Azerkan Fatima, Zendehdel Kazem, Tillgren Per, Faxelid Elisabeth, Sparén Pär
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Int J Cancer. 2008 Dec 1;123(11):2664-70. doi: 10.1002/ijc.23843.
Because of great variation in the prevalence of human papilloma virus infection and other risk factors of cervical cancer worldwide, migrant studies may help further the understanding of the aetiology and improve prevention of cervical cancer. Our aim was to study the risk of invasive cervical cancer among immigrant women. We followed 758,002 immigrants from different countries who resided in Sweden between 1968 and 2004. Age-standardised incidence rates (ASRs) of immigrants were compared with that in their countries of origin. Poisson regression models estimated the relative risks of cervical cancer among immigrants, overall and stratified by age at migration and follow-up time, compared to Swedish-born women. Overall 1,991 of 19,542 observed cases of cervical cancer occurred among immigrants. Generally they had lower ASRs than in their countries of origin, with the exception of Nordic immigrants. Compared to Swedish-born women, we observed a higher relative risk of cervical cancer among immigrants overall (RR = 1.13, 95% CI 1.08-1.18), and particularly among women from Denmark (RR = 1.8, 95% CI 1.6-2.1), Norway (RR = 1.7, 95% CI 1.5-1.9) and Central America (RR = 2.5, 95% CI 1.3-4.9), while the relative risks were lower in immigrants from Eastern Africa (RR = 0.2, 95% CI 0.1-0.6), South Central Asia (RR = 0.4, 95% CI 0.2-0.6) and South Western Asia (RR = 0.5, 95% CI 0.4-0.7). Follow-up time and age at migration were important effect modifiers for cervical cancer risks. We suggest targeted prevention toward high-risk immigrants, specifically older women, in the first 10 years after arrival into their new homeland.
由于全球范围内人乳头瘤病毒感染的患病率以及宫颈癌的其他风险因素存在很大差异，移民研究可能有助于进一步了解病因并改善宫颈癌的预防。我们的目的是研究移民妇女患浸润性宫颈癌的风险。我们追踪了1968年至2004年间居住在瑞典的758,002名来自不同国家的移民。将移民的年龄标准化发病率（ASRs）与其原籍国的发病率进行比较。泊松回归模型估计了移民中宫颈癌的相对风险，总体上以及按移民年龄和随访时间分层后，与瑞典出生的女性相比。在19,542例观察到的宫颈癌病例中，共有1,991例发生在移民中。总体而言，除北欧移民外，他们的年龄标准化发病率低于原籍国。与瑞典出生的女性相比，我们观察到移民总体上患宫颈癌的相对风险更高（RR = 1.13，95% CI 1.08 - 1.18），特别是来自丹麦的女性（RR = 1.8，95% CI 1.6 - 2.1）、挪威的女性（RR = 1.7，95% CI 1.5 - 1.9）和中美洲的女性（RR = 2.5，95% CI 1.3 - 4.9），而来自东非的移民（RR = 0.2，95% CI 0.1 - 0.6）、中南亚的移民（RR = 0.4，95% CI 0.2 - 0.6）和西南亚的移民（RR = 0.5，95% CI 0.4 - 0.7）的相对风险较低。随访时间和移民年龄是宫颈癌风险的重要效应修饰因素。我们建议针对高危移民，特别是老年女性，在抵达新家园后的头10年进行有针对性的预防。
