Mancuso Pamela, Sacchettini Claudio, Vicentini Massimo, Caroli Stefania, Giorgi Rossi Paolo
Servizio interaziendale di epidemiologia, Azienda unità sanitaria locale, Reggio Emilia.
Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia.
Epidemiol Prev. 2016 Mar-Apr;40(3-4):157-63. doi: 10.19191/EP16.3-4.AD02.076.
reduction in cervical cancer mortality is the ultimate goal of the screening. Quality of death certificate reports has been improved over time, but they are still inaccurate, making it difficult to assess time trends in mortality.
to evaluate the accuracy of the topographic coding of causes of death and to estimate the mortality time trend for cervical cancer through the method of incidence-based mortality (IBM) using cancer registry (CR) data.
from the mortality registry (MR), we extracted data on deaths for cervix uteri cancer, corpus uteri cancer, and uterus cancer not otherwise specified (NOS) referred to residents in Reggio Emilia (Emilia-Romagna Region, Northern Italy) from 1997 to 2013. Deaths were checked with the CR to verify the topographical site of the primary tumour. Furthermore, by using CR data, we constructed a cohort of incident cervical cancer cases diagnosed between 1997 and 2009 with a 5-year follow-up. We calculated cause-specific IBM (excluding ovary) and IBM for all cause, crude and standardized, and annual percentage change (APC).
out of 369 deaths for uterine cancer, 269 were reported in the RT: 32 for cervix uteri cancer, 76 for corpus uteri cancer, 161 for uterus cancer NOS. 28 of the 32 persons who died for cervical cancer were incidents for cervix uteri cancer. 63 of the 76 who died for corpus uteri cancer were incidents for corpus uteri cancer. Of the 161 who died of uterus cancer NOS, 80 were incidents for corpus uteri cancer, 45 for cervix uteri cancer, 28 for uterus cancer NOS, 5 for vagina cancer, and 3 for cancer of other non-specified organs. Applying these proportions of misclassification, we can estimate that the real number of cervical cancer deaths is 2.4 folds the number of cases reported in the MR as cervical cancer. IBM for all causes decreased significantly over the years (APC: -9.5; 95%CI -17.1;-1.1); cause-specific IBM decreases, but not significantly (APC: -5.1; 95%IC -16.1;+7.3). There is no improvement in survival (r2=0.02; p=0.6), while the incidence shows a decrease (APC: -6.6;95%CI -10.0;-3.0).
mortality for cervical cancer is still underestimated by deaths certificates: for each reported case, there are other 1.4 cases that are reported with other less specific causes.
降低宫颈癌死亡率是筛查的最终目标。死亡证明报告的质量虽随时间有所提高，但仍不准确，这使得评估死亡率的时间趋势变得困难。
通过使用癌症登记处（CR）数据，采用基于发病率的死亡率（IBM）方法，评估死因的地形编码准确性，并估计宫颈癌的死亡率时间趋势。
从死亡率登记处（MR）提取了1997年至2013年期间意大利北部艾米利亚 - 罗马涅大区雷焦艾米利亚居民子宫颈癌、子宫体癌和未另行指定（NOS）的子宫癌死亡数据。通过CR检查死亡情况，以核实原发性肿瘤的地形部位。此外，利用CR数据构建了一个1997年至2009年期间确诊的宫颈癌病例队列，并进行了5年随访。我们计算了特定病因的IBM（不包括卵巢）和所有病因的IBM，包括粗率和标准化率以及年度百分比变化（APC）。
在369例子宫癌死亡病例中，RT报告了269例：子宫颈癌32例，子宫体癌76例，子宫NOS癌161例。32例死于宫颈癌的患者中有28例是子宫颈癌病例。76例死于子宫体癌的患者中有63例是子宫体癌病例。在161例死于子宫NOS癌的患者中，80例是子宫体癌病例，45例是子宫颈癌病例，28例是子宫NOS癌病例，5例是阴道癌病例，3例是其他未指定器官的癌症病例。应用这些错误分类比例，我们可以估计宫颈癌的实际死亡人数是MR报告为宫颈癌病例数的2.4倍。多年来所有病因的IBM显著下降（APC：-9.5；95%CI -17.1；-1.1）；特定病因的IBM下降，但不显著（APC：-5.1；95%IC -16.1；+7.3）。生存率没有改善（r2 = 0.02；p = 0.6），而发病率呈下降趋势（APC：-6.6；95%CI -10.0；-3.0）。
死亡证明仍低估了宫颈癌的死亡率：每报告1例病例，还有另外1.4例被报告为其他不太明确的病因。
