Robles S C, White F, Peruga A
Division of Disease Prevention and Control, Pan American health Organization, Washington, D.C., USA.
Bull Pan Am Health Organ. 1996 Dec;30(4):290-301.
This article presents an assessment of cervical cancer mortality trends in the Americas based on PAHO data. Trends were estimated for countries where data were available for at least 10 consecutive years, the number of cervical cancer deaths was considerable, and at least 75% of the deaths from all causes were registered. In contrast to Canada and the United States, whose general populations had been screened for many years and where cervical cancer mortality has declined steadily (to about 1.4 and 1.7 deaths per 100,000 women, respectively, as of 1990), most Latin American and Caribbean countries with available data have experienced fairly constant levels of cervical cancer mortality (typically in the range of 5-6 deaths per 100,000 women). In addition, several other countries (Chile, Costa Rica, and Mexico) have exhibited higher cervical cancer mortality as well as a number of noteworthy changes in this mortality over time. Overall, while actual declining trends could be masked by special circumstances in some countries, cervical cancer mortality has not declined in Latin America as it has in developed countries. Correlations between declining mortality and the intensity of screening in developed countries suggest that a lack of screening or screening program shortcomings in Latin America could account for this. Among other things, where large-scale cervical cancer screening efforts have been instituted in Latin America and Caribbean, these efforts have generally been linked to family planning and prenatal care programs serving women who are typically under 30; while the real need is for screening of older women who are at substantially higher risk.
本文基于泛美卫生组织的数据，对美洲地区宫颈癌死亡率趋势进行了评估。对那些有至少连续10年数据、宫颈癌死亡人数可观且至少75%的全因死亡进行了登记的国家，估算了其死亡率趋势。与加拿大和美国不同，这两个国家的普通人群多年来一直接受筛查，宫颈癌死亡率稳步下降（截至1990年，分别降至每10万名女性约1.4例和1.7例死亡），大多数有可用数据的拉丁美洲和加勒比国家的宫颈癌死亡率一直相当稳定（通常在每10万名女性5 - 6例死亡的范围内）。此外，其他几个国家（智利、哥斯达黎加和墨西哥）不仅宫颈癌死亡率较高，而且随着时间推移，这一死亡率还出现了一些值得注意的变化。总体而言，虽然某些国家的特殊情况可能掩盖了实际的下降趋势，但拉丁美洲的宫颈癌死亡率并未像发达国家那样下降。发达国家死亡率下降与筛查强度之间的相关性表明，拉丁美洲缺乏筛查或筛查项目存在缺陷可能是造成这种情况的原因。除此之外，在拉丁美洲和加勒比地区开展大规模宫颈癌筛查工作的地方，这些工作通常与为通常年龄在30岁以下的女性提供计划生育和产前护理项目相关；而实际需求是对风险高得多的老年女性进行筛查。
