Trends of cervical cancer in Greenland: A 60-year overview

Abstract

Background. Due to its extraordinarily fast economic and social transition, virtually closed borders before 1940 and, moreover, that 85% of the population has the distinctive genetics of the Inuit, Greenland is a very interesting country to study cervical cancer from a historical perspective. Nevertheless, little has been reported about long-term cancer trends in Greenland. Our aim was to describe and interpret the incidence of cervical cancer from 1950 to 2009.

Material and methods. We systematically searched PubMed for articles reporting the incidence of cervical cancer in Greenland. We supplemented this with data for 1980–2009 obtained from the Chief Medical Officer of Greenland.

Results. Incidence of cervical cancer was around 10 per 100 000 women (age-standardised, world population, ASW) in the 1950s, 30 per 100 000 in the 1960s, and in the 1980s around 60 per 100 000. From 1985 onwards, the incidence of cervical cancer started decreasing to the current level of 25 per 100 000.

Conclusion. The steep increase in the incidence of cervical cancer from the 1950s onwards is unlikely to be explained by increasing completeness of data. In parallel with the economic development, however, out-of-wedlock births (proxy for sexual behaviour) increased dramatically from 1935 onwards while tobacco use increased from the 1950s onwards. From the late 1960s to around 1990, data suggested rather stable but high levels of sexual habits. The decrease in the incidence of cervical cancer since 1985 is consistent with the introduction of screening. The data strongly suggested that the increased burden of cervical cancer in Greenlandic women was real and followed earlier changes in sexual behaviour; these changes were likely a consequence of the tremendous societal changes.

Acknowledgements

Bente Braad Sander holds a PhD-scholarship from the Danish Research and Innovation Agency, and has received a grant from Aase and Ejnar Danielsens foundation. Matejka Rebolj is supported by a grant from the Danish Strategic Research Council. The authors would like to thank Nils Højgaard Nielsen for his valuable comments on an earlier draft of this paper, Gorm Nørgaard Pedersen for the data, and Pierre-Antoine Dugué for help with graphic presentation and statistical analysis.

Declaration of interest: Elsebeth Lynge and Matejka Rebolj are currently undertaking a comparative study of new-generation HPV tests, involving collaboration with Roche Diagnostics, Genomica, Qiagen, and Hologic/Gen-Probe. Elsebeth Lynge has served as unpaid scientific advisor to Gen-Probe and Norchip, and Matejka Rebolj's employer has received honoraria for lectures from Qiagen on her behalf. Concerning the present paper, there has been no collaboration with, or support from any of the companies.