Castanon Alejandra, Landy Rebecca, Sasieni Peter D
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Int J Cancer. 2016 Sep 1;139(5):1040-5. doi: 10.1002/ijc.30152. Epub 2016 May 6.
While the incidence of squamous carcinoma of the cervix has declined in countries with organised screening, adenocarcinoma has become more common. Cervical screening by cytology often fails to prevent adenocarcinoma. Using prospectively recorded cervical screening data in England and Wales, we conducted a population-based case-control study to examine whether cervical screening leads to early diagnosis and down-staging of adenocarcinoma. Conditional logistic regression modelling was carried out to provide odds ratios (ORs) and 95% confidence intervals (CIs) on 12,418 women with cervical cancer diagnosed between ages 30 and 69 and 24,453 age-matched controls. Of women with adenocarcinoma of the cervix, 44.3% were up to date with screening and 14.6% were non-attenders. The overall OR comparing women up to date with screening with non-attenders was 0.46 (95% CI: 0.39-0.55) for adenocarcinoma. The odds were significantly decreased (OR: 0.22, 95% CI: 0.15-0.33) in up to date women with Stage 2 or worse adenocarcinoma, but not for women with Stage1A adenocarcinoma 0.71 (95% CI: 0.46-1.09). The odds of Stage 1A adenocarcinoma was double among lapsed attenders (OR: 2.35, 95% CI: 1.52-3.62) compared to non-attenders. Relative to women with no negative cytology within 7 years of diagnosis, women with Stage1A adenocarcinoma were very unlikely to be detected within 3 years of a negative cytology test (OR: 0.08, 95% CI: 0.05-0.13); however, the odds doubled 3-5 years after a negative test (OR: 2.30, 95% CI: 1.67-3.18). ORs associated with up to date screening were smaller for squamous and adenosquamous cervical carcinoma. Although cytology screening is inefficient at preventing adenocarcinomas, invasive adenocarcinomas are detected earlier than they would be in the absence of screening, substantially preventing Stage 2 and worse adenocarcinomas.
在开展有组织筛查的国家，宫颈癌鳞癌的发病率有所下降，而腺癌却变得更为常见。通过细胞学进行的宫颈筛查往往无法预防腺癌。利用英格兰和威尔士前瞻性记录的宫颈筛查数据，我们开展了一项基于人群的病例对照研究，以检验宫颈筛查是否能实现腺癌的早期诊断和降期。我们对12418名年龄在30至69岁之间被诊断为宫颈癌的女性以及24453名年龄匹配的对照者进行了条件逻辑回归建模，以提供比值比（OR）和95%置信区间（CI）。在患有宫颈腺癌的女性中，44.3%的人筛查及时，14.6%的人未参加筛查。对于腺癌，将筛查及时的女性与未参加筛查的女性进行总体比较，OR为0.46（95%CI：0.39 - 0.55）。对于2期或更严重腺癌且筛查及时的女性，发病几率显著降低（OR：0.22，95%CI：0.15 - 0.33），但对于1A期腺癌女性则不然，OR为0.71（95%CI：0.46 - 1.09）。与未参加筛查者相比，筛查中断者患1A期腺癌的几率增加了一倍（OR：2.35，95%CI：1.52 - 3.62）。与诊断后7年内无阴性细胞学检查结果的女性相比，1A期腺癌女性在细胞学检查呈阴性后的3年内极不可能被检测到（OR：0.08，95%CI：0.05 - 0.13）；然而，在检查呈阴性后的3 - 5年，几率翻倍（OR：2.30，95%CI：1.67 - 3.18）。对于宫颈鳞癌和腺鳞癌，与筛查及时相关的OR值较小。尽管细胞学筛查在预防腺癌方面效率不高，但浸润性腺癌的检测时间比未进行筛查时要早，从而在很大程度上预防了2期及更严重的腺癌。
