上海市浸润性子宫颈癌的流行现况与趋势分析

Prevalence and temporal trend of invasive cervical cancer in Shanghai

目的:分析上海市浸润性子宫颈癌的流行特征,并将之与世界其他国家的浸润性子宫颈癌流行病学资料进行比较。方法:利用上海市肿瘤登记报告和随访管理系统收集的子宫颈癌发病资料,运用年度变化百分比(annual percent change,APC)对上海市1973至2006年浸润性子宫颈癌发病率的时间趋势进行分析。结果:浸润性子宫颈癌居上海市女性恶性肿瘤第14位,2002至2006年上海全市共新诊断浸润性子宫颈癌病例1913例,浸润性子宫颈癌粗发病率为5.72/10万,标化发病率为3.57/10万。年龄别发病率曲线在绝经期前、后呈现双峰现象。1973至2006年,浸润性子宫颈癌标化发病率共下降了86.43%。阶段趋势分析显示,自1996年始,上海市区浸润性子宫颈癌的标化发病率由降转为升,小于35岁组发病率在1973～2006年间呈现持续的显著上升趋势,45～54岁组标化发病率也从1996年始由之前的下降转为上升。上海是浸润性子宫颈癌低发地区,但也出现了与发达国家相似的年轻浸润性子宫颈癌上升趋势。结论:上海市浸润性子宫颈癌发病率处于较低水平。从1996年开始,浸润性子宫颈癌发病率由下降转为上升,主要是由45～54岁组发病率上升和小于35岁组发病率快速持续上升所致。未来子宫颈癌的预防应着重控制危险因素和倡导筛检及提高筛查普及率,减少人乳头瘤病毒(HPV)感染,建立良好的生活方式。

Objective To describe the characteristics of prevalence of invasive cervical cancer in Shanghai,analyze the temporal trend,and compare with those in other countries and districts.Methods Based on the case diagnosis data during 1973-2006 collected by Shanghai Cancer Registry System,the incidence distribution by age and time-period was described,meanwhile,the temporal trend by APC model was analyzed.Results Invasive cervical cancer is the 14th common cancer in female in Shanghai.One thousand nine hundred and thirteen cases of invasive cervical cancer were reported in 2002-2006,with a crude incidence rate of 5.72/100 000 and a standardized incidence rate of 3.57/100 000.The age-specific incidence curve showed a double-peak before and after menopause.The standardized incidence rate decreased 86.43% in the past 34 years.However,analysis of temporal trend demonstrated that the rising trend of standardized incidence rate after 1996.Temporal trends were different among different age groups.The age group below 35 years old showed a constant rise in the past 34 years,while the 45-54 years old group showed a decrease before 1996 and turn to a rise after 1996.Shanghai is among the districts with the lowest cervical cancer incidence rate in the world,but the incidence rate in younger women is increasing,which is similar to those in developed countries.Conclusions Although the prevalence of cervical cancer is quite low in Shanghai,there is a trend of rise since 1996 and this is contributed mostly by the rise of incidence rate in 45-54 age group and the rapid and persistent rise in young women.We should focus our intention on interventions to reduce the risk factors of cervical cancer,decrease HPV infection,avoid unhealthy lifestyle,and promote mass screening in order to control the development and prevalence of cervical cancer.