1. European Programme for Cervical Cancer Screening Dr Ahti Anttila Finnish Cancer Registry, Helsinki BALKAN MASTERCLASS IN CLINICAL ONCOLOGY Dubrovnik 11-15 May, 2011 Finnish Cancer Registry Institute for Statistical and Epidemiological Cancer Research

2. Burden of Colorectal, Breast and Cervical Cancer in the EU in 2006 proportion of deaths from cancer by sex, except non-melanoma skin cancer* Women N = 536,700 Men N = 690,100 Breast 17% Cervix 3% Colon and rectum 13% Other 67% Colon and rectum 11% Other 89% * Estimates by IARC (2007) adapted from: Arbyn M, Autier P, Ferlay J (2007); Arbyn M, Raifu AO, Autier P, Ferlay J (2007); Boyle P, Ferlay J (2005); Ferlay J et al. (2007); Karsa et al. 2008

4. Fig. 1 . Age-standardised rated of incidence of and mortality from cervical cancer (/100,000 women-years) in the 27 member states of the European Union, estimates for 2004 (direct standardisation using the World reference population). (derived from Arbyn et al. , Ann Oncol. 2007).

8. Reduction in the cumulative rate of invasive Sq Cx Ca over the age range 35-64 years, with different frequencies of screening (IARC 1986) Assuming a negative screen occurring at age 35 years, and that a previous negative screen had been performed 4 64.1 10 years 7-8 83.6 5 years 12-15 90.8 3 years 31-44 93.5 1 year Number of tests % reduction in the cumulative rate Screening frequency

9. Sasieni & Cuzick, BMJ 2009

10. Examples of screening policy for cervical cancer in EU countries (Anttila et al. EJC 2009) No Yes 10-16 3 or 5 (20)25-(60)64 UK (England) Yes Yes 12 3 or 5 23-60 Sweden Yes Yes 15 3 20-64 Slovenia No Yes 7 5 30-60 Netherlands Yes No 11 3 30-60 Lithuania Yes No 50+ 1 20+ Germany Yes Yes 7 – 9 5 (25)30 - 60(65) Finland Yes No 45 1 25-69 Czech Republic Yes No 50+ 1 18+ Austria Non-popula tion based Population-based Smears per woman lifetime Screening interval (years) Target age

13. Death rates from cervical cancer in the Czech Republic and Finland

14. Estimated mortality trends from cervical cancers in some European countries Arbyn et al. EJC 2009

18. Extension of CERVICAL Cancer Screening Programme Implementation in the EU Estimated targeted proportion of 30-60-year-old women in the EU by programme type and implementation status in 2007 Karsa et al., 2008 Population-based 22% 29% Rollout complete Rollout ongoing 20% Nationwide Planning / Piloting 7% Nationwide Regional 2% Non population-based nationwide 47% 41 nationwide 7 regional <1% no prog. 2% Excluded

19. Estimated number of Persons attending Breast, Cervical and CRC Screening Programmes in the EU by Target Cancer and Programme Type in 2007 Estimates corrected for programmes in rollout phase and for missing data in Austria, Latvia, Greece, and Slovak Republic (all programmes) and in Denmark, France and Spain for cervical screening; and in Bulgaria for CRC screening. KARSA ET AL. 2008

26. FUTURE

27. CIN3+ cumulative incidence after screening visit (Dillner ym., BMJ 2008)

28. Detection rate ratio of CIN3+ in HPV group versus cytology group in 2 nd screening round (M.Arbyn, EUROGIN 2010)

32. Efficacy on CIN3+/Referral/Local therapy /hrHPV TVC naive cohort, Cervarix ® Paavonen J et al. Lancet 2009; 374 (9686): 301 - 314 <0.0001 36 19 28 803 585 Any oncogenic HPV, 12 month persistent infection <0.0001 98 55 87 23 3 CIN3+ irrespective HPV DNA P-value UL LL VE (%) Control HPV Final Analysis, Phase III study <0.0001 36 15 26 476 354 Colposcopy referrals <0.0001 81 50 69 83 26 Number of cervical excision procedures

34. Thank you for your attention!