Levi F, La Vecchia C, Randimbison L, Te V C
Registre Vaudois des Tumeurs, Institut universitaire de médecine sociale et préventive, CHUV, Lausanne, Switzerland.
Ann Oncol. 1994 Oct;5(8):747-52. doi: 10.1093/oxfordjournals.annonc.a058980.
Several factors have contributed to the substantial decline in mortality from cervical cancer registered in most areas of the world, i.e., improved sexual hygiene, changes in reproductive factors, cervical screening, and, possibly, improved treatment. Each of these components is evaluated through a systematic inspection of trends in incidence, mortality and survival rates registered for a well-defined population.
Trends in incidence, mortality and survival from invasive cervical cancer over the period 1974-1991 were analysed for three separate age groups (< 55, 55-64, > or = 65 years), histological type and stage using data from the Cancer Registry of the Swiss Canton of Vaud.
Below age 55, the age-standardized (world standard) incidence rate was 9.3/100,000 women in 1974-76, it declined steadily thereafter down to 2.9 in 1986-88, but increased to 4.3 in 1989-91. In the age group 55-64, cervical cancer incidence remained around 40/100,000 to the end of the 1970s, but thereafter declined to 10.9 in 1989-91. No consistent trend was observed in elderly women, and the rate in 1989-91 (26.7/100,000) was similar to that in 1974-76 (33.7). The overall age-standardized cervical cancer incidence declined from 13.5/100,000 in 1974-76 to 5.8 in 1986-88, but rose to 6.4 in 1989-91. A similar pattern was observed for mortality, with a fall in rates in younger women between 1974 and 1985 (from 2.1 to 0.6/100,000), and a subsequent rise to 1.1/100,000 in 1989-91. A substantial decline in mortality was observed in women aged 55 to 64 since the early 1980's, from 17.2 in 1980-82 to 3.3 in 1989-91. No clear mortality trend was evident in older women. Overall, cervical cancer mortality declined from 4.3/100,000 in 1974-76 to 2.3 in 1989-91. The five-year relative survival rates were around 0.70-0.75 for younger women, around 0.60 for those aged 55 to 64, and 0.50 for elderly ones. In a Cox proportional hazard model, age and clinical stage were significantly related to survival, but not histological type and calendar period of diagnosis. No substantial change in survival from invasive cervical cancer was observed over the 18-year period considered, nor was there any notable change in the stage distribution over time. The proportion of adenocarcinomas, however, appears to have increased in the most recent calendar period.
These data reflect the impact of screening on cervical cancer rates, which, however, appeared restricted to women below age 65. An upward trend in cervical cancer incidence and mortality rates for younger women was also apparent, and there was no indication from these data of an improved survival for invasive cervical cancer patients over the last two decades. Extention of screening to elderly women appears to be a priority for reducing cervical cancer rates in this population.
世界上大多数地区宫颈癌登记死亡率大幅下降，这得益于多个因素，即性卫生改善、生殖因素变化、宫颈筛查以及可能的治疗改善。通过对明确界定人群的发病率、死亡率和生存率趋势进行系统检查，对这些因素逐一进行了评估。
利用瑞士沃州癌症登记处的数据，分析了1974年至1991年期间三个不同年龄组（<55岁、55 - 64岁、≥65岁）、组织学类型和分期的浸润性宫颈癌的发病率、死亡率和生存率趋势。
55岁以下年龄组，1974 - 1976年年龄标准化（世界标准）发病率为9.3/10万女性，此后稳步下降，1986 - 1988年降至2.9，但1989 - 1991年又升至4.3。在55 - 64岁年龄组，宫颈癌发病率在20世纪70年代末前一直保持在约40/10万左右，但此后在1989 - 1991年降至10.9。老年女性未观察到一致趋势，1989 - 1991年发病率（26.7/10万）与1974 - 1976年（33.7）相似。总体年龄标准化宫颈癌发病率从1974 - 1976年的13.5/10万降至1986 - 1988年的5.8，但1989 - 1991年又升至6.4。死亡率呈现类似模式，1974年至1985年年轻女性死亡率下降（从2.1降至0.6/10万），随后在1989 - 1991年升至1.1/10万。自20世纪80年代初以来，55至64岁女性死亡率大幅下降，从1980 - 1982年的17.2降至1989 - 1991年的3.3。老年女性未观察到明显的死亡率趋势。总体而言，宫颈癌死亡率从1974 - 1976年的4.3/10万降至1989 - 91年的2.3。年轻女性的五年相对生存率约为0.70 - 0.75，55至64岁女性约为0.60，老年女性约为0.50。在Cox比例风险模型中，年龄和临床分期与生存率显著相关，但组织学类型和诊断的日历期无关。在所考虑的18年期间，浸润性宫颈癌的生存率没有实质性变化，分期分布也没有随时间发生显著变化。然而，腺癌的比例在最近的日历期似乎有所增加。
这些数据反映了筛查对宫颈癌发病率的影响，然而，这种影响似乎仅限于65岁以下女性。年轻女性宫颈癌发病率和死亡率也呈上升趋势，这些数据没有表明过去二十年来浸润性宫颈癌患者的生存率有所改善。将筛查扩展到老年女性似乎是降低该人群宫颈癌发病率的优先事项。
