Cervical Cancer Registered in Two Developed Regions from Brazil: Upper Limit of Reachable Results from Opportunistic Screening

Abstract Objective The aim of this study was to assess the time trends and pattern of cervical cancer diagnosed in the period from 2001 to 2012 by means of an opportunistic screening program from two developed regions in Brazil. Methods An observational study analyzing 3,364 cancer records (n = 1,646 from Campinas and n = 1,718 from Curitiba region) available in hospital-based cancer registries was done. An additional 1,836 records of CIN3/AIS from the region of Campinas was analyzed. The statistical analysis assessed the pooled data and the data by region considering the year of diagnosis, age-group, cancer stage, and histologic type. The Cochran-Armitage trend test was applied and p-values < 0.05 were considered significant. Results The total annual cervical cancer registered from2001 to 2012 showed a slight drop (273-244), with an age average of 49.5 y, 13 years over the average for CIN3/AIS (36.8 y). A total of 20.6% of the diagnoses (1.6% under 25 y) were done out of the official screening age-range. The biennial rate of diagnoses by age group for the region of Campinas showed an increase trend for the age groups under 25 y (p = 0.007) and 25 to 44 y (p = 0.003). Stage III was the most recorded for both regions, with an annual average of 43%, without any trend modification. There was an increasing trend for stage I diagnoses in the region of Campinas (p = 0.033). The proportion of glandular histologic types registered had an increased trend over time (p = 0.002), higher for the region of Campinas (21.1% versus 12.5% for the region of Curitiba). Conclusion The number, pattern and trends of cervical cancer cases registered had mild and slow modifications and reflect the limited effectivity of the opportunistic screening program, even in developed places.

摘要
研究目的：本研究旨在评估巴西两个发达地区通过机会性筛查项目（opportunistic screening program）于2001年至2012年间确诊的宫颈癌的时间趋势与发病模式。
方法：本研究为观察性研究，分析了来自医院癌症登记处的3364份癌症记录（坎皮纳斯（Campinas）地区1646份，库里提巴（Curitiba）地区1718份），并额外分析了坎皮纳斯地区的1836份宫颈上皮内瘤变3级/原位腺癌（CIN3/AIS）记录。统计分析针对合并数据及分地区数据展开，分析维度包括确诊年份、年龄组、癌症分期及组织学类型；采用Cochran-Armitage趋势检验（Cochran-Armitage trend test），以P值<0.05为差异具有统计学意义。
结果：2001年至2012年登记的宫颈癌年确诊总数呈小幅下降趋势（273例至244例），患者平均年龄为49.5岁，较CIN3/AIS患者的平均年龄（36.8岁）高出13岁。共有20.6%的确诊病例（其中1.6%的患者年龄低于25岁）不在官方推荐的筛查年龄范围内。坎皮纳斯地区按年龄组划分的两年期确诊率显示，25岁以下组（P=0.007）与25~44岁组（P=0.003）的确诊率呈上升趋势。两个地区均以Ⅲ期癌症为最常见确诊分期，年平均占比达43%，未出现明显趋势变化。坎皮纳斯地区的Ⅰ期癌症确诊率呈上升趋势（P=0.033）。登记病例中腺体型组织学类型的占比随时间呈上升趋势（P=0.002），坎皮纳斯地区的占比高于库里提巴地区（21.1% vs 12.5%）。
结论：登记的宫颈癌病例数量、发病模式及趋势仅存在轻微且缓慢的变化，这反映出即使在发达地区，机会性筛查项目的有效性仍较为有限。