Trends of cervical cancer mortality in the member states of the European Union
Trends of cervical cancer mortality in the member states of the European Union
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DOI：
10.1016/j.ejca.2009.07.018
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发表时间：
2009-10-01
影响因子：
8.4
通讯作者：
Anttila, Ahti
中科院分区：
文献类型：
--
作者：
Arbyn, Marc;Raifu, Amidu O.;Anttila, Ahti
背景：通过筛查和治疗筛查发现的宫颈病变，可以在很大程度上避免宫颈癌死亡。然而，2004年，欧洲联盟(欧盟)有16,000多名妇女死于宫颈癌。在这篇论文中，我们分析了自1970年以来27个成员国的宫颈癌死亡率趋势，并试图解释筛查和其他因素是如何推动变化的。方法：从世界卫生组织死亡率数据库中提取欧盟成员国子宫癌死亡人数和总女性人口的数据。三种不同的再分配规则被应用于纠正宫颈癌死亡率，以纠正在证明未明确指定的子宫癌死因时的不准确性。采用JINPOINT回归方法研究所有成员国校正后宫颈癌死亡率的年变化。我们区分了12个新成员国中的15个旧成员国，这些新成员国于2004年或更晚加入欧盟。对于芬兰、法国和罗马尼亚，分析了按日历周期划分的特定年龄趋势和按出生队列划分的标准化队列死亡率。结果：在过去几十年中，老成员国的校正年龄标准化宫颈癌死亡率显著下降。东欧成员国和波罗的海国家的死亡率下降幅度较小(捷克共和国、波兰)，死亡率保持不变(爱沙尼亚、斯洛伐克)，甚至有所上升(保加利亚、拉脱维亚、立陶宛、罗马尼亚)。标准化队列死亡率表明，1940年以后出生的妇女的死亡率没有进一步下降甚至上升。结论：宫颈癌死亡率存在显著差异，特别是在欧盟新老成员国之间，这可能是由于预防策略的差异所致。除非采取充分的预防措施，否则未来这种对比可能会增加。(C)2009爱思唯尔有限公司。保留所有权利。
Background: Cervical cancer mortality can be avoided to a large extent by screening and treatment of screen-detected cervical lesions. However, in 2004, more than 16,000 women died from cervical cancer in the European Union (EU). In the current paper, we analyse cervical cancer mortality trends in the 27 member states since 1970 and, subsequently, try to explain how screening and other factors have driven changes.Methods: Data on number of deaths from uterine cancers and overall female populations from EU member states were extracted from the World Health Organisation mortality database. Three different reallocation rules were applied to correct cervical cancer mortality for inaccuracies in certification of cause of death of not otherwise specified uterine cancer. Joinpoint regression was used to study annual variation of corrected cervical cancer mortality in all member states. We distinguished the 15 old from the 12 new member states, which acceded to the EU in 2004 or later. For Finland, France and Romania, age-specific trends by calendar period and the standardised cohort mortality ratios by birth cohort were analysed.Results: Corrected age-standardised cervical cancer mortality rates have decreased significantly over the past decades in the old member states. Member states in Eastern Europe and also the Baltic states showed mortality rates that decreased at a lower intensity (Czech Republic, Poland), remained constant at a high rate (Estonia, Slovakia) or even increased (Bulgaria, Latvia, Lithuania, Romania). The standardised cohort mortality ratio indicated that mortality does not decrease further or even increase among women born after 1940.Conclusion: Remarkable contrasts were observed on cervical cancer mortality, in particular, between the old and new member states of the EU, which might probably be explained by differences in preventive strategies. This contrast might increase in the future, unless adequate preventive measures are adopted. (C) 2009 Elsevier Ltd. All rights reserved.