Cervical cancer is the fourth most prevalent cancer disease in women worldwide. It is more common in countries with low and average income, and is less prevalent in Israel.
Infection caused by certain types of the Human Papilloma Virus (HPV) is an essential factor in the disease development.
Other known risk factors are smoking and AIDS virus infection.
Including the HPV vaccination in the national vaccination routine may contribute, in the long run, to a primary prevention of the disease. Secondary prevention of the disease, that is, detection of precancerous lesions (stage 3) or early stage invasive cervical cancer, is made possible by taking a PAP smear test or testing the presence of the virus (HPV test). (See further details on the tests below).Prof. Lital Keinan-Boker, Director of the Israel Center for Disease Control (ICDC) of the Ministry of Health: "The incidence rate (the number of newly diagnosed cases) of invasive cervical cancer in Israel has kept stable in the last decades (1996-2017). However, there has been an increase in the incidence rate of stage 3 precancerous lesions, indicating, among other things, an increase in the compliance rate to PAP tests from 48.1% in 2014 to 51.5% in 2018. The PAP test is included in the healthcare basket but is a screening test not proactively offered to all women of a certain age. Hence, a considerable section of the main target population – women at high risk – is not properly covered."
Moshe Bar-Haim, CEO of the Israel Cancer Association: "the ICA urges all relevant frameworks to help increase awareness and vaccination rates against HPV. According to numerous research findings published to date, one can expect that the vaccines will prevent most of the advanced stage precancerous changes, thus making the vaccine the main prevention measure currently available against cervical cancer. If we increase the vaccination rate, we can lead to a significant decrease in the number of cancer cases."
Dr. Mario Beiner, head of the Gynecologic Oncology unit at Meir Medical Center, and president of the Israeli Association of Gynecologic Oncology (ISGO): "In recent years, we are witnessing an improvement in women's referral to take the PAP test. The rate of women taking PAP tests as a screening measure in the last 3 years has risen from 48.1% to 51.5%, and the rate of women who have not taken a PAP test in the last 5 years has dropped from 39% to 34.8%. Unfortunately, the screening rate is still low, especially amongst populations with low socioeconomic background. Moreover, the compliance rate to the HPV vaccine, administered for free to both male and female school kids, is still low and is less than 60%. From my knowledge of female patients, they do not receive information from family doctors or gynecologists regarding the recommendation and possibility of getting vaccinated until the age of 45 within the healthcare funds – if they did not receive the vaccine during school years."According to the National Cancer Registry at the Ministry of Health, 248 women were diagnosed with invasive cervical cancer in Israel in 2018, and 717 women with precancerous lesions (stage 3). The incidence rates of both invasive cervical cancer and precancerous lesions (stage 3) were higher amongst Jewish women compared to Arab women. An international comparison shows that invasive cervical cancer incidence in Israel is among the lowest in the OECD countries (33 out of 36 countries).
Amongst women diagnosed with invasive cervical cancer in 2012-2017, the average age at diagnosis was 54 in Jewish and "other" women, and 50 in Arab women. Morbidity trends remains stable with no significant change throughout the entire period in both population groups. The age-standardized incidence of cervical cancer (per 100,000) of precancerous lesions (stage 3) in 2017 were higher than the rates recorded in 1996.
During 2017, 81 women died of invasive cervical cancer. No significant gap was found in mortality rates between Jewish and "other" women, and Arab women. The average age upon death from cervical cancer in 2017 was 65 in Jewish and other women and 58 in Arab women. By international comparison, although incidence rates of invasive cervical cancer in Israel were low in comparison to other OECD countries, (according to Globocan 2018), mortality rates in Israel are in the average range – ranking one-half above of these countries and below the second half.
According to recent data published by the national program for quality measures in community healthcare, 51.5% of women ages 35-54 underwent screening for cervical cancer in between 2016-2018. This is less than the rate reported in 2013 for women aged 20-69 in the OECD countries (61.6%). However, those are different age groups. It is important to remember that in 50% of the OECD countries, the cervical cancer screening program is national, whereas in Israel, the program is opportunistic. And indeed, the compliance rate amongst women from high socioeconomic background in 2018 was twice as high (63.0%) as the rate reported amongst women of low socioeconomic background.
The national program for quality measures in community healthcare also examined the rate of Israeli women aged 35-54 who were not screened at all in the last five years. It was found that the rate dropped throughout those years: from 39.0% in 2014 to 34.8% in 2018. The rate of those not screened was 2.5 times higher in women of low socioeconomic background (55.4%) compared to women of high socioeconomic background (23.1%), 51.5% of women ages 35-54 underwent screening for cervical cancer in between 2016-2018.