Parikh Seema, Brennan Paul, Boffetta Paolo
Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon cedex 08, France.
Int J Cancer. 2003 Jul 10;105(5):687-91. doi: 10.1002/ijc.11141.
Previous studies of the relationship between socio-economic status and cervical cancer have been mainly based on record linkage of routine data, such as cancer registry incidence rates and regional measures of social class based on census data. These routine data are liable to substantial misclassification with respect to socio-economic status. Previous reports are also primarily from developed countries, whereas the major burden of cervical cancer is in developing countries. We have therefore pooled the data from previously reported case-control studies of cervical cancer or dysplasia, which contain individual-level information on socio-economic characteristics to investigate the relationship between cervical cancer, social class, stage of disease, geographical region, age and histological type. Based on 57 studies, we found an increased risk of approximately 100% between high and low social class categories for the development of invasive cervical cancer, and an increased risk of approximately 60% for dysplasia, including carcinoma in situ. Although the difference was observed in all countries, it was stronger in low/middle income countries and in North America than in Europe. No clear differences were observed between squamous cell carcinoma and adenocarcinoma, or between younger and older women. These results indicate that both cervical infection with human papillomavirus, which is linked to both female and male sexual behaviour, and access to adequate cervical cancer screening programmes are likely to be important in explaining the large cervical cancer incidence rates observed in different socio-economic groups, and that the importance of these factors may vary between different geographical regions.
先前关于社会经济地位与宫颈癌之间关系的研究主要基于常规数据的记录链接，比如癌症登记发病率以及基于人口普查数据的社会阶层区域衡量指标。这些常规数据在社会经济地位方面容易出现大量错误分类。先前的报告也主要来自发达国家，而宫颈癌的主要负担在发展中国家。因此，我们汇总了先前报告的宫颈癌或发育异常病例对照研究的数据，这些研究包含了关于社会经济特征的个体层面信息，以调查宫颈癌、社会阶层、疾病阶段、地理区域、年龄和组织学类型之间的关系。基于57项研究，我们发现高社会阶层与低社会阶层相比，浸润性宫颈癌发生风险增加约100%，发育异常（包括原位癌）发生风险增加约60%。尽管在所有国家都观察到了这种差异，但在低收入/中等收入国家和北美比在欧洲更为明显。在鳞状细胞癌和腺癌之间，以及年轻女性和年长女性之间未观察到明显差异。这些结果表明，与女性和男性性行为都相关的人乳头瘤病毒宫颈感染以及获得充分的宫颈癌筛查项目，可能在解释不同社会经济群体中观察到的高宫颈癌发病率方面都很重要，而且这些因素的重要性可能在不同地理区域有所不同。
