Background: Cervical cancer is an important cause of death throughout the world, especially in less developed countries. Reports of trends in cervical cancer mortality from less developed countries have been limited by poor data quality and inaccurate population estimates. This paper examines trends in cervical cancer mortality in South Africa from 1949 to 1990 and discusses the impact of cytology screening on these trends.
Methods: Analysis of national mortality statistics and reconstructed population data.
Results: The age-standardized mortality rates for Whites declined after the mid 1960s, while that for Coloureds rose, particularly before the 1970s. These trends were affected predominantly by trends among women in the 35-64 age range.
Conclusions: The pattern of mortality in successive birth cohorts for Whites is consistent with a reduction in age-specific mortality following the advent of cytological screening. The same pattern is not evident in trends for Coloureds, among whom screening has apparently had a minor impact if any at all. The apparent lack of impact of screening in those groups of women most at risk of cervical cancer lends weight to demands for the implementation of equitable and rational screening programmes for cervical cancer in South Africa and internationally.
PIP: A review of cervical cancer mortality statistics from South Africa for the period 1949-90 suggested that screening has disproportionately benefited White women--the population group at lowest risk of this form of cancer. For Whites, the annual number of deaths from cervical cancer peaked in the late 1960s at 133, then began a steady decline, reaching 102 in 1986-90. Among Coloreds, however, there was a steady increase in annual deaths throughout the entire period under review--from 55 in 1949-55 to 219 in 1986-90. Most of this increase occurred among Colored women over 34 years of age. A similar increase, from 8 to 25 deaths/year, was recorded among Asian women in the period under review. (Deficiencies in mortality data precluded calculation of mortality rates for South African Blacks; however, cervical cancer mortality is known to be highest among this population group.) The decline in cervical cancer mortality among White women coincided with the introduction of cytologic screening in the mid-1960s. More widespread use of screening in the public sector is urged to reduce the disparities in cervical cancer rates between racial groups.