Trends In Cervical Cancer Incidence Research Articles

Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county-level income in the United States, 2000-2019.

Early evidence suggests that declining cervical cancer incidence reversed in low-income regions in the United States in recent years; however, it is unclear whether there are distinct patterns by race/ethnicity and stage at diagnosis and if the increase has translated into rising mortality. Using Surveillance, Epidemiology, and End Results data, we evaluated trends in hysterectomy-corrected cervical cancer incidence rates (2000-2019) and mortality rates (2005-2019) by county-level income and race/ethnicity, with further stratification of incidence by stage at diagnosis. Following a period of decline, hysterectomy-corrected cervical cancer incidence increased 1.0%/year (95% CI = 0.1% to 4.5%) among Non-Hispanic White women in low-income counties. Particularly, a statistically significant 4.4%/year (95% CI = 1.7% to 7.5%) increase in distant-stage cancer occurred in this group. Additionally, recent increases in cervical cancer mortality (1.1%/year [95% CI = -1.4% to 3.7%]) were observed among this group and Non-Hispanic Black women in low-income counties (2.9%/year [95% CI = -2.3% to 18.2%]), but trends were not statistically significant. Among Hispanic women in low-income counties, distant-stage cervical cancer incidence increased 1.5%/year (95% CI = -0.6% to 4.1%), albeit not statistically significant. The increasing incidence of distant-stage cervical cancer and mortality in specific racial/ethnic groups suggests that the recent introduction of higher sensitivity screening tests may not explain increasing trends in low-income counties. Our findings suggest that the observed rise in cervical cancer incidence may reflect disruptions along the screening and treatment continuum. Future research to further comprehend these trends and continued enhancements in prevention are crucial to combat rising cervical cancer incidence and mortality in low-income counties in the United States.

County-Level Trends in Cervical Cancer Incidence, Stage at Diagnosis, and Mortality in Kentucky

This cross-sectional study evaluates recent trends in rates of cervical cancer incidence and incidence-based mortality among women in Appalachian and non-Appalachian Kentucky counties.

Population-Based Trends in Cervical Cancer Incidence and Mortality in Brazil: Focusing on Black and Indigenous Population Disparities.

This study aimed to explore trends in cervical cancer (CC) incidence and mortality rates according to race/skin color in Brazil focusing on the seriousness of the racial disparity. Data from Brazilian Population-Based Cancer Registries (PBCRs) were analyzed for trends in incidence between 2010 and 2015. For mortality, data from the National Mortality Information System were retrieved between 2000 and 2020. A self-declaration on race/skin color was collected following the classification proposed by the Brazilian Institute of Geography and Statistics - white, black, brown/mixed race, yellow, or indigenous. For the analysis, black and brown/mixed race were grouped as black. Between 2010 and 2015, 10,844 new cases of CC were registered in the participating PBCRs, distributed among white women (49.6%), black (48.0%), and other race/skin color (2.3%). Compared with white counterparts, black women had a 44% higher risk of incident CC. As for mortality, between 2000 and 2020, 108,590 deaths from CC occurred nationwide. The mean age-adjusted mortality rates according to race/skin color were 3.7/100,000 for white, 4.2/100,000 for black, 2.8 for yellow, and 6.7 for indigenous women. Taking the mortality rates in white women as a reference, there was a 27% increase in death risk in black women (RR = 1.27) and 82% in indigenous women (RR = 1.82). These findings suggest that the higher rates of incidence and mortality from CC in vulnerable populations of black and more impactfully indigenous women in Brazil remain alarming. More efficient HPV vaccination strategies synchronized with well-conducted Pap smear-based screening should be prioritized in these more vulnerable populations.

Cervical Cancer Incidence Among US Women, 2001-2019

This study uses national cancer incidence data to evaluate calendar trends in cervical cancer incidence by age at diagnosis.

Trends in cervical cancer incidence and mortality of young and middle adults in Japan.

