Cross-sectionally derived hysterectomy prevalence for correcting uterine and ovarian cancer incidence rates and probabilities

PURPOSE: This paper presents a cross-sectional method for deriving age-specific hysterectomy prevalence. The influence of hysterectomy prevalence on uterine and ovarian cancer incidence rates and probabilities is illustrated.METHODS: Hysterectomy prevalence estimates are derived from cross-sectional data using a life table method. Analysis is based on hysterectomy data from the Utah Hospital Discharge Data Base and cancer cases recorded by the Utah Cancer Registry, 1995-1997.RESULTS: Correction for hysterectomy prevalence increases cancer incidence rates, more so at older ages, such that by ages 85 and older the increase is 92% for uterine cancers of the cervix and corpus, and 17% for ovarian cancer. Over the life span, correction for hysterectomy prevalence increases the estimated number per 100,000 developing these diseases by 195 (from 603 to 798) for uterine cervical cancer, 1,553 (from 2,580 to 4,133) for corpus uterine cancer, and 911 (1,674 to 2,585) for ovarian cancer.CONCLUSIONS: The utility of the cross-sectional method for deriving hysterectomy prevalence is that it does not require several years of data to obtain reasonable estimates. Correction for hysterectomy prevalence has a large effect on the cancer rates and probabilities, providing a more accurate representation of the risk and burden of these cancers.     

Hysterectomy prevalence by Hispanic ethnicity: evidence from a national survey

OBJECTIVES: We investigated hysterectomy prevalence among Hispanic women. METHODS: We obtained data from 4684 Hispanic women and 20 604 non-Hispanic White women from the 1998-1999 National Health Interview Survey. We calculated nationally representative odds ratios of previous hysterectomy, controlling for confounders. RESULTS: Compared with non-Hispanic White women, the odds ratio for hysterectomy was 0.36 (95% confidence interval [CI] = 0.30, 0.44) for Hispanic women with no high school diploma, 0.57 (95% CI = 0.44, 0.74) for high school graduates, and 0.67 (95% CI = 0.42, 0.87) for college attenders. Country of origin had little influence on hysterectomy prevalence. Hysterectomy was positively associated with acculturation. CONCLUSIONS: Hispanic women undergo fewer hysterectomies than do non-Hispanic White women. The reasons for this, as well as information on ethnicity-specific appropriateness of hysterectomy, should be explored.     

Invasive cervical cancer among Hispanic and non-Hispanic women--United States, 1992-1999

During 1973-1999, both the incidence of and death rates for cervical cancer decreased approximately 50% in the United States. For 2002, approximately 13,000 new cases of invasive cervical cancer are expected, and approximately 4,100 women will die of the disease. Although invasive cervical cancer can be prevented by regular screening, the prevalence of Papanicolaou (Pap) testing remains relatively low among minority populations such as Hispanic women. To characterize the incidence of invasive cervical cancer, CDC analyzed incidence data for Hispanic and non-Hispanic women during 1992-1999 in 11 geographic areas with population-based registries. This report summarizes the results of this analysis, which indicate that the incidence of invasive cervical cancer decreased for Hispanic and non-Hispanic women. However, among women aged > or = 30 years, cervical cancer incidence for Hispanic women was approximately twice that for non-Hispanic women. To lower the incidence of invasive cervical cancer, local health organizations should provide culturally appropriate public health interventions that encourage participation in readily accessible cervical cancer-screening programs.     

Potential for HPV vaccination and primary HPV screening to reduce cervical cancer disparities: Example from New Zealand

