Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
Int J Cancer. 2018 Nov 1;143(9):2238-2249. doi: 10.1002/ijc.31610. Epub 2018 Aug 7.
Cervical cancer (CC) is the leading cause of cancer death among female South Africans (SA). Improved access to reproductive health services following multi-ethnic democracy in 1994, HIV epidemic, and the initiation of CC population-based screening in early 2000s have influenced the epidemiology of CC in SA. We therefore evaluated the trends in CC age-standardised incidence (ASIR) (1994-2009) and mortality rates (ASMR) (2004-2012) using data from the South African National Cancer Registry and the Statistics South Africa, respectively. Five-year relative survival rates and average per cent change (AAPC) stratified by ethnicity and age-groups was determined. The average annual CC cases and mortalities were 4,694 (75,099 cases/16 years) and 2,789 (25,101 deaths/9 years), respectively. The ASIR was 22.1/100,000 in 1994 and 23.3/100,000 in 2009, with an average annual decline in incidence of 0.9% per annum (AAPC = -0.9%, p-value < 0.001). The ASMR decreased slightly by 0.6% per annum from 13.9/100,000 in 2004 to 13.1/100,000 in 2012 (AAPC = -0.6%, p-value < 0.001). In 2012, ASMR was 5.8-fold higher in Blacks than in Whites. The 5-year survival rates were higher in Whites and Indians/Asians (60-80%) than in Blacks and Coloureds (40-50%). The incidence rate increased (AAPC range: 1.1-3.1%, p-value < 0.001) among young women (25-34 years) from 2000 to 2009. Despite interventions, there were minimal changes in overall epidemiology of CC in SA but there were increased CC rates among young women and ethnic disparities in CC burden. A review of the CC national policy and directed CC prevention and treatment are required to positively impact the burden of CC in SA.
宫颈癌（CC）是南非女性癌症死亡的主要原因。1994 年实行多种族民主后，人们获得了更多的生殖健康服务，艾滋病流行，21 世纪初还启动了宫颈癌人群筛查，这些因素都对南非的宫颈癌流行病学产生了影响。因此，我们分别利用南非国家癌症登记处和南非统计局的数据，评估了 1994 年至 2009 年宫颈癌年龄标准化发病率（ASIR）和 2004 年至 2012 年死亡率（ASMR）的趋势。我们还按种族和年龄组确定了五年相对生存率和平均百分比变化（AAPC）。每年平均 CC 病例和死亡人数分别为 4694 例（75099 例/16 年）和 2789 例（25101 例/9 年）。1994 年的 ASIR 为 22.1/100000，2009 年为 23.3/100000，发病率平均每年下降 0.9%（AAPC=-0.9%，p 值<0.001）。2004 年至 2012 年，ASMR 每年略有下降 0.6%，从 13.9/100000 降至 13.1/100000（AAPC=-0.6%，p 值<0.001）。2012 年，黑人的 ASMR 比白人高 5.8 倍。白人、印度裔/亚裔（60-80%）的 5 年生存率高于黑人（40-50%）和混血儿（40-50%）。2000 年至 2009 年，年轻女性（25-34 岁）的发病率呈上升趋势（AAPC 范围：1.1-3.1%，p 值<0.001）。尽管采取了干预措施，但南非宫颈癌的总体流行病学仍无明显变化，但年轻女性的宫颈癌发病率有所上升，且不同族裔之间的宫颈癌负担存在差异。需要审查全国宫颈癌政策，并开展宫颈癌的防治工作，以积极降低南非的宫颈癌负担。
