Cancer Council NSW, Sydney, NSW
Cancer Council NSW, Sydney, NSW.
Med J Aust. 2016 Oct 17;205(8):359-364. doi: 10.5694/mja16.00289.
The Australian National Cervical Screening Program (NCSP) will transition in 2017 from cytology-based screening every two years, starting from age 18-20 years, to HPV-based screening every 5 years, starting from age 25. To examine the impact of the program before this transition we analysed trends in the incidence of cervical cancer, by age and histological subtype.
DESIGN, SETTING AND PARTICIPANTS: National cervical cancer incidence data, 1982-2010.
Standardised rate ratios (SRR) for 3-yearly average cervical cancer incidence, relative to the rate during 1988-1990, by age group and histological type.
Between 1988-1990 and 2008-2010, cervical cancer incidence fell substantially in women aged 25-49 (SRR, 0.55; 95% CI, 0.51-0.59), 50-69 (SRR, 0.46; 95% CI, 0.42-0.51) and 70 years or more (SRR, 0.50; 95% CI, 0.43-0.58), but not in women aged 20-24 years (SRR, 0.70; 95% CI, 0.46-1.05). These declines were primarily driven by drops in squamous cell carcinoma (SCC) in women aged 25-49 (SRR, 0.50; 95% CI, 0.46-0.55), 50-69 (SRR, 0.39; 95% CI, 0.35-0.45) and more than 70 years (SRR, 0.43; 95% CI, 0.36-0.51). However, rates have now plateaued in women aged 25-69 years. The incidence of adenocarcinoma did not consistently decline across the program period in any age group. The incidence of neither SCC (SRR, 0.91; 95% CI, 0.55-1.51) nor adenocarcinoma (SRR, 0.91; 95% CI, 0.35-2.40) declined in women aged 20-24 years.
Although women aged 20-24 years have been included in the NCSP since its inception, no significant impact on cervical cancer incidence was observed in this age group. The NCSP has had a substantial impact on SCC and overall cervical cancer incidence in women aged 25 years and over. Its impact on the incidence of adenocarcinoma, in contrast, has been limited.
澳大利亚国家宫颈癌筛查计划（NCSP）将于 2017 年从 18-20 岁开始每两年进行一次基于细胞学的筛查，转变为每 5 年进行一次基于 HPV 的筛查，起始年龄为 25 岁。为了在这一转变之前评估该计划的影响，我们分析了宫颈癌发病率的趋势，按年龄和组织学亚型进行了分析。
设计、地点和参与者：全国宫颈癌发病率数据，1982-2010 年。
每三年平均宫颈癌发病率的标准化率比（SRR），与 1988-1990 年期间的发病率相比，按年龄组和组织学类型划分。
在 1988-1990 年至 2008-2010 年期间，25-49 岁（SRR，0.55；95%CI，0.51-0.59）、50-69 岁（SRR，0.46；95%CI，0.42-0.51）和 70 岁及以上（SRR，0.50；95%CI，0.43-0.58）的女性宫颈癌发病率显著下降，但 20-24 岁的女性（SRR，0.70；95%CI，0.46-1.05）则不然。这些下降主要归因于 25-49 岁（SRR，0.50；95%CI，0.46-0.55）、50-69 岁（SRR，0.39；95%CI，0.35-0.45）和 70 岁及以上（SRR，0.43；95%CI，0.36-0.51）女性的鳞状细胞癌（SCC）下降。然而，目前 25-69 岁的女性发病率已经趋于平稳。在任何年龄组，腺癌的发病率在整个计划期间都没有持续下降。20-24 岁的女性中 SCC（SRR，0.91；95%CI，0.55-1.51）和腺癌（SRR，0.91；95%CI，0.35-2.40）的发病率均未下降。
尽管自 NCSP 成立以来，20-24 岁的女性就已经被纳入其中，但在该年龄组中并未观察到对宫颈癌发病率的显著影响。NCSP 对 25 岁及以上女性的 SCC 和总体宫颈癌发病率产生了重大影响。相比之下，其对腺癌发病率的影响则较为有限。
