Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Eur J Cancer. 2020 Mar;127:207-223. doi: 10.1016/j.ejca.2019.12.013. Epub 2020 Jan 21.
Organised cervical cancer (CC) screening programmes are delivered in many different ways across the European Union and its regions. Our aim was to systematically review the impact of these programs on CC mortality.
Two independent reviewers identified all eligible studies investigating the effect of organised screening on CC mortality in Europe. Six databases including Embase, Medline and Web of Science were searched (March 2018) with predefined inclusion and exclusion criteria. Only original studies with at least five years of follow-up were considered. Validated tools were used to assess the risk of bias of the included studies.
Ten observational studies were included: seven cohort and three case-control studies. No randomised controlled trials were found, and there were no eligible studies from the eastern and southern part of Europe. Among the eligible studies, seven were conducted in the twentieth century; they scored lower on the risk of bias assessment. CC mortality reduction for women attending organised screening vs. non-attenders ranged from 41% to 92% in seven studies. Reductions were similar in Western (45-92%) and Northern (41-87%) Europe and were higher in the three more recent studies (66-92%). For invited vs. non-invited women, this reduction ranged from 17% to 79% in five studies.
Although data were lacking in Southern and Eastern Europe and the effect size varied between countries and studies, this systematic review provides evidence that organised CC screening reduces CC mortality in those parts of Europe where CC screening was implemented and monitored.
在欧盟及其地区，组织化的宫颈癌（CC）筛查计划以多种不同方式实施。我们的目的是系统地审查这些计划对 CC 死亡率的影响。
两名独立的审查员确定了所有符合条件的研究，这些研究调查了组织化筛查对欧洲 CC 死亡率的影响。使用预设的纳入和排除标准，从 Embase、Medline 和 Web of Science 等六个数据库中进行了搜索（2018 年 3 月）。仅考虑具有至少五年随访的原始研究。使用经过验证的工具评估纳入研究的偏倚风险。
共纳入了 10 项观察性研究：7 项队列研究和 3 项病例对照研究。未发现随机对照试验，也没有来自东欧和南欧的合格研究。在合格研究中，有 7 项研究是在 20 世纪进行的；它们在偏倚风险评估中得分较低。与未参加组织化筛查的女性相比，参加组织化筛查的女性的 CC 死亡率降低幅度在 7 项研究中为 41%至 92%。在西欧（45-92%）和北欧（41-87%），这种降低是相似的，在 3 项更新的研究中更高（66-92%）。对于被邀请和未被邀请的女性，5 项研究中这一降低幅度从 17%到 79%不等。
尽管在南欧和东欧缺乏数据，且各国和研究之间的效应大小存在差异，但本系统评价提供了证据，表明在实施和监测 CC 筛查的欧洲部分地区，组织化 CC 筛查可降低 CC 死亡率。
