Taylor Richard, Morrell Stephen, Mamoon Hassan, Wain Gerard, Ross Jayne
NSW Cervical Screening Program, Cumberland Hospital, Sydney, Australia.
Cancer Causes Control. 2006 Apr;17(3):299-306. doi: 10.1007/s10552-005-0515-z.
To examine time trends in cervical cancer incidence and mortality in NSW women aged yen20 years in relation to important health service initiatives and programs.
Data on cervical cancer incidence and mortality were obtained from the NSW Central Cancer Registry for 1972-2001, and corresponding annual populations obtained from the Australian Bureau of Statistics. Direct age-standardised rates in the yen20 year population were calculated using the 2001 NSW census population as standard. Proportional reductions in incidence and mortality since 1972-1974 were also calculated and related to key health service factors and to published NSW 5-year cervical cancer relative survival for similar periods.
Declines in cervical cancer incidence (-10%) and mortality (-20%), and increased degree-of-spread specific survival following the introduction of universal health care in 1975 suggest effects of greater access to Pap screening, earlier access to diagnosis and treatment services, and improved effectiveness of treatment. Incidence plateaued during the 1980s, but mortality fell further (-7%) due to an increased proportion of localised cancers (without change to degree-of-spread specific survival). The 1980s mortality reduction was a consequence of earlier diagnosis and/or secondary prevention, not improved treatment effectiveness or reduced incidence. A marked and sustained incidence decline to 2001 (-35%) occurred after the introduction of the NSW Cervical Screening Program in 1992. This was followed 3 years later by a sustained mortality decline (-20%). During the 1990s survival across all degrees of spread remained unchanged and the mortality reduction was due entirely to reduction in incidence.
The substantial reduction of cervical cancer incidence and mortality in NSW over the last 3 decades is associated with important health service interventions that relate to control of cervical cancer, particularly the implementation of a population-based organised cervical screening program.
研究新南威尔士州20岁及以上女性宫颈癌发病率和死亡率的时间趋势，以及相关重要卫生服务举措和项目的影响。
从新南威尔士州中央癌症登记处获取1972 - 2001年宫颈癌发病率和死亡率数据，并从澳大利亚统计局获取相应年份的人口数据。以2001年新南威尔士州人口普查人口为标准，计算20岁及以上人群的直接年龄标准化率。还计算了自1972 - 1974年以来发病率和死亡率的比例下降情况，并将其与关键卫生服务因素以及同期新南威尔士州公布的5年宫颈癌相对生存率相关联。
1975年全民医疗保健实施后，宫颈癌发病率下降了10%，死亡率下降了20%，且不同扩散程度的生存率有所提高，这表明更容易获得巴氏涂片筛查、更早获得诊断和治疗服务以及治疗效果得到改善所产生的影响。20世纪80年代发病率趋于平稳，但由于局部癌症比例增加（不同扩散程度的生存率无变化），死亡率进一步下降（7%）。20世纪80年代死亡率的下降是早期诊断和/或二级预防的结果，而非治疗效果改善或发病率降低。1992年新南威尔士州宫颈癌筛查项目实施后，发病率显著且持续下降至2001年（35%）。3年后，死亡率持续下降（20%）。20世纪90年代，所有扩散程度的生存率保持不变，死亡率下降完全归因于发病率的降低。
过去30年新南威尔士州宫颈癌发病率和死亡率的大幅下降与宫颈癌控制相关的重要卫生服务干预措施有关，特别是基于人群的有组织宫颈癌筛查项目的实施。
