Nieminen Pekka, Hakama Matti, Tarkkanen Jussi, Anttila Ahti
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Int J Cancer. 2002 Jun 10;99(5):732-6. doi: 10.1002/ijc.10396.
The incidence of cervical cancer decreased in Finland over a 30-year period because of an effective screening program, but in the beginning of the 1990s it began to increase. Reasons for such an increase are variable: changes in sexual habits, shortcomings in attendance for screening and possibly variation in laboratory quality. We evaluated the impact of 3 laboratories in the greater Helsinki area on screening performance and on the incidence of invasive cervical cancer and preinvasive cervical lesions in the target population. We studied time trends, geographic differences in attendance and detection rates from screening and the incidence of invasive cancer in the greater Helsinki area (population about 1 million) during the 1990s, when screening was reorganized from the Cancer Society of Finland laboratory to the municipal one (Helsinki) and to a private laboratory (Espoo), while in Vantaa screening remained with the same Cancer Society laboratory. The attendance rate for screening increased during the study period in all 3 cities. The numbers of cytologically suspected and histologically confirmed precancerous lesions found, including severe lesions, decreased significantly with the change of laboratory in Espoo; but in Helsinki and Vantaa, they increased. The overall incidence of invasive cervical cancer increased in all cities in the age groups screened but mostly in Espoo. The rather rapid changes and variation in trends in the number of screening findings cannot be explained by changes in etiologic factors or attendance. They may be related more to the quality of the laboratory performance and perhaps to the criteria used in cytology and colposcopy. A well-organized auditing system is proposed to maintain high quality in screening.
由于有效的筛查计划，芬兰宫颈癌的发病率在30年期间有所下降，但在20世纪90年代初又开始上升。这种上升的原因多种多样：性行为习惯的改变、筛查参与率的不足以及可能的实验室质量差异。我们评估了大赫尔辛基地区3家实验室对筛查效果以及目标人群中浸润性宫颈癌和宫颈上皮内瘤变发病率的影响。我们研究了20世纪90年代大赫尔辛基地区（人口约100万）的时间趋势、筛查参与率和检出率的地理差异以及浸润性癌症的发病率，在此期间筛查从芬兰癌症协会实验室重新组织到赫尔辛基市立实验室和一家私立实验室（埃斯波），而万塔的筛查仍由同一家癌症协会实验室负责。在研究期间，所有3个城市的筛查参与率都有所上升。随着埃斯波实验室的更换，包括严重病变在内的细胞学可疑和组织学确诊的癌前病变数量显著减少；但在赫尔辛基和万塔，这些病变数量增加了。在所有接受筛查的年龄组中，浸润性宫颈癌的总体发病率在所有城市都有所上升，但在埃斯波上升幅度最大。筛查结果数量趋势的相当迅速的变化和差异无法用病因因素或参与率的变化来解释。它们可能更多地与实验室检测质量有关，也许还与细胞学和阴道镜检查所采用的标准有关。建议建立一个组织完善的审计系统以维持筛查的高质量。
