上海市黄浦区户籍人口1973-2012年宫颈癌发病及出生队列分析
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摘要
目的了解1973-2012年上海市黄浦区宫颈癌的发病流行病学特征和趋势,为制定防治策略提供科学依据。方法收集1973-2012年黄浦区肿瘤登记数据库中30岁及以上户籍人口的宫颈癌发病资料,采用Excel 2007计算中位发病年龄、粗发病率、年龄别发病率和标化发病率。采用年龄-队列模型进行出生队列分析,采用R 3.4.3软件计算发病相对危险度(RR)及其95%可信区间(CI)。结果 1973-2012年,黄浦区≥30岁户籍人口宫颈癌粗发病率为8.85/10万,标化发病率为3.70/10万。1973-1997年宫颈癌标化发病率从11.48/10万下降至1.48/10万;1998-2007年,宫颈癌标化发病率从1.95/10万上升至2.66/10万;2008-2012年,标化发病率下降为2.62/10万。30~34、35~39岁人群在2008-2012年的发病率远高于1973-1977年发病水平,分别上升340.43%和54.63%,而其他年龄组在后期的发病率低于早期水平。出生队列分析结果显示,以1931-1935年出生人群宫颈癌发病率为参照组,1886-1890年出生人群发病风险最高(RR=36.46,95%CI:14.30~92.94),此后1891-1930年期间各出生队列人群的宫颈癌发病风险均高于1931-1935年出生人群,但整体呈下降趋势(RR值范围为2.12~13.88);而1936-1960年期间各出生队列人群的宫颈癌发病风险均低于1931-1935年出生人群(RR范围为0.20~0.55),1966-1980年期间各出生队列人群的宫颈癌发病风险升高(RR范围为1.83~3.31),发病率的变化均有统计学意义(P<0.05)。结论目前上海市黄浦区宫颈癌发病尚处于较低水平,但仍应重视人群发病年轻化的趋势,加强健康教育,控制相关危险因素。
Objective To analyze the epidemiological characteristics and incidence trends of cervical cancer and to provide the scientific basis for making the preventing and treating strategy.Methods The data of cervical cancer incidences in residents(≥30 years old) were obtained from Cancer Registration Database in Huangpu District.Median age,crude incidence rate,age-specific incidence rate and age-standardized rate(ASR) were calculated by Excel 2007.Age-cohort effects were analyzed with age-cohort model,and the relative risk(RR) and 95% confidence interval(CI) were calculated by R 3.4.3 software.Results From 1973 to 2012,the crude incidence of cervical cancer in registered population(≥ 30 years old) was 8.85/105.The standardized incidence was 3.70/105.The standardized incidence decreased from 11.48/105 to 1.48/105 during 1973 to 1997.The standardized incidence increased from 1.95/105 to 2.66/105 during 1998 to 2007.During 2008 to 2012,the standardized incidence decreased to 2.62/105.The cervical cancer incidences in residents(30-34 years old and 35-39 years old) during 2008 to 2012 were significantly higher than those during 1973 to 1977,increased 340.43% and 54.63%,respectively;but the trend was not observed in the other age groups.The birth cohort analysis showed that the cervical cancer incidence in residents born from 1931 to 1935 served as the control group,the risk in residents born from 1886 to 1890 was the highest(RR=36.46,95%CI:14.30-92.94);the risk in residents born from 1891 to 1930 was higher than control group but with decreasing trend(RR:2.12 to 13.88);the risk in residents born from 1936 to 1960 was lower than control group(RR:0.20 to 0.55);then the risk in residents born from1966 to 1980 increased(RR:1.83 to 3.31);all incidences changed significantly(P<0.05).Conclusion At present,the incidence level of cervical cancer in Huangpu District of Shanghai was lower.It should be paid more attention to the younger trend of cervical cancer inciderce,enhance the health education and control the related risk factors.