BackgroundCervical cancer rates are over twice as high, and screening coverage is lower, in Māori women compared to other women in New Zealand, whereas uptake of HPV vaccine is higher in Maori females. We aimed to assess the impact of HPV vaccination and the proposed transition to 5-yearly primary HPV screening in Māori and other women in New Zealand, at current participation levels; and additionally to investigate which improvements to participation in Māori females (in vaccination, screening, or surveillance for screening-defined higher-risk women) would have the greatest impact on cervical cancer incidence/mortality.MethodsAn established model of HPV vaccination and cervical screening in New Zealand was adapted to fit observed ethnicity-specific data. Ethnicity-specific models were used to estimate the long-term impact of vaccination and screening (vaccination coverage 63% vs 47%; five-year screening coverage 68% vs 81% in Maori vs European/Other women, respectively).ResultsShifting from cytology to HPV-based screening is predicted to reduce cervical cancer incidence by 17% (14%) in Maori (European/Other) women, respectively. The corresponding reductions due to vaccination and HPV-based screening combined were 58% (44%), but at current participation levels long-term incidence would remain almost twice as high in Māori women (6.1/100,000 compared to 3.1/100,00 in European/Other women). Among strategies we examined, the greatest impact came from high vaccine coverage and achieving higher attendance by Māori women under surveillance for screen-detected abnormalities.ConclusionRelative reductions in cervical cancer due to vaccination and HPV-based screening are predicted to be greater in Maori than in European/Other women. While these interventions have the potential to substantially reduce between-group differences, cervical cancer incidence would remain higher in Maori women. These findings highlight the importance of multiple approaches and the potential influence of factors beyond HPV prevention.     

Racial/Ethnic Disparities in Gestational Diabetes Mellitus: Findings from a Population-Based Survey

PurposeWe sought to explore racial/ethnic disparities in the prevalence of gestational diabetes mellitus (GDM) in a population-based sample.MethodsData from the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS), a stratified, random sample of postpartum women who delivered in Oregon in 2004 and 2005 (n = 3,883; weighted response rate, 75.2%) and linked birth certificates were analyzed. Hispanic, non-Hispanic Black, non-Hispanic American Indian, and non-Hispanic Asian/Pacific Islander (API) women were oversampled. We categorized women as having had GDM if they gave an affirmative answer on the birth certificate or the PRAMS survey.ResultsNon-Hispanic API women had the highest prevalence of GDM (14.8%); this was true for women with both a normal and a high body mass index (BMI). Asian women were more likely to have had GDM than Pacific Islander women. On multivariate analysis, non-Hispanic APIs were significantly more likely to have a pregnancy complicated by GDM (adjusted odds ratio, 2.26; 95% confidence interval, 1.23–4.13) than non-Hispanic White women.ConclusionNon-Hispanic API women, especially Asian women with both normal and high BMI, have increased risk of GDM. Future research should examine the unique risk factors experienced by Asians and health practitioners should be vigilant in screening for GDM regardless of BMI.     

Improving survival disparities in cervical cancer between Māori and non‐Māori women in New Zealand: a national retrospective cohort study

Objective: Māori women in New Zealand have higher incidence of and mortality from cervical cancer than non‐Māori women, however limited research has examined differences in treatment and survival between these groups. This study aims to determine if ethnic disparities in treatment and survival exist among a cohort of Māori and non‐Māori women with cervical cancer. Methods: A retrospective cohort study of 1911 women (344 Māori and 1567 non‐Māori) identified from the New Zealand Cancer Register with cervical cancer (adenocarcinoma, adenosquamous or squamous cell carcinoma) between 1 January 1996 and 31 December 2006. Results: Māori women with cervical cancer had a higher receipt of total hysterectomies, and similar receipt of radical hysterectomies and brachytherapy as primary treatment, compared to non‐Māori women (age and stage adjusted). Over the cohort period, Māori women had poorer cancer specific survival than non‐Māori women (mortality hazard ratio (HR) 2.07, 95% confidence interval (CI): 1.63–2.62). From 1996 to 2005, the survival for Māori improved significantly relative to non‐Māori. Conclusion: Māori continue to have higher incidence and mortality than non‐Māori from cervical cancer although disparities are improving. Survival disparities are also improving. Treatment (as measured) by ethnicity is similar. Implications: Primary prevention and early detection remain key interventions for addressing Māori needs and reducing inequalities in cervical cancer in New Zealand.     

