Cervical cancer

325 women in Norway contracted cervical cancer in 2023. This type of cancer occurs most frequently at the age of 30 and 40, but can be prevented with screening and vaccines.

Last updated: 8/12/2024

The incidence of cervical cancer in Norway had a steady decline in the period from 1975 to the 2000s. From the mid-2000s, however, we see an increase in incidence in the age group 35 to 49 years. From 2013, we also see an increase in the age group 25 to 34 years. We do not know the reasons for this, but there are two factors in particular that influence the incidence of cervical cancer; screening-participation and exposure to HPV.

After a decline in the number of new diagnoses in 2020 in connection with the COVID-19 pandemic, an increase in incidence due to delayed diagnostics was expected. Currently, no signs of an increase in new diagnoses are seen, the decline in new diagnoses will continue in 2022.

New cases

325 women contracted cervical cancer in Norway in 2023. The number of cases per 100,000 people is 11.8.

In the period 2019-2023, 51.4 per cent of cases were detected in stage I (early stage), while 13.1 per cent were detected in stage II and 18.5 per cent in stage III. 7.1 per cent had distant metastasis, stage IV, at the time of diagnosis, while 8.4 per cent had an unknown stage.

Aging

The median age for cervical cancer is 47 years, which means that half of all those diagnosed are over 47 years of age. The diagnosis is rare in women under 25 years of age.

Survival

Five-year relative survival after cervical cancer is high, at 82.6 percent. If the disease is detected early (stage I), 96.1 percent survive their cancer for 5 years or more.

For those diagnosed late in the disease (stage IV), the prognosis is still poor, only 26.5 percent survive the disease for 5 years or more.

5-year relative survival for cervical cancer in total and for different age groups from 1980 to 2023. From figure 2.55 in the Gynecological Cancer Annual Report 2023 (Only in Norwegian).

There is a slight decline in 5-year relative survival through the 1980s for all groups combined, but from 1990 until today there has been a steady increase for all age groups to 82.7 per cent in the period. In 30 years, the 5-year survival rate has increased by 11.8 per cent. We see the most marked increase in the age group 50 to 69 years.

Survivors with cervical cancer

At the end of 2023, there were 7,945 women in Norway who either have or have had cervical cancer in their lifetime.

Of these, 5,037 women were diagnosed at least a decade ago.

Number of deaths

In 2022, 81 women died of cervical cancer.

Over the past 40 years, mortality has fallen for all age groups. For the age group 25 to 49 years, mortality has remained stable.

Mortality rates in cervical cancer in different age groups 1970-2022. From Fig. 2.53 in the Gynecological Cancer Annual Report 2023. (Norwegian only).

The figure shows that there has been a steady decline in mortality rates at cervical cancer from the 80s until today. This can be explained by factors such as better treatment and introduction of screening.The cervical screening program (national screening program) was introduced in 1995, but also in the decades before, unorganized screening with cell samples (wild screening) was carried out. Screening participation can reduce the incidence of cervical cancer by detecting precursors to cancer before the disease has developed.

When it comes to the development of cancer treatment in recent decades, radiation therapy has developed a lot with new techniques. From the beginning of the 2000s, it was introduced to give chemotherapy together with radiation therapy. From the late 90s, local radiation therapy was introduced into the cervix.

In cases of advanced cancer, new combination treatments with chemotherapy were also introduced during the 2000s. All of these treatments may have contributed to lower mortality.

Development over time

In Norway, over 300 women get cervical cancer each year, and between 70 and 90 women die from the disease.

The incidence of cervical cancer in Norway has been reduced by almost 40 per cent over the past 50 years.

Trends in incidence (red), mortality (pink) and 5-year relative survival (brown) of cervical cancer in the period 1965-2023. From figure 9.1-N in Cancer in Norway 2023.

There has been a marked fall in the incidence of cervical cancer from the mid-70s until today for all age groups as a whole (age-standardised incidence rate). From the mid-2000s, however, we see an increase in incidence in the age group 35 to 49 years.

From 2013, we also see an increase in the age group 25 to 34 years. We do not know the reasons for this, but there are two factors in particular that influence the occurrence of cervical cancer; screening-participation and exposure to HPV. Lack of screening participation, as well as increased exposure to oncogenic (carcinogenic) variants of HPV are possible explanations for the increase we see in the two relevant age groups. To answer these questions, further analyses and links to the cervical screening programme need to be undertaken.

