Dalla Lana School of Public Health, University of Toronto, Canada.
J Public Health Policy. 2012 May;33(2):148-64. doi: 10.1057/jphp.2012.8. Epub 2012 Mar 1.
We performed a systematic review and meta-analysis of cervical cancer risk in indigenous women in Australia, Canada, New Zealand, and the United States, in order to identify whether risks of cervical dysplasia, cervical cancer, and cervical cancer-related mortality are higher in indigenous relative to non-indigenous populations. We identified 35 studies published in 1969-2008. In our findings, indigenous populations did not have an elevated risk of cervical dysplasia or carcinoma in situ relative to non-indigenous populations, but had elevated risks of invasive cervical cancer (pooled RR=1.72) and cervical cancer-related mortality (pooled RR=3.45). There was a log-linear relationship between relative risk and disease stage. In conclusion, the indigenous women have a markedly higher risk of cervical cancer morbidity and mortality than non-indigenous women, but no increased risk of early-stage disease, suggesting that structural, social, or individual barriers to screening, rather than baseline risk factors, are influencing poor health outcomes.
我们对澳大利亚、加拿大、新西兰和美国的土著妇女的宫颈癌风险进行了系统评价和荟萃分析，以确定宫颈发育不良、宫颈癌和宫颈癌相关死亡率的风险在土著人群中是否高于非土著人群。我们确定了 1969 年至 2008 年发表的 35 项研究。我们的研究结果表明，与非土著人群相比，土著人群宫颈发育不良或原位癌的风险没有增加，但浸润性宫颈癌（合并 RR=1.72）和宫颈癌相关死亡率（合并 RR=3.45）的风险增加。相对风险与疾病阶段之间存在对数线性关系。总之，与非土著妇女相比，土著妇女宫颈癌发病率和死亡率明显更高，但早期疾病风险没有增加，这表明结构性、社会性或个体性的筛查障碍，而不是基线风险因素，正在影响健康不良的结果。
