– This is a top position that we definitely do not want, writes Giske Ursin to news. She is director of the Cancer Registry, which is responsible for the mass examination against cervical cancer, called the cervical programme. We know that HPV is the main cause of cervical cancer. The World Health Organization believes that this form of cancer can be eradicated. This means that fewer than 4 out of 100,000 women receive the diagnosis. In the Nordic countries, only one country is close to reaching the target. What is it about Finland? Finland, like Norway, has a mass examination, a so-called screening programme, against cervical cancer for women aged 30 to 65. The aim is to detect cell changes in the cervix as early as possible, provide treatment and thus prevent cervical cancer. Finnish women have had this offer since 1971, while in Norway it was first introduced in 1995. And here lies part of the answer to why Finland is best in class, Veli-Matti Partanen believes. He is the development manager for the screening program in Finland. – Another reason is that removal of the uterus is more common in Finland. It has helped eliminate the risk of cervical cancer. But it is of course an operation with other risks, according to Partanen. In addition, he points out that Finland has had good quality in the analysis of the cell samples that are done in the laboratories of the Finnish Cancer Society. 50 percent? In Norway, the cell samples of women aged 25 to 33 are interpreted by a bioengineer in a laboratory. Recently, it has been discussed whether this test method is good enough, and whether the test result can be trusted. Are 50 percent of the cell samples wrong? In the TV2 program “Norge behind the facade” which dealt with cervical cancer, we got to know 28-year-old Maren Walvik Johnsen. She had followed the screening programme, and had been told that the pap smear was normal. But the test was misinterpreted, and she now has cervical cancer. This has caused many to wonder whether the answer from the pap smear can be trusted? And could it be true that half of the cell samples are misinterpreted? No. Half of the 400,000 cervical samples taken annually are not misinterpreted. But it is true that half of those who have followed the screening program and have been diagnosed with cervical cancer have been told to have a normal pap smear. The figures from 2021 show that: 51 women aged 25 to 33 got cervical cancer. Of these, 22 of them had taken a pap smear three and a half years before the cancer diagnosis. 14 of the 22 had been told that the Pap test was normal, and got cancer some three years later. It usually takes at least 10 to 15 years to develop cervical cancer. If we look at the big picture, there are between one and two per 10,000 women who are told that the cervical smear is normal, even though it is not. So how much is the risk really reduced by participating in the cervical program? In 2014, the Norwegian Cancer Registry mentioned a British study. It showed that a single pap smear reduces the risk of cervical cancer over the next five years by 60 to 80 percent among women aged 40 to 64. For women between the ages of 30 and 37, the risk is reduced by 40 to 60 percent, according to the study. The Norwegian Cancer Registry’s figures for 2021 show that half of those who followed the screening program and got cervical cancer had been told that they had a normal Pap smear some three years earlier. The Norwegian Cancer Registry does not believe that this is the reason why Norway is the worst. – We have to look at the total picture – where we also look at how many samples are taken, and how many are followed up and treated. But we are not satisfied, and we are constantly working on quality improvements, so that this happens as little as possible, says Ursin. Why is Norway struggling? She believes the main reason for the increase is inadequate HPV vaccination and an ongoing HPV epidemic in the country. Giske Ursin says that they are constantly working to improve the cervix programme. In 2014, researchers found that there was slightly more HPV in Norway among young people aged 18 to 26, compared to the other Scandinavian countries. But they also found that there was generally a lot of HPV in all the countries. According to Ursin, more cancer cases are discovered when more women participate in the mass examination. In addition, several cell samples are now tested for HPV. It is a more sensitive test which means that more people are caught. – Therefore, the rise in recent years is not entirely unexpected, and these factors can explain some of the increase in cancer we are seeing in this country, says Ursin. From pap smear to HPV test We will still take pap smear in the same way, at a GP or gynaecologist. What is new is the way the sample is examined. Instead of the usual microscopic examination of cell changes in the laboratory, the cell sample will be tested for HPV. The aim of using this test for all age groups is to prevent even more cases of cervical cancer, and to reduce the mortality rate of the disease. Why is it only happening now? According to the Norwegian Cancer Registry, both they and international professional communities have been skeptical about HPV testing young women, because it is very common for them to have an ongoing HPV infection. And most often it goes away on its own. But in recent years there has been an increasing incidence of cervical cancer in Norway, particularly among younger, unvaccinated women. Therefore, a different type, more sensitive HPV test is now being introduced. The cancer registry believes it will contribute to more early stages being detected and treated, and that fewer women will eventually develop cervical cancer. Negative and positive test If you get a response that says your test is HPV negative, you can wait five years before taking another one. BUT, if you experience symptoms in the abdomen you should go to the doctor anyway. If the sample is HPV positive, it is examined under a microscope and the answer is sent to your doctor. The doctor is then responsible for following you up and sending you for further investigation, if there is a need for it. A positive HPV test does not necessarily mean you will develop cervical cancer. Many people have the virus without it resulting in illness. From 2023, the HPV test will also be used for women between the ages of 25 and 33. Source: The Norwegian Cancer Registry and the Norwegian Cancer Society have recently examined cervical cancer cases in the world. They found that Norway is number five on the list of countries with the greatest increase in the incidence of cervical cancer. The figures for Norway apply to the period 2007–2016. – The development worries us, because we are working to ensure that as few as possible are affected by cervical cancer. We are also concerned that we are now treating three times as many pre-stages among younger women as we did in 2010, says Ursin. Is there hope for Norway? Yes, says the Cancer Registry. Why? We have the HPV vaccine. But here, too, Norway was late. And we are paying the price for that now, says Giske Ursin. In 2009, all 12-year-old girls in the country were offered the HPV vaccine. The boys received the same offer in 2018. – Sweden and Denmark started even earlier with even more comprehensive vaccination than we did. In addition, several cohorts were offered the vaccines early, and that probably had a lot to say. In these countries, research has already been published that shows an effect on the incidence of cancer for those who received the vaccine before the age of 20, explains Ursin. The first 12-year-olds who received the vaccine in Norway are now turning 25 and are thus part of the cervical programme. – Going forward, we expect to see a marked decrease in HPV infection – and in the coming years there will be fewer cases of cancer in the vaccinated cohorts, according to Giske Ursin. Both the Cancer Register and the FHI believe that cervical cancer will be eradicated by 2039. You can do this to reduce the cancer risk: Follow the Cervical Cancer Program and take a Pap test from the cervix when you receive a reminder from the Cancer Register. If the test shows that further investigations are necessary, it is important that you attend a new appointment when you are summoned. Taking the HPV vaccine reduces the risk of getting infected with HPV. The vaccine is offered free of charge to girls and boys in the 7th grade. For adults, doctors can write a prescription for the HPV vaccine, and it can be given by a doctor, medical secretary, public health nurse or nurse. Stay smoke-free. Source: Health Care
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More women are affected by cervical cancer in Norway than in the other Nordic countries – news Trøndelag
