Impact of hysterectomy on the age-specific incidence of cervical and uterine cancer in Germany and other countries
ABSTRACT BACKGROUND: Incidence rates of cervical and uterine cancer are usually determined without elimination of hysterectomized women from the population at risk. The aim of this report is to provide age-specific incidence rates of these cancers uncorrected and corrected for hysterectomized women in Germany and to compare these findings with the international literature. METHODS: Most recent incidence estimates of cervical and uterine cancer (11,318 and 26,379 cervical and uterine cancer cases, respectively) of the years 2003-7 in Germany were included. The population at risk was corrected by age-specific prevalence estimates of hysterectomy in Germany. Thereafter, corrected incidence rates were estimated. RESULTS: The incidence of cervical and uterine cancer among women aged 65 years or more increased by 67% (cervical cancer from 16.5 to 27.5 and uterine cancer from 79.6 to 133.2 per 100,000 person-years) after correction for hysterectomized women. The distortion of the age pattern of uncorrected incidence rates of cervical cancer for women aged 45-64 years (apparent decline) in Germany virtually disappeared after correction for hysterectomized women. Correction for hysterectomized women resulted in larger relative increases of the cancer rates in the U.S. than European countries. CONCLUSIONS: Inclusion of hysterectomized women in the population at risk results in a marked underestimate of the incidences of cervical and uterine cancer among elderly women and potentially biases age-specific incidence patterns and lifetime risk estimates of these cancers. Continuous monitoring of the incidences of cervical cancer corrected for hysterectomized women is needed.
- [Show abstract] [Hide abstract]
ABSTRACT: Individual country- and cancer site-specific studies suggest that the age-adjusted incidence of many common cancers has increased in European populations over the past two decades. To quantify the extent of these trends and the recent burden of cancer, here we present a comprehensive overview of trends in population-based incidence of the five common cancers across Europe derived from a new web-based portal of the European cancer registries. Data on incidence for cancers of the colon and rectum, prostate, breast, corpus uteri and stomach diagnosed from 1988 to 2008 were obtained from the European Cancer Registry (EUREG) database for cancer registries from 26 countries. Annual age-standardised incidence rates and average annual percentage changes were calculated. Incidence of four common cancers in eastern and central European countries (prostate, postmenopausal breast, corpus uteri and colorectum) started to approach levels in northern and western Europe, where rates were already high in the past but levelled off in some countries in recent years. Decreases in stomach cancer incidence were seen in all countries. Increasing trends in incidence of the most common cancers, except stomach cancer, are bad news to public health but can largely be explained by well-known changes in society in the past decades. Thus, current and future efforts in primary cancer prevention should not only remain focussed on the further reduction of smoking but engage in the long-term efforts to retain healthy lifestyles, especially avoiding excess weight through balanced diets and regular physical exercise.European journal of cancer (Oxford, England: 1990) 10/2013; 51(9). DOI:10.1016/j.ejca.2013.09.002 · 4.82 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The Human Papillomavirus (HPV) is a sexually transmitted virus that causes cervical cancer. Since 2008 a vaccination program targeting 12-year-old girls has been initiated in Italy, backing up the cervical screening program already active since 1996. We propose a mathematical model of HPV transmission dynamics with the aim of evaluating the impact of these prevention strategies. The model considers heterosexual transmission of HPV types 16 and 18, structured by sex, age and sexual activity level, where transition to sexual activity is explicitly modeled from recent survey data. The epidemiological structure is a hybrid SIS/SIR, where a fraction of individuals recovering from infection develops permanent immunity against reinfection. Infections may progress to cervical lesions and cancer and heal spontaneously or upon treatment. Women undergoing hysterectomy (either after treatment of HPV lesions or by other causes) also transmit HPV infection. The model fits well both the age-specific prevalence of HPV infections and the incidence of cervical cancers in Italy, and accurately reproduces the decreasing trend in cancer incidence due to the introduction of the screening program. The model predicts that if the screening coverage is maintained at current levels, even in the absence of vaccination, such trend will continue in the next few decades, eventually plateauing at 25% below the current level. The additional initiation of routine vaccination targeting 12-year-old girls will further reduce cervical cancer incidence by two thirds at equilibrium, under realistic assumptions of 70% coverage and a duration of protective immunity of 50 years. If catch-up immunization of 25-year-old women at first cervical screening is also introduced, about 3,000 cervical cancer cases overall can be averted, corresponding to 9.6% of all cases expected in the scenario without catch-up. We conclude that HPV vaccination in addition to cervical screening will significantly reduce the burden of cervical cancer in Italy.PLoS ONE 03/2014; 9(3):e91698. DOI:10.1371/journal.pone.0091698 · 3.23 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Purpose: The aim was to provide ethnicity-specific incidence trends of cervical and uterine cancers uncorrected and corrected for the prevalence of hysterectomy in Massachusetts. Methods: We used incidence data of invasive cervical (International Classification of Diseases for Oncology, Third Edition: C53) and uterine cancer (International Classification of Diseases for Oncology, Third Edition: C54-055) diagnosed from 1995 to 2010 from the Massachusetts Cancer Registry. Data from the Behavioral Risk Factor Surveillance Survey for Massachusetts were used to model the ethnicity-specific prevalence of hysterectomy. We standardized rates by the US 2000 population standard for the periods 1995 to 1998, 1999 to 2002, 2003 to 2006, and 2007 to 2010. Results: Depending on the period, corrected cervical cancer rates increased by 1.2 to 2.8, 5.6 to 83, and 3.2 to 8.2 per 100,000 person-years, and uterine cancer rates increased by 143 to 16.7, 14.8 to 29.3, and 6.7 to 15.4 per 100,000 person-years among white non-Hispanic women, black non-Hispanic women, and Hispanic women, respectively. Corrected estimated annual percentage changes increased for uterine cancer among black non-Hispanic women aged 60 years and older. Ethnic disparities between white non-Hispanic women and the other groups became smaller for uterine cancer and larger for cervical cancer after correction. Discussion: Corrections of cervical and uterine cancer rates for hysterectomy prevalence are important as ethnic disparities, age patterns and time trends of cervical and uterine cancer incidence rates change.Annals of Epidemiology 08/2014; 24(11). DOI:10.1016/j.annepidem.2014.07.018 · 2.15 Impact Factor