THE INCIDENCE OF HYSTERECTOMY AND ITS EFFECT ON THE PROBABILITY OF DEVELOPING UTERINE CANCERS

Published hysterectomy rates from several Australian States range between 376 and 489 per 10⁵ women — values that lie between the lower European rates and the higher North American rates. We used a life-table method to calculate that for a woman aged 65 years exposed lifelong to current rates in New South Wales, the probability of having had a hysterectomy would be 25 per cent, and for an 85 year old, 29 per cent. One consequence of this finding is that the rates of acquiring cervical and uterine cancer are not reflected accurately in disease incidence rates based on all women as the denominator: our calculations show that the actual rates applying to a woman with her uterus in-situ could be much higher in older age groups than apparent from crude rates. This is important to understand trends in female genital cancer, and to ensure appropriate screening and prevention strategies are developed.     

Geographic Poverty and Racial/Ethnic Disparities in Cervical Cancer Precursor Rates in Connecticut, 2008–2009

Objectives. We examined associations of geographic measures of poverty, race, ethnicity, and city status with rates of cervical intraepithelial neoplasia grade 2 or higher and adenocarcinoma in situ (CIN2+/AIS), known precursors to cervical cancer.Methods. We identified 3937 cases of CIN2+/AIS among women aged 20 to 39 years in statewide surveillance data from Connecticut for 2008 to 2009. We geocoded cases to census tracts and used census data to calculate overall and age-specific rates. Poisson regression determined whether rates differed by geographic measures.Results. The average annual rate of CIN2+/AIS was 417.6 per 100 000 women. Overall, higher rates of CIN2+/AIS were associated with higher levels of poverty and higher proportions of Black residents. Poverty was the strongest and most consistently associated measure. However, among women aged 20 to 24 years, we observed inverse associations between poverty and CIN2+/AIS rates.Conclusions. Disparities in cervical cancer precursors exist for poverty and race, but these effects are age dependent. This information is necessary to monitor human papillomavirus vaccine impact and target vaccination strategies.Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with an estimated 6.2 million adolescents and young adults newly infected every year.1 The prevalence of infection ranges from 27% to 45% among young women, and nearly 40% of women acquire HPV within 2 years of initiating sexual activity.2–4 HPV is also an important public health problem because persistent infection with a high-risk HPV type is a necessary cause of cervical cancer.5–7 Women living in poverty and racial/ethnic minorities continue to bear a disproportionate burden of cervical cancer incidence and mortality despite the decrease in rates that has resulted from widespread cervical cancer screening.8,9 In 1998 to 2003, US incidence rates of invasive cervical cancer were 12.6 per 100 000 among Black women, 14.2 among Hispanics, and 8.4 among Whites; mortality rates showed similar disparities.10 This pattern continued through 2007.11 In a study from Massachusetts and Rhode Island, incidence rates in areas with 20% or higher and less than 5% of the population living in poverty were 17.6 and 9.2 per 100 000, respectively.12 Data from a study in New York City revealed neighborhood poverty to be an important predictor of cervical cancer mortality.13Precursors to cervical cancer are cervical intraepithelial neoplasia grades 2, 2/3, and 3 (CIN2+) and adenocarcinoma in situ (AIS). CIN2+/AIS diagnoses are an important public health problem not only because they are precursors to invasive disease, but also because they are common diagnoses that impose substantial health care costs and patient burden. Approximately 500 000 women are diagnosed each year with high-grade cervical disease, and these diagnoses account for annual health care costs of $450 million.14–16 At the individual level, a diagnosis of CIN2+ results in an average of 7 to 8 office visits and 20 months of follow-up.16 Many women also experience adverse psychological consequences following a diagnosis, such as fear of cancer, anxiety, distress, and concern about future fertility, along with medical procedures and difficulties with sexual relationships.17 Disparities in precancerous lesions have not been directly examined, to the best of our knowledge. Data from 2 studies reveal noticeably higher rates of precancerous lesions among low-income women in a national screening program (4.6–7.4/1000 women) than among health plan enrollees (1.5/1000), who were likely of higher socioeconomic status18,19; however this is not a direct or precise comparison.Since 2006, the Food and Drug Administration has approved 2 HPV vaccines that protect against 2 high-risk HPV types (HPV 16/18), which cause approximately 70% of cervical cancers. These vaccines have proven efficacy of 95% or higher in protecting against HPV 16/18–associated cervical lesions in HPV-naive women.20,21 The Advisory Committee on Immunization Practices recommends routine use of either vaccine in a 3-dose regimen for girls aged 11 or 12 years and catch-up vaccination through age 26 years.22 These vaccines have the potential to reduce disparities in cervical cancer. However, the extent to which this is realized will depend on high vaccine coverage for populations at greatest risk for outcomes associated with HPV infection. If vaccine coverage is not adequate and targeted, current disparities in cervical cancer may widen rather than narrow.HPV vaccination programs may affect cervical cancer precursors and associated procedures within years rather than the decades it will take to measure impact on cervical cancer.21,23–26 Therefore, determining the burden of cervical cancer precursors should be a public health priority because this information can be used to target vaccination strategies and provide a baseline for monitoring vaccine impact and disparities over time. We examined disparities in CIN2+/AIS rates in Connecticut, a state with mandatory reporting of these conditions, during prevaccine impact years 2008 to 2009, by geographic sociodemographic measures of poverty, race, ethnicity, and city status. We chose the first 3 measures because they are the most commonly used indicators of disparities in cervical cancer.8,10,12,13 We included a city measure because we hypothesized that disparities may exist along an urban gradient. Our results fill a key knowledge gap because few states mandate CIN2+/AIS reporting, and no statewide analysis of cervical cancer precursors and geographic measures has been reported.     