In most high‐resource countries with organized screening programs, the incidence and mortality of cervical cancer is decreasing. Recent statistics have also revealed a reduction in invasive cervical cancer incidence as a result of national vaccination programs. Paradoxically, cervical cancer incidence has increased in Japan, particularly amongst women of reproductive age. This study aimed to examine the trends in cervical cancer incidence and mortality for young and middle adult women in Japan, by analyzing trends in 10‐year interval age‐groups. Cervical cancer incidence for young and middle adult women (ages 20‐59 years) was obtained from high‐quality population‐based cancer registries in three prefectures from 1985 to 2015. National cancer mortality data were obtained from published vital statistics from 1985 to 2019. Trends in crude and age‐standardized rates (ASR) were analyzed using Joinpoint regression. The cervical cancer incidence trend in 20‐59‐year‐old women combined significantly increased over the observation period. Both crude and ASR increased from 1985 to 2015 with an annual percent change (APC) of +1.6% (95% confidence interval, 1.1, 2.1) and +1.7% (1.2, 2.3), respectively. Similar increases were seen in ages 20‐29, 30‐39, and 40‐49 years with higher APCs especially in 20s and 30s. Both crude and ASR mortality significantly increased after the early 1990s in ages 20‐59 years combined. Based on the recognition that current cervical cancer control strategies in Japan have not been effective in reducing the cervical cancer burden in young and middle adults, promotion of screening and vaccination should be urgently strengthened.

Human Papillomavirus Vaccination and Trends in Cervical Cancer Incidence and Mortality in the US

This cohort study examines the association of human papillomvirus vaccination with cervical cancer incidence and mortality rates in the US, comparing age groups understood to have differing levels of vaccination.

Worldwide trends in cervical cancer incidence and mortality, with predictions for the next 15 years.

Cervical cancer is 1 of the most common cancers in females worldwide. Understanding the most recent global patterns and temporal trends of cervical cancer burden might be helpful for its prevention and control. Data on cervical cancer (International Classification of Diseases, Tenth Revision, code C53) incidence and mortality in 2018 were extracted from the GLOBOCAN 2018 database and further analyzed for their correlations with the Human Development Index. Temporal trends were analyzed using the annual percent change with joinpoint analysis among 31 countries with highly qualified data from the Cancer Incidence in Five Continents Plus and World Health Organization mortality databases. Future trends for the next 15 years were predicted using an open-source age-period-cohort model. Cervical cancer incidence and mortality rates were both negatively correlated with the Human Development Index (r = -0.56 for incidence, r = -0.69 for mortality; P < .001) in cross-sectional analysis, and both remained stable in 12 countries or even decreased in 14 and 18 countries for incidence and mortality, respectively, during the most recent 10 data years. Similar findings were observed for the next 15 years. Cervical cancer burden was correlated with socioeconomic development. An overwhelming majority of countries had stable or decreasing trends in incidence and mortality rates, especially in those with effective cervical cancer screening programs and human papillomavirus vaccination. The authors investigated the most up-to-date data from official databases released by the International Agency for Research on Cancer and found that cervical cancer incidence and mortality were negatively correlated with socioeconomic development. Among the 31 countries analyzed, most (26 countries were analyzed for incidence, and 30 were analyzed for mortality) had stable or even decreasing temporal trends over the most recent 10 years, especially in those with effective cervical cancer screening programs. In addition, the predicted trends for the next 15 years were basically consistent with the observed trends among most of the analyzed countries (19 countries for incidence and 26 countries for mortality).

