Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors
Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors
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DOI：
10.1016/j.ejca.2013.04.024
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发表时间：
2013-10-01
影响因子：
8.4
通讯作者：
Bray, Freddie
中科院分区：
文献类型：
--
作者：
Vaccarella, Salvatore;Lortet-Tieulent, Joannie;Bray, Freddie
背景：某一国家的宫颈癌趋势主要取决于是否存在有效的筛查规划和疾病风险因素的时间变化，特别是暴露于人乳头瘤病毒（HPV）。筛查主要影响诊断期间的差异，而风险因素的变化主要表现为连续出生妇女队列的风险差异。方法：我们使用年龄标准化发病率（ASRs）和年龄-时期-队列（APC）模型评估了五大洲38个国家30-74岁年龄组的宫颈癌趋势。通过基于年龄与宫颈癌发病率之间的一致关系（即45岁以后的发病率近似恒定）进行假设，避免了APC模型的不可识别性。研究结果：除了大多数东欧人口、泰国和乌干达外，几个国家的ASRs有所下降，尽管时期和出生队列效应的方向和幅度存在很大差异。在收入最高的国家，按时期划分的宫颈癌风险有明显下降趋势，而在资源较低的国家，按时期划分的宫颈癌风险没有明显变化。在1940年或1950年以后出生的连续几代妇女要么表现出宫颈癌风险增加（在大多数欧洲国家、日本、中国），要么没有实质性变化（北美和澳大利亚），要么下降（厄瓜多尔和印度）。解释：在长期实施有效筛查的国家，基本避免了群体特异性风险潜在增加的后果。在没有筛查的情况下，观察到人群主导的宫颈癌asr增加或稳定。我们的研究强调了加强筛查工作和通过HPV疫苗接种加强现有癌症控制工作的重要性，特别是在那些不利的队列效应仍在继续或正在出现的国家。(C) 2013 Elsevier Ltd.版权所有。
Background: Cervical cancer trends in a given country mainly depend on the existence of effective screening programmes and time changes in disease risk factors, notably exposure to human papillomavirus (HPV). Screening primarily influences variations by period of diagnosis, whereas changes in risk factors chiefly manifest themselves as variations in risk across successive birth cohorts of women.Methods: We assessed trends in cervical cancer across 38 countries in five continents, age group 30-74 years, using age-standardised incidence rates (ASRs) and age-period-cohort (APC) models. Non-identifiability in APC models was circumvented by making assumptions based on a consistent relationship between age and cervical cancer incidence (i.e. approximately constant rates after age 45 years).Findings: ASRs decreased in several countries, except in most of Eastern European populations, Thailand as well as Uganda, although the direction and magnitude of period and birth cohort effects varied substantially. Strong downward trends in cervical cancer risk by period were found in the highest-income countries, whereas no clear changes by period were found in lower-resourced settings. Successive generations of women born after 1940 or 1950 exhibited either an increase in risk of cervical cancer (in most European countries, Japan, China), no substantial changes (North America and Australia) or a decrease (Ecuador and India).Interpretation: In countries where effective screening has been in place for a long time the consequences of underlying increases in cohort-specific risk were largely avoided. In the absence of screening, cohort-led increases or, stable, cervical cancer ASRs were observed. Our study underscores the importance of strengthening screening efforts and augmenting existing cancer control efforts with HPV vaccination, notably in those countries where unfavourable cohort effects are continuing or emerging. (C) 2013 Elsevier Ltd. All rights reserved.