Objective To analyze the epidemiological characteristics and incidence trends of cervical cancer and to provide the scientific basis for making the preventing and treating strategy.Methods The data of cervical cancer incidences in residents(≥30 years old) were obtained from Cancer Registration Database in Huangpu District.Median age,crude incidence rate,age-specific incidence rate and age-standardized rate(ASR) were calculated by Excel 2007.Age-cohort effects were analyzed with age-cohort model,and the relative risk(RR) and 95% confidence interval(CI) were calculated by R 3.4.3 software.Results From 1973 to 2012,the crude incidence of cervical cancer in registered population(≥ 30 years old) was 8.85/105.The standardized incidence was 3.70/105.The standardized incidence decreased from 11.48/105 to 1.48/105 during 1973 to 1997.The standardized incidence increased from 1.95/105 to 2.66/105 during 1998 to 2007.During 2008 to 2012,the standardized incidence decreased to 2.62/105.The cervical cancer incidences in residents(30-34 years old and 35-39 years old) during 2008 to 2012 were significantly higher than those during 1973 to 1977,increased 340.43% and 54.63%,respectively;but the trend was not observed in the other age groups.The birth cohort analysis showed that the cervical cancer incidence in residents born from 1931 to 1935 served as the control group,the risk in residents born from 1886 to 1890 was the highest(RR=36.46,95%CI:14.30-92.94);the risk in residents born from 1891 to 1930 was higher than control group but with decreasing trend(RR:2.12 to 13.88);the risk in residents born from 1936 to 1960 was lower than control group(RR:0.20 to 0.55);then the risk in residents born from1966 to 1980 increased(RR:1.83 to 3.31);all incidences changed significantly(P<0.05).Conclusion At present,the incidence level of cervical cancer in Huangpu District of Shanghai was lower.It should be paid more attention to the younger trend of cervical cancer inciderce,enhance the health education and control the related risk factors.
引文
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[15]包鹤龄,赵振平,张梅,等.中国农村子宫颈癌筛查实施5年对人群筛查率的影响[J].中华预防医学杂志,2018,52(3):260-264.
[16]包鹤龄,王临虹,王丽敏,等.中国2013年35~69岁女性人群子宫颈癌和乳腺癌筛查率及影响因素研究[J].中华流行病学杂志,2018,39(2):208-212.
[17]杨文蕾,田甜,万德芝,等.中国3省妇女宫颈癌防治知信行现况调查及影响因素分析[J].中国健康教育,2017,33(10):876-880.
[18]彭鹏,鲍萍萍,王春芳,等.上海市女性居民宫颈癌筛查知识和行为现状调查[J].环境与职业医学,2014,31(5):342-346.
[19]孟瑞琳,马文军,许燕君,等.广东省妇女乳腺癌和宫颈癌筛查率及相关影响因素分析[J].华南预防医学,2010,36(2):8-10,14.
[20]The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer.The American Cancer Society medical and editorial content team[EB/OL].(2016-12-09).[2018-05-14].https://www.cancer.org/cancer/cervical-cancer/prevention-andearly-detection/cervical-cancer-screening-guidelines.html.
[21]Chen HY,L Kessler C,Mori N,et al.Cervical cancer screening in the United States,1993-2010:characteristics of women who are never screened[J].J Womens Health,2012,21(11):1132-1138.
[22]Lee M,Park EC,Chang HS,et al.Socioeconomic disparity in cervical cancer screening among Korean women:1998-2010[J].BMC Public Health,2013,13:553-553.DOI:10.1186/1471-2458-13-553.
[23]Villain P,Gonzalez P,Almonte M,et al.European Code against Cancer 4th Edition:Infections and Cancer[J].Cancer Epidemiol,2015,39:S120-S138.DOI:10.1016/j.canep.2015.10.006.
[24]王烨菁,高淑娜,何丽华,等.2007-2013年上海市黄浦区居民吸烟、戒烟及被动吸烟状况变化趋势[J].环境与职业医学,2016,33(5):471-474,479.
[25]赵俊峰,倪一宏,张艳,等.上海市黄浦区20~69岁常住居民吸烟行为流行特征分析[J].上海预防医学,2017,29(9):673-677.
[26]Lowy DR,Schiller JT.Reducing HPV-associated cancer globally[J].Cancer Prev Res,2012,5(1):18-23.
[27]Di JL,Rutherford S,Wu JL,et al.Knowledge of cervical cancer screening among health care workers providing services across different socio-economic regions of China[J].Asian Pac J Cancer Prev,2016,17(6):2965-2972.
[2]Moon EK,Oh CM,Won YJ,et al.Trends and age-period-cohort effects on the incidence and mortality rate of cervical cancer in Korea[J].Cancer Res Treat,2017,49(2):526-533.
[3]Raifu AO,Arbyn M.Description of cervical cancer mortality in Belgium using Bayesian age-period-cohort models[J].Arch Public Health,2009,67(3):100-115.
[4]郑荣寿,陈万青.基于贝叶斯方法的年龄-时期-队列预测模型的介绍[J].中华预防医学杂志,2012,46(7):648-650.
[5]Bray F,Ren JS,Masuyer E,et al.Global estimates of cancer prevalence for 27 sites in the adult population in 2008[J].Int J Cancer,2012,132(5):1133-1145.