Trends in cervical cancer incidence in sub-Saharan Africa

BackgroundCervical cancer is the second most common cancer and the leading cause of cancer death in women in sub-Saharan Africa (SSA).MethodsTrends in the incidence of cervical cancer are examined for a period of 10–25 years in 10 population-based cancer registries across eight SSA countries (Gambia, Kenya, Malawi, Mauritius, Seychelles, South Africa, Uganda and Zimbabwe). A total of 21,990 cases of cervical cancer were included in the analyses.ResultsIncidence rates had increased in all registries for some or all of the periods studied, except for Mauritius with a constant annual 2.5% decline. Eastern Cape and Blantyre (Malawi) registries showed significant increases over time, with the most rapid being in Blantyre (7.9% annually). In Kampala (Uganda), a significant increase was noted (2.2%) until 2006, followed by a non-significant decline. In Eldoret, a decrease (1998–2002) was followed by a significant increase (9.5%) from 2002 to 2016.ConclusionOverall, cervical cancer incidence has been increasing in SSA. The current high-level advocacy to reduce the burden of cervical cancer in SSA needs to be translated into support for prevention (vaccination against human papillomavirus and population-wide screening), with careful monitoring of results through population-based registries.

Cervical cancer burden in Latin America and the Caribbean: Where are we?

In May 2018, the World Health Organization (WHO) called for the elimination of cervical cancer. To monitor this initiative, we examined cervical cancer incidence and mortality in the Latin America and Caribbean (LAC) region using GLOBOCAN 2018, Cancer Incidence in Five Continents Series, and the WHO Mortality Database. We estimated the number of cases and age-standardized rates (ASRs) for cervical cancer incidence and mortality for 2018. We also presented the ASRs for recorded cervical cancer incidence from the period 2008 to 2012. We calculated annual rates and analyzed trends in cervical cancer incidence and mortality for all ages combined and for the following age groups: 0-29, 30-49, 50-64 and 65+. Finally, we calculated the estimated average annual percentage change in incidence and mortality rates for the past 10 years. In 2018, an estimated 56,000 new cervical cancer cases and 28,000 cervical cancer deaths occurred among women in LAC with great variations between subregions and countries/territories. Overall, trends in cervical cancer incidence and mortality have decreased over the past decade; however, the rates are still above the elimination threshold of 4 per 100,000 in most LAC countries/territories. Despite the encouraging trends observed, achieving the elimination of cervical cancer in the region still requests substantial political commitment and economic effort. Population-based cancer registries are critical in monitoring the elimination initiative.

Increasing Cervical Cancer Incidence in Rural Eastern Cape Province of South Africa, 1998-2012 - A Population-Based Cancer Registry Study

Background: South Africa introduced free cytology-based screening for cervical cancer in 1999. A high cervical cancer incidence has been observed in rural Eastern Cape Province, an area with a high prevalence of Human Immunodeficiency Virus and extensive provision of highly active anti-retroviral therapy. Cervical cancer incidence trends from the population-based Eastern Cape Cancer Registry are further examined by distinct geographic areas; northern and southern. Methods: Cases (topography C53.0-C53.9) for the period 1998-2012 were extracted from a cancer registry database from which basic descriptive statistics and frequencies were analysed for all variables using CanReg4.Trends over time were estimated using a direct standardization method and world standard population as a reference. Screening coverage annualized figures for women 30 years and older by sub-health district were extracted from the District Health Information System. Findings: In the northern area, annual age-standardized incidence rates per 100 000 women increased from 24.0 (95% CI: 21.1-27.0) in 1998-2002 to 39.0 (95% CI: 35.6-42.5) in 2008-2012, with a screening coverage rate of 15% by 2012. In contrast, no increase was observed in incidence in the southern area, with rates of 20.0 (95% CI: 18.5-21.4) in 1998-2002 and 18.8 (95% CI: 16.2-21.4) in 2008-2012, and a higher screening coverage of 41% in 2012. Overall, the percentage distribution of stage at diagnosis showed that 28.5% of cases were diagnosed at disease stages I and II, 35% III and IV, and 36% with missing stage information (2003-2012). In 77% of cases, a histologically verified diagnosis was made, compared with only 12.3% by cytology. Interpretation: The significant increase in the incidence in the northern area does not appear to be directly related to the screening programme but may portend increases associated with the widespread provision of highly active ante-retroviral therapy. Funding Statement: South African Medical Research Council. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This study was approved by the South African Medical Research Council.

