Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
School of Public Health, University of Haifa, Haifa, Israel.
Int J Gynecol Cancer. 2020 Jul;30(7):959-968. doi: 10.1136/ijgc-2019-000884. Epub 2020 Mar 12.
Pre-malignant cervical disease and invasive cervical cancer present a significant global health burden with respect to morbidity and mortality, mostly in low- and middle-income countries. Human papillomavirus (HPV) infection typically manifests for the first time in adolescence. We aimed to identify adolescent sociodemographic and anthropometric characteristics associated with subsequent risk for pre-malignant cervical disease and cervical cancer, in a country that offers free screening and HPV vaccines.
This historical cohort study included 969 123 Israeli women examined and anthropometrically measured at age 17 years between January 1967 and December 2011. Data on pre-malignant disease and invasive cervical tumors were obtained from the national cancer registry by linkage. We excluded non-Jewish minorities (a total of 25 472 women) and orthodox/ultraorthodox Jewish women since these populations are not required by law to serve in the military, as well as women with a pre-examination diagnosis of cancer. Cox proportional hazards regression models were applied per each lesion type, adjusted for origin, measured body mass index, height, education, dwelling type, birth year, and age at examination.
In total, 5094 and 859 incident pre-malignant cervical disease and cervical cancer cases, respectively, were diagnosed during a median follow-up of 17.6 years. Risk for both lesions was origin-dependent, with higher incidence in women of North-African origin (HR (pre-malignant cervical disease) 1.22, 95% CI 1.04 to 1.42; HR (cervical cancer) 1.87, 95% CI 1.30 to 2.69) compared with European origin. Height, lower education, and later birth year were associated with higher pre-malignant cervical disease and cervical cancer risk also. Adolescent overweight (HR 0.81, 95% CI 0.74 to 0.90) and obesity (HR 0.56, 95% CI 0.43 to 0.71) status were associated with reduced pre-malignant cervical disease but not cervical cancer incidence, as did urban (vs rural) residence.
Ethnic background, tall stature, and education were associated with pre-malignant cervical disease and cervical cancer incidence, while adolescent overweight and obesity were inversely associated with only pre-malignant cervical disease. Despite free screening and HPV vaccines, these findings suggest that there is still a need for appropriate safe sex and screening education in adolescence.
宫颈癌前病变和宫颈癌是全球范围内发病率和死亡率较高的疾病，主要发生在中低收入国家。人乳头瘤病毒（HPV）感染通常在青少年时期首次出现。本研究旨在探讨在提供免费筛查和 HPV 疫苗接种的国家中，青少年的社会人口学和人体测量特征与宫颈癌前病变和宫颈癌风险之间的关系。
本历史队列研究纳入了 1967 年 1 月至 2011 年 12 月期间在以色列接受 17 岁体检的 969123 名女性，记录了她们的人口学和人体测量学数据。通过国家癌症登记处的链接获取宫颈癌前病变和浸润性宫颈癌的相关数据。我们排除了非犹太少数民族（共 25472 名女性）和正统/极端正统犹太妇女，因为这些人群不需要服兵役，同时也排除了在体检前被诊断患有癌症的女性。采用 Cox 比例风险回归模型，按病变类型进行分层，调整了来源、测量体重指数、身高、教育、居住类型、出生年份和体检年龄。
在中位随访 17.6 年后，共诊断出 5094 例宫颈癌前病变和 859 例宫颈癌病例。两种病变的发病风险均与来源有关，与欧洲起源的女性相比，北非起源的女性发病风险更高（宫颈癌前病变：HR=1.22，95%CI=1.04 至 1.42；宫颈癌：HR=1.87，95%CI=1.30 至 2.69）。身高、较低的教育程度和较晚的出生年份也与宫颈癌前病变和宫颈癌的发病风险增加相关。青少年超重（HR=0.81，95%CI=0.74 至 0.90）和肥胖（HR=0.56，95%CI=0.43 至 0.71）与宫颈癌前病变的发病风险降低相关，但与宫颈癌的发病风险无关，而城市（与农村）居住也与宫颈癌前病变的发病风险降低相关。
本研究表明，在提供免费筛查和 HPV 疫苗接种的情况下，青少年的种族背景、身高和教育程度与宫颈癌前病变和宫颈癌的发病风险相关，而青少年超重和肥胖与宫颈癌前病变的发病风险相关，与宫颈癌的发病风险无关。因此，仍需要对青少年进行适当的安全性行为和筛查教育。
