丹麦的宫颈癌发病率：分解时间趋势的决定因素
Cervical cancer incidence in Denmark: Disentangling determinants of time trend
影响因子:4.70000
分区:医学2区 / 肿瘤学2区
发表日期:2024 Nov 15
作者:
Elsebeth Lynge, Jeppe Bennekou Schroll, Berit Andersen, Kirubakaran Balasubramaniam, Anna Poulsgaard Frandsen, Else Helene Ibfelt, Kirsten Marie Jochumsen, Maja Ulrikka Bruun Laustsen, Susanne Nielsen, Rouzbeh Salmani, Doris Schledermann, Petra Birgitta Hall Viborg, Marianne Waldstrøm, George Napolitano, Reza Serizawa
摘要
宫颈癌是可预防的疾病。然而，在功能良好的医疗保健国家的国家中，发病率也存在停滞。在此基础上，我们研究了从2009年到2022年丹麦的控制干预措施与宫颈癌发病率的变化之间的关联。从史坦顿血清研究所检索了人类乳头瘤病毒（HPV）疫苗接种的数据；丹麦卫生管理局（Danish Health Authority）的筛查建议，丹麦质量数据库筛查宫颈筛查的筛查；以及诺德坎和丹麦癌症登记册的宫颈癌发病率。我们报道了HPV疫苗接种（1+剂量）的覆盖范围；宫颈细胞样品的覆盖范围；主要HPV测试的女性数量；无及时随访的非正常细胞样品的比例；连接数；和宫颈癌的发病率。在2022年，所有年龄≤29岁的妇女均已提供童年HPV疫苗接种，覆盖率为80％-90％。到2020 - 2022年，20-29岁妇女的宫颈癌发病率为每10万人3；在消除疾病的水平上。 2017年，为70岁以上的妇女提供了一次HPV筛查，到2020 - 2022年，宫颈癌发病率的老年高峰已经消失了。从2009年到2022年，没有及时随访的非正常细胞样品的比例从20％降低到10％，而常规细胞学则在很大程度上被确定的基于液体的基于液体的细胞学替代。这些因素可以解释宫颈癌发病率的稳定下降。 2021年在2021年30-59岁的女性中实施原发性HPV筛查，在2022年的宫颈癌发病率中可能会增加。总之，与儿童HPV疫苗接种的干预措施相结合；一次性HPV筛查老年妇女；筛查的更好管理破坏了宫颈癌发病率的先前停滞。
Abstract
Cervical cancer is a preventable disease. Nevertheless, stagnation has been seen in incidence rates also in countries with well-functioning healthcare. On this basis, we investigated associations between control interventions and changes in cervical cancer incidence in Denmark from 2009 to 2022. Data on human papillomavirus (HPV)-vaccination were retrieved from Staten's Serum Institute; on screening recommendations from Danish Health Authority, on screening performance from Danish Quality Database for Cervical Screening; and on cervical cancer incidence from Nordcan and Danish Cancer Register. We reported coverage with HPV vaccination (1+ dose); coverage with cervical cell samples; number of women with primary HPV tests; proportion of non-normal cell samples without timely follow-up; number of conizations; and cervical cancer incidence rates. In 2022, all women aged ≤29 had been offered childhood HPV vaccination with coverage of 80%-90%. By 2020-2022, the cervical cancer incidence rate in women aged 20-29 was 3 per 100,000; at level of disease elimination. In 2017, women aged 70+ were offered a one-time HPV screening, and by 2020-2022, the old-age peak in cervical cancer incidence had largely disappeared. From 2009 to 2022, proportion of non-normal cell samples without timely follow-up decreased from 20% to 10%, and conventional cytology was largely replaced by SurePath liquid-based cytology; these factors could explain the steady decrease in cervical cancer incidence rate. Implementation of primary HPV screening in women aged 30-59 in 2021 was reflected in a, probably temporary, increase in the 2022 cervical cancer incidence rate. In conclusion, combined interventions with childhood HPV vaccination; one-time HPV screening of elderly women; and better management of screening broke previous stagnation in cervical cancer incidence rate.