Adino T. Tsegaye1, Aimée R. Kreimer1, Jaimie Z. Shing1, Megan A. Clarke1, Tabassum Insaf2, Jennifer H. Hayes3, Qianlai Luo1, Jennifer McGee-Avila1, Ena Omoike4, Ana Patricia Ortiz5, Karen Pawlish6, Nicolas Wentzensen1, Eric A. Engels1, Meredith S. Shiels1
1National Cancer Institute, Bethesda, MD,2Bureau of Cancer Epidemiology, New York State Cancer Registry, New York, NY,3Maryland Department of Health, Prevention & Health Promotion Administration, Maryland Cancer Registry, Baltimore, MD,4Division of HIV, STD, and TB Services New Jersey Department of Health, Trenton, NJ,5Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR,6New Jersey Department of Health, New Jersey State Cancer Registry, Trenton, NJ
摘要 Abstract
Background: Including hysterectomized women in cervical cancer rates potentially inflates incidence and may misguide prevention programs. We estimated the hysterectomy-corrected incidence rate (IR) of cervical cancer among women with HIV, overall and by histology, age, race and ethnicity.
Methods: We used data from the HIV/AIDS Cancer Match Study - a linkage of 14 HIV and cancer registries in the US. We calculated age-standardized IR (ASIR) of cervical cancer and compared the absolute and relative differences between corrected and uncorrected IRs across age, racial/ethnic and histology groups. Data from the Behavioral Risk Factor Surveillance System was used to correct for hysterectomy. A Poisson regression model was used to estimate hysterectomy-corrected and uncorrected incidence rate ratios (IRR) comparing rates in 2005-2009, 2010-2014, and 2015-2019 to 2001-2004, adjusted for race and ethnicity, age, and region.
Results: During 2001-2019, there were 958 cervical cancer cases in 2,007,406 total person-years of follow-up (uncorrected ASIR: 47.7 per 100,000) and 1,632,853 person-years of follow-up after hysterectomy correction (ASIR=58.7). The ASIR after hysterectomy correction increased by 28% among Black women (50.3 vs 64.4), 18% among Hispanic women (52.1 vs 61.6), and 19% among White women (31.6 vs 37.6). The uncorrected IRs had a peak at ages 40-49 with a sharp peak and decline in the younger and older age groups while hysterectomy-corrected IRs had relatively flatter patterns with similar estimates for 30-39, 50-59 and 60-84-year-old women. Compared to the ASIRs in 2001-2004, the hysterectomy-corrected ASIRs were lower in subsequent calendar periods: IRR (2005-2009): 0.80, 95%CI:0.66,0.97, IRR (2010-2014): 0.75, 95%CI:0.61,0.91, and IRR (2015-2019): 0.79, 95%CI:0.64,0.97.
Conclusions: Hysterectomy correction unmasked substantial underestimation of cervical cancer ASIRs among women with HIV. There was a significant difference between hysterectomy-corrected and uncorrected estimates across age and racial groups, being more pronounced among Black and White women, and women aged ≥50 years due to the cumulatively rising prevalence of hysterectomy with age.
利益披露 Disclosure
A. T. Tsegaye, None..
A. R. Kreimer, None..
J. Z. Shing, None..
M. A. Clarke, None..
T. Insaf, None..
J. H. Hayes, None..
Q. Luo, None..
J. McGee-Avila, None..
E. Omoike, None..
A. P. Ortiz, None..
K. Pawlish, None..
N. Wentzensen, None..
E. A. Engels, None..
M. S. Shiels, None.