Cervical cancer in the screening era: who fell victim in spite of successful screening programs?
Cervical cancer in the screening era: who fell victim in spite of successful screening programs?
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DOI：
10.3802/jgo.2011.22.2.76
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发表时间：
2011-06-01
影响因子：
3.9
通讯作者：
Hellstrom, Ann-Cathrin
中科院分区：
文献类型：
--
作者：
Pettersson, B. Folke;Hellman, Kristina;Hellstrom, Ann-Cathrin
目的：比较宫颈癌妇女的预筛选和筛查队列的组织病理学和临床变量，以确定那些尽管成功的筛查计划仍有风险的妇女。通过分析这些资料，我们希望改善未来的筛查方法。方法：预筛选和筛查队列分别由5,046和1,174名妇女组成，在1944-1957年和1990- 2004年期间在卡罗林斯卡大学医院Radiumhemmet妇科肿瘤科接受宫颈癌治疗。在1944-1957年和1990-2004年接受治疗的队列中，平均年龄分别从48.9岁增加到55.3岁。在预筛选和筛选期间，69岁以上患者的百分比分别为5.4%和27.3%。在筛查队列中观察到诊断向早期转移，宫颈鳞癌减少，腺癌增加。腺癌的比例在年轻患者中高出约6倍。与怀孕有关的残端癌和宫颈癌病例有所减少。87名妇女在筛查队列中有原位癌锥切治疗的历史，这些病例中有28%的宫颈癌锥切术后一年内发生。结论：轮廓改变了筛查时代，需要完善筛查，以提高检测老年妇女。这项研究是宫颈癌最大的临床系列之一，提供了一个重要的基线，可以与以后的研究进行比较，以评估人乳头瘤病毒疫苗的效果和该领域的其他重要变化。
Objective: To compare profiles of a prescreening and screening cohort of women with cervical cancer regarding histopathology and clinical variables in order to identify those remaining at risk despite successful screening programs. By analyzing these profiles we hope to improve future screening methods.Methods: The prescreening and screening cohorts consisted of 5,046 and 1,174 women, respectively, treated for cervical cancer at the Department of Gynecological Oncology at Radiumhemmet, Karolinska University Hospital, during the periods 1944-1957 and 1990-2004.Results: Mean age increased from 48.9 years to 55.3 years in the cohorts treated 1944-1957 and 1990-2004, respectively. The percentage of patients older than 69 years was 5.4% and 27.3% in the prescreening and screening period, respectively. A shift towards earlier stages at diagnosis, a reduction of squamous cervical cancer and an increase of adenocarcinoma were observed in the screening cohort. The percentage of adenocarcinoma was about 6 times higher among younger patients. Cases of stump cancer and cervical cancer associated with pregnancy have declined. Eighty-seven women in the screening cohort had a history of treatment for in situ carcinoma by conization; 28% of these cases developed cervical cancer within one year after conization.Conclusion: The profile changed in the screening era indicating a need to refine screening for improved detection of in older women. This study, one of the largest clinical series of cervical cancer, provides an important baseline with which later studies can be compared to evaluate the effects of human papillomavirus vaccine and other important changes in this field.