Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France.
Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France.
Lancet Glob Health. 2023 Feb;11(2):e197-e206. doi: 10.1016/S2214-109X(22)00501-0. Epub 2022 Dec 14.
BACKGROUND: Tracking progress and providing timely evidence is a fundamental step forward for countries to remain aligned with the targets set by WHO to eliminate cervical cancer as a public health problem (ie, to reduce the incidence of the disease below a threshold of 4 cases per 100 000 women-years). We aimed to assess the extent of global inequalities in cervical cancer incidence and mortality, based on The Global Cancer Observatory (GLOBOCAN) 2020 estimates, including geographical and socioeconomic development, and temporal aspects. METHODS: For this analysis, we used the GLOBOCAN 2020 database to estimate the age-specific and age-standardised incidence and mortality rates of cervical cancer per 100 000 women-years for 185 countries or territories aggregated across the 20 UN-defined world regions, and by four-tier levels of the Human Development Index (HDI). Time trends (1988-2017) in incidence were extracted from the Cancer Incidence in Five Continents (CI5) plus database. Mortality estimates were obtained using the most recent national vital registration data from WHO. FINDINGS: Globally in 2020, there were an estimated 604 127 cervical cancer cases and 341 831 deaths, with a corresponding age-standardised incidence of 13·3 cases per 100 000 women-years (95% CI 13·3-13·3) and mortality rate of 7·2 deaths per 100 000 women-years (95% CI 7·2-7·3). Cervical cancer incidence ranged from 2·2 (1·9-2·4) in Iraq to 84·6 (74·8-94·3) in Eswatini. Mortality rates ranged from 1·0 (0·8-1·2) in Switzerland to 55·7 (47·7-63·7) in Eswatini. Age-standardised incidence was highest in Malawi (67·9 [95% CI 65·7 -70·1]) and Zambia (65·5 [63·0-67·9]) in Africa, Bolivia (36·6 [35·0-38·2]) and Paraguay (34·1 [32·1-36·1]) in Latin America, Maldives (24·5 [17·0-32·0]) and Indonesia (24·4 [24·2-24·7]) in Asia, and Fiji (29·8 [24·7-35·0]) and Papua New Guinea (29·2 [27·3-31·0]) in Melanesia. A clear socioeconomic gradient exists in cervical cancer, with decreasing rates as HDI increased. Incidence was three times higher in countries with low HDI than countries with very high HDI, whereas mortality rates were six times higher in low HDI countries versus very high HDI countries. In 2020 estimates, a general decline in incidence was observed in most countries of the world with representative trend data, with incidence becoming stable at relatively low levels around 2005 in several high-income countries. By contrast, in the same period incidence increased in some countries in eastern Africa and eastern Europe. We observed different patterns of age-specific incidence between countries with well developed population-based screening and treatment services (eg, Sweden, Australia, and the UK) and countries with insufficient and opportunistic services (eg, Colombia, India, and Uganda). INTERPRETATION: The burden of cervical cancer remains high in many parts of the world, and in most countries, the incidence and mortality of the disease remain much higher than the threshold set by the WHO initiative on cervical cancer elimination. We identified substantial geographical and socioeconomic inequalities in cervical cancer globally, with a clear gradient of increasing rates for countries with lower levels of human development. Our study provides timely evidence and impetus for future strategies that prioritise and accelerate progress towards the WHO elimination targets and, in so doing, address the marked variations in the global cervical cancer landscape today. FUNDING: French Institut National du Cancer, Horizon 2020 Framework Programme for Research and Innovation of the European Commission; and EU4Health Programme.
背景:跟踪进展并提供及时的证据,是各国与世界卫生组织(WHO)消除宫颈癌作为公共卫生问题的目标保持一致的重要步骤(即,将疾病发病率降低到每 10 万名妇女年 4 例以下)。我们旨在根据 2020 年全球癌症观察站(GLOBOCAN)的数据评估全球范围内宫颈癌发病率和死亡率的不平等程度,这些数据包括地理和社会经济发展以及时间方面。
方法:在这项分析中,我们使用 GLOBOCAN 2020 数据库,根据联合国定义的 20 个世界区域和人类发展指数(HDI)的四个层次,估算了 185 个国家或地区每 10 万名妇女年的宫颈癌年龄特异性和年龄标准化发病率和死亡率。从癌症在五大洲加数据库(CI5)中提取了发病率的时间趋势(1988-2017 年)。使用 WHO 最新的国家生命登记数据获得死亡率估计数。
结果:2020 年全球宫颈癌发病病例数估计为 604127 例,死亡病例数为 341831 例,相应的年龄标准化发病率为 13.3 例/10 万名妇女年(95%CI 13.3-13.3),死亡率为 7.2 例/10 万名妇女年(95%CI 7.2-7.3)。宫颈癌发病率从伊拉克的 2.2(1.9-2.4)到斯威士兰的 84.6(74.8-94.3)不等。死亡率从瑞士的 1.0(0.8-1.2)到斯威士兰的 55.7(47.7-63.7)不等。马拉维(67.9 [95%CI 65.7-70.1])和赞比亚(65.5 [63.0-67.9])在非洲的年龄标准化发病率最高,玻利维亚(36.6 [35.0-38.2])和巴拉圭(34.1 [32.1-36.1])在拉丁美洲,马尔代夫(24.5 [17.0-32.0])和印度尼西亚(24.4 [24.2-24.7])在亚洲,斐济(29.8 [24.7-35.0])和巴布亚新几内亚(29.2 [27.3-31.0])在美拉尼西亚的年龄标准化发病率最高。宫颈癌存在明显的社会经济梯度,随着人类发展指数的增加,发病率呈下降趋势。低人类发展指数国家的宫颈癌发病率是高人类发展指数国家的三倍,而死亡率则是高人类发展指数国家的六倍。在 2020 年的估计中,世界上大多数有代表性趋势数据的国家的发病率都呈下降趋势,在一些高收入国家,发病率在 2005 年左右趋于稳定在相对较低的水平。相比之下,在同一时期,一些东非和东欧国家的发病率有所上升。我们观察到,在具有发达的基于人群的筛查和治疗服务的国家(如瑞典、澳大利亚和英国)和服务不足和机会主义的国家(如哥伦比亚、印度和乌干达)之间,年龄特异性发病率存在不同的模式。
解释:宫颈癌在世界许多地区的负担仍然很高,在大多数国家,宫颈癌的发病率和死亡率仍然远远高于世卫组织消除宫颈癌倡议设定的阈值。我们发现全球范围内宫颈癌存在明显的地理和社会经济不平等,随着人类发展水平的降低,发病率呈上升趋势。我们的研究为未来的战略提供了及时的证据和动力,这些战略优先考虑并加速实现世卫组织消除目标的进展,从而解决当今全球宫颈癌景观的显著差异。
资金:法国国家癌症研究所、欧盟地平线 2020 研究和创新计划以及欧盟健康计划。
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