Trends in cervical squamous cell carcinoma incidence in 13 European countries: Changing risk and the effects of screening
Trends in cervical squamous cell carcinoma incidence in 13 European countries: Changing risk and the effects of screening
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DOI：
10.1158/1055-9965.epi-04-0569
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发表时间：
2005-03-01
影响因子：
3.8
通讯作者：
Parkin, DM
中科院分区：
文献类型：
--
作者：
Bray, F;Loos, AH;Parkin, DM
尽管有足够的证据表明细胞学筛查在预防子宫颈癌方面的有效性，但欧洲各国的筛查政策差异很大，年轻女性的发病率正在上升。本研究分析了13个欧洲国家宫颈鳞状细胞癌（SCC）的趋势，以评估在风险变化背景下筛查的有效性。拟合了年龄-时期-队列模型，并估计了时期和队列效应；这些分别被认为是筛查干预和改变病因的主要指示。在假设年龄和宫颈癌发病率之间的关系是由生物学决定的情况下，通过将年龄斜率固定在几条看似合理的年龄曲线中的一条上，得出了一组独特的估计。在一些国家，宫颈鳞状细胞癌出现了特定时期的下降，北欧的下降幅度最大。整个欧洲出现了一种模式，即1930年以后出生的几代人的风险不断上升。在西欧国家，风险下降后按队列稳定，并伴随着特定时期的下降。在南欧，观察到稳定时期，但队列趋势增加。在欧洲，宫颈鳞状细胞癌的发病率发生了实质性的变化，组织良好的筛查项目在降低宫颈鳞状细胞癌的发病率方面非常有效。筛选和改变性观念在很大程度上分别解释了时期和群体特定模式的变化。在最近的队列中，风险的增加明显令人担忧，特别是在没有筛查项目的国家。有必要对机会性筛查的有效性进行进一步调查，因为在社会结构相对相似的国家中，观察到年轻人群的不同风险模式。
Despite there being sufficient evidence for the effectiveness of screening by cytology in preventing cancer of the cervix uteri, screening policies vary widely among European countries, and incidence is increasing in younger women. This study analyzes trends in squamous cell carcinoma (SCC) of the cervix uteri in 13 European countries to evaluate effectiveness of screening against a background of changing risk. Age-period-cohort models were fitted and period and cohort effects were estimated; these were considered as primarily indicative of screening interventions and changing etiology, respectively. A unique set of estimates was derived by fixing age slopes to one of several plausible age curves under the assumption that the relation between age and cervical cancer incidence is biologically determined. There were period-specific declines in cervical SCC in several countries, with the largest decreases seen in northern Europe. A pattern emerged across Europe of escalating risk in successive generations born after 1930. In the western European countries, a decrease followed by a stabilization of risk by cohort was accompanied by period-specific declines. In southern Europe, stable period, but increasing cohort trends, were observed. Substantial changes have occurred in cervical SCC incidence in Europe and well-organized screening programs have been highly effective in reducing the incidence of cervical SCC. Screening and changing sexual mores largely explain the changing period- and cohort-specific patterns, respectively. The increasing risk in recent cohorts is of obvious concern particularly in countries where no screening programs are in place. Further investigation of the effectiveness of opportunistic screening is warranted as is the observation of differing risk patterns in young cohorts in countries with relatively similar societal structures.