Hopenhayn Claudia, King Jessica B, Christian Amy, Huang Bin, Christian W Jay
Markey Cancer Control Program, Lexington, Kentucky, USA.
Cancer. 2008 Nov 15;113(10 Suppl):2974-80. doi: 10.1002/cncr.23749.
Although the rates of invasive cervical cancer (ICC) have decreased substantially in the US since the advent of the Papanicolaou (Pap) test, Appalachian women remain at increased risk compared with the nation as a whole. The ICC incidence rates were compared in 5 Appalachian states with population-based cancer registries to investigate variability within the Appalachian region.
Alabama, Kentucky, Ohio, Pennsylvania, and West Virginia were selected for the analysis on the basis of their having high-quality cancer registry data for 1998 through 2003. Incidence rates were calculated by state and by Appalachia/non-Appalachia, urban/rural, and black/nonblack within each state, following the standard case definition and inclusion criteria used in this supplement. Data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to characterize the prevalence of Pap testing and smoking.
The ICC incidence rates varied among the 5 states, being highest in West Virginia (10.9 of 100,000) and Kentucky (10.7 of 100,000), and lowest in Ohio (8.2 of 100,000). The Appalachian regions of Kentucky, West Virginia, and Ohio had considerably higher rates than those of Alabama and Pennsylvania. These variations reflected patterns in the rates of poverty, education, smoking, and Pap testing.
The variability in ICC risk across subgroups of Appalachia should be considered in the planning of preventive strategies, including reduction in risk factors and promotion of screening and vaccination.
自从巴氏涂片检查问世以来，美国浸润性宫颈癌（ICC）的发病率已大幅下降，但与全国整体情况相比，阿巴拉契亚地区的女性患病风险仍然较高。为了调查阿巴拉契亚地区内部的差异，我们比较了5个设有基于人群的癌症登记处的阿巴拉契亚州的ICC发病率。
基于阿拉巴马州、肯塔基州、俄亥俄州、宾夕法尼亚州和西弗吉尼亚州拥有1998年至2003年的高质量癌症登记数据，选择这几个州进行分析。按照本增刊中使用的标准病例定义和纳入标准，计算每个州以及阿巴拉契亚地区/非阿巴拉契亚地区、城市/农村和黑人/非黑人的发病率。行为危险因素监测系统（BRFSS）的数据用于描述巴氏涂片检查和吸烟的流行情况。
5个州的ICC发病率各不相同，西弗吉尼亚州（每10万人中有10.9例）和肯塔基州（每10万人中有10.7例）最高，俄亥俄州（每10万人中有8.2例）最低。肯塔基州、西弗吉尼亚州和俄亥俄州的阿巴拉契亚地区的发病率明显高于阿拉巴马州和宾夕法尼亚州。这些差异反映了贫困率、教育程度、吸烟率和巴氏涂片检查率的模式。
在制定预防策略时，应考虑阿巴拉契亚地区不同亚组之间ICC风险的差异，包括降低危险因素以及推广筛查和疫苗接种。
