Screening and adenocarcinoma of the cervix
Screening and adenocarcinoma of the cervix
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DOI：
10.1002/ijc.24410
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发表时间：
2009-08-01
影响因子：
6.4
通讯作者：
Cuzick, Jack
中科院分区：
文献类型：
--
作者：
Sasieni, Peter;Castanon, Alejandra;Cuzick, Jack
在许多国家，筛查对宫颈癌产生了重大影响。尽管它在预防鳞状细胞癌方面的有效性是毋庸置疑的，但几乎没有证据表明它对子宫颈的腺癌和腺鳞癌有任何好处，许多作者得出结论认为它是无效的。以人群为基础的病例对照设计在英国20-69岁的妇女中使用，筛查信息从常规数据库中获得。在3305例组织学已知的病例中，腺癌641例，腺鳞癌133例。鳞癌(75%，95%CI 71-79%)和腺鳞癌(83%，95%CI 68-91%)和腺癌(43%，95%CI 24-58%)与3年筛查相关的风险降低更大。在1B+期病例中，83%(335/406)的女性腺癌患者在确诊后10年内进行了筛查。这与对照组(82%，3292/3965)非常相似，但远高于鳞癌女性(57%，852/1493)。腺癌的发病率在涂片阴性后2.5年内较低(OR 2.3，95%CI 0.15~0.34)，但在涂片阴性后4.5~5.5年的背景率无明显差异。我们得出的结论是，筛查降低了子宫颈腺癌的发生率，但细胞学对腺癌的预后价值(无论是大小还是病程)都低于鳞癌。筛查对腺鳞癌的影响与其对鳞癌的影响相似。(C)2009年UICC
Screening has had a major impact on cervical cancer in many countries. Although there can be no doubt about its effectiveness in preventing squamous-cell carcinoma, there is little evidence of any benefit on adenocarcinoma and adenosquamous carcinoma of the cervix, and many authors have concluded that it is ineffective. A population-based case-control design was used in women aged 20-69 in the United Kingdom, with information on screening obtained from routine databases. Among 3,305 cases with known histology, 641 had adenocarcinoma and 133 adenosquamous carcinoma. The risk reduction associated with 3-yearly screening was greater for squamous carcinoma (75%, 95% CI 71-79%) and adenosquamous carcinoma (83%, 95% CI 68-91%) titan for adenocarcinoma (43%, 95% CI 24-58%). Among stage 1B+ cases, 83% (335/406) of women with adenocarcinoma had been screened within 10 years of diagnosis. This is very similar to controls (82%, 3,292/3,965), but much higher than in women with squamous carcinoma (57%, 852/1,493). Incidence of adenocarcinoma was low within 2.5 years of a negative smear (OR 2.3, 95% CI 0.15-0.34), but was no different front the background rates 4.5-5.5 years after a negative smear. We conclude that screening has reduced the incidence of adenocarcinoma of the cervix, but the prognostic value of cytology is less (in both magnitude and duration) for adenocarcinoma than for squamous carcinoma. The impact of screening on adenosquamous carcinoma is similar to its impact on squamous carcinoma. (C) 2009 UICC