significant decline is found in those aged 50-64. In comparison to the other age groups, incidence rates for women under 25 have remained largely stable. .In the UK the age-standardised (European) incidence rate for cervical cancer has decreased by 19% since 1996 ( Figure 1.3).
One in ten female cancers diagnosed worldwide are cancers of the cervix and it is the most commonly diagnosed cancer among women in Southern Africa and Central America. There is a seven-fold variation in the incidence of cervical cancer between the different regions of the world (Figure 1.413).
Human papillomavirus (HPV) is the most important cause of cervical cancer and much of the international variation in rates of cervical cancer may relate to population prevalence of HPV and other co-factors that modify the risk in women infected with HPV such as the Pill and smoking. Cervical cancer incidence and mortality rates have declined substantially in Western countries with screening programmes, such as the UK where incidence rates rank 141st of the 172 countries worldwide and the mortality rate ranks 148th.
Around two thirds of cervical cancers are squamous cell carcinoma (SCC).Adenocarcinoma is the next most common histology (around 15%); a further 15% are poorly specified carcinomas 7.
One study10, 11 reported an increase in adenocarcinoma and a downward trend in SCC in many countries worldwide. It is possible that some of this increase is due to increased awareness and referrals for diagnosis of abnormal glandular cells of unknown significance.
Analysis of Swedish data has shown that the early age peak of cervical cancer incidence at 35-39 years is apparent for both SCC and adenocarcinoma, but different birth cohort trends have been observed for the two histologies12.
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