Impact of screening on cervical cancer incidence in England: a time trend analysis

ObjectivesTo better model underlying trends in cervical cancer incidence so as to model past trends, to estimate the impact of cervical screening on cervical cancer rates at different ages and...

Trends in cervical cancer incidence and survival in Estonia from 1995 to 2014

BackgroundCervical cancer (CC) incidence in Estonia is the third highest in Europe, even though an organised nation-wide screening program has been in place since 2006.The aim of the study was to analyse the incidence and survival of CC in Estonia, focusing on age, morphology and stage at diagnosis.MethodsData from Estonian Cancer Registry were used to analyse age-standardized (world) and age-specific incidence for 1968–2014 rates. Joinpoint regression was used to estimate the annual percentage change (APC) for incidence trends. Age-period-cohort model was used to summarise time trends in terms of cohort and period effects. Relative survival ratios (RSR) were calculated for cases diagnosed in 1995–2014. Union for International Cancer Control version 7 of the TNM classification for malignant tumours was used to categorise stage.ResultsThe age-standardized incidence of CC increased since 1980s at a rate of 0.8% per year. A significant increase was seen for all age groups except for 70+. The incidence of squamous cell carcinoma mimicked the overall trend, while adenocarcinoma showed increase since mid-1990s (APC 6.7). Age-period-cohort modelling showed strong cohort effects with the lowest risk for birth-cohorts born around 1940 and significantly increasing risks for successive cohorts born thereafter. No period effects were seen.The proportion of stage IV cases increased from 13% in 2005–2009 to 18% in 2010–2014. A significant increase was seen in the overall 5-year RSR from 1995 to 1999 to 2010–2014 (58% vs 66%). In 2010–2014, the 5-year RSRs ranged from 89% in women aged 15–39 to 41% in age group 70+. For stages I to IV, the respective RSRs were 98, 74, 57 and 22%.ConclusionsThe inadequate uptake and insufficient quality of the Pap-smear based screening program has not brought along a decline in the incidence of CC in Estonia. Stage distribution has shifted towards later stages. New approaches are needed to prevent CC in Estonia.

Trends in cervical cancer incidence and mortality in Oklahoma and the United States, 1999–2013

BackgroundThe twin prevention strategies of HPV vaccination and cervical cancer screening reduce new cases and averts deaths, yet women still develop or die from cervical cancer. To assess and better understand the burden of cervical cancer in Oklahoma, we analyzed incidence and mortality trends in Oklahoma from 1999 to 2013. MethodsWe obtained age-adjusted cervical cancer incidence and mortality rates and calculated standardized rate ratios (RR) for women in Oklahoma compared to the US. To evaluate temporal changes in annual age-adjusted incidence and mortality, we calculated the annual percent change (APC) using the Joinpoint Regression Program. ResultsWe observed higher age-adjusted incidence (RR: 1.2; 95% CI: 1.1, 1.3) and mortality (RR: 1.2; 95% CI: 1.1, 1.2) rates among women in Oklahoma compared to the US. The overall incidence and mortality rates in Oklahoma were 9.7 and 2.9 per 100,000 women, respectively. In Oklahoma, the highest age-adjusted incidence rates were in American Indian/Alaska Native (AI/AN) (14.8 per 100,000 females) and Asian or Pacific Islander (API) (11.7 per 100,000 females) women and the highest mortality rates were in AI/AN (4.5 per 100,000 females) and African American (AA) (3.9 per 100,000 females) women. Incidence rates decreased for AA women (APC: −4.0; 95% CI: −7.7, −0.2), but were stable for all other races and ethnicities in Oklahoma (APC: −0.8; 95% CI: −2.2, 0.7). A stable trend for mortality was observed in Oklahoma (APC: 0.1; 95% CI: −2.2, 2.5) each year. ConclusionWomen in Oklahoma had a higher cervical cancer incidence and mortality rate than the US. A disproportionately higher incidence of cervical cancer among AI/AN and API women and deaths among AI/AN and AA women were observed signaling continuing racial disparities.

