Success of a Cervical Cancer Screening Program: Trends in Incidence in Songkhla, Southern Thailand, 1989-2010, and Prediction of Future Incidences to 2030

  • Sriplung, Hutcha (Epidemiology Unit, Faculty of Medicine, Prince of Songkla University) ;
  • Singkham, Phathai (International Field Epidemiology Training Program, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health) ;
  • Iamsirithaworn, Sopon (International Field Epidemiology Training Program, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health) ;
  • Jiraphongsa, Chuleeporn (International Field Epidemiology Training Program, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health) ;
  • Bilheem, Surichai (Epidemiology Unit, Faculty of Medicine, Prince of Songkla University)
  • Published : 2014.12.18


Background: Cervical cancer has been a leading female cancer in Thailand for decades, and has been second to breast cancer after 2007. The Ministry of Public Health (MoPH) has provided opportunistic screening with Pap smears for more than 30 years. In 2002, the MoPH and the National Health Security Office provided countrywide systematic screening of cervical cancer to all Thai women aged 35-60 years under universal health care coverage insurance scheme at 5-year intervals. Objectives: This study characterized the cervical cancer incidence trends in Songkhla in southern Thailand using joinpoint and age period cohort (APC) analysis to observe the effect of cervical cancer screening activities in the past decades, and to project cervical cancer rates in the province, to 2030. Materials and Methods: Invasive and in situ cervical cancer cases were extracted from the Songkhla Cancer Registry from 1990 through 2010. Age standardized incidence rates were estimated. Trends in incidences were evaluated by joinpoint and APC regression models. The Norpred package was modified for R and was used to project the future trends to 2030 using the power of 5 function and cut trend method. Results: Cervical cancer incidence in Songkhla peaked around 1998-2000 and then dropped by -4.7% per year. APC analysis demonstrated that in situ tumors caused an increase in incidence in early ages, younger cohorts, and in later years of diagnosis. Conclusions: Both joinpoint and APC analysis give the same conclusion in continuation of a declining trend of cervical cancer to 2030 but with different rates and the predicted goal of ASR below 10 or even 5 per 100,000 women by 2030 would be achieved. Thus, maintenance and improvement of the screening program should be continued. Other population based cancer registries in Thailand should analyze their data to confirm the success of cervical cancer screening policy of Thailand.