Prevalence and Associated Factors of Precancerous Cervical Lesions among Women in Ethiopia: A Systematic Review and Meta-Analysis

BackgroundCervical cancer remains the most common cancer of women worldwide. Its burden is more serious in developing countries. It is also the second common cancer deaths of women in Ethiopia followed by breast cancer. The aim of this study was to determine the pooled prevalence and associated factors of precancerous cervical lesions among women in Ethiopia.MethodsWe systematically searched published and unpublished articles reported from 2010 to 2019 using a comprehensive search of electronic databases including PubMed and Google scholar for grey literature from August 1 to September 1, 2019. The methodological qualities of included studies were evaluated using Joanna Briggs Institute meta-analysis of Statistics Assessment. The pooled prevalence estimate was calculated using MedCalc software-version 19.0.7, and the pooled odd ratios for predictors was calculated using RevMan software version 5.3.ResultsThe pooled prevalence of precancerous cervical lesions among women in Ethiopia was 13.4% (95% CI:10.63% 16.37%). Statistically significant heterogeneity between studies was detected (I²=83.1%, P < 0.001). Among all measured associated factors: numbers of women life time sexual partners > 1, OR=2.5 (95% CI:3.70,4.76), being HIV positive women, OR=2.4 (95% CI:1.33,4.61) and women having history of STI, OR=2.0 (95% CI:1.02,3.87) had statistically significant association with precancerous cervical lesions among women in EthiopiaConclusionThe pooled prevalence of precancerous cervical lesions among women in Ethiopia was high as compared to the 5-year worldwide cervical cancer prevalence. Women having more than one life time sexual partners, being HIV positive women and women having history of STI had a statistically significant association with precancerous cervical lesions.     

Breast and Cervical Cancer Screening Disparities Associated with Disability Severity

BackgroundPrior research has noted disparities between women with and without disabilities in receipt of timely screening for breast and cervical cancer. Some studies suggest greater disparities for women with more severe disabilities, but the research to date has yielded inconsistent findings. Our purpose was to further examine differences in receipt of breast and cervical cancer screening in relation to severity of disability.MethodsWe analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses examined whether Pap smears and mammograms had been received within the recommended timeframe according to U.S. Preventive Services Task Force Guidelines. We compared four groups of women aged 18 to 64 years, categorized by presence and complexity of disability: 1) No limitations, 2) basic action difficulties only, 3) complex activity limitations only, and 4) both basic and complex activity limitations.FindingsWomen both with and without disabilities fell short of Healthy People 2020 goals for breast and cervical cancer screening. Overall, women with disabilities were less likely to be up to date with both mammograms and Pap tests. The magnitude of disparities was greater for women with complex limitations. Disparities in Pap testing, but not mammography, remained significant when controlling for demographic, geographic, and socioeconomic factors.ConclusionsWomen with more complex or severe disability were less likely to be up to date with breast and cervical cancer screenings. Targeted efforts are needed to reduce barriers to breast and cervical cancer screening for women with significant disabilities, especially those who also experience other socioecological disadvantages.     