Incidence Trends of Cervical Cancer and Its Precancerous Lesions in Women of Central Switzerland from 2000 until 2014.

Cervical cancer (CC) screening by Pap smears has led to a decrease in the incidence of CC worldwide. Indeed, the incidence of CC in Switzerland is very low; however, there is a lack of data to evaluate the efficiency of the Pap smear as a screening tool. Until now, only Pap smears have been used and other methods such as the presence of an infection with HPV have not been integrated into the routine screening. The aim of this study is to evaluate trends in the incidence of CC and its precancerous lesions in Central Switzerland, which represents a rural region, with those in urban regions and the entire country of Switzerland. All conizations and CC registered between 2000 and 2014 at the Institute of Pathology at the Cantonal Hospital of Lucerne have been included in our study. The incidence of CC and its precancerous lesions have been categorized according to age, stage, morphology, and study period. Age-standardized incidence in the Canton of Zurich and the entire country served as reference for the assessment of trends in CC incidence in the study region. In Central Switzerland, the number of conizations performed annually has more than doubled over the observed 15 years. There has been a significant increase in precancerous lesions, which were found in approximately 50% of conizations. The total number of CC diagnosed by conization increased by 37.5% and the total of CIN3 increased by 130%. Age-standardized incidence of CC and CIN3 increased from 2.4 to 3.3/100,000 and from 11.6 to 26.9/100,000, respectively. The incidence of CC was lower in Central Switzerland compared to incidence in the Canton of Zurich and in Switzerland generally. Approximately 50% of all conizations were performed on women without serious precancerous lesions. For this reason, we recommend the adaptation of screening modalities and the use of risk stratification to avoid overtreatment. In light of the forthcoming implementation of an HPV vaccination program, our data provides important baseline information.

Trends in Cervical Cancer Incidence in Iran from 2003 to 2009

Background: Cancer is the second leading cause of death worldwide and the third in Iran. Among cancers, cervical cancer is the third leading cause of death in women. Thus, recognizing the epidemiology and trends of cervical cancer can be effective for planning and policy-making. This study aims to investigate the incidence and trends of cervical cancer in Iran due to the few studies that have addressed this issue and the unclear trend for cervical cancer in Iran.Methods: This study re-analyzed existing data from the cancer data recording system in Iran during years 2003 to 2009. We used available data from the National Cancer Registry and Center for Disease Control of the Ministry of Health, Treatment and Medical Education. Stata software (version 11) was used for data analysis and the significance of the incidence trend diagram was derived with WINPEPI software.Results: Assessment of the National Cancer Registry statistics from 2003 to 2009 showed an increased trend in cervical cancer from 2003 to 2008 and a decreased trend from 2008 to 2009. During this period, there were 4273 cases of cervical cancer registered. From these, 394 cases were registered in 2003 which peaked at 907 cases in 2009. The registered cancer cases had an approximately 3-fold increase during this period. Most provinces reported an increased trend of incidence in cervical cancer.Conclusion: Based on the results of this study, the incidence of cervical cancer is increasing in Iran, especially in the central regions of the country. Therefore, considering the growing trend of cancer, we recommend early detection through screening programs, public awareness, and public training programs that particularly target high risk populations.

Incidence Trends of Cervical Cancer in Adolescents and Young Adults: Brazilian Population Based Data.

