Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis
Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis
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DOI：
10.1016/s2214-109x(19)30482-6
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发表时间：
2020-02-01
影响因子：
34.3
通讯作者：
Bray, Freddie
中科院分区：
文献类型：
--
作者：
Arbyn, Marc;Weiderpass, Elisabete;Bray, Freddie
背景持续的人乳头瘤病毒（HPV）感染是宫颈癌的主要原因，这一认识导致了预防HPV感染的预防性疫苗和检测病毒核酸的HPV检测的发展。世卫组织发起了一项全球倡议，以扩大预防、筛查和治疗干预措施的规模，消除宫颈癌这一世纪公共卫生问题。因此，我们的研究旨在评估宫颈癌的现有负担，作为评估该倡议效果的基线。方法对于这项全球分析，我们使用了来自全球癌症观察站2018数据库的185个国家的癌症估计数据。我们使用了一系列方法，这些方法依赖于基于人群的癌症登记处的源信息的可用性和质量来估计宫颈癌的发病率。对于宫颈癌死亡率的估计，我们使用了WHO死亡率数据库。这些国家被分为21个次大陆，并根据其人类发展指数被分为高资源或低资源国家。我们计算了特定国家的宫颈癌病例和死亡人数、宫颈癌的直接年龄标准化发病率和死亡率、间接标准化发病率和死亡率、累积发病率和死亡率以及诊断时的平均年龄。结果2018年发生了约57万例宫颈癌病例和311000例死亡。宫颈癌是妇女第四大常见癌症，排在乳腺癌（210万例）、结肠直肠癌（80万例）和肺癌（70万例）之后。全球宫颈癌的年龄标准化发病率估计为每10万名妇女13.1例，各国之间差异很大，发病率从每10万名妇女不到2例到75例不等。宫颈癌是东部、西部、中部和南部非洲妇女癌症相关死亡的主要原因。据估计，斯威士兰的发病率最高，约有6.5%的妇女在75岁以前患上宫颈癌。中国和印度共同贡献了全球宫颈负担的三分之一以上，中国有106000例病例，印度有97000例病例，中国有48000例死亡，印度有60000例死亡。在全球范围内，诊断宫颈癌的平均年龄为53岁，从44岁（瓦努阿图）到68岁（新加坡）不等。全球死于宫颈癌的平均年龄为59岁，从45岁（瓦努阿图）到76岁（马提尼克）不等。在185个接受评估的国家中，有146个国家（79%）的45岁以下女性患宫颈癌的比例位居前三位。解读宫颈癌仍然是影响中年女性的主要公共卫生问题，尤其是在资源较少的国家。HPV疫苗接种和基于HPV的筛查（包括自我采样）在全球范围内的扩大有可能使宫颈癌在未来几十年成为一种罕见疾病。我们的研究可以帮助塑造和监测主动消除宫颈癌作为一个主要的公共卫生问题。版权所有（C）2019作者。由Elsevier Ltd.发布，这是CC BY 4.0许可下的开放获取文章。
Background The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of prophylactic vaccines to prevent HPV infection and HPV assays that detect nucleic acids of the virus. WHO has launched a Global Initiative to scale up preventive, screening, and treatment interventions to eliminate cervical cancer as a public health problem during the 21st century. Therefore, our study aimed to assess the existing burden of cervical cancer as a baseline from which to assess the effect of this initiative.Methods For this worldwide analysis, we used data of cancer estimates from 185 countries from the Global Cancer Observatory 2018 database. We used a hierarchy of methods dependent on the availability and quality of the source information from population-based cancer registries to estimate incidence of cervical cancer For estimation of cervical cancer mortality, we used the WHO mortality database. Countries were grouped in 21 subcontinents and were also categorised as high-resource or lower-resource countries, on the basis of their Human Development Index. We calculated the number of cervical cancer cases and deaths in a given country, directly age-standardised incidence and mortality rate of cervical cancer, indirectly standardised incidence ratio and mortality ratio, cumulative incidence and mortality rate, and average age at diagnosis.Findings Approximately 570 000 cases of cervical cancer and 311000 deaths from the disease occurred in 2018. Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2.1 million cases), colorectal cancer (0.8 million) and lung cancer (0.7 million). The estimated age-standardised incidence of cervical cancer was 13.1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100 000 women. Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa. The highest incidence was estimated in Eswatini, with approximately 6.5% of women developing cervical cancer before age 75 years. China and India together contributed more than a third of the global cervical burden, with 106 000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India. Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore). The global average age at death from cervical cancer was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed.Interpretation Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. The global scale-up of HPV vaccination and HPV-based screening-including self-sampling-has potential to make cervical cancer a rare disease in the decades to come. Our study could help shape and monitor the initiative to eliminate cervical cancer as a major public health problem. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access artide under the CC BY 4.0 license.