Racial/Ethnic Variation in Breastfeeding Across the US: A Multilevel Analysis from the National Survey of Children’s Health, 2007

We examined whether differences across states in race/ethnicity-specific breastfeeding rates are due solely to state differences in individual factors associated with breastfeeding or additionally, certain state “contextual” factors. Using data from the 2007 National Survey of Children’s Health, multilevel models examined whether state variability in race/ethnicity specific breastfeeding initiation and duration to 6 months were explained by (1) individual sociodemographic characteristics of women in states, and (2) an aggregate state measure of the availability of evidence-based maternity care services related to breastfeeding. Observed variability of race/ethnicity-specific breastfeeding rates was only minimally reduced after adjusting for sociodemographic characteristics (Median Odds Ratios (MOR), breastfeeding initiation: non-Hispanic White = 1.46, non-Hispanic Black = 2.26; Hispanic = 1.89. MOR, breastfeeding for 6 months: non-Hispanic White = 1.36, non-Hispanic Black = 1.84; Hispanic = 1.56). Overall variability in the degree of state gaps changed little in adjusted models (breastfeeding initiation: non-Hispanic Black σ² = 0.74, se 0.28, Hispanic σ² = 0.45, se 0.11; breastfeeding to 6-months: non-Hispanic Black σ² = 0.41, se 0.10, Hispanic σ² = 0.22, se 0.05). The measure of maternity care services was positively associated with breastfeeding overall but generally did not explain a substantial portion of between-state variability nor the overall variability in racial/ethnic gaps. Contextual sources of variation in state breastfeeding practices and disparities remain poorly understood. Differences in the socioeconomic makeup of states do not fully explain variability. The association of state breastfeeding rates and disparities with relevant policy and practice factors should be further investigated.     

Racial/Ethnic,Socioeconomic, and Geographic Disparities of Cervical Cancer Advanced-Stage Diagnosis in Texas

BackgroundAdvanced-stage diagnosis is among the primary causes of mortality among cervical cancer patients. With the wide use of Pap smear screening, cervical cancer advanced-stage diagnosis rates have decreased. However, disparities of advanced-stage diagnosis persist among different population groups. A challenging task in cervical cancer disparity reduction is to identify where underserved population groups are.MethodsBased on cervical cancer incidence data between 1995 and 2008, this study investigated advanced-stage cervical cancer disparities in Texas from three social domains: Race/ethnicity, socioeconomic status (SES), and geographic location. Effects of individual and contextual factors, including age, tumor grade, race/ethnicity, as well as contextual SES, spatial access to health care, sociocultural factors, percentage of African Americans, and insurance expenditures, on these disparities were examined using multilevel logistic regressions.FindingsSignificant variations by race/ethnicity and SES were found in cervical cancer advanced-stage diagnosis. We also found a decline in racial/ethnic disparities of advanced cervical cancer diagnosis rate from 1995 to 2008. However, the progress was slower among African Americans than Hispanics. Geographic disparities could be explained by age, race/ethnicity, SES, and the percentage of African Americans in a census tract.ConclusionsOur findings have important implications for developing effective cervical cancer screening and control programs. We identified the location of underserved populations who need the most assistance with cervical cancer screening. Cervical cancer intervention programs should target Hispanics and African Americans, as well as individuals from communities with lower SES in geographic areas where higher advanced-stage diagnosis rates were identified in this study.     

