Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
Department of Research, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway.
Eur J Public Health. 2023 Feb 3;33(1):64-68. doi: 10.1093/eurpub/ckac176.
Despite the national cervical cancer screening programme launched in 2006, Estonia has one of the highest cervical cancer incidence rates in Europe. While the overall coverage of cervical cytology is high, the factors related to cancer screening history prior to cancer diagnosis need to be studied.
In this study, we aimed to examine the 10-year screening history of women diagnosed with cervical cancer in Estonia in 2017-18, using data collected from laboratory reports from 2007 to 2018. From each report, we extracted information on the date and result of cytology and on the laboratory where the sample was assessed. We analysed these data across cancer histology, the time interval between the last test result and cancer diagnosis and the laboratory type (local or regional).
Among 319 women with cervical cancer, 181 (56.7%) did not have any cytology reports available. Among 138 women with at least one cytology, 60% had 1-3, 24% 4-6 and 16% ≥7 tests (mean 3.7) before cancer. In 78% of women, the last test was performed less than 5 years before cancer diagnosis and 62% of these tests did not report any abnormalities. The last cytology results differed significantly between the regional and local laboratories (P = 0.028).
Women received the cervical cancer diagnosis in Estonia despite having several screening tests 10 years prior to the diagnosis. The proportion of cytology tests without any abnormalities less than 5 years before the diagnosis was worryingly high and needs further investigation together with the difference between laboratory types.
尽管 2006 年启动了全国宫颈癌筛查计划，但爱沙尼亚仍是欧洲宫颈癌发病率最高的国家之一。虽然宫颈细胞学检查的总体覆盖率较高，但仍需研究与癌症诊断前癌症筛查史相关的因素。
在这项研究中，我们旨在检查 2017-18 年在爱沙尼亚被诊断患有宫颈癌的妇女的 10 年筛查史，使用 2007 年至 2018 年的实验室报告收集的数据。从每份报告中，我们提取了细胞学日期和结果以及评估样本的实验室的信息。我们根据癌症组织学、最后一次检测结果与癌症诊断之间的时间间隔以及实验室类型（本地或区域）对这些数据进行了分析。
在 319 名宫颈癌妇女中，有 181 名（56.7%）没有任何细胞学报告。在 138 名至少有一次细胞学检查的妇女中，60%有 1-3 次检查，24%有 4-6 次检查，16%有≥7 次检查（平均 3.7 次），在癌症之前。在 78%的妇女中，最后一次检查是在癌症诊断前不到 5 年进行的，其中 62%的检查未报告任何异常。最后一次细胞学检查结果在区域和当地实验室之间存在显著差异（P=0.028）。
尽管在诊断前 10 年有多次筛查试验，但爱沙尼亚的妇女仍被诊断出患有宫颈癌。在诊断前不到 5 年没有任何异常的细胞学检查比例高得令人担忧，需要与实验室类型之间的差异一起进一步调查。
