Finland’s mass cancer screening at 50 – the cervical cancer success story

This year marks the 50th anniversary of the start of population-based cancer screening in Finland, launched by the Cancer Society of Finland. Cervical cancer screening has been a success story because it is responsible for 80 % reduction in the cervical cancer burden.

Tytti Sarkeala  of the Cancer Society of Finland will give a talk at World Cancer Congress in Kuala Lumpur on Thursday 4 October about the evolution of Finnish cervical cancer screening programme and the lessons learnt from the five decades Finland has done cancer screenings.

Cervical cancer screening has a long history in Finland, going back to 1963.

Cervical cancer screening has a long history in Finland, going back to 1963. It has yielded impressive results, with about an 80 % reduction in the cervical cancer burden. It has now been reduced to the status of a rare cancer in Finland. Each year, about 160 cases of cervical cancer are detected in Finland each year, and some 55 women die of the disease.

Women in developing countries suffer the most from cervical cancer

Worldwide, cervical cancer is the fourth most common cancer in women, accounting for some 570 000 new cancer cases and 310 000 deaths a year. The World Health Organization has called for global elimination of cervical cancer.  The International Union for Cancer Control UICC is collaborating with UN agencies in this endeavour.

Women in low to middle income countries are the hardest hit, accounting for some 8 in 10 deaths, and in part reflecting a lack of screening programmes for early detection of cancers and pre-cancerous lesions.

“The Finnish experience with cervical cancer screening is therefore of value beyond purely national concerns in cancer prevention. It demonstrates the value of population screening for cervical cancer within a prevention strategy, including HPV vaccinations and lifestyle interventions, which needs foregrounding in poorer countries”, says Tytti Sarkeala.

In Finland, all women are invited for cervical cancer screening every five years from the age of 30 to 60, and some municipalities provide screening for women aged 25 and 65. At present screening is carried out also for breast cancers. Breast cancer screening started nationwide in 1987. Next year also a growing number of municipalities will start providing screening for colorectal cancer.

Cervical cancer among young women on the rise

Despite the progress made in combatting cervical cancer, there has been a slight increase in recent years in precancerous conditions of the cervix detected in women under 40.

The worry is that more young women have been missing screenings. Efforts to improve the situation include using reminders in the screening invitation process – a move that has resulted better screening attendance – making self-sampling devices available, and enhancing awareness raising communications.

Another strategy to reduce the incidence of cervical cancer is to widen the age range for screening. A major part of the remaining cervical cancer burden occurs in ages beyond the screening age range.

This could be addressed by increasing the invitational age to 65-plus in all municipal screening programmes. National coverage by the HPV vaccination programme, now 70%, is unsatisfactory and needs to be increased. There also needs to be a new screening policy for the population that has been vaccinated.

Screenings proven to be effective

The lessons of the screening programme over its first half-century show that with a robust methodology and solid registry database, the use of screening in the early detection of cervical cancer points the way to drastically reducing it worldwide.

Further information:

Director of Screening Tytti Sarkeala, tytti.sarkeala@cancer.fi, tel. +358 50 411 4238