Adenomyosis: Pathologies associated in a set of patients underwent hysterectomy

ObjectiveTo determine if a relationship exists between the histopathological diagnosis of adenomyosis and the clinical conditions and pathologies that are more commonly related to it in patients undergoing hysterectomy.MethodsRetrospective, comparative, case-control study was conducted. With previous approval by ethics committee, we included 794 patients undergoing hysterectomy at a University Hospital. The Medical records and pathology reports of patients undergoing hysterectomy over a two-year period were reviwed. Clinical conditions and associated pathologies, in patients with and without adenomyosis, were reviewed and compared. Statistical analysis was done using the Chi-square test.ResultsAdenomyosis was reported in 140 out of 794 patients, 17.6% (95% CI: 15.1–20.4). No differences in adenomyosis prevalence were found among patients with or without uterine fibroids, 20.2% (75/371) vs. 15.5% (65/423); endometrial polyps, 9.7% (6/62) vs. 18.3% (134/732); and the presence or lack of endometrial hyperplasia 13.9% (5/36) vs. 17.4% (135/758). The prevalence of adenomyosis among patients with endometriosis was 40.7% (11/27), and among those without this diagnosis, 16.8% (129/767). This difference was significant (P=0.001). A history of two or more curettages was also positively related to adenomyosis.ConclusionsThere was a statistically significant difference in the prevalence of adenomyosis in women with endometriosis when compared to women without endometriosis. A higher incidence of adenomyosis was found in patients with a history of two or more curettages. Trauma to the endometrium could explain the higher incidence of adenomyosis in both conditions.     

Racial/ethnic variation in breastfeeding across the US: a multilevel analysis from the National Survey of Children's Health, 2007

We examined whether differences across states in race/ethnicity-specific breastfeeding rates are due solely to state differences in individual factors associated with breastfeeding or additionally, certain state "contextual" factors. Using data from the 2007 National Survey of Children's Health, multilevel models examined whether state variability in race/ethnicity specific breastfeeding initiation and duration to 6 months were explained by (1) individual sociodemographic characteristics of women in states, and (2) an aggregate state measure of the availability of evidence-based maternity care services related to breastfeeding. Observed variability of race/ethnicity-specific breastfeeding rates was only minimally reduced after adjusting for sociodemographic characteristics (Median Odds Ratios (MOR), breastfeeding initiation: non-Hispanic White = 1.46, non-Hispanic Black = 2.26; Hispanic = 1.89. MOR, breastfeeding for 6 months: non-Hispanic White = 1.36, non-Hispanic Black = 1.84; Hispanic = 1.56). Overall variability in the degree of state gaps changed little in adjusted models (breastfeeding initiation: non-Hispanic Black σ(2) = 0.74, se 0.28, Hispanic σ(2) = 0.45, se 0.11; breastfeeding to 6-months: non-Hispanic Black σ(2) = 0.41, se 0.10, Hispanic σ(2) = 0.22, se 0.05). The measure of maternity care services was positively associated with breastfeeding overall but generally did not explain a substantial portion of between-state variability nor the overall variability in racial/ethnic gaps. Contextual sources of variation in state breastfeeding practices and disparities remain poorly understood. Differences in the socioeconomic makeup of states do not fully explain variability. The association of state breastfeeding rates and disparities with relevant policy and practice factors should be further investigated.     

Cervical cancer screening rate differs by HPV vaccination status: An interim analysis

BackgroundThe incidence of cervical cancer has been increasing, especially in younger generation, in Japan. The females born between 1994 and 1999, who achieved rates of HPV vaccination approaching 70%, have become the target of cervical cancer screening programs. Here, we have analyzed the cervical cancer screening rates among the vaccinated and unvaccinated women.MethodsThe survey data for cervical cancer screening at age 20 in FY 2015 was derived from two cities, Toyonaka and Iwaki.ResultsAmong 2,727 females, in Toyonaka and Iwaki, who were born in FY 1995 and targeted in FY 2015 at age 20 for cervical cancer screening, their HPV vaccination rate was 64.2% (1,753/2,727). The screening rate was 6.4% (112/1,753) in the vaccinated and 3.9% (38/974) in the unvaccinated. This difference was statistically significant (p < 0.01).ConclusionsWe have demonstrated that HPV-vaccinated females tended to be effectively protected from future cervical cancer than the unvaccinated.     