[6]王春芳,鲍萍萍,吴春晓,等.上海市浸润性子宫颈癌的流行现况与趋势分析[J].诊断学理论与实践,2010,9(1):35-41.
[7]Danaei G,Vander Hoorn S,Lopez AD,et al.Causes of cancer in the world:comparative risk assessment of nine behavioural and environmental risk factors[J].Lancet,2005,366(9499):1784-1793.
[8]Benard VB,Johnson CJ,Thompson TD,et al.Examining the association between socioeconomic status and potential human papillomavirus-associated cancers[J].Cancer,2008,113(10):2910-2918.
[9]谭美丽,龚伟明,乐嘉豫.上海市性病流行概况及防治对策[J].上海预防医学杂志,1998,10(6):257-259.
[10]许振慧,周建军,宿飞,等.上海市黄浦区1990-2013年艾滋病、淋病和梅毒疫情分析[J].上海预防医学,2015,27(10):609-611.
[11]Woodman CBJ,Collins S,Winter H,et al.Natural history of cervical human papillomavirus infection in young women:a longitudinal cohort study[J].Lancet,2001,357(9271):1831-1836.
[12]Ma X,Wang Q,Ong JJ,et al.Prevalence of human papillomavirus by geographical regions,sexual orientation and HIV status in China:a systematic review and meta-analysis[J].Sex Transm Infect,2018,94(6):434-442.
[13]L觍觍r觍E,Day N,Hakama M.Trends in mortality from cervical cancer in the nordic countries:association with organised screening programmes[J].Lancet,1987,329(8544):1247-1249.
[14]Wang J,Bai Z,Wang Z,Yu C.Comparison of secular trends in cervical cancer mortality in China and the United States:an ageperiod-cohort analysis[J].Int J Environ Res Public Health,2016,13(13):1148-1163.
[15]包鹤龄,赵振平,张梅,等.中国农村子宫颈癌筛查实施5年对人群筛查率的影响[J].中华预防医学杂志,2018,52(3):260-264.
[16]包鹤龄,王临虹,王丽敏,等.中国2013年35~69岁女性人群子宫颈癌和乳腺癌筛查率及影响因素研究[J].中华流行病学杂志,2018,39(2):208-212.
[17]杨文蕾,田甜,万德芝,等.中国3省妇女宫颈癌防治知信行现况调查及影响因素分析[J].中国健康教育,2017,33(10):876-880.
[18]彭鹏,鲍萍萍,王春芳,等.上海市女性居民宫颈癌筛查知识和行为现状调查[J].环境与职业医学,2014,31(5):342-346.
[19]孟瑞琳,马文军,许燕君,等.广东省妇女乳腺癌和宫颈癌筛查率及相关影响因素分析[J].华南预防医学,2010,36(2):8-10,14.
[20]The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer.The American Cancer Society medical and editorial content team[EB/OL].(2016-12-09).[2018-05-14].https://www.cancer.org/cancer/cervical-cancer/prevention-andearly-detection/cervical-cancer-screening-guidelines.html.
[21]Chen HY,L Kessler C,Mori N,et al.Cervical cancer screening in the United States,1993-2010:characteristics of women who are never screened[J].J Womens Health,2012,21(11):1132-1138.
[22]Lee M,Park EC,Chang HS,et al.Socioeconomic disparity in cervical cancer screening among Korean women:1998-2010[J].BMC Public Health,2013,13:553-553.DOI:10.1186/1471-2458-13-553.
[23]Villain P,Gonzalez P,Almonte M,et al.European Code against Cancer 4th Edition:Infections and Cancer[J].Cancer Epidemiol,2015,39:S120-S138.DOI:10.1016/j.canep.2015.10.006.
[24]王烨菁,高淑娜,何丽华,等.2007-2013年上海市黄浦区居民吸烟、戒烟及被动吸烟状况变化趋势[J].环境与职业医学,2016,33(5):471-474,479.
[25]赵俊峰,倪一宏,张艳,等.上海市黄浦区20~69岁常住居民吸烟行为流行特征分析[J].上海预防医学,2017,29(9):673-677.
[26]Lowy DR,Schiller JT.Reducing HPV-associated cancer globally[J].Cancer Prev Res,2012,5(1):18-23.
[27]Di JL,Rutherford S,Wu JL,et al.Knowledge of cervical cancer screening among health care workers providing services across different socio-economic regions of China[J].Asian Pac J Cancer Prev,2016,17(6):2965-2972.
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