Morrow C P, Cozen W
Division of Gynecologic Oncology, Women's and Children's Hospital, University of Southern California School of Medicine, Los Angeles 90033, USA.
J Cell Biochem Suppl. 1995;23:61-70. doi: 10.1002/jcb.240590909.
Cervical carcinoma (CC) remains a significant health problem in the United States (U.S.) despite the progressive fall in the mortality rate during the past 60 years. However, CC is still the most common cancer among women worldwide and the leading cancer cause of death in many countries. In the U.S., the current age-adjusted incidence of CC is about 8 per 100,000 population, which compares to 54.6 in Peru and 4.2 in Israel. The lifetime risk for acquiring CC in the U.S. is about 1%, while the lifetime risk in Peru is more than 5 times greater. Recently some industrialized countries have reported a 2-3-fold increase in the death rate from CC among women less than 35 years of age. The primary strategy to reduce the incidence and death rate from CC is screening by cervical cytology. Because of the high incidence of CC precursor lesions, as well as the lack of specifically and sensitivity, CC screening has proven very costly. Nevertheless, in countries or regions where such screening has been repetitive and comprehensive, the mortality rate from CC has been reduced up to 80%, with most cases of CC occurring in non-compliant patients. The decrease in mortality results from detection of invasive cancer at an earlier, and therefore more curable stage, as well as detection and treatment of precursors which prevent the development of invasive carcinoma. Because the strategy involves detection of cancer precursors, the rate of abnormal Pap smears and the number of women requiring medical intervention is many times higher than the CC rate. The age-adjusted incidence of carcinoma in situ is reported to be 3-5-fold that of invasive cervical cancers. The age-adjusted incidence of all dysplasias is unknown, but it is reported that more than half (perhaps up to 90%) of mild and moderate dysplasias regress spontaneously. Considering that there are 15,000 cases of invasive cervical cancer diagnosed in the U.S. annually, cytologic screening involves the diagnosis and treatment of 750,000 or more women each year for precursor lesions. The impact of CC on the patient and society, as well as the role of other strategies for early diagnosis and prevention, will be briefly reviewed.
尽管在过去60年里宫颈癌（CC）死亡率逐步下降，但在美国它仍是一个重大的健康问题。然而，CC仍是全球女性中最常见的癌症，也是许多国家癌症死亡的主要原因。在美国，目前CC的年龄调整发病率约为每10万人中有8例，相比之下，秘鲁为54.6例，以色列则为4.2例。在美国，患CC的终生风险约为1%，而在秘鲁，终生风险则高出5倍多。最近，一些工业化国家报告称，35岁以下女性因CC导致的死亡率增加了2至3倍。降低CC发病率和死亡率的主要策略是通过宫颈细胞学检查进行筛查。由于CC前驱病变的高发病率，以及缺乏特异性和敏感性，CC筛查已被证明成本非常高。尽管如此，在那些进行了反复和全面筛查的国家或地区，CC死亡率已降低了80%，大多数CC病例发生在未遵守筛查要求的患者中。死亡率的下降源于在更早、因而更可治愈的阶段检测到浸润性癌，以及检测和治疗前驱病变从而预防浸润性癌的发展。由于该策略涉及癌症前驱病变的检测，异常巴氏涂片的比例以及需要医疗干预的女性数量比CC发病率高出许多倍。据报道，原位癌的年龄调整发病率是浸润性宫颈癌的3至5倍。所有发育异常的年龄调整发病率尚不清楚，但据报道，超过一半（可能高达90%）的轻度和中度发育异常会自发消退。考虑到美国每年有15000例浸润性宫颈癌被诊断出来，细胞学筛查每年涉及对75万或更多女性的前驱病变进行诊断和治疗。本文将简要回顾CC对患者和社会的影响，以及其他早期诊断和预防策略的作用。
