Changing rates of adenocarcinoma and adenosquamous carcinoma of the cervix in England
Changing rates of adenocarcinoma and adenosquamous carcinoma of the cervix in England
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DOI：
10.1016/s0140-6736(00)04646-8
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发表时间：
2001-05-12
期刊：
影响因子：
168.9
通讯作者：
Adams, J
中科院分区：
文献类型：
--
作者：
Sasieni, P;Adams, J
背景 最近的一项分析显示，1971 年至 1992 年间，筛查对宫颈腺癌的发病率几乎没有影响。我们使用了 1993-94 年英国诊断的癌症以及截至 1997 年英国五个癌症登记处诊断的癌症的额外数据，以调查更近期的趋势。方法 在估算组织学未知的女性中的腺癌数量后，我们拟合了一个年龄队列模型8062 1971 年至 1987 年间在英国诊断出的子宫颈腺癌。该模型的预测应用于 5854 例病例的最新数据。根据四个年龄组中每个年龄组的诊断年份绘制残留效应。结果我们估计 1960 年代初出生的女性患宫颈腺癌的潜在风险比 1935 年之前出生的女性高 14 倍 (95% CI 11-19)。年龄队列模型很好地拟合了英格兰截至 1987 年的数据，但大大高估了年轻人中的腺癌数量妇女来自 1990年起。 1996-97年，25-54岁女性的发病率低于年龄队列模型预测的40%。 解释 近年来宫颈腺癌的大幅增加主要是出生队列效应，可能与20世纪60年代性革命后更多地接触人乳头瘤病毒有关。近年来观察到的年轻女性的相对下降表明宫颈筛查的作用。
Background A recent analysis showed little or no effect of screening on the incidence of adenocarcinoma of the cervix between 1971 and 1992. We have used additional data on cancers diagnosed in 1993-94 in England and up to 1997 in five English cancer registries to investigate more recent trends.Methods After imputing the number of adenocarcinomas in women with unknown histology, we fitted an age-cohort model to 8062 adenocarcinomas of the cervix diagnosed in England between 1971 and 1987. Predictions from this model were applied to the more recent data on 5854 cases. Residual effects were plotted against year of diagnosis in each of four age-groups.Findings We estimated the underlying risk of cervical adenocarcinoma to be 14 times (95% CI 11-19) greater in women born in the early 1960s than in cohorts born before 1935. An age-cohort model fitted the data for England well up to 1987, but substantially overestimated the numbers of adenocarcinomas in young women from 1990 onwards. In 1996-97 the incidence rate in women aged 25-54 years was less than 40% of that predicted from the age-cohort model.Interpretation The substantial increase in cervical adenocarcinoma in recent years is largely a birth-cohort effect presumably associated with greater exposure to human papillomavirus after the sexual revolution in the 1960s. The relative decline in younger women observed in more recent years suggests an effect of cervical screening.