Finnish Cancer Registry, Helsinki, Finland.
Department of Research, Cancer Registry of Norway, Oslo, Norway.
Acta Oncol. 2023 Sep;62(9):977-987. doi: 10.1080/0284186X.2023.2245557. Epub 2023 Aug 18.
Cervical, liver and stomach cancers are the most common infection-associated malignancies and the leading cause of morbidity in non-Western regions. We compared the incidence and mortality of these cancers between non-Western immigrant and non-immigrant Nordic female populations. We also analysed the effect of age at immigration, duration of residence and education on cancer burden.
Study population consisted of women residents in Denmark, Finland, Iceland and Norway in 1973-2020. Non-Western women contributed 3.1% of the total 260 million person-years at risk. All women were followed from their 20th birthday, or from the date of immigration if after, until the date of their first primary cancer diagnosis, death, emigration, or the end of the country-specific study period. All data were adjusted for 10-year age groups and calendar periods, and immigrant data was further broken down by region of birth, age at immigration and education level. Country-specific estimates were produced by multivariable Poisson regression and pooled in Finland with a random effects model.
Altogether, there were 60 982 cases of cervical, liver and stomach cancer in the study population, causing 36 582 deaths. The immigrant women had significantly higher liver (rate ratio [RR] 1.78, 95% confidence interval (CI) 1.03-3.06) and stomach cancer incidence (RR 1.68, CI 1.29-2.18), and stomach cancer mortality (RR 1.49, CI 1.17-1.92) than non-immigrant women. In the immigrant population, high education was related to lower incidence and mortality of studied cancers. The rate ratio of cervical cancer decreased with duration of residence and increased with rising age at immigration.
Due to the increased incidence and mortality of infection-related cancers and changes in cancer patterns by age at immigration and duration of residence, attention should be paid to targeted health care services for immigrants. Special efforts should be given to women who have spent their youth in high-risk areas.
在非西方区域，宫颈癌、肝癌和胃癌是最常见的感染相关恶性肿瘤，也是发病率的主要原因。我们比较了非西方移民和非移民北欧女性人群中这些癌症的发病率和死亡率。我们还分析了移民年龄、居住时间和教育程度对癌症负担的影响。
研究人群包括丹麦、芬兰、冰岛和挪威的女性居民，研究时间为 1973 年至 2020 年。在 2.6 亿人年的总风险中，非西方女性占 3.1%。所有女性从 20 岁生日开始随访，或从移民日期开始随访（如果晚于 20 岁生日），直至首次原发性癌症诊断、死亡、移民或国家特定研究期结束。所有数据均按 10 岁年龄组和日历期进行调整，移民数据按出生地、移民年龄和教育程度进一步细分。通过多变量泊松回归对各国数据进行估计，并在芬兰使用随机效应模型进行汇总。
在研究人群中，共有 60982 例宫颈癌、肝癌和胃癌病例，导致 36582 人死亡。移民女性的肝癌（率比 [RR]1.78，95%置信区间 [CI]1.03-3.06）和胃癌发病率（RR1.68，CI1.29-2.18）以及胃癌死亡率（RR1.49，CI1.17-1.92）显著高于非移民女性。在移民人群中，高教育程度与研究癌症的发病率和死亡率降低有关。宫颈癌的 RR 随居住时间的延长而降低，随移民年龄的增加而增加。
由于感染相关癌症的发病率和死亡率增加，以及移民年龄和居住时间对癌症模式的影响，应关注移民的针对性医疗保健服务。应特别关注在高风险地区度过青春岁月的女性。
