Queen Mary University, Wolfson Institute of Preventive Medicine, Charterhouse square, London EC1M 6BQ, United Kingdom.
Queen Mary University, Wolfson Institute of Preventive Medicine, Charterhouse square, London EC1M 6BQ, United Kingdom; King's College London, United Kingdom.
Prev Med. 2018 Feb;107:21-28. doi: 10.1016/j.ypmed.2017.12.002. Epub 2017 Dec 13.
The rates of cervical cancer (CxCa) in England among women aged 20-24yrs increased from 2.7 in 2012 to 4.6 per 100,000 in 2014 (p=0.0006). There was concern that the sudden increase was linked to the withdrawal of cervical screening in women aged 20-24 (a policy that affected women born since 1984). We analyse granular data on age and FIGO stage at diagnosis using a generalised linear model to see whether the unprecedented increase in CxCa in young women in 2014 was linked to the change in 2012 to the age at which the first invitation to screening was sent (from 25.0 to 24.5). Annual rates of CxCa per 100,000 women aged 20.0-24.5yrs decreased gradually over time, whereas at age 24.5-25.0yrs they increased from an average of 16 pre-2013 to 49 in 2015. An increase of 20.3 per 100,000 women aged 24.5-25.0yrs (95% CI: 15.2-25.4) was associated with inviting women for screening at age 24.5yrs instead of at age 25.0. At age 25.0-25.5yrs, rates decreased by 23.7 per 100,000 after women were invited at age 24.5yrs (p<0.001). All these changes were limited to stage I CxCa. There was a dramatic increase in diagnoses at age 25yrs in 2009-2011 associated with changing the age at first invitation from 20yrs to 25yrs. No changes were observed at age 26.0-27.0yrs. The increase in CxCa aged 20-24 is attributable to an increase in the proportion of women first screened aged 24.5yrs. The increase was limited to stage I CxCa. There is no evidence of a lack of screening leading to increasing rates.
英格兰 20-24 岁女性的宫颈癌（CxCa）发病率从 2012 年的每 10 万人 2.7 例上升到 2014 年的每 10 万人 4.6 例（p=0.0006）。有人担心，这种突然增加与 20-24 岁女性的宫颈癌筛查取消有关（这一政策影响了自 1984 年以来出生的女性）。我们使用广义线性模型分析了诊断时年龄和 FIGO 分期的详细数据，以观察 2014 年年轻女性中宫颈癌发病率的空前增加是否与 2012 年首次筛查邀请年龄的变化有关（从 25.0 岁降至 24.5 岁）。20.0-24.5 岁女性的宫颈癌发病率逐年下降，而 24.5-25.0 岁女性的发病率从 2013 年前的平均 16 例上升到 2015 年的 49 例。24.5-25.0 岁女性发病率增加了 20.3 例/10 万（95%CI：15.2-25.4），这与 24.5 岁时邀请女性进行筛查有关，而不是 25.0 岁。25.0-25.5 岁女性的发病率在 24.5 岁时被邀请后下降了 23.7 例/10 万（p<0.001）。所有这些变化都仅限于 I 期宫颈癌。2009-2011 年，由于将首次邀请年龄从 20 岁改为 25 岁，25 岁时的诊断病例数急剧增加。26.0-27.0 岁时未观察到变化。20-24 岁女性宫颈癌发病率的增加归因于首次筛查年龄为 24.5 岁的女性比例增加。这种增加仅限于 I 期宫颈癌。没有证据表明筛查不足导致发病率上升。
