OBJECTIVETo evaluate the trend of cervical cancer incidence and mortality rates during 1989-2008 in Chinese women, so as to inform the development of relevant policies and strategies in China.

METHODSThe incidence and mortality rates of cervical cancer during 1989-2008 in urban and rural areas were calculated based on the data from the National Cancer Registry Database. Age-standardized rates were calculated using the Chinese population of 1982 and World Segi's population of 1985. Joinpoint regression analysis was performed to obtain annual percentage changes (APC) so as to assess the trend of incidence and mortality rates over the period from 1989 to 2008.

RESULTSThe crude incidence rate of cervical cancer in Chinese women increased from 3.06/10(5) in 1989-1990 to 11.87/10(5) in 2007-2008 (from 4.96/10(5) to 11.98/10(5) in urban registration areas and from 2.39/10(5) to 11.77/10(5) in rural registration areas).The crude mortality rate slightly increased from 2.19/10(5) in 1989-1990 to 3.20/10(5) in 2007-2008 (from 3.21/10(5) to 2.56/10(5) in urban registration areas and from 1.82/10(5) to 3.75/10(5) in rural registration areas). Generally, the upward trends of crude incidence rates were shown over the year 1989-2008, with an APC of 14.4% after 1997 in urban areas and 22.5% after 1999 in rural areas.After age standardization of world population, the APC of incidence rates in recent decade in urban areas remained stable, and the one in rural areas slightly decreased.Although the overall crude and world age-standardized mortality rates had no significant changes during 1989-2008, the crude mortality rates increased by 8.1% annually after 1999.The upward trends were also shown for crude and world age-standardized mortality rates in urban areas after 2001 with an APC of 7.3%.The crude mortality rates in rural areas increased by 3.9% annually during 1989-2008, but no significant change was found after age standardization.

CONCLUSIONSOver the last decade, the cervical cancer incidence and mortality rates ascended by year in China. It is particularly urgent to establish a comprehensive prevention and control system that combines cervical cancer screening and human papillomavirus vaccination, so as to reduce the burden of cervical cancer in Chinese women.

Endometrial Neoplasms ; classification ; epidemiology ; mortality ; pathology ; Female ; Humans ; Uterine Cervical Neoplasms ; classification ; epidemiology ; mortality ; pathology

Objective: To analyze the data of malignant tumor mortality and change in disease burden in Hebei province from 1973 to 2013. Methods: Cancer mortality rate, age-standardized mortality rate and the years of life lost due to premature mortality (YLLs) were calculated by using the data from three rounds of all death causes survey and database of cancer registry in Hebei during 1973-2013. Results: From 1973 to 2013, a linear upward of malignant tumor mortality was observed, with a 51.57% increase. The mortality rate during 1973-1975 was 98.52/100 000 and it was 149.33/100 000 during 2011-2013. During 1973-1975, the YLLs was 17.0/1 000 in males and 12.8/1 000 in females. While during 2011-2013, the YLLs was 23.2/1 000 in males and 15.9/1 000 in females. During 1973-1975, esophagus cancer, stomach cancer and liver cancer were top three leading causes of deaths. During 2011-2013, lung cancer, stomach cancer and liver cancer were main leading causes of deaths. During the past 40 years, the deaths of esophagus cancer and cervix cancer decreased dramatically, but the deaths of lung cancer and breast cancer increased sharply. Conclusions: The disease burden caused by malignant tumor is becoming more serious in Hebei. It is necessary to strengthen the primary prevention and screening of malignant tumor.
Breast Neoplasms ; Esophageal Neoplasms ; Female ; Humans ; Liver Neoplasms ; Lung Neoplasms ; Male ; Mortality/trends* ; Mortality, Premature ; Neoplasms/mortality* ; Primary Prevention ; Reference Standards ; Registries ; Stomach Neoplasms ; Uterine Cervical Neoplasms

