台灣於1996年至2014年的子宮頸癌篩檢：子宮頸腺癌發生率之變化

Screening for cervical cancer in Taiwan, 1996-2014: change in cervical adenocarcinoma incidence

陳怡倫(Yi-Lun Chen)

指導教授 ： 翁瑞宏

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00149

摘要

背景與目的：經由推動多年的子宮頸癌 (cervical cencer) 篩檢，台灣的子宮頸癌死亡率已有下降的趨勢；然而，篩檢對於不同組織形態的子宮頸癌之發生趨勢是否產生差異仍然不清楚。因此，本研究觀察子宮頸鱗狀細胞癌 (squamous cell carcinoma) 與腺癌 (adnocarcinoma) 之長期發生趨勢，並且分析子宮頸抹片 (Pap smear) 篩檢率與子宮頸癌發生率之相關，藉以評估篩檢之效益。
方法：利用衛生福利部之子宮頸抹片篩檢檔計算30歲以上婦女在1996年至2014年之間的每三年一次篩檢率；此外，利用癌症登記檔來計算1995年至2010年之間的子宮頸癌年齡標準化發生率。斯皮爾曼相關 (Spearman’s correlation) 被進一步地計算，以評估子宮頸抹片篩檢率與子宮頸癌發生率之相關。
結果：在台灣，子宮頸抹片的每三年一次篩檢率於1999-2001年達到最高為58.5%，在2012-2014年的篩檢率則下降至52.6%，17年期間之平均篩檢率為55.1%。此外，子宮頸腺癌年齡標準化發生率在1995-2010年期間增加29.4%；相對地，鱗狀細胞癌發生率下降50.2%。特別地是，40-69歲者其子宮頸抹片篩檢率與鱗狀細胞癌發生率呈現負相關，30-39歲者 (r = 0.79, p = 0.02) 以及70歲以上者 (r = 0.71, p = 0.05) 則分別為顯著正相關。然而，子宮頸抹片篩檢率與腺癌發生率在各年齡分層之婦女中均呈現正相關 (除了40-49歲)，特別是30-39歲者具有統計顯著性 (r = 0.90, p < 0.01)。
結論：經由子宮頸抹片篩檢的實施之後，子宮頸腺癌發生率明顯是上升的，特別是在愈年輕的婦女。

關鍵字

子宮頸癌 ； 發生率 ； 鱗狀細胞癌 ； 腺癌 ； 子宮頸抹片

並列摘要

Background and purpose: There is a declining trend in cervical cancer mortality in Taiwan by the promotion of cervical cancer screening over the years. However, it is still unclear if screening could make a difference in trends of incidence by different histologic subtypes of cervical cancer. Therefore, this study observed long-term incidence trends of squamous cell carcinoma and adenocarcinoma; and analyzed the correlation of Pap smear screening rate and the incidence of cervical cancer in order to evaluate the effectiveness of screening.
Methods: Triennial screening rates of Pap smear for women aged over 30 years old from 1996 to 2014 were calculated by using the national files of the cervical Pap smear tests. In addition, the age-standardized incidences of cervical cancer between 1995 and 2010 were calculated by using the national cancer registries. Spearman’s correlations were further calculated to evaluate the relationship of Pap smear screening rate and the incidence of cervical cancer.
Results: In Taiwan, triennial screening rate of Pap smear reached a peak at 58.5% in 1999-2001, and declined to 52.6% in 2012-2014. Average screening rate was 55.1% for a period of 17 years. In addition, the age-standardized incidence of cervical adenocarcinoma in the period of 1995-2010 increased by 25.7%. In contrast, the incidence rate of squamous cell carcinoma decreased by 50.2%. Especially, the negative correlations of Pap smear screening rates and the incidences of squamous cell carcinoma in individuals aged 40-69 were presented; significantly positive correlations were in those aged 30-39 (r = 0.79, p = 0.02) and in those aged over 70 (r = 0.71, p = 0.05), respectively. However, all positive correlations were revealed between Pap smear screening rates and the incidences of adenocarcinoma in women of all ages (except those aged 40-49), especially a statistical significance in those aged 30-39 (r = 0.90, p < 0.01).
Conclusion: After the implementation of Pap smear screening, the incidence of cervical adenocarcinoma appears to be increasing, especially in younger women.

並列關鍵字

cervical cancer ； incidence ； squamous cell carcinoma ； adenocarcinoma ； Pap smear

參考文獻

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