In the Scandinavian countries of Denmark, Norway and Sweden, organised cervical cancer prevention programmes have contributed to reducing the cervical cancer burden. However, new technologies, such as primary human papillomavirus (HPV) DNA testing and HPV vaccination, necessitate comprehensive policy analyses to identify optimal prevention approaches. To inform future policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Scandinavia.
We compiled and summarised data on current prevention strategies, population demography, and epidemiology for each Scandinavian country by reviewing published literature and official guidelines, performing registry-based analyses using primary data, and discussions with experts in each country. We compared age-specific cervical cancer incidence for years 1960-66 and 2010-14 across the countries using Poisson regression with indicators for five-year age-groups (ages 20-84 years) and for each country. We also assessed country-specific variations in age-specific HPV prevalence using Fisher’s exact test and logistic regression.
In general, nationwide organised cytology-based screening was implemented in all Scandinavian countries by 1996, but opportunistic screening occurred as early as the 1950s. Prior to implementation of widespread screening and during years 1960-1966, cervical cancer incidence was considerably higher in Denmark than in Norway and Sweden. Decades of cytology-based screening later (i.e. years 2010-14), the incidence remains the lowest in Sweden, with Norway and Denmark having an age-adjusted incidence rate ratio (95% CI) of 1.28 (1.20-1.37) and 1.36 (1.28-1.45), respectively. HPV prevalence peaks at younger ages (i.e. younger than age 24 years) and thereafter decreases by age for all genotypes in all countries, but was generally lowest in Sweden. For all countries the most prevalent HPV genotypes were HPV16, 18 and 31.
Scandinavian countries generally face similar cervical cancer burden and utilise similar prevention approaches; however, important differences remain as cervical incidence and HPV prevalence remains lowest in Sweden. Future policy analysis will need to evaluate whether these differences warrant differential prevention policies, or whether efforts can be streamlined across Scandinavia.