Epidemic Intelligence Service, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J Womens Health (Larchmt). 2024 May;33(5):594-603. doi: 10.1089/jwh.2023.0462. Epub 2024 Apr 12.
Although invasive cervical cancer (ICC) rates have declined since the advent of screening, the annual age-adjusted ICC rate in the United States remains 7.5 per 100,000 women. Failure of recommended screening and management often precedes ICC diagnoses. The study aimed to evaluate characteristics of women with incident ICC, including potential barriers to accessing preventive care. We abstracted medical records for patients with ICC identified during 2008-2020 in five U.S. population-based surveillance sites covering 1.5 million women. We identified evidence of adverse social and medical conditions, including uninsured/underinsured, language barrier, substance use disorder, incarceration, serious mental illness, severe obesity, or pregnancy at diagnosis. We calculated descriptive frequencies and compared potential barriers by race/ethnicity, and among women with and without symptoms at diagnosis using chi-square tests. Among 1,606 women with ICC (median age: 49 years; non-White: 47.4%; stage I: 54.7%), the majority (68.8%) presented with symptoms. Forty-six percent of women had at least one identified potential barrier; 15% had multiple barriers. The most common potential barriers among all women were being underinsured/uninsured (17.3%), and language (17.1%). Presence of any potential barrier was more frequent among non-White women and women with than without symptoms ( < 0.05). In this population-based descriptive study of women with ICC, we identified adverse circumstances that might have prevented women from seeking screening and treatment to prevent cancer. Interventions to increase appropriate cervical cancer screening and management are critical for reducing cervical cancer rates.
虽然自筛查出现以来，侵袭性宫颈癌 (ICC) 的发病率有所下降，但美国每年每 10 万名妇女中 ICC 的年龄调整发病率仍为 7.5 例。推荐的筛查和管理的失败往往先于 ICC 诊断。本研究旨在评估患有 ICC 的女性的特征，包括获得预防保健的潜在障碍。 我们从五个美国基于人群的监测站点的病历中提取了 2008 年至 2020 年间诊断为 ICC 的患者的记录，这些站点覆盖了 150 万女性。我们确定了不良社会和医疗条件的证据，包括没有保险/保险不足、语言障碍、药物使用障碍、监禁、严重精神疾病、严重肥胖或诊断时怀孕。我们计算了描述性频率，并使用卡方检验比较了不同种族/族裔的潜在障碍，以及在诊断时有症状和无症状的女性之间的潜在障碍。 在 1606 名患有 ICC 的女性中（中位年龄：49 岁；非白人：47.4%；I 期：54.7%），大多数（68.8%）有症状。46%的女性有至少一个确定的潜在障碍；15%的女性有多个障碍。所有女性中最常见的潜在障碍是保险不足/没有保险（17.3%）和语言障碍（17.1%）。在非白人女性和有症状的女性中，存在任何潜在障碍的情况更为常见（<0.05）。 在这项基于人群的 ICC 女性描述性研究中，我们确定了可能导致女性无法寻求筛查和治疗以预防癌症的不良情况。增加适当的宫颈癌筛查和管理的干预措施对于降低宫颈癌发病率至关重要。