1990年与2016年中国女性子宫纤维瘤的疾病负担研究

目的 分析1990年与2016年中国女性子宫纤维瘤的疾病负担。方法 利用2016年全球疾病负担分析结果,分析1990年和2016年中国不同年龄、不同地区女性子宫纤维瘤的疾病负担,主要指标包括患病数、患病率、伤残调整寿命年（DALY）、DALY率等。标化率的计算使用2010-2035年WHO的世界标准人口进行。结果 1990年和2016年中国≥ 15岁女性子宫纤维瘤的患病人数分别为13 695 567和27 169 312人,患病率分别为2.48%和4.10%,DALY值分别为146 045.05人年和281 976.67人年,DALY率分别为26.40/10万和42.50/10万。1990年和2016年中国女性子宫纤维瘤的患病率和DALY率均随年龄增加而增加,45~49岁达顶峰,之后随年龄增加而降低。中国女性子宫纤维瘤40~54岁年龄段的患病数占总量的55.60%（1990年）和66.74%（2016年）;该年龄段DALY值占总量的48.37%（1990年）和60.65%（2016年）。1990年和2016年DALY值较高的3个省份均为山东（1990年：12 574.67人年;2016年：22 728.12人年）、河南（1990年：10 849.29人年;2016年：18 454.32人年）和江苏（1990年：10 501.55人年;2016年：18 274.10人年）,标化DALY率较高的3个省份在1990年和2016年均为黑龙江（1990年：48.20/10万;2016年：47.00/10万）、山西（1990年：44.50/10万;2016年：47.70/10万）和天津（1990年：43.80/10万;2016年：46.40/10万）。与1990年相比,2016年中国女性子宫纤维瘤的患病人数增加13 473 745人（变化率：98.38%）,标化患病相对上升1.88%、DALY值增加135 931.62人年（变化率：93.08%）、标化DALY率相对上升5.92%。结论 2016年中国女性子宫纤维瘤疾病负担较1990年明显增加,尤其困扰绝经期女性。     

Rural–Urban Trends and Patterns in Cervical Cancer Mortality, Incidence, Stage, and Survival in the United States, 1950–2008

This study examined disparities in cervical cancer mortality rates among US women in metropolitan and non-metropolitan areas from 1950 through 2007. Inequalities in incidence, stage of disease at diagnosis, and patient survival were analyzed during 2000–2008. Age-adjusted mortality, incidence, and 5-year relative survival rates were calculated for women in metropolitan and non-metropolitan areas, and differences in relative risks were tested for statistical significance. Log-linear regression was used to analyze annual rates of change in mortality over time. During the last five decades, women in non-metropolitan areas had significantly higher cervical cancer mortality than those in metropolitan areas. Disparities persisted against a backdrop of consistently declining mortality rates. Throughout 1969–2007, both white and black women in non-metropolitan areas maintained significantly higher cervical cancer mortality rates than their metropolitan counterparts. Among black women, cervical cancer mortality declined at a faster pace in metropolitan than in non-metropolitan areas. In both metropolitan and non-metropolitan areas, black women had twice the mortality rate of white women. During 2000–2008, white, black, and American Indian women in non-metropolitan areas had significantly higher cervical cancer incidence rates than their metropolitan counterparts. Survival rates were significantly lower in non-metropolitan areas, particularly among rural black women. The 5-year survival rate for black women diagnosed with cervical cancer was 50.8% in non-metropolitan areas, compared with 60.2% for black women and 71.0% for white women in metropolitan areas. Disparities in survival existed after controlling for disease stage. Rural–urban disparities in cervical cancer have persisted despite steep declines in incidence and mortality rates.     

44例宫颈肌瘤手术探究

目的:探讨宫颈肌瘤的术式选择及手术途径。方法:对1995年1月2004年12月该院收治的44例宫颈肌瘤的手术途径、术式选择以及结果进行评估。结果:8例小型宫颈壁间及浆膜下肌瘤(<5 cm),采用经阴道推开膀胱或直肠剔除肌瘤是可行的,符合微创手术的特点;12例中等大宫颈肌瘤(510 cm)采用腹式不剔肌瘤,由健侧进入阴道穹窿切除子宫,能达到出血少,并发症少,保留足够阴道长度的目的;9例巨大宫颈肌瘤(>10 cm)采用先剔除肌瘤后切除子宫法;15例悬垂型肌瘤直接阴道摘除术。结论:宫颈肌瘤手术方式及手术途径因肌瘤大小、类型而不同,按上述方法可有效切除肌瘤及子宫,防止并发症发生。