Abstract
Simple SummaryCervical cancer (CC) is one of the most common gynecological malignancies in females, mainly caused by human papillomavirus (HPV). In countries with lower HPV vaccine coverage, such as Japan, medical examination may play a key role in decreasing CC incidence. The aim of this study is to measure the effect of medical examination (i.e., screening and detailed examination) on CC incidence in Japan by considering the effects of risk factors for the development of CC. We clarified associations between CC and possible risk factors by Pearson’s correlation coefficients and generalized linear models. Taking the time-dependent effects of Chlamydia, Gonorrhea, Condyloma, population economic status, and smoking rate into account, the effect of screening testing on CC incidence was estimated. The increase in screening rate was considered to decrease CC incidence effectively but not drastically, suggesting the need for the combined use of other efficient preventive measures such as HPV vaccination.Cervical cancer (CC) is one of the most common gynecological malignancies in females, mainly caused by human papillomavirus (HPV). In countries with lower HPV vaccine coverage, such as Japan, medical examination may play a key role in decreasing CC incidence. This study aimed to quantify the effect of medical examination on cervical cancer (CC) incidence in Japan, considering the effects of possible risk factors. By collecting Japan’s Prefectural data on CC incidence (2013–2017), incidence of sexually transmitted diseases (STDs; Chlamydia, Herpes, Condyloma, and Gonorrhea; 1993–2012), screening and detailed examination rate against CC (2013–2016), smoking rate (2001–2013), economic status (disposable income and economic surplus; 2014–2015), and education status (2015), we analyzed associations among them using Pearson’s correlation coefficients. Additionally, assuming that the incidence of STDs reflects the frequency of risky sexual behavior at the co-infection point with HPV, we constructed generalized linear models to predict CC incidence, taking a 5–20-year time-lag between incidences of STDs and the CC incidence. Against CC incidence, Chlamydia in females and Gonorrhea in males with a 15-year time-lag showed positive associations, while Condyloma in both genders with a 15-year time-lag, screening rate, economic status, and smoking rate showed negative associations. An increase in screening test rate by 10% was estimated to decrease CC incidence by 9.6%. This means that screening tests decrease CC incidence effectively, but not drastically, suggesting the need for additional countermeasures for CC prevention.
Highlights
Human papillomavirus (HPV) is a double-stranded DNA virus belonging to the Papillomaviridae family, and the primary causal factor for the development of cervical cancer (CC) [1]
It has been reported that approximately 20–40% of cervical precancerous lesions [2,3] and 90% to 98% of CC are associated with HPV infection [4]
In the present study, we aimed to elucidate how sexually transmitted diseases (STDs) incidence, smoking rate, CC screening rate, detailed examination rate, income, and education level are associated with the incidence rate of CC, quantifying the effect of medical examination rate toward the decrease of CC
Summary
Human papillomavirus (HPV) is a double-stranded DNA virus belonging to the Papillomaviridae family, and the primary causal factor for the development of cervical cancer (CC) [1]. It has been reported that approximately 20–40% of cervical precancerous lesions (i.e., cervical intraepithelial neoplasia) [2,3] and 90% to 98% of CC are associated with HPV infection [4]. HPVs consist of a large number of varieties, and not all the virus types are associated with the development of CC: there are more than one hundred known genotypes of HPV, classified as “high-risk (HR)” and “low-risk (LR)” varieties based on the frequency of their identification in CCs [5]. The LR-types are associated with benign hyperplastic growths such as genital warts (i.e., Condyloma acuminatum), while the HR-HPV may cause cervical intraepithelial neoplasia (CIN) and can result in the development of CC [6].
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