丹麦宫颈癌发生率：揭示时间趋势的决定因素

Cervical cancer incidence in Denmark: Disentangling determinants of time trend

INTERNATIONAL JOURNAL OF CANCER

影响因子:4.7

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

DOI: 10.1002/ijc.35081

摘要

宫颈癌是一种可预防的疾病。然而，即使在医疗体系运作良好的国家，发病率也呈现停滞。因此，我们研究了2009年至2022年间丹麦控制干预措施与宫颈癌发病变化之间的关系。人乳头瘤病毒（HPV）疫苗接种数据来自Statens Serum Institut，筛查建议来自丹麦卫生局，筛查效果数据来自丹麦质量数据库——宫颈筛查，以及宫颈癌发病数据来自Nordcan和丹麦癌症登记处。我们报道了HPV疫苗（1+剂次）覆盖率、宫颈细胞样本覆盖率、进行HPV检测的女性人数、未及时随访的非正常细胞样本比例、宫颈锥切术次数和宫颈癌发病率等指标。2022年，所有≤29岁的女性均已接受儿童期HPV疫苗接种，覆盖率达80%-90%。到2020-2022年，20-29岁女性的宫颈癌发病率为每十万3例，达到了疾病消除水平。2017年，70岁及以上女性接受了一次性HPV筛查，到2020-2022年，老年群体的宫颈癌高发峰值基本消失。从2009年至2022年，未及时随访的非正常细胞样本比例由20%降至10%，常规细胞学检查大部分被液基细胞学（SurePath）取代，这些因素可能共同解释了宫颈癌发病率的持续下降。2021年开始实施的30-59岁女性的初级HPV筛查，导致2022年宫颈癌发病率可能出现短暂上升。综上所述，儿童HPV疫苗接种、一次性老年女性HPV筛查以及筛查管理的改善，有效打破了宫颈癌发病率的停滞状态。

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.