Comparison of breast cancer and cervical cancer stage distributions in ten newly independent states of the former Soviet Union: a population-based study.
Comparison of breast cancer and cervical cancer stage distributions in ten newly independent states of the former Soviet Union: a population-based study.
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DOI：
10.1016/s1470-2045(20)30674-4
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发表时间：
2021-03
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影响因子：
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通讯作者：
Znaor A
中科院分区：
文献类型：
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作者：
Ryzhov A;Corbex M;Piñeros M;Barchuk A;Andreasyan D;Djanklich S;Ghervas V;Gretsova O;Kaidarova D;Kazanjan K;Mardanli F;Michailovich Y;Ten E;Yaumenenka A;Bray F;Znaor A
前苏联新独立国家的乳腺癌和宫颈癌筛查在很大程度上是机会性的，该区域的国家是世卫组织欧洲区域宫颈癌发病率最高的国家之一。我们的目的是比较新独立的前苏联国家中乳腺癌和宫颈癌发病率的分期分布和随时间的变化。我们从亚美尼亚、阿塞拜疆、白俄罗斯、格鲁吉亚、哈萨克斯坦、吉尔吉斯斯坦、摩尔多瓦共和国、俄罗斯联邦、乌克兰和乌兹别克斯坦的官方统计数据中收集了2008-17年乳腺癌和宫颈癌发病率数据，按肿瘤、淋巴结、转移（TNM）分期和年龄分类，其中以人口为基础的癌症登记数据可用。我们使用对数线性回归来量化年龄标准化率随时间的变化。在2013 - 2017年期间，在所分析的国家中，超过50%的乳腺癌病例和白俄罗斯、哈萨克斯坦和乌克兰超过75%的乳腺癌病例登记在I-II期。与摩尔多瓦和俄罗斯登记处的其他年龄段相比，筛查年龄组（50-69岁）的I期乳腺癌病例比例最高，但在格鲁吉亚和乌克兰的15-49岁人群中比例最高。乳腺癌分期特异性发病率随着时间的推移而增加，最显著的是第一阶段癌症。对于宫颈癌，晚期（III期和IV期）诊断出的癌症比例很高，特别是在摩尔多瓦和亚美尼亚（50%）。在所有国家，第一阶段宫颈癌病例的比例随着年龄的增长而下降，而晚期癌症的比例随着年龄的增长而增加。在2008-17年期间，子宫颈癌按阶段划分的发病率普遍上升。我们的研究结果表明，在新独立的前苏联国家中，乳腺癌的早期检测取得了适度的进展。在没有乳房x光检查的情况下，早期疾病的比例很高（例如在白俄罗斯），这为快速诊断所能实现的目标提供了一个基准。对于子宫颈癌，有必要解决该地区随着时间的推移而产生的高负担和不利的阶段特异性变化。迫切需要将国家政策从机会性筛查转向有组织的、以人群为基础的、有质量保证的人乳头瘤病毒疫苗接种和筛查规划。国际癌症控制联盟、世卫组织欧洲区域办事处和乌克兰卫生部。
Screening for breast cancer and cervical cancer in the newly independent states of the former Soviet Union is largely opportunistic, and countries in the region have among the highest cervical cancer incidence in the WHO European Region. We aimed to compare the stage-specific distributions and changes over time in breast cancer and cervical cancer incidence in the newly independent states of the former Soviet Union. We collected breast cancer and cervical cancer incidence data from official statistics from Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Ukraine, and Uzbekistan for the years 2008–17 by tumour, node, metastasis (TNM) stage, and by age where population-based cancer registry data were available. We used log-linear regression to quantify the changes over time in age-standardised rates. During the period 2013–17, more than 50% of breast cancer cases across the analysed countries, and more than 75% of breast cancer cases in Belarus, Kazakhstan, and Ukraine, were registered at stages I–II. The proportion of stage I breast cancer cases was highest in the screening age group (50–69 years) compared with other ages in Moldova and the Russian registries, but was highest in those aged 15–49 years in Georgia and Ukraine. Breast cancer stage-specific incidence rates increased over time, most prominently for stage I cancers. For cervical cancer, the proportions of cancers diagnosed at a late stage (stages III and IV) were high, particularly in Moldova and Armenia (>50%). The proportion of stage I cervical cancer cases decreased with age in all countries, whereas the proportions of late stage cancers increased with age. Stage-specific incidence rates of cervical cancer generally increased over the period 2008–17. Our results suggest modest progress in early detection of breast cancer in the newly independent states of the former Soviet Union. The high proportions of early-stage disease in the absence of mammography screening (eg, in Belarus) provide a benchmark for what is achievable with rapid diagnosis. For cervical cancer, there is a need to tackle the high burden and unfavourable stage-specific changes over time in the region. A radical shift in national policies away from opportunistic screening toward organised, population-based, quality-assured human papillomavirus vaccination and screening programmes is urgently needed. Union for International Cancer Control, WHO Regional Office for Europe, and Ministry of Health of Ukraine.