Laboratory for Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 8717 Grovemont Circle, Gaithersburg, MD 20892, USA.
Cancer Epidemiol Biomarkers Prev. 2011 Apr;20(4):591-9. doi: 10.1158/1055-9965.EPI-10-1183. Epub 2011 Jan 25.
Cervical cancer prevention programs are being reconfigured to incorporate human papillomavirus (HPV) testing and vaccination. To define priority areas for prevention efforts, we examined the geographic distribution of cervical cancer screening, incidence, stage, and mortality in the United States, prior to the introduction of HPV-based prevention technologies.
County-level cervical cancer incidence data from 37 central registries were obtained from Surveillance, Epidemiology, and End Results and North American Association of Central Cancer Registries. A spatial-temporal model that accounted for demographic and behavioral attributes was used to generate a complete view of county-level incidence from 1995 to 2004, including counties with missing data. Distribution of stage at diagnosis was examined by registry. Counties with high mortality and infrequent screening were identified using vital statistics and newly available county-level screening estimates.
Compared with non-Hispanic whites and Asian and Pacific Islanders, incidence rates were higher among non-Hispanic black, American Indian and Alaska Native, and Hispanic women. Counties with infrequent screening often experienced elevated incidence and mortality rates and were located in states with suboptimal stage at diagnosis profiles. Affected areas included Appalachia, the southeastern Atlantic states, and the lower Mississippi Valley. Elevated death rates were experienced in central counties of large metropolitan areas.
Geographic and racial/ethnic variability were evident in cervical cancer incidence and mortality. Women living in areas with endemic poverty would benefit from access to HPV-based prevention technologies.
These findings provide a baseline for monitoring progress in cervical cancer control in the era of HPV-based prevention.
宫颈癌预防计划正在进行重新配置，以纳入人乳头瘤病毒（HPV）检测和疫苗接种。为了确定预防工作的优先领域，我们在美国引入 HPV 预防技术之前，检查了宫颈癌筛查、发病率、分期和死亡率的地理分布。
从监测、流行病学和最终结果以及北美中央癌症登记协会的 37 个中央登记处获得了 37 个县的宫颈癌发病率数据。使用考虑人口统计学和行为特征的时空模型，从 1995 年到 2004 年生成了县一级发病率的完整视图，包括数据缺失的县。通过登记处检查了诊断时的分期分布。使用生命统计数据和新获得的县级筛查估计值，确定死亡率高和筛查不频繁的县。
与非西班牙裔白人以及亚洲和太平洋岛民相比，非西班牙裔黑人、美洲印第安人和阿拉斯加原住民以及西班牙裔妇女的发病率较高。筛查不频繁的县通常发病率和死亡率较高，且位于诊断分期不理想的州。受影响的地区包括阿巴拉契亚地区、东南部大西洋各州和密西西比河下游地区。在大型大都市地区的中心县出现了高死亡率。
在宫颈癌发病率和死亡率方面存在明显的地理和种族/族裔差异。生活在流行贫困地区的妇女将受益于 HPV 预防技术。
这些发现为监测 HPV 预防时代宫颈癌控制进展提供了基线。