National Quality Registry for Gynecological Cancer

In 2019, data from cervical cancer were included in the quality registry, which until then has had data from ovarian cancer. Registration of electronic messages
started in the fall of 2019. The coverage rate for reporting on investigations increased from 42.4 per cent in 2020 to 87.1 per cent in 2022. This increases the data quality significantly and has contributed to the addition of several new analyses for cervical cancer in the annual report.

The Quality Registry collects data on assessment and treatment of this patient group. The purpose is to use the data from the registry to illustrate practice in hospitals, which can be of help in assessing practice in individual hospitals and for the patient group as a whole.

Screening behind most of decline in incidence

The Cervical Screening Programme recommends women between the ages of 25-69 to have a sample taken from the cervix when it is reminded. The cervical swab can reveal serious cell changes that can lead to cervical cancer.

Of the more than 400,000 cervical swabs taken annually in Norway and reported to the Cervical Screening Programme, about 5 per cent are abnormal.

Around 7,000 cell changes are high-grade and are treated to prevent the development of cancer.

More than half of those who get cervical cancer have not followed the recommendations of the Cervical Screening Programme, and in the target group for the programme there are more than 200,000 women who have not checked themselves for ten years or more.

Risk factors

The cause of cancer of the cervix is in over 99 percent of cases long-term infection with HPV (Human Papillomavirus).

Studies show a good effect of screening against cervical cancer, and the most important thing to reduce the risk is to follow the Cervical Screening Programme and to take the vaccine against HPV.

Other factors that may cause a small increased risk, if you also have a long-term HPV infection.

Women who are infected with both HPV and Chlamydia are at increased risk
Use of oral contraceptives over a long period of time
Reduced immune function can cause an HPV infection to flourish and lead to cervical cancer
Tobacco smoking increases the risk of cervical cancer
Exposure to Diethylbestrol (DES) in fetal life (used by pregnant women in 1940-1791 to prevent pregnancy complications) increases the risk of cell changes and cancer

Source:  IARC «Kreft hos menneske: kjente årsaker og forebyggende tiltak etter kreftform» 

Read about the connection between cancer risk and diet, nutrition, weight and physical activity at World Cancer Research Fund International (WCRF) - Cervical cancer.

Read about prevention of cancer at kreftregisteret.no

HPV vaccine reduces the risk of cervical cancer in the future

Vaccines are available against the types of HPV that cause the vast majority of cases of cervical cancer in Norway. In Norway, 7th grade students are offered the HPV vaccine.

12-year-old girls have been offered the vaccine as part of the Norwegian Childhood Immunisation Programme since 2009. From autumn 2018, boys were also included, and are now offered a vaccine against HPV.

Between 2016 and 2018, women born after 1991, who have not been vaccinated previously, also received the vaccine free of charge. From 1 July 2019, the offer of so-called pick-up vaccine ceased, and outside the childhood vaccination programme, you now have to pay for the vaccine yourself.

Read more about HPV vaccination at the Norwegian Institute of Public Health, which is responsible for vaccines in Norway.

Those who take the vaccine are less likely to develop severe precancerous lesions of the cervix compared to those who are not vaccinated.

Cervical cancer develops slowly. The full effect of the vaccine will therefore not be seen until at least ten years from now, when the large cohorts of vaccinated women reach the age where neckneck cancer most typically occurs.

Although vaccinated women have a lower risk of developing precancerous lesions of the cervix, they are still recommended to take a Pap smear from the cervix when the Cervical Screening Programme sends out reminders.

Read about the causes of cervical cancer on helsenorge.no

Steps you can take to reduce your risk of getting cervical cancer

By participating in the Cervical Screening Programme, the disease can at best be prevented, but also diagnosed and treated at an early stage. Read about the Cervical Screening Programme
HPV vaccine may reduce the risk of cervical cancer later in life
Read about HPV vaccine in the Childhood Immunisation Programme at helsenorge.no
Read more about symptoms and prevention of cervical cancer on kreftforeningen.no

Questions about cancer

The Cancer Registry of Norway is a research institution. Our professionals therefore do not answer questions about diagnosis, assessment, treatment and follow-up from patients or their relatives.