Regional differences in cervical cancer incidence among American Indians and Alaska Natives, 1999-2004
Regional differences in cervical cancer incidence among American Indians and Alaska Natives, 1999-2004
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DOI：
10.1002/cncr.23736
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发表时间：
2008-09-01
期刊：
影响因子：
6.2
通讯作者：
Waxman, Alan G.
中科院分区：
文献类型：
--
作者：
Becker, Thomas M.;Espey, David K.;Waxman, Alan G.
背景。来自有限地理区域的报告表明，美洲印第安人和阿拉斯加原住民 (AI/AN) 妇女的宫颈癌发病率高于其他种族的妇女。然而，中央癌症登记处的种族错误分类阻碍了 AI/AN 女性宫颈癌发病率的准确确定。作者将参与国家癌症登记计划 (NPCR) 和监测、流行病学和最终结果 (SEER) 计划的癌症登记处的数据与印度卫生服务 (IHS) 登记记录联系起来，以提高对 AI/AN 种族的识别。结合 NPCR 和 SEER 数据来估计 1999 年至 2004 年诊断年的年化年龄调整率（以每 100,000 人表示）。分析集中于已知种族错误分类较少的县，结果按 IHS 区域进行分层。美国大约 56% 的 AI/AN 居住在这些县。作者检查了 AV AN 女性与非西班牙裔白人 (NHW) 女性的总体发病率和特定年龄发病率以及诊断阶段。结果。在 IHS 地区，AI/AN 女性的侵袭性宫颈癌发病率相差近 2 倍，其中南部平原 (14.1) 和北部平原 (12.5) 的发病率最高；东部地区和太平洋沿岸地区的比率最低。总体而言，AI/AN 女性的宫颈癌发病率高于 NHW 女性，并且更有可能被诊断为晚期疾病。结论。浸润性宫颈癌发病率的广泛区域差异表明，迫切需要开展有关宫颈癌筛查和预防教育的卫生服务研究以及有关人乳头瘤病毒疫苗使用的政策制定，特别是在发病率高的地区。
BACKGROUND. Reports from limited geographic regions indicate higher rates of cervical cancer incidence in American Indian and Alaska Native (AI/AN) women than in women of other races. However, accurate determinations of cervical cancer incidence in AI/AN women have been hampered by racial misclassification in central cancer registries.METHODS. The authors linked data from cancer registries participating in the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program with Indian Health Service (IHS) enrollment records to improve identification of AI/AN race. NPCR and SEER data were combined to estimate annualized age-adjusted rates (expressed per 100,000 persons) for the diagnosis years 1999 to 2004. Analyses focused on Counties known to have less racial misclassification, and results were stratified by IHS Region. Approximately 56% of AI/ANs in the US reside in these counties. The authors examined overall and age-specific incidence rates and stage at diagnosis for AV AN women compared with non-Hispanic white (NHW) women.RESULTS. Invasive cervical cancer incidence rates among AI/AN women varied nearly 2-fold across IHS regions, with the highest rates reported in the Southern Plains (14.1) and Northern Plains (12.5); the lowest rates were in the Eastern region and the Pacific Coast. Overall, AI/AN women had higher rates of cervical cancer than NHW women and were more likely to be diagnosed with later stage disease.CONCLUSIONS. The wide regional variation of invasive cervical cancer incidence indicates an important need for health services research regarding cervical cancer screening and prevention education as well as policy development regarding human papillomavirus vaccine use, particularly in the regions with high incidence rates.