Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics
Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics
复制标题
DOI：
10.1136/bmj.318.7188.904
复制
发表时间：
1999-04-03
影响因子：
--
通讯作者：
Allen, E
中科院分区：
文献类型：
--
作者：
Quinn, M;Babb, P;Allen, E
目的评价筛查对宫颈癌发病率和死亡率的影响。以19岁以上妇女为研究对象，对1988年全国呼叫召回制度实施前后的年龄别发病率和死亡率进行设计比较。结果20世纪60年代中期至80年代末，涂抹量持续上升至450万。在1988至1994年间，较大群体的覆盖率翻了一番，达到约85%，原位疾病登记与涂片数量大致同步增加。到1980年代末，侵袭性疾病的总发病率保持稳定，尽管有很强的队列效应；自1990年以来，发病率持续下降，1995年比1980年代低35%。自1950年以来，总死亡率在1980年代末加速下降；出现了强烈的群体效应。20世纪90年代55岁以下女性的死亡率远低于预期。结论国家呼叫和召回系统以及对全科医生的奖励支付使覆盖率提高到85%左右。这导致英格兰所有地区和30至74岁的所有年龄段的侵袭性疾病发病率下降。老年妇女死亡率的下降在很大程度上与筛查无关，但如果没有筛查，1997年55岁以下妇女死于宫颈癌的人数可能会增加800人。
Objective To assess die impact of screening on the incidence of and mortality from cervical cancer.Design Comparison of age specific incidence and mortality before and after the introduction of the national call and recall system in 1988Setting England.Subjects Women aged over 19 years.Results From the mid-1960s, the number of smears taken rose continuously to 4.5 million at the end of the 1980s. Between 1988 and 1994, coverage of the larger group doubled to around 85%, Registrations of in situ disease increased broadly in parallel with the numbers of smears taken. The overall incidence of invasive disease remained stable up to the end of the 1980s, although there were strong cohort effects; from 1990 incidence fell continuously and in 1995 was 35% lower than in the 1980s. The fall in overall mortality since 1950 accelerated at the end of the 1980s; there were strong cohort effects. Mortality in women under 55 was much lower in the 1990s than would have been expected.Conclusions The national call and recall system and incentive payments to general practitioners increased coverage to around 85%. This resulted in falls in incidence of in invasive disease in all regions of England and in all age groups from 30 to 74. The falls in mortality in older women were largely unrelated to screening, but without screening there might have been 800 more deaths from cervical cancer in women under 55 in 1997.