In 1994, a pilot program of cervical cancer screening was introduced in the Alsace region, France. The objectives of this program are to increase screening coverage and to insure high quality in every step of the screening process. Within this context, we assessed cervical morbidity in Alsace before the HPV vaccinated population reaches the age of screening.
Data on cervical lesions and cancers were collected for the period between September 1st, 2008 and August 31st, 2011. The data collection covers the Alsace region which comprises the Bas-Rhin and the Haut-Rhin departments for a total of about 500,000 women aged 25 to 65 years. The screening relies on existing medical structures and collects data from all cytopathology laboratories in the area. Data are centralized and managed by the EVE association. Cytological and histological data are completed with data from two cancer registries of the Alsace region.
During the 2008-2011 period, 565,153 smears were performed in women aged 25 to 64 years in Alsace, representing an average of 1.1 smear per woman and 1.62 smear/screened woman. The overall screening coverage was 70.1% over the 3-year period and varied according to age. It increased from 63.4% in women aged 25-29 to 83.4% in women aged 30-34 and then decreased regularly to 56.7% in 60-64-year-old women. Over the same period, 2,664 cases of CIN1, 962 CIN2 and 1,283 CIN3 were reported representing a prevalence of 1.78/1,000, 0.64/1,000 and 0.86/1,000 screened women, respectively. The world standardized prevalence of CIN1, CIN2, and CIN3 with its 95% CI was 2.03/1,000 [1.97-2.1/1,000], 0.73/1,000 [0.69-0.77/1,000] and 0.97/1,000 [0.93-1.03/1,000], respectively. Moreover, 154 cervical cancers were reported giving an incidence proportion of 10.3/100,000 women-years. The incidence increased from 5.6/100,000 in women aged 25 to 29 years to about 13.3/100,000 in women between 40 and 54 years, and decreased after 55 years reaching 7.5/100,000 in 60-64 year-old women.
The Alsace region is the first French region where an organized cervical cancer screening program was implemented. The overall screening coverage of 70% at three years is higher than the national rate (57%) and reflects the strength of an organized screening program. The EVE database will be a useful tool to assess trends in cervical morbidity over time and to further assess the impact of screening as well as of HPV vaccination.