Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan.
Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
BMC Public Health. 2023 May 5;23(1):834. doi: 10.1186/s12889-023-15531-z.
Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation.
To estimate the burden of cervical cancer in Pakistan using available data sources.
We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan.
A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995-1997 ASIR = 6.81, 1998-2002 ASIR = 7.47, and 2017-2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015-2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year.
The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.
宫颈癌是全球女性癌症相关死亡的主要原因之一。在巴基斯坦等国家，缺乏关于宫颈癌负担的数据，这阻碍了必要的资源分配。
利用现有数据源估计巴基斯坦的宫颈癌负担。
我们进行了一项系统评价，以确定 1995 年至 2022 年期间与巴基斯坦相关的相关数据。通过系统评价确定的研究数据，如果提供了足够的宫颈癌特定年龄发病率和年龄标准化发病率 (ASIR) 计算信息，则将其合并。计算了风险人群估计值，并对寻求治疗途径中的重要变量进行了调整。将计算出的 ASIR 应用于 2020 年的人口估计数，以估计巴基斯坦的宫颈癌病例数。
共有 13 项研究报告了巴基斯坦宫颈癌的 ASIR。在所选择的研究中，卡拉奇癌症登记处报告了所有报告时期的最高疾病负担估计数：1995-1997 年 ASIR=6.81，1998-2002 年 ASIR=7.47，2017-2019 年 ASIR=6.02/100,000 名妇女。使用 2015-2019 年来自卡拉奇、旁遮普和巴基斯坦原子能源癌症登记处的数据，我们得出了宫颈癌未经调整的 ASIR 为 4.16/100,000 名妇女（95%置信区间 3.28，5.28）。不同的模型假设产生了调整后的 ASIR 范围为 5.2 至 8.4/100,000 名妇女。我们得出的调整后的 ASIR 为 7.60（95%置信区间 5.98，10.01），估计每年有 6166 例（95%置信区间 4833，8305）新的宫颈癌病例。
估计巴基斯坦的宫颈癌负担高于世卫组织的目标。这些估计数对寻求医疗服务的行为和适当的医生诊断干预很敏感，这些因素与宫颈癌有关，宫颈癌是一个在中低收入国家中存在污名化的疾病。这些估计数为通过多方面的策略来消除宫颈癌提供了依据。
