Int J Cancer 2012 Feb;130 (3): 641-52. [IF:4.926]
The burden of cervical cancer in China: Synthesis of the evidence.
Shi JF , Canfell K , Lew JB , Qiao YL .
Cancer Epidemiology Research Unit, Cancer Council NSW, New South Wales, Australia; Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China; School of Public Health, Sydney Medical School, University of Sydney, Australia.
中国医学科学院中国协和医科大学，澳大利亚新南威尔士州癌症协会肿瘤流行病学研究室
Abstract
The burden of cervical cancer in China has not been characterized in detail. We reviewed cervical cancer data from national mortality surveys and registries, and conducted a meta-analysis to estimate the prevalence of high-grade lesions (HSIL) and high-risk human papillomavirus (HR-HPV) infections in rural Shanxi Province. We found that a national survey in the 1970s estimated age-standardized cervical cancer mortality rates as ～15 and ～83/100,000 women nationally and in Xiangyuan, Shanxi; but the latest survey (2004-2005) found much lower rates of ～3 and ～7/100,000, respectively. IARC registries record age-standardized cervical cancer incidence in China as <5/100,000 (1998-2002); but the five registry sites cover <2% of the population, and the gross domestic product per capita at each of the registry sites is higher than China's average (by a factor ranging from 1.3 to 3.9). The pooled estimate of the prevalence of HSIL and HR-HPV in women aged 30-54 years in Shanxi was 3.7%(95%CI:2.7-4.8%) and 17.2%(95%CI:13.1-21.3%), respectively. Based on a feasible range informed by the incidence data for China and other unscreened populations, the predicted indicative annual number of new cervical cancer cases nationally, in the absence of any intervention, ranges from ～27,000 to 130,000 (2010) to 42,000 to 187,000 (2050). In conclusion, recent data suggest comparatively low rates of cervical cancer incidence in China, which may be partly explained by the location of registry sites in higher socioeconomic status areas. However, the evidence is consistent with considerable heterogeneity within China, with a higher disease burden in some rural areas such as Shanxi. Therefore, the lower reported rates of cervical cancer in China should be interpreted cautiously.
摘要：
中国的宫颈癌负担尚未有详细报道。我们查阅国家死亡调查登记的相关数据，采用荟萃分析的方法估算山西省农村宫颈高度鳞状上皮内病变(HSIL)患病率和高危型人乳头瘤病毒(HR-HPV)感染率。根据1970年代的全国调查估计，全国和山西襄垣的宫颈癌年龄标准化死亡率分别为15/100,000和83/100,000。根据最近的调查（2004-2005年）显示，这一数字分别降至3/100,000和7/100,000。国际癌症研究总署（IARC）的登记数据显示，中国宫颈癌年龄标准化死亡率小于5/100,000(1998-2002年)，但研究包含的5个登记地点仅覆盖不足2%的人口，且这些地区的人均国民生产总值高于中国平均水平（为全国水平的1.3倍到3.9倍）。合并后的估算显示，山西省30-54岁女性的HSIL患病率为3.7%(95%CI:2.7-4.8%) ，HR-HPV感染率为17.2%(95%CI:13.1-21.3%)。根据全国和其他未筛查人群的发病率数据计算可行域，如不采取任何干预，全国每年新发宫颈癌例数将从2010年的27,000-130,000人增加到2050年的42,000-187,000人。综上，最近的数据提示中国宫颈癌发病率相对较低，可能原因之一是登记地点集中于社会经济较发达地区。但国内发展不均一的情况，在山西等地农村地区发病情况仍然较严重。因此，对中国宫颈癌发病率的报告应谨慎解读。
