Stewart Tessa S, Moodley Jennifer, Walter Fiona M
The University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Hills Road, Cambridge CB2 0SP, United Kingdom.
Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa; Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa; SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Cancer Epidemiol. 2018 Apr;53:81-92. doi: 10.1016/j.canep.2018.01.014. Epub 2018 Feb 4.
Cervical cancer is the most prevalent malignancy in sub-Saharan Africa (SSA) with many women only seeking professional help when they are experiencing symptoms, implying late-stage malignancy and higher mortality rates. This ecological study assesses population-level exposures of SSA women to the numerous risk factors for HPV infection and cervical cancer, against late-stage presentation of cervical cancer.
A literature review revealed the relevant risk factors in SSA. Open-access databases were mined for variables closely representing each risk factor. A proxy for late-stage presentation was used (ratio of incidence-to-mortality, IMR), and gathered from IARC's GLOBOCAN 2012 database. Variables showing significant correlation to the IMR were used in stepwise multiple regression to quantify their effect on the IMR.
Countries with high cervical cancer mortality rates relative to their incidence have an IMR nearer one, suggesting a larger proportion of late-stage presentation. Western Africa had the lowest median IMR (1.463), followed by Eastern Africa (IMR = 1.595) and Central Africa (IMR = 1.675), whereas Southern Africa had the highest median IMR (1.761). Variables selected for the final model explain 65.2% of changes seen in the IMR. Significant predictors of IMR were GDP (coefficient = 2.189 × 10, p = 0.064), HIV infection (-1.936 × 10, p = 0.095), not using a condom (-1.347 × 10, p = 0.013), high parity (-1.744 × 10, p = 0.008), and no formal education (-1.311 × 10, p < 0.001).
Using an IMR enables identification of factors predicting late-stage cervical cancer in SSA including: GDP, HIV infection, not using a condom, high parity and no formal education.
宫颈癌是撒哈拉以南非洲地区（SSA）最常见的恶性肿瘤，许多女性只有在出现症状时才寻求专业帮助，这意味着癌症已处于晚期，死亡率更高。这项生态研究评估了SSA地区女性在人群层面接触多种HPV感染和宫颈癌风险因素的情况，以及宫颈癌晚期的表现。
文献综述揭示了SSA地区的相关风险因素。在开放获取数据库中挖掘紧密代表每个风险因素的变量。使用了一个晚期表现的替代指标（发病率与死亡率之比，IMR），并从国际癌症研究机构（IARC）的2012年全球癌症数据库中收集。将与IMR显示出显著相关性的变量用于逐步多元回归，以量化它们对IMR的影响。
宫颈癌死亡率相对于发病率较高的国家，其IMR更接近1，这表明晚期病例的比例更大。西非的IMR中位数最低（1.463），其次是东非（IMR = 1.595）和中非（IMR = 1.675），而南非的IMR中位数最高（1.761）。最终模型中选择的变量解释了IMR中65.2%的变化。IMR的显著预测因素包括国内生产总值（系数 = 2.189×10，p = 0.064）、艾滋病毒感染（-1.936×10，p = 0.095）、不使用避孕套（-1.347×10，p = 0.013）、多胎妊娠（-1.744×10，p = 0.008）以及未接受正规教育（-1.311×10，p < 0.001）。
使用IMR能够确定预测SSA地区宫颈癌晚期的因素，包括：国内生产总值、艾滋病毒感染、不使用避孕套、多胎妊娠以及未接受正规教育。