High incidence rates for cervical cancer in adolescents and young adults (AYAs: 15-29 years) make this the most common carcinoma in Brazil. Our aim was to analyze the incidence trends for cervical cancer (CC) and in situ neoplasia (IsN) among this age group. Incidence data were extracted from 21 Brazilian population-based cancer registries (PBCRs). Tumors with behavior code/3 (malignant) were classified as CC. Tumors with behavior code/2 were classified as IsN. Age-adjusted and age-specific incidence rates were calculated for individuals aged 15-19 years, 20-24 years, and 25-29 years. Incidence trends were evaluated by joinpoint regression analyses. The median incidence rate of CC for AYA in Brazil was 3.63 per 100,000, with the highest rate observed in Recife (27.50 per 100,000). Significant increase in incidence for CC was identified in two PBCRs, with decreased rates for three PBCRs. The median incidence rate of IsN was 16.78 per 100,000 and was highest in Roraima (93.37 per 100,000). Increased incidence rates for IsN were identified in six PBCRs, with significant decreases in two PBCRs. The incidence rate for CC among AYA in Brazil is high and warrants intervention in terms of both prevention and control.

Decreasing Trends in Cervical Cancer Incidence among Young Women (15–34 Years) in the United States during the Human Papillomavirus (HPV) Vaccine Era

Abstract Human papillomavirus (HPV) vaccine has been recommended for girls 11–12 years of age since 2006, with catch-up vaccination up to 26 years, to protect against most common types of HPV that cause cervical cancer. Cervical cancer incidence stabilized in women &amp;lt;50 years during 2008–2012. Comparing trends and incidence of cervical cancer before and during the vaccine era among vaccine-eligible young women (15–34 years) may provide valuable insight about potential vaccine impact. Methods: We examined trends in the incidence of invasive cervical cancer by race and histology among young women (15–24 years and 25–34 years) during the prevaccine era (2000–2006) and the vaccine era (2007–2013). Data were from the Surveillance, Epidemiology, and End Results (SEER) Program, including 18 SEER registry areas (Hurricane Katrina impacted Louisiana population excluded). Incidence rates (per 1,000,000) were age-adjusted to the 2010 US standard population by the direct method, using SEER*Stat software. Confidence intervals were calculated using the Tiwari method. Joinpoint regression modeling was used to compare the difference in the trends between the prevaccine era and the vaccine era. Results: Cervical cancer incidence among young women 15–24 years of age was stable during 2000–2006 from 9.5 in 2000 to 9.1 in 2006, but decreased from 6.9 in 2007 to 5.3 in 2013 (annual percentage decrease [APD] 5.7, 95% confidence interval [CI] 1.1–10.2, significantly different from the APD during 2000–2006). Cervical cancer incidence among young females 25–34 years of age also decreased from 99.7 in 2000 to 78.2 in 2006 (APD 4.0, 95% CI 2.3–5.6), and from 78.6 in 2007 to 68.2 in 2013 (APD 2.5, 95% CI 0.5–4.5). A significance decrease in the incidence was only observed in Whites, but not in Blacks, Hispanics, or Asians/Pacific Islanders. A significance decrease was observed in the incidence of non-squamous cell carcinoma (SCC) rather than SCC among young females 15–24 years from 3 in 2007 to 1.5 in 2013 (APD 9.1, 95% CI 3.1–14.7). Conclusion: A significance decrease in the incidence of cervical cancer during the vaccine era among young females 15–24 years may indicate early effects of HPV vaccination. Further research is needed to confirm this trend.

