Improved control of invasive cervical cancer in Sweden over six decades by earlier clinical detection and better treatment.
Cancer of the cervix uteri can be controlled by cytologic screening for the detection of precursor lesions, but such intervention remains unrealistic in many countries in which this cancer is common.
The possibility of reducing mortality by earlier clinical detection, followed by basic therapy, has never been properly assessed.
Patients and Methods
We compiled records of incident cases of invasive cancer of the cervix diagnosed in a defined area of Sweden from 1930 through 1990.
In a cohort of 6,044 women, we analyzed temporal trends in incidence and survival by clinical stage and age at diagnosis.
Generalized proportional hazards models were used to study several factors simultaneously and quantify the overall reduction in mortality.
For each successive stage at diagnosis, the overall risk of dying increased 2.5-fold (95% confidence interval [CI], 2.4 to 2.7).
From 1930, a marked improvement in stage distribution was accompanied by increasing survival rates in stages I and II disease.
These changes largely took place before the introduction of screening and external-beam radiation.
The 10-year relative survival rate increased from 33% in the 1930s to approximately 55% in the 1950s and thereafter.
Improvements in public and professional awareness of cervical cancer resulted in diagnoses at earlier clinical stages.
Mots-clés Pascal : Tumeur maligne, Col utérus, Homme, Incidence, Dépistage, Stade clinique, Pronostic, Survie, Age, Epidémiologie, Politique sanitaire, Suède, Europe, Variation long terme, Appareil génital femelle pathologie, Col utérus pathologie
Mots-clés Pascal anglais : Malignant tumor, Uterine cervix, Human, Incidence, Medical screening, Clinical stage, Prognosis, Survival, Age, Epidemiology, Health policy, Sweden, Europe, Long term variation, Female genital diseases, Uterine cervix diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0188893
Code Inist : 002B20C02. Création : 09/06/1995.