研究分析實現世衛組織消除宮頸癌的目標對死亡率的影響
作者：
小柯機器人發布時間：2020/2/14 15:48:11
澳大利亞新南威爾斯州癌症委員會Karen Canfell研究組在研究中取得進展。他們詳細分析了實現世界衛生組織（WHO）消除宮頸癌的目標對死亡率的影響。該項研究成果發表在2020年1月30日出版的《柳葉刀》上。
WHO正在制定一項將宮頸癌作為一個公共衛生問題進行消除的全球戰略，提出消除閾值為每10萬名女性中僅有4例宮頸癌，並在2030年實現人乳頭狀瘤病毒（HPV）疫苗接種率90%、兩次終生宮頸篩查率70%、浸潤前病變和浸潤癌治療率90%的三重幹預覆蓋目標。
研究組評估了實現90-70-90三重幹預目標對下世紀宮頸癌死亡率和避免死亡的影響。還評估了聯合國可持續發展目標（SDG）中2030年將非傳染性疾病過早死亡率降低三分之一的可能性。
到2020年，所有78個中低收入國家的宮頸癌死亡率預計為每10萬名女性中有13.2例。與現在相比，到2030年，僅接種疫苗對宮頸癌死亡率的影響微乎其微，可降低0.1%，而增加兩次終生篩查和癌症治療將使死亡率降低34.2%，到2030年將減少30萬人死亡。
到2070年，僅加強疫苗接種便可降低61.7%的死亡率，避免480萬人的死亡。2070年還將進一步加大篩查和癌症治療的力度，一次終生篩查可將死亡率降低88.9%，避免1330萬人死亡；兩次終生篩查可將死亡率降低92.3%，避免1460萬人死亡。
到2120年，僅接種疫苗將使死亡率降低89.5%，避免4580萬人死亡。到2120年，進一步加大篩查和癌症治療的力度，一次終生篩查可使死亡率降低97.9%，避免6080萬人死亡；兩次終生篩查可將死亡率降低98.6%，避免6260萬人死亡。
根據WHO的三重幹預戰略，在未來10年內，撒哈拉以南非洲和近三分之一的南亞可減少大約一半的死亡病例；在未來100年內，這些地區將減少幾乎90%的死亡病例。
對於過早死亡（30-69歲死亡），WHO的三重幹預策略將使2030年的死亡率降低33.9%，2070年的死亡率降低96.2%，2120年的死亡率降低98.6%。
該發現強調了立即擴大預防接種、篩查和治療浸潤前病變和浸潤性宮頸癌的重要性。
在未來10年，中低收入國家可將宮頸癌的過早死亡率降低三分之一，向實現2030年聯合國可持續發展目標邁進。 到下個世紀，成功實施WHO消除宮頸癌的戰略將使宮頸癌死亡率降低99%，從而挽救6200多萬女性的生命。
附：英文原文
Title: Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries
Author: Karen Canfell, Jane J Kim, Marc Brisson, Adam Keane, Kate T Simms, Michael Caruana, Emily A Burger, Dave Martin, Diep T N Nguyen, élodie Bénard, Stephen Sy, Catherine Regan, Mélanie Drolet, Guillaume Gingras, Jean-Francois Laprise, Julie Torode, Megan A Smith, Elena Fidarova, Dario Trapani, Freddie Bray, Andre Ilbawi, Nathalie Broutet, Raymond Hutubessy
Issue&Volume: January 30, 2020
Abstract:
Background
WHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100?000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus (HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90–70–90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality from non-communicable diseases by 2030.
Methods
The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries (LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10–14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median (range) of model predictions.
Findings
In 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 (range 12·9–14·1) per 100?000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% (0·1–0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% (23·3–37·8), averting 300?000 (300?000–400?000) deaths by 2030 (with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% (61·4–66·1), averting 4·8 million (4·1–4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% (84·0–89·3), averting 13·3 million (13·1–13·6) deaths (with once-lifetime screening), or by 92·3% (88·4–93·0), averting 14·6 million (14·1–14·6) deaths (with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% (86·6–89·9), averting 45·8 million (44·7–46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% (95·0–98·0), averting 60·8 million (60·2–61·2) deaths (with once-lifetime screening), or by 98·6% (96·5–98·6), averting 62·6 million (62·1–62·8) deaths (with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half (48% [45–55]) of deaths averted would be in sub-Saharan Africa and almost a third (32% [29–34]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths (age 30–69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% (24·4–37·9) by 2030, 96·2% (94·3–96·8) by 2070, and 98·6% (96·9–98·8) by 2120.
Interpretation
These findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives.
DOI: 10.1016/S0140-6736(20)30157-4
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30157-4/fulltext