Gynecological Oncology, Radiumhemmet, Department of Oncology, Karolinska University Hospital, Solna, Karolinska Institute, Stockholm, Sweden.
J Gynecol Oncol. 2011 Jun 30;22(2):76-82. doi: 10.3802/jgo.2011.22.2.76.
To compare profiles of a prescreening and screening cohort of women with cervical cancer regarding histopathology and clinical variables in order to identify those remaining at risk despite successful screening programs. By analyzing these profiles we hope to improve future screening methods.
The prescreening and screening cohorts consisted of 5,046 and 1,174 women, respectively, treated for cervical cancer at the Department of Gynecological Oncology at Radiumhemmet, Karolinska University Hospital, during the periods 1944-1957 and 1990-2004.
Mean age increased from 48.9 years to 55.3 years in the cohorts treated 1944-1957 and 1990-2004, respectively. The percentage of patients older than 69 years was 5.4% and 27.3% in the prescreening and screening period, respectively. A shift towards earlier stages at diagnosis, a reduction of squamous cervical cancer and an increase of adenocarcinoma were observed in the screening cohort. The percentage of adenocarcinoma was about 6 times higher among younger patients. Cases of stump cancer and cervical cancer associated with pregnancy have declined. Eighty-seven women in the screening cohort had a history of treatment for in situ carcinoma by conization; 28% of these cases developed cervical cancer within one year after conization.
The profile changed in the screening era indicating a need to refine screening for improved detection of in older women. This study, one of the largest clinical series of cervical cancer, provides an important baseline with which later studies can be compared to evaluate the effects of human papillomavirus vaccine and other important changes in this field.
比较宫颈癌的预筛和筛查队列的患者在组织病理学和临床变量方面的特征，以确定尽管筛查计划成功但仍处于风险中的患者。通过分析这些特征，我们希望改进未来的筛查方法。
预筛和筛查队列分别包括 5046 名和 1174 名在 1944 年至 1957 年和 1990 年至 2004 年期间在卡罗林斯卡大学医院拉迪姆海梅特妇科肿瘤学系治疗的宫颈癌患者。
在 1944 年至 1957 年和 1990 年至 2004 年治疗的队列中，平均年龄分别从 48.9 岁增加到 55.3 岁。69 岁以上患者的百分比在预筛和筛查期分别为 5.4%和 27.3%。在筛查队列中，观察到诊断时更早的阶段、鳞状宫颈癌的减少和腺癌的增加。在年轻患者中，腺癌的比例约高 6 倍。残端癌和与妊娠相关的宫颈癌病例有所减少。在筛查队列中有 87 名妇女有因宫颈上皮内瘤变而行锥切术治疗的病史；其中 28%的病例在锥切术后一年内发展为宫颈癌。
在筛查时代，患者特征发生了变化，表明需要改进筛查，以提高对老年女性的检测效果。这项研究是最大的宫颈癌临床系列研究之一，为以后的研究提供了一个重要的基线，可用于评估人乳头瘤病毒疫苗和该领域其他重要变化的效果。
