Prevalence of self-reported cervical cancer screening and impact on cervical cancer mortality in Austria.

Pap smear screening was introduced in Austria in the late 1960's and was recommended annually for all women older than 20 years ever since. This is an opportunistic screening. The evaluation has to rely on population based data (mortality, stage distribution, screening prevalence). In a representative cross-sectional study (women aged 20-69 years, n = 933, conducted in 1995), 76% reported at least one Pap screening during their life; the highest prevalence (88%) was reported by women aged 50-59 years, the lowest prevalence (65%) by women aged 60-69 years. Forty-eight per cent of all women reported that they had undergone screening at least 4 times (40-49 years: 57%, 20-29 years: 34%). Between 1980 and 1996, mortality due to cancer of the uterus, part unspecified (ICD-9: 179), decreased by 54% (P = 0.0001) and that of cancer of the cervix (ICD-9: 180) by 44% (P = 0.0001). Since 1980, age-specific incidence rates of invasive disease decreased (P = 0.0001) in all 10-year age groups (20-29 years: -59%, 30-39 years: -48%, 40-49 years: -34%, 50-59 years: -62%, 60-69 years: -59%). The incidence of preinvasive disease increased significantly (P = 0.001) in the age groups 20-29 years by 30% and 30-39 years by 45%, respectively. No significant changes are observed in other age groups. Opportunistic screening has reduced mortality from cervical cancer and particularly limited the increase among younger women, but the high proportion of cancer deaths from uterine cancer, in part unspecified, obscures the actual trend. We estimate that the true mortality from cervical cancer has been nearly halved between 1980 and 1996. Most of this reduction must be attributed to the screening activities in the 1970's and we expect a further decrease as a result of the expanded screening activities in the 1980's.