Dillner Joakim, Sparén Pär, Andrae Bengt, Strander Björn
Karolinska Institutet - Laboratory Medicine Stockholm, Sweden Karolinska Institutet - Laboratory Medicine Stockholm, Sweden.
Karolinska Institutet - Stockholm, Sweden Karolinska Institutet - Stockholm, Sweden.
Lakartidningen. 2018 Jun 5;115:E9FD.
Cervical cancer has increased in Sweden in recent years. The increase is 17% in 2014-15 compared to the reference period 2002-13. The increase is largest for adenocarcinoma (+ 31%) and shows remarkable differences between counties, from continued incidence decreases to increases of >80%. The increase is seen in most ages that are offered screening, but is confined to early stage cancers and there is no increase in mortality. Population test coverage of screening has increased since 2002. The Swedish National Cervical Screening Registry has analysed the increase in relation to screening history. The most significant increase (+ 30%) is seen in women who had a normal cervical smear (P < 0.0001) in the preceding screening interval. The cancer risk for women who previously had a high grade abnormality has also increased (P = 0.0009). Data from several laboratories still show very low cancer risk following normal cytology, indicating that the increase is related to factors that can be addressed. All data on re-review of samples taken before cancer and high grade intraepithelial neoplasia will be requested and nationally analyzed to further elucidate the exact cause.
近年来,瑞典宫颈癌发病率呈上升趋势。与2002 - 2013年参考期相比,2014 - 2015年发病率上升了17%。腺癌发病率上升幅度最大(+31%),且各郡之间存在显著差异,从持续下降到上升超过80%不等。在大多数接受筛查的年龄段都出现了上升,但仅限于早期癌症,死亡率并未上升。自2002年以来,宫颈癌筛查的人群检测覆盖率有所提高。瑞典国家宫颈癌筛查登记处分析了与筛查史相关的发病率上升情况。在前一个筛查间隔期宫颈涂片正常的女性中,发病率上升最为显著(+30%)(P < 0.0001)。既往有高级别异常的女性患癌风险也有所增加(P = 0.0009)。多个实验室的数据仍显示,细胞学检查正常后患癌风险极低,这表明发病率上升与一些可以解决的因素有关。将要求提供所有在癌症和高级别上皮内瘤变之前采集的样本重新审查的数据,并进行全国性分析,以进一步阐明确切原因。