Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Cancer Registry of Norway, Oslo, Norway.
Acta Obstet Gynecol Scand. 2022 Sep;101(9):952-959. doi: 10.1111/aogs.14402. Epub 2022 Jun 11.
The association between cervical cancer screening and reduction of cervical cancer has been dealt with in much research. However, little has been published on the association between screening and cervical cancer mortality. We assessed cervical cancer deaths according to screening history, histopathology, and age among women in, under, and above screening age.
In this nationwide, registry-based case-control study from Norway, we included 817 cervical cancer deaths in women diagnosed with cervical cancer in the period 1998-2009. We matched each case with 10 population-based controls free from cervical cancer, obtained by density-based sampling. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between screening attendance and cervical cancer mortality were estimated using conditional logistic regression models.
Of all fatal cervical cancers, 35% were diagnosed among women over screening age and altogether, 83% were either in age groups not covered by the screening program or in non-attenders of screening age. The estimated risk reduction associated with a cytology test in the preceding 3.5 years was 80% in screening age 25-69 years (OR 0.20; 95% CI 0.16-0.24) with the largest reduction in squamous cell carcinomas (84%) but also a substantial estimated risk reduction of 65% for adenocarcinomas. The associated risk reduction was strongest in women aged 45-69 years, with ORs in the range 0.09-0.18, compared with ORs 0.42-1.35 in women aged 25-39 years.
To reduce the mortality of cervical cancer, screening programs should focus on increasing adherence to the program, as half of all the fatal cases were in the non-attender group. Further assessments regarding the potential preventive impact of extending screening to women over the current screening age should be considered.
大量研究探讨了宫颈癌筛查与宫颈癌发病率降低之间的关系。然而，关于筛查与宫颈癌死亡率之间的关系，相关研究则较少。我们评估了不同筛查史、组织病理学和年龄组的女性中宫颈癌死亡与筛查的关系。
在挪威进行的这项全国性基于登记的病例对照研究中，我们纳入了 1998 年至 2009 年间诊断为宫颈癌的 817 名女性的宫颈癌死亡病例。我们通过基于密度的抽样，为每个病例匹配了 10 名未患宫颈癌的基于人群的对照者。使用条件逻辑回归模型，估计筛查参与情况与宫颈癌死亡率之间的比值比（OR）及其 95%置信区间（CI）。
所有致命性宫颈癌中，35%发生在筛查年龄以上的女性中，总共 83%的患者要么处于筛查计划未覆盖的年龄组，要么未参加过筛查。在过去 3.5 年内进行细胞学检查与宫颈癌死亡风险降低相关，在 25-69 岁的筛查年龄组中风险降低 80%（OR 0.20；95%CI 0.16-0.24），鳞状细胞癌降低幅度最大（84%），但腺癌也有相当大的估计风险降低 65%。在 45-69 岁的女性中，风险降低最为显著，OR 范围为 0.09-0.18，而 25-39 岁女性的 OR 为 0.42-1.35。
为了降低宫颈癌死亡率，筛查计划应重点提高对该计划的依从性，因为半数以上的致命病例都在未参与者中。应进一步评估将筛查范围扩大到当前筛查年龄以上的女性的潜在预防效果。