Supported by : National Science and Technology Development Agency


  1. Carstensen B. (2012). Statistical Analysis in the Lexis Diagram: Age-Period-Cohort Models. Center of Statistics and Applications, Faculty of Sciences, University of Lisbon. [cited 2013 January 10]. Available from:
  2. Carstensen B, Plummer M, Laara E, Hills M (2013). Epi: a package for statistical analysis in epidemiology. R package version 1.1.49. Available from:
  3. Dickinson JA, Stankiewicz A, Popadiuk C, et al (2012). Reduced cervical cancer incidence and mortality in Canada: national data from 1932 to 2006. BMC Public Health, 12, 992.
  4. Doll R. (1976). Comparison between Registries. Age- Standardized Rates. In: Waterhouse JAH, Muir CS, Correa P, Powell J (eds.). Cancer incidence in Five Continents, Vol. III (IARC Scientific Publications No. 15), Lyon, France: International Agency for Research on Cancer, pp.453-459.
  5. Gakidou E, Nordhagen S, Obermeyer Z (2008). Coverage of Cervical Cancer Screening in 57 Countries: Low Average Levels and Large Inequalities. PLOS Med. 5(6): e132. [cited 2014 September 11]. Available at:
  6. Hakama M, Louhivuori K (1988). A screening programme for cervical cancer that worked. Cancer Surv. 7(3):403-416.
  7. Joinpoint Regression Program, Version 4.0.4. (2013)statistical methodology and applications branch. Surveillance Research Program, National Cancer Institute.
  8. Khuhaprema T, Attasara P, Sriplung H, Wiangnon S, Sangrajrang S, eds. (2013) Cancer in Thailand Vol. VII, 2007-2009. Bangkok, Thailand: National Cancer Institute.
  9. Khuhaprema T, Attasara P, Srivatanakul P, et al. (2012) Organization and evolution of organized cervical cytology screening in Thailand. Int J Gynecol Obstet, 118, 107-11.
  10. Khuhaprema T, Srivatanakul P, Sriplung H, Wiangnon S, Sumitsawan Y, Attasara P, eds. (2007) Cancer in Thailand Vol. IV, 1998-2000. Bangkok, Thailand:Bangkok Medical Publisher.
  11. Kim HJ, Fay MP, Feuer EJ, Midthune DN. (2000). Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 19, 335-51<335::AID-SIM336>3.0.CO;2-Z
  12. Gunnell AS, Ylitalo N, Sandin S, Sparen P, Adami HO, Ripatti S. (2007) A longitudinal Swedish study on screening for squamous cell carcinoma and adenocarcinoma: evidence of effectiveness and overtreatment. Cancer Epidemiol Biomarkers Prev, 16, 2641-8.
  13. Laara E, Day NE, Hakama M. (1987) Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmes. Lancet, 1, 1247-9.
  14. Mahlck CG, Jonsson H, Lenner P. (1994) Pap smear screening and changes in cervical cancer mortality in Sweden. Int J Gynaecol Obstet. 44(3):267-272.
  15. Mathew A, George PS. (2009) Trends in incidence and mortality rates of squamous cell carcinoma and adenocarcinoma of cervix--worldwide. Asian Pac J Cancer Prev. 10(4): 645-650.
  16. Mistry M, Parkin DM, Ahmad AS, Sasieni P. (2011) Cancer incidence in the United Kingdom: projections to the year 2030. Br J Cancer, 105, 1795-803.
  17. National Statistical Office. (1992) Advance Report: 1990 Population and Housing Census. Bangkok, Thailand, National Statistical Office.
  18. National Statistical Office. (2002) 2000 Population and Housing Census. Bangkok, Thailand, National Statistical Office.
  19. National Statistical Office. (2012)2010 Population and Housing Census. Bangkok, Thailand, National Statistical Office. [cited 2014 July 16]. Available from:
  20. NORDPRED software package [Internet]. (2013) Oslo: Cancer Registry of Norway. [cited 2013 January 10]. Available from:
  21. Office of the National Economic and Social Development Board (2013) Population Projections for Thailand 2010-2040. Bangkok, Thailand: Office of the National Economic and Social Development Board.
  22. Olsen AH, Parkin DM, Sasieni P. (2008) Cancer mortality in the United Kingdom: projections to the year 2025. 99: 1549-54.
  23. R Core Team. (2013) R: A language and environment for statistical computing [Internet]. Vienna: R Foundation for Statistical Computing. [cited 2013 January 10]. Available from:
  24. Shastri SS, Mittra I, Mishra GA, et al. (2014) Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J Natl Cancer Inst, 106, 9.
  25. Sigurdsson K. (1999) The Iceandic and Nordic cervical screening programs: Trends in incidence and mortality reates through 1995. ActaObstetGynaecol Scand, 77, 478-485.
  26. Sirisamutr T, Butchon R, Putchong C, et al. (2010) The Evaluation of Outcomes and Determinants of Cervical Cancer Screening Programme Using Pap Smear and Visual Inspection with Acetic Acid in Thailand (in Thai). Health Intervention and Technology Assessment Program. [cited 2014 September 11]. Available from:
  27. Sriamporn S, Khuhaprema T, Parkin M. (2006) Cervical cancer screening in Thailand: an overview. J Med Screen, 1, 39-43.
  28. Srivatanakul P. (2004) Prevention and Control Strategy for Cervical Cancer in Thailand. Nonthaburi, Thailand: Ministry of Public Health.
  29. Segi M. (1960) Cancer mortality for selected sites in 24 countries (1950-57). Department of Public Health, Tohoku University of Medicine, Sendai, Japan.

Cited by

  1. Association between Early Marriage and Other Sociomedical Characteristics with the Cervical Pap Smear Results in Iraqi Women vol.05, pp.04, 2015,
  2. Inhibitory effect and mechanisms of microRNA-146b-5p on the proliferation and metastatic potential of Caski human cervical cancer cells vol.11, pp.5, 2015,
  3. The Level of Squamous Cell Carcinoma Antigen and Lymph Node Metastasis in Locally Advanced Cervical Cancer vol.16, pp.11, 2015,
  4. Cost-effectiveness Analysis of Cervical Cancer Screening Strategies Based on the Papanicolaou Smear Test in Korea vol.16, pp.6, 2015,
  5. Differences in childhood leukemia incidence and survival between Southern Thailand and the United States: a population-based analysis vol.62, pp.10, 2015,
  6. National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens vol.9, pp.8, 2017,
  7. Cancer incidence in northern Thailand: Results from six population-based cancer registries 1993-2012 vol.142, pp.9, 2017,
  8. Effect of the national screening program on malignancy status of cervical cancer in Northern Thailand vol.63, pp.3, 2018,