Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
JAMA Oncol. 2024 Nov 1;10(11):1561-1564. doi: 10.1001/jamaoncol.2024.3675.
The World Health Organization has called for eliminating cervical cancer as a public health problem. Accurate and up-to-date estimates of population-based cervical cancer incidence are essential for monitoring progress toward elimination and informing local cancer control strategies, but these estimates are lacking for the US-Affiliated Pacific Islands (USAPI).
To calculate age-standardized incidence rates for cervical cancer in the 6 USAPI and compare these rates with rates in the US (50 states and the District of Columbia).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used population-based data from the Pacific Regional Central Cancer Registry for women aged 20 years or older who were diagnosed with invasive cervical cancer from January 1, 2007, to December 31, 2020. The registry comprises data on all cervical cancers from the USAPI, which include 3 US territories (American Samoa, Commonwealth of the Northern Mariana Islands, and Guam) and 3 freely associated states (Federated States of Micronesia [FSM], Republic of the Marshall Islands [RMI], and Republic of Palau). Data were analyzed from July 10, 2023, to November 28, 2023.
The main outcome was age-standardized cervical cancer incidence rates, stratified by age, stage, and histologic code for the USAPI using population estimates from 3 different sources (US Census Bureau International Database, United Nations Population Division, and Pacific Data Hub). Rate ratios were calculated to compare incidence rates between the USAPI and the US.
From 2007 to 2020, 409 cases of cervical cancer were diagnosed in the USAPI (median age at diagnosis, 46.0 years [25th-75th percentile, 39.0-55.0 years]), with an age-standardized incidence rate ranging from 21.7 (95% CI, 19.6-23.9) to 22.1 (95% CI, 20.0-24.4) per 100 000 women, depending on the population estimate. Incidence rates were highest in RMI, ranging from 58.1 (95% CI, 48.0-69.7) to 83.4 (95% CI, 68.3-101.0) per 100 000 women, followed by FSM, ranging from 28.7 (95% CI, 23.4-34.9) to 29.8 (95% CI, 24.3-36.3) per 100 000 women. Compared with the US, incidence rates were highest in RMI (rate ratio, 5.7 [95% CI, 4.7-6.8] to 8.2 [95% CI, 6.7-9.9]) and FSM (rate ratio; 2.8; 95% CI, 2.3-3.4). Of all cases in the USAPI, 213 (68.2%) were diagnosed at a late stage.
In this cross-sectional study, cervical cancer remained a major public health issue in some USAPI, with RMI reporting the highest incidence rates. The findings suggest that improvements in human papillomavirus vaccination and cancer screening coverage through efforts tailored to the unique geographic, sociocultural, economic, and health care landscape of the USAPI may reduce the burden of cervical cancer.
世界卫生组织呼吁消除宫颈癌这一公共卫生问题。准确和最新的基于人群的宫颈癌发病率估计对于监测消除宫颈癌的进展和为当地癌症控制策略提供信息至关重要，但美国太平洋属地（USAPI）缺乏这些估计数据。
计算 6 个 USAPI 地区宫颈癌的年龄标准化发病率，并将这些比率与美国（50 个州和哥伦比亚特区）的比率进行比较。
设计、地点和参与者：这是一项使用基于人群的数据的横断面研究，纳入了 2007 年 1 月 1 日至 2020 年 12 月 31 日期间诊断为浸润性宫颈癌的年龄在 20 岁或以上的女性。该登记处包含了来自 USAPI 的所有宫颈癌数据，包括 3 个美国领土（美属萨摩亚、北马里亚纳群岛联邦和美属关岛）和 3 个自由联系州（密克罗尼西亚联邦、马绍尔群岛共和国和帕劳共和国）。数据于 2023 年 7 月 10 日至 2023 年 11 月 28 日进行分析。
主要结局是使用来自 3 个不同来源（美国人口普查局国际数据库、联合国人口司和太平洋数据中心）的人口估计数，为 USAPI 计算的年龄标准化宫颈癌发病率，按年龄、分期和组织学代码进行分层。计算发病率比率以比较 USAPI 和美国之间的发病率。
2007 年至 2020 年，USAPI 诊断出 409 例宫颈癌（中位诊断年龄为 46.0 岁[25 分位数至 75 分位数，39.0-55.0 岁]），年龄标准化发病率范围为 21.7（95%CI，19.6-23.9）至 22.1（95%CI，20.0-24.4）每 100000 名女性，具体取决于人口估计数。发病率最高的是马绍尔群岛共和国，范围为每 100000 名女性 58.1（95%CI，48.0-69.7）至 83.4（95%CI，68.3-101.0），其次是密克罗尼西亚联邦，范围为每 100000 名女性 28.7（95%CI，23.4-34.9）至 29.8（95%CI，24.3-36.3）。与美国相比，发病率最高的是马绍尔群岛共和国（发病率比率，4.7-6.8 至 6.7-9.9）和密克罗尼西亚联邦（发病率比率，2.3-3.4）。在 USAPI 的所有病例中，213 例（68.2%）在晚期诊断。
在这项横断面研究中，宫颈癌仍然是一些 USAPI 的主要公共卫生问题，马绍尔群岛共和国的发病率最高。研究结果表明，通过针对 USAPI 独特的地理、社会文化、经济和医疗保健环境量身定制的努力，改善人乳头瘤病毒疫苗接种和癌症筛查覆盖范围，可能会降低宫颈癌的负担。
