Falcaro Milena, Castañón Alejandra, Ndlela Busani, Sasieni Peter
Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, UK.
Lancet Reg Health Eur. 2024 Dec 10;49:101157. doi: 10.1016/j.lanepe.2024.101157. eCollection 2025 Feb.
Monitoring trends in diseases after the implementation of new public health interventions or policy changes is crucial for public health planning and surveillance. In this study we look at variations in rates of cervical cancer and grade-3 cervical intraepithelial neoplasia (CIN3) incidence between 2006 and 2020 in England and relate them to predictions based on the changes in HPV vaccination and cervical screening policy.
Using population-based registry data, we estimated incidence rates and their 95% confidence intervals for cervical cancer and CIN3 by age group and by either year of diagnosis or 1-year birth cohort. Trends were compared over time and across birth cohorts by calculating relative changes with respect to reference time points. We also tested if trends in women offered HPV vaccination were significantly different across outcomes (cervical cancer and CIN3) and age groups. To do this, we used Poisson regression with adjustments for interval censoring, overdispersion and correlation between observations.
There were 5558 cancers and 164,682 cases of CIN3 from 53.4 million women-years of observation in the age group 20-29.99 years. We found no evidence of increased cervical cancer rates over the age of 26 in cohorts not offered cervical screening until age 24.5 or 25 years. Substantial and increasing reductions in CIN3s and cervical cancers were observed in the cohorts offered HPV vaccination and were consistent with an 80% (95% CI: 72.9%-87.1%) decrease in cervical neoplasia in the routine vaccination group.
Plots against different time scales (e.g., calendar year and date of birth) may provide important insights that could otherwise be missed. Our findings are consistent with a sustained high effectiveness of the HPV immunization programme as the catch-up vaccination cohorts age.
Cancer Research UK.
在实施新的公共卫生干预措施或政策变化后监测疾病趋势，对于公共卫生规划和监测至关重要。在本研究中，我们观察了2006年至2020年英格兰宫颈癌和3级宫颈上皮内瘤变（CIN3）发病率的变化，并将其与基于HPV疫苗接种和宫颈筛查政策变化的预测相关联。
利用基于人群的登记数据，我们按年龄组以及诊断年份或1年出生队列估计了宫颈癌和CIN3的发病率及其95%置信区间。通过计算相对于参考时间点的相对变化，比较了不同时间和不同出生队列的趋势。我们还测试了接受HPV疫苗接种的女性在不同结局（宫颈癌和CIN3）和年龄组中的趋势是否存在显著差异。为此，我们使用了泊松回归，并对区间删失、过度离散和观察值之间的相关性进行了调整。
在20 - 29.99岁年龄组的5340万女性年观察期内，有5558例癌症和164,682例CIN3病例。我们发现，在24.5岁或25岁才开始接受宫颈筛查的队列中，26岁以上人群的宫颈癌发病率没有增加的迹象。在接受HPV疫苗接种的队列中，CIN3和宫颈癌的发病率大幅下降且呈上升趋势，这与常规疫苗接种组宫颈瘤变减少80%（95%CI：72.9% - 87.1%）一致。
针对不同时间尺度（如日历年份和出生日期）的图表可能会提供重要的见解，否则可能会被忽略。我们的研究结果与HPV免疫计划随着补种疫苗队列年龄增长而持续保持高效一致。
英国癌症研究中心
