Completed Manuscript as Member of the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Davis Medical Center, 4860 Y Street, Suite 2500, Sacramento, CA, 95817. Previously in Department of Obstetrics and Gynecology, U.S. Naval Hospital Okinawa, Okinawa Prefecture, Japan; initiated study as member of Department of Obstetrics and Gynecology, U.S. Naval Hospital Twentynine Palms, Twentynine Palms, CA.
Navy & Marine Corps Public Health Center, 620 John Paul Jones Circle, Suite 1100, Portsmouth, VA 23708-2103.
Mil Med. 2020 Sep 18;185(9-10):e1590-e1595. doi: 10.1093/milmed/usaa083.
Despite an increasing number of female service members, incidence rates of gynecologic cancers (other than cervical cancer) have not been previously documented in the U.S. active duty military population. This study sought to determine the incidence rates of all gynecologic, including peritoneal, malignancies in the U.S. Active Duty population compared to the general US population as reported in the Surveillance, Epidemiology, and End Results Program database.
Gynecologic cancers diagnosed in U.S. Active Duty women aged 20-59 between 2004 and 2013 were retrospectively ascertained. Cancer cases were identified in both the Automated Central Tumor Registry and the Military Health System Data Repository. All cases in Automated Central Tumor Registry plus cases recorded in Military Health System Data Repository, but not duplicative of Automated Central Tumor Registry cases, were included. Age-specific and age-adjusted incidence rates were calculated in military and Surveillance, Epidemiology, and End Results cases.
In U.S. Active Duty women, 327 incident cases of gynecologic cancer were identified. There were 110 cases of cervical cancer, 40 cases of endometrial cancer, 152 cases of ovarian cancer, and 25 other gynecologic malignancies. Of the 327 cases, 154 were ascertained from the Automated Central Tumor Registry database and the remainder from Military Health System Data Repository claims data. The age-adjusted rate of all gynecologic cancers for U.S. Active Duty women was 49.17 per 105 (95%CI 37.58, 65.12), while the age-adjusted rate for Surveillance, Epidemiology, and End Results -18 was 42.09 per 105 (95%CI 41.83, 42.35). The kappa coefficient assessing the overlap between the data sources was -0.1937. Though insufficient in numbers for statistical analysis, the observed proportion of ovarian to cervical cancer cases in active duty women < 45 years of age was substantially greater than in the general population.
U.S. Active Duty women exhibited a similar age-adjusted rate of gynecologic cancer as the general US population. There was suboptimal overlap between the Automated Central Tumor Registry and Military Health System Data Repository databases, indicating the necessity of using both databases in order to obtain reliable data in the active duty population. This study is the current best estimate of a baseline rate of gynecologic cancer in U.S. active duty military women. This rate might change over time as women's roles and exposures in recent and future military conflicts evolve.
尽管女性军人的数量不断增加，但在美国现役军人中，妇科癌症（宫颈癌除外）的发病率以前并未记录在案。本研究旨在确定与美国监测、流行病学和最终结果计划数据库中报告的普通美国人群相比，美国现役女性中所有妇科（包括腹膜）恶性肿瘤的发病率。
回顾性确定了 2004 年至 2013 年间年龄在 20-59 岁之间的美国现役女性中诊断出的妇科癌症病例。癌症病例在自动中央肿瘤登记处和军事卫生系统数据存储库中均有记录。自动中央肿瘤登记处中所有病例加上军事卫生系统数据存储库中记录的病例，但与自动中央肿瘤登记处中的病例不重复，均包括在内。按年龄和年龄调整后的发病率分别在军事和监测、流行病学和最终结果病例中计算。
在美国现役女性中，发现 327 例妇科癌症新发病例。其中 110 例为宫颈癌，40 例为子宫内膜癌，152 例为卵巢癌，25 例为其他妇科恶性肿瘤。在 327 例中，有 154 例从自动中央肿瘤登记处数据库中确定，其余病例从军事卫生系统数据存储库索赔数据中确定。美国现役女性所有妇科癌症的年龄调整率为 49.17/105（95%CI 37.58，65.12），而监测、流行病学和最终结果-18 的年龄调整率为 42.09/105（95%CI 41.83，42.35）。评估数据源重叠的kappa 系数为-0.1937。尽管数量不足进行统计分析，但现役女性中卵巢癌与宫颈癌病例的观察比例<45 岁明显大于普通人群。
美国现役女性的妇科癌症年龄调整率与普通美国人群相似。自动中央肿瘤登记处和军事卫生系统数据存储库数据库之间的重叠程度不足，表明为了在现役人群中获得可靠的数据，有必要同时使用这两个数据库。本研究是目前对美国现役女兵妇科癌症基线发病率的最佳估计。随着女性在最近和未来军事冲突中的角色和暴露情况的变化，这一比率可能会发生变化。
