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Evidence for cervical cancer mortality with screening program in Taiwan, 1981–2010: age-period-cohort model

Shih-Yung Su12, Jing-Yang Huang1, Chien-Chang Ho3 and Yung-Po Liaw1*

Author Affiliations

1 Department of Public Health and Institute of Public Health, Chung Shan Medical University, No. 110 Sec 1 Chien-Kuo N. Road, Taichung City 40201, Taiwan

2 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm. 536, No. 17, Xuzhou Rd, Taipei 100, Taiwan

3 Department of Health and Leisure Management, Yuanpei University, Hsinchu City, 30015, Taiwan

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BMC Public Health 2013, 13:13  doi:10.1186/1471-2458-13-13

Published: 8 January 2013



Cervical cancer is the most common cancer experienced by women worldwide; however, screening techniques are very effective for reducing the risk of death. The national cervical cancer screening program was implemented in Taiwan in 1995. The objective of this study was to examine and provide evidence of the cervical cancer mortality trends for the periods before and after the screening program was implemented.


Data from 1981 to 2010 of the causes of death registered were obtained from the Department of Health, Taiwan. Age-standardized mortality rates, age-specific rates, and age-period-cohort models that employed the sequential method were used to assess temporal changes that occurred between 1981 and 2010, with 1995 used as the separating year.


The results showed that for both time periods of 1981 to 1995 and 1996 to 2010, age and period had significant effects, whereas the birth cohort effects were insignificant. For patients between 80 and 84 years of age, the mortality rate for 1981 to 1995 and 1996 to 2010 was 48.34 and 68.08. The cervical cancer mortality rate for 1996 to 2010 was 1.0 for patients between 75 and 79 years of age and 1.4 for patients between 80 and 84 years of age compared to that for 1981 to 1995. Regarding the period effect, the mortality trend decreased 2-fold from 1996 to 2010.


The results of this study indicate a decline in cervical cancer mortality trends after the screening program involving Papanicolaou tests was implemented in 1995. However, the positive effects of the screening program were not observed in elderly women because of treatment delays during the initial implementation of the screening program.

Cervical cancer; Age-period-cohort model; Mortality; Gynecologic oncology; Screening program