Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
PLoS One. 2020 May 19;15(5):e0233354. doi: 10.1371/journal.pone.0233354. eCollection 2020.
Cervical cancer is a health issue that disproportionately affects developing countries, where the Papanicolaou test (Pap smear) remains an important screening tool. Brazilian government recommendations have focused screening on the female population aged from 25 to 64 years old. In this study, we examined the incidence and mortality rates of invasive cervical cancer lesions and the incidence rates of in situ precancerous cervical lesions, aiming to calculate their respective statistics over time in a mid-sized Brazilian city, Aracaju. The 1996-2015 database from the Aracaju Cancer Registry and Mortality Information System was used to calculate age standardized rates for all invasive cervical tumors (International code of diseases, ICD-10: C53) and preinvasive cervical lesions (ICD-10: D06) in the following patient age ranges; ≤ 24, 25-34, 35-44, 45-54, 55-64 and ≥ 65 years old. We identified 1,030 cancer cases, 1,871 in situ lesions and 334 deaths. Using the Joinpoint Regression Program, we calculated the annual percentage incidence changes and our analyses show that cervical cancer incidence decreased up to 2008, increased up to 2012 and decreased again thereafter, a significant trend in all age groups from 25 years. The incidence of precursor lesions increased from 1996 to 2005 and has since decreased, a result significant in all age groups until 64 years. Cervical cancer mortality has decreased by 3.8% annually and trend analysis indicates that Pap smears have been effective in decreasing cancer incidence and mortality. However, recent trends shown here show a decreasing incidence of in situ lesions and may indicate either a real decrease or incomplete catchment. Thus, we suggest health policies should be re-considered and include sufficient screening and HPV vaccination strategies to avoid cervical cancer resurgence in the population.
宫颈癌是一个在发展中国家影响不成比例的健康问题，巴氏涂片检查（Pap 涂片）仍然是一种重要的筛查工具。巴西政府的建议将筛查重点放在 25 至 64 岁的女性人群。在这项研究中，我们检查了浸润性宫颈癌病变的发病率和死亡率，以及原位宫颈癌前病变的发病率，目的是计算巴西一个中型城市阿拉卡茹（Aracaju）在一段时间内的这些数据。使用 1996 年至 2015 年阿拉卡茹癌症登记处和死亡率信息系统的数据库，我们为以下年龄段的所有浸润性宫颈癌肿瘤（国际疾病分类，ICD-10：C53）和宫颈前病变（ICD-10：D06）计算了年龄标准化率：≤24 岁、25-34 岁、35-44 岁、45-54 岁、55-64 岁和≥65 岁。我们确定了 1030 例癌症病例、1871 例原位病变和 334 例死亡病例。使用 Joinpoint 回归程序，我们计算了每年的发病率变化百分比，我们的分析表明，宫颈癌的发病率直到 2008 年下降，直到 2012 年上升，此后再次下降，所有 25 岁以上年龄组均呈显著趋势。前体病变的发病率从 1996 年到 2005 年增加，此后下降，所有年龄组直到 64 岁的发病率均显著下降。宫颈癌的死亡率每年下降 3.8%，趋势分析表明巴氏涂片检查在降低癌症发病率和死亡率方面是有效的。然而，这里显示的最近趋势表明原位病变的发病率下降，这可能表明实际下降或不完全捕获。因此，我们建议重新考虑卫生政策，并纳入充分的筛查和 HPV 疫苗接种策略，以避免宫颈癌在人群中的再次流行。