Cervical cancer is the second most common malignant neoplasm affecting women worldwide, with a high rate of mortality throughout the world. Since epidemiologic, biologic, and genetic data have identified a consistent association of human papillomavirus (HPV) infection with cervical cancer development, many researchers have worked on the development of HPV vaccine to establish an efficient program to manage cervical carcinoma in developed countries. Therefore, the aims of this study are to overview the current status of vaccine and to systematically analyze the development process of HPV vaccine through a review of the literature. The basic and clinical data on HPV vaccine inside and outside the country were collected by Medline searching. Recent lines of research on the safety and efficacy of candidate prophylactic vaccines against HPV have shown very promising results with nearly 100% efficacy in preventing persistent infections and the development of cervical precancerous lesions. The variable routes of vaccine administration have been tried-nasal and oral vaccination, as well as parental injection. Recently, clinical trials involving a large population and multi-institutions are ongoing, and also clinical trials are expected in Korea. Although the results of previous HPV vaccine studies are invariably encouraging, several drawbacks need to be addressed. Because the genotype of HPV is regionally different, Korean-specific vaccine needs to be developed, and there are many unsolved problems regarding, for example, the booster injection, optimal timing of vaccination, and vaccination in men.
Developed Countries ; Female ; Genotype ; Humans ; Korea ; Male ; Mortality ; Parents ; Uterine Cervical Neoplasms ; Vaccination ; Vaccines

In Korea, cervical cancer is the fifth most common female cancer and the eighth most common cause of female cancer deaths. It is the most frequently diagnosed gynecologic cancer. Over the past decades, a marked reduction in the incidence and mortality of this malignancy has been documented. This has been largely attributed to widespread screening using papanicolaou smear, the early detection and treatment of preivasive lesions, and development of an effective treatment modality for invasive cervical cancer. The recently developed human papilomavirus vaccine is expected to further reduce the incidence and mortality of this malignancy markedly. Epidemiologic, biologic, and clinical research on cervical cancer is carried out worldwide to introduce human papillomavirus test and vaccine and to develop effective treatment for invasive cancer. At this point of time, the author reviewed the present status of research on cervical cancer and proposed future studies required to reduce the incidence and mortality of this malignancy in Korea.
Female ; Humans ; Incidence ; Korea* ; Mass Screening ; Mortality ; Papanicolaou Test ; Uterine Cervical Neoplasms*

OBJECTIVE: Few data exist regarding adjuvant hysterectomy (AH) in locally advanced cervical cancer (LACC) patients treated with chemoradiotherapy. We investigated the effect of AH on prognosis in LACC patients, through meta-analysis. METHODS: EMBASE and MEDLINE databases and the Cochrane Library were searched for published studies comparing LACC patients who received AH after chemoradiotherapy with those who did not, through April 2016. Endpoints were mortality and recurrence rates. For pooled estimates of the effect of AH on mortality/recurrence, random- or fixed-effects meta-analytical models were used. RESULTS: Two randomized trials and six observational studies (AH following chemoradiotherapy, 630 patients; chemoradiotherapy, 585 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated no significant difference in mortality between the groups (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.58–1.78; p=0.968) with low cross-study heterogeneity (p=0.73 and I2=0.0). This pattern was observed in subgroup analysis for study design, radiation type, response after chemoradiotherapy, and hysterectomy type. The pooled OR for AH and recurrence was 0.59 (95% CI=0.44–0.79; p < 0.05) with low cross-study heterogeneity (p=0.29 and I2=17.8), favoring the AH group. However, this pattern was not observed in the subgroup analysis for the randomized trials. There was no evidence of publication bias. CONCLUSION: In this meta-analysis, AH following chemoradiotherapy did not improve survival in patients with LACC, although it seemed to reduce the risk of recurrence. Concerning the significant morbidity of AH after chemoradiotherapy, routine use of AH should be avoided.
Chemoradiotherapy* ; Humans ; Hysterectomy* ; Mortality ; Population Characteristics ; Prognosis* ; Publication Bias ; Recurrence ; Uterine Cervical Neoplasms*

Cancer of the cervix is the most common malignancy in women in developing countries and the second most common cancer in women throughout the world with approximately 500,000 new cases each year. Prevention of this large number of premature deaths among women is, therefore, a goal worthy of urgent and serious consideration. In this thesis, an automatic cancerous nucleus detection method essential to a screening system with Papanicolaou stained specimens called Pap-smear is proposed which employs image processing techniques. It uses edge information to segment objects and morphologic as well as densitometric information to distinguish cancerous nuclei from dirts or normal nuclei. It has produced useful results in our study.
Developing Countries ; Female ; Humans ; Mass Screening ; Mortality, Premature ; Uterine Cervical Neoplasms

