Evolución de la mortalidad por cáncer de cérvix por regiones en España entre 1975 y 2004

BACKGROUND AND OBJECTIVES: To estimate the temporal trend of the cervical cancer mortality rates among Autonomous Communities (AACC) in Spain. MATERIAL AND METHODS: Individual death cases recorded as "cervical cancer', 'corpus uteri cancer' and 'uterus, site unspecified' -codes 180,182 and 179 in ICD8 and 9 and codes C53, C54 and C55 in ICD 10- were obtained, as well as women population estimates broken down by age and AACC from the Spanish National Institute for Statistics (INE). To correct distortions due to increasing improvement in death certification, deaths from 'uterus, site unspecified' were reallocated. Using the European standard population, age-adjusted mortality rates were calculated per year and AACC. Annual percent change (APC) and joinpoints, if existed, were estimated using Joinpoint regression analysis for all women and two broad age-groups: younger and older than 50 years. RESULTS: Cervical cancer mortality rates follow a decreasing trend, with important differences among AACC. Catalonia (PCA -4.55; IC95%: -4.85,-4.23), and Navarra (PCA -4.31; IC95% -5.85,-2.75) decreased more their annually mortality rates than Madrid (PCA -2.32; IC95%: -2.93, -1.70), Canarias (PCA -2,36; IC95% -3.00,-1.72) or Galicia (PCA -2.60; IC95% -3.07,-2.10), which showed the less marked decreased. CONCLUSIONS: Cervical cancer mortality is decreasing in Spain. Trend differences among CCAA could be related to organizational differences and coverages of their screening programs, disparities in exposure to HPV and socioeconomic level as well as to differences in socioeconomic factors.