U.S. geographic distribution of prevaccine era cervical cancer screening, incidence, stage, and mortality.
U.S. geographic distribution of prevaccine era cervical cancer screening, incidence, stage, and mortality.
复制标题
美国Prevacine时代宫颈癌筛查，发病率，阶段和死亡率的地理分布。
DOI：
10.1158/1055-9965.epi-10-1183
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发表时间：
2011-04
期刊：
影响因子：
--
通讯作者：
Stinchcomb DG
中科院分区：
文献类型：
--
作者：
Horner MJ;Altekruse SF;Zou Z;Wideroff L;Katki HA;Stinchcomb DG
宫颈癌预防计划正在重新配置，以纳入人乳头瘤病毒（HPV）检测和疫苗接种。为了确定预防工作的优先领域，我们在引入基于HPV的预防技术之前检查了美国宫颈癌筛查的地理分布、发病率、分期和死亡率。县级宫颈癌发病率数据来自37个中央登记处，来自监测、流行病学和最终结果（SEER）和北美中央癌症登记协会（NAACCR）登记处。一个时空模型，占人口统计学和行为属性被用来生成一个完整的视图县级发病率从1995年至2004年，包括县的数据缺失。通过登记研究检查诊断时的分期分布。使用生命统计数据和新获得的县级筛查估计数确定了死亡率高和筛查不频繁的县。与非西班牙裔白人和亚洲及太平洋岛民相比，非西班牙裔黑人、美洲印第安人和阿拉斯加原住民以及西班牙裔妇女的发病率更高。筛查不频繁的县通常发生率和死亡率升高，并且位于诊断阶段不理想的州。受影响的地区包括阿巴拉契亚、东南大西洋各州和密西西比河谷下游。在大都市区的中心县，死亡率上升。宫颈癌的发病率和死亡率存在明显的地理和种族/民族差异。生活在地方性贫困地区的妇女将受益于获得基于HPV的预防技术。这些发现为在HPV预防时代监测宫颈癌控制进展提供了基线。
Cervical cancer prevention programs are being reconfigured to incorporate human papillomavirus (HPV) testing and vaccination. To define priority areas for prevention efforts, we examined the geographic distribution of cervical cancer screening, incidence, stage, and mortality in the United States prior to the introduction of HPV-based prevention technologies. County-level cervical cancer incidence data from 37 central registries were obtained from Surveillance, Epidemiology, and End Results (SEER) and North American Association of Central Cancer Registries (NAACCR) registries. A spatial- temporal model that accounted for demographic and behavioral attributes was used to generate a complete view of county-level incidence from 1995–2004, including counties with missing data. Distribution of stage at diagnosis was examined by registry. Counties with high mortality and infrequent screening were identified using vital statistics and newly available county level screening estimates. Compared to non-Hispanic whites and Asian and Pacific Islanders, incidence rates were higher among non-Hispanic black, American Indian and Alaska Native, and Hispanic women. Counties with infrequent screening often experienced elevated incidence and mortality rates and were located in states with suboptimal stage-at-diagnosis profiles. Affected areas included Appalachia, the southeastern Atlantic states, and the lower Mississippi Valley. Elevated death rates were experienced in central counties of large metropolitan areas. Geographic and racial/ethnic variability were evident in cervical cancer incidence and mortality. Women living in areas with endemic poverty would benefit from access to HPV-based prevention technologies. These findings provide a baseline for monitoring progress in cervical cancer control in the era of HPV-based prevention.