Cancer screening is one of the most effective methods for cancer control. The national cancer screening program has provided regular cancer screenings for all people at a certain age, regardless of symptoms. This program covers five major cancers: stomach, colorectal, liver, breast, and cervical cancer. Recently, a research project was performed to develop and revise the guidelines for cancer screening, based on the assessment of effectiveness compared to harm and on the evidence from a systematic review of related studies. Target cancers for screening guideline are not only for five major cancers which are included in national cancer screening program, but also for thyroid cancer and lung cancer, because thyroid cancer is rapidly increased recently and lung cancer has the highest mortality rate among cancers. Multidisciplinary expert committees were composed for developing and revising the guidelines for cancer screening. This process of national cancer screening guideline development and revision comprised three steps. First, an expert committee developed key questions for consideration in revision and development of the guidelines. A systematic literature review related to these key questions was performed. In the second step, the effectiveness of the national cancer screening program for five major cancers was analyzed, including analysis of screening rates, early cancer detection rates, and mortality reduction effects. Through this process, a draft of the revised guidelines was created. The draft was open to the public to gather external expert opinions. After review of the expert opinions, the final guidelines for cancer screening were published. In the third step, based on the revised cancer screening guideline, the national cancer screening program will be modified. In this step, cost-effectiveness and feasibility of the revised guideline will be considered.
Breast ; Early Detection of Cancer* ; Expert Testimony ; Liver ; Lung Neoplasms ; Mass Screening ; Mortality ; Stomach ; Thyroid Neoplasms ; Uterine Cervical Neoplasms

We evaluated the influence of socioeconomic factors on female cancer mortality using death data from the Cause of Death Statistics and the Korean Population and Housing Census databases collected in 2001, 2006, and 2011. We estimated Relative Index of Inequality (RII) of female cancer mortality using Poisson regression analysis. RII greater than 1 indicates increased mortality risk for women at the lowest educational level compared with women at the highest educational level. The RII for cervical cancer mortality was persistently greater than 1 for the entire study period, with a gradual increase over time. Subgroup analysis stratified by age (25-44 and 45-64 yr) revealed that younger women had increased RIIs of mortality due to cervical cancer and ovarian cancer during the entire study period. Older women had higher RII only for cervical cancer mortality, but the value was much lower than that for younger women. The RII for breast cancer mortality was greater than 1 for younger women since 2006. In conclusion, socioeconomic inequality in female cancer mortality has persisted for the last decade in Korea, which was most evident for cervical cancer, and for younger women.
Adult ; Age Factors ; Breast Neoplasms/*mortality ; Educational Status ; Female ; *Health Status Disparities ; Humans ; Middle Aged ; Ovarian Neoplasms/*mortality ; Republic of Korea ; Socioeconomic Factors ; Uterine Cervical Neoplasms/*mortality ; Uterine Neoplasms/*mortality

OBJECTIVE: To analyze the clinical features and prognosis of cervical adenocarcinoma (AC) and adenosquamous carcinoma of cervix (ASC). METHODS: The clinical data of 237 patients, including 201 cases of AC and 36 cases of ASC (FIGO stage ⅠB1-ⅡA), who underwent surgery in Qilu Hospital between September 2007 and September 2016 were reviewed. Clinical features of two groups were compared, and Kaplan-Meier survival analysis was performed to evaluate the prognosis. RESULTS: A larger proportion of ASC patients had lymphovascular space invasion compared with AC patients (<0.01), but no significant differences were observed in the age, FIGO stage, size of tumor, depth of stromal invasion, parametrial invasion, lymphatic metastasis and risk grade between two groups (all >0.05). The 5-year overall survival rates of AC and ASC groups were 79.4% and 78.3%, and the 5-year recurrence-free survival rates were 77.4% and 73.0%. Among patients received concurrent chemoradiotherapy, the 5-year overall survival rates were 71.0% and 61.4%, and the 5-year recurrence-free survival rates were 68.8% abd 61.1%, respectively. No significant differences were observed in 5-year overall survival rates and recurrence-free survival rates between AC and ASC patients (all >0.05). CONCLUSIONS Lymphovascular space invasion was more likely to occur in patients with ASC, but there was no significant difference in the prognosis between AC and ASC patients.
Adenocarcinoma ; diagnosis ; mortality ; Carcinoma, Adenosquamous ; diagnosis ; mortality ; Female ; Humans ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms ; diagnosis ; mortality