Trends in cervical cancer incidence in younger US women from 2000 to 2013

ObjectiveThis study aimed to assess the temporal trends in invasive cervical cancer (ICC) incidence rates among 21–25year-olds. US guidelines no longer recommend screening prior to age 21, and concerns have been raised that delayed screening initiation may increase ICC incidence among young women. MethodsThis study utilized ICC incidence data from 18 US population-based cancer registries in SEER from 2000 to 2013 and Pap test prevalence data from the Behavioral Risk Factor Surveillance System from 1996 to 2012. Trends were evaluated with annual percent changes (APCs) using Joinpoint regression. ResultsThe prevalence of never having a Pap test before age 21 increased from 22.0% in 1996–2004 to 38.3% in 2006–2012 (APC=+5.48, 95%CI=+4.20, +7.50). Despite this decline in screening, ICC incidence among 21–23year olds significantly declined between 2000 and 13 (APC=−5.36, 95%CI=−7.83,−2.82), particularly from 2006 to 2013 (APC=−9.70, 95%CI=−15.79, −3.17). ICC incidence remained constant among 24–25year olds (APC=+0.45, 95%CI=−2.00, 2.97). Compared to women born in 1978–1985, women born in 1986–1991 had a higher prevalence of never receiving a Pap test prior to 21 (35.4% vs. 22.1%, p<0.001), but a lower ICC incidence at 21–23 (0.98 vs. 1.55 per 100,000, p<0.001). ConclusionWhile US females born in 1986–1991 were less likely to receive a Pap test before age 21, diagnoses of ICC in the early 20s were rare and lower than for those born in earlier years. This provides reassurance that the updated guidelines to delay screening until 21 has not resulted in a population-level increase in ICC rates among young women.

Spatiotemporal mapping of cervical cancer incidence highlights need for targeted prevention in Songkhla province, Thailand.

The national cervical cancer screening program in Thailand has been successful in reducing overall burden from this disease. However, evaluation on spatial and temporal scales is needed to assess the efficacy of this program in smaller regions. Here, we geographically assess incidence in a province with a uniquely heterogeneous distribution of lifestyle factors associated with religiosity. Cervical cancer cases were extracted from the provincial cancer registry from 1989 to 2013. Age-adjusted incidence rates were calculated using population statistics from the census bureau and adjusted to the Segi world standard population. Bayesian hierarchical modelling was employed to spatiotemporally map cervical cancer incidence trends in Songkhla province in 5-year period. Overall, the incidence of cervical cancer decreased in Songkhla province. The three districts with a Muslim population of greater than 70% had consistently lower cervical cancer rates from 1989 to 2013 compared with the rest of the predominantly Buddhist districts. Hotspots of incidence were identified in Sadao, Hat Yai and the juncture of Mueang Songkhla and Singhanakhon in each 5-year period. Distinct cervical cancer incidence trends by religion over time indicate differences in sexual habits, lifestyle and religion-associated culture between Muslims and Buddhists, and suggest divergent risk factor profiles for these groups. The high incidence rates in Sadao and Hat Yai is likely explained by the main road to Malaysia, which runs across these two areas and has frequent commercial sex trade. Female sex workers should be targeted as a vulnerable population for screening efforts to address this continuing burden of cervical cancer.

Incidence trends of cervical cancer in Tianjin, 2007-2013

To investigate the change of incidence and age distribution of cervical cancer in Tianjin from 2007 to 2013. The incidence data of cervical cancer and population data were collected from the cancer registry system of Tianjin Center for Disease Control and Prevention and Tianjin Municipal Public Security Bureau, respectively. The crude incidence, and age-standardized incidence of cervical cancer were calculated by using SPSS software. The Join Point Regression Program software was used to detect the trend of cervical cancer incidence. A total of 3 362 cervical cancer patients were diagnosed during 2007 to 2013. The average age of the patients was 48.11 years. The crude incidence was 9.85/100 000. The annual world standard age specific incidence was 6.65 /100 000. The incidence in urban area was higher than that in rural area, but the proportion of the cases in urban area showed a downward trend(trend χ(2)=21.92, P=0.001)and the proportion of the cases in rural area showed a upward trend(trend χ(2)=12.70, P=0.048). The difference was significant. The incidence was generally stable in urban area, the APC value was 2.7%(95%CI:-9.1%-16.2%), the difference was not significant(Z=0.564, P=0.597); The incidence rate in rural area showed an upward trend, APC value was 13.4%(95% CI: 3.5%-24.2%), the difference was significant(Z=3.549, P=0.016). The two incidence peaks were in age groups 40-44 years and 75-79 years. The overall incidence of cervical cancer in Tianjin was still stable during 2007-2013, and the disease mainly occurred in middle-aged and elderly population. More attention should be paid to the increased incidence of cervical cancer in rural area.