Beachler Daniel C, Tota Joseph E, Silver Michelle I, Kreimer Aimée R, Hildesheim Allan, Wentzensen Nicolas, Schiffman Mark, Shiels Meredith S
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Gynecol Oncol. 2017 Feb;144(2):391-395. doi: 10.1016/j.ygyno.2016.11.031. Epub 2016 Nov 26.
This study aimed to assess the temporal trends in invasive cervical cancer (ICC) incidence rates among 21-25year-olds. US guidelines no longer recommend screening prior to age 21, and concerns have been raised that delayed screening initiation may increase ICC incidence among young women.
This study utilized ICC incidence data from 18 US population-based cancer registries in SEER from 2000 to 2013 and Pap test prevalence data from the Behavioral Risk Factor Surveillance System from 1996 to 2012. Trends were evaluated with annual percent changes (APCs) using Joinpoint regression.
The prevalence of never having a Pap test before age 21 increased from 22.0% in 1996-2004 to 38.3% in 2006-2012 (APC=+5.48, 95%CI=+4.20, +7.50). Despite this decline in screening, ICC incidence among 21-23year olds significantly declined between 2000 and 13 (APC=-5.36, 95%CI=-7.83,-2.82), particularly from 2006 to 2013 (APC=-9.70, 95%CI=-15.79, -3.17). ICC incidence remained constant among 24-25year olds (APC=+0.45, 95%CI=-2.00, 2.97). Compared to women born in 1978-1985, women born in 1986-1991 had a higher prevalence of never receiving a Pap test prior to 21 (35.4% vs. 22.1%, p<0.001), but a lower ICC incidence at 21-23 (0.98 vs. 1.55 per 100,000, p<0.001).
While US females born in 1986-1991 were less likely to receive a Pap test before age 21, diagnoses of ICC in the early 20s were rare and lower than for those born in earlier years. This provides reassurance that the updated guidelines to delay screening until 21 has not resulted in a population-level increase in ICC rates among young women.
本研究旨在评估21至25岁女性浸润性宫颈癌（ICC）发病率的时间趋势。美国指南不再建议在21岁之前进行筛查，有人担心延迟开始筛查可能会增加年轻女性的ICC发病率。
本研究利用了2000年至2013年美国监测、流行病学和最终结果（SEER）计划中18个基于人群的癌症登记处的ICC发病率数据，以及1996年至2012年行为危险因素监测系统的巴氏试验患病率数据。使用Joinpoint回归分析年度百分比变化（APC）来评估趋势。
21岁之前从未进行过巴氏试验的女性比例从1996 - 2004年的22.0%上升至2006 - 2012年的38.3%（APC = +5.48，95%CI = +4.20，+7.50）。尽管筛查率下降，但21至23岁女性的ICC发病率在2000年至2013年间显著下降（APC = -5.36，95%CI = -7.83，-2.82），尤其是在2006年至2013年期间（APC = -9.70，95%CI = -15.79，-3.17）。24至25岁女性的ICC发病率保持稳定（APC = +0.45，95%CI = -2.00，2.97）。与1978 - 1985年出生的女性相比，1986 - 1991年出生的女性在21岁之前从未接受过巴氏试验的比例更高（35.4%对22.1%，p<0.001），但在21至23岁时的ICC发病率更低（每10万人中0.98例对1.55例，p<0.001）。
虽然1986 - 1991年出生的美国女性在21岁之前接受巴氏试验的可能性较小，但20岁出头时被诊断为ICC的情况很少见，且低于早年出生的女性。这让人放心，将筛查推迟到21岁的更新指南并未导致年轻女性人群中ICC发病率的上升。
