Lynge E, Engholm G, Madsen M
Kraeftens Bekaempelse, København.
Ugeskr Laeger. 1992 May 4;154(19):1330-4.
The policy concerning organization of screening for cervical cancer has varied in the Danish counties. Organized programmes started in the municipality of Frederiksberg in 1962, in the municipality of Copenhagen and the county of Maribo in 1967, and in the country of Copenhagen in 1968. On the other hand organized screening programmes have never existed in the counties of Vestsjaelland, Viborg, Ringkøbing and Ribe. We have used this "natural experiment" to study the influence of organized screening on the incidence and mortality of cervical cancer in Denmark. Women aged 30-59 years during the period 1968-87 are included in the study. The effect of organized screening has been estimated employing multiplicative Poisson models, where age, period, region and organized screening have been considered. Women living in counties where organized screening started three or more years ago have a statistically significantly reduced risk of cervical cancer. The relative risk for the incidence in this group is 0.77 (95% confidence interval 0.69-0.86), and the relative risk for the mortality is 0.75 (95% confidence interval 0.61-0.92). Only a part of the decrease in the incidence and mortality of cervical cancer which can be attributed to the organized screening activity. The additional decrease can be attributed to the considerable unorganized screening activity during the past 20 years, and to changes in exposure to risk factors.
丹麦各郡关于宫颈癌筛查组织的政策不尽相同。有组织的筛查项目于1962年在腓特烈斯贝格市启动，1967年在哥本哈根市和马里博郡启动，1968年在哥本哈根郡启动。另一方面，西兰岛、维堡、灵克宾和 Ribe 郡从未有过有组织的筛查项目。我们利用这个“自然实验”来研究有组织的筛查对丹麦宫颈癌发病率和死亡率的影响。研究纳入了1968 - 1987年期间年龄在30 - 59岁的女性。采用乘法泊松模型估计有组织的筛查的效果，其中考虑了年龄、时期、地区和有组织的筛查。生活在有组织的筛查开始三年或更久之前的郡的女性患宫颈癌的风险在统计学上显著降低。该组发病率的相对风险为0.77（95%置信区间0.69 - 0.86），死亡率的相对风险为0.75（95%置信区间0.61 - 0.92）。宫颈癌发病率和死亡率的下降只有一部分可归因于有组织的筛查活动。额外的下降可归因于过去20年大量的无组织筛查活动以及风险因素暴露的变化。
