Abstract：
Cervical cancer is a preventable disease. Nevertheless, stagnation has been seen in incidence rates also in countries with well-functioning healthcare. On this basis, we investigated associations between control interventions and changes in cervical cancer incidence in Denmark from 2009 to 2022. Data on human papillomavirus (HPV)-vaccination were retrieved from Staten\'s Serum Institute; on screening recommendations from Danish Health Authority, on screening performance from Danish Quality Database for Cervical Screening; and on cervical cancer incidence from Nordcan and Danish Cancer Register. We reported coverage with HPV vaccination (1+ dose); coverage with cervical cell samples; number of women with primary HPV tests; proportion of non-normal cell samples without timely follow-up; number of conizations; and cervical cancer incidence rates. In 2022, all women aged ≤29 had been offered childhood HPV vaccination with coverage of 80%-90%. By 2020-2022, the cervical cancer incidence rate in women aged 20-29 was 3 per 100,000; at level of disease elimination. In 2017, women aged 70+ were offered a one-time HPV screening, and by 2020-2022, the old-age peak in cervical cancer incidence had largely disappeared. From 2009 to 2022, proportion of non-normal cell samples without timely follow-up decreased from 20% to 10%, and conventional cytology was largely replaced by SurePath liquid-based cytology; these factors could explain the steady decrease in cervical cancer incidence rate. Implementation of primary HPV screening in women aged 30-59 in 2021 was reflected in a, probably temporary, increase in the 2022 cervical cancer incidence rate. In conclusion, combined interventions with childhood HPV vaccination; one-time HPV screening of elderly women; and better management of screening broke previous stagnation in cervical cancer incidence rate.
摘要：
宫颈癌是一种可预防的疾病。然而，在医疗保健运作良好的国家，发病率也出现了停滞。在此基础上,我们调查了2009~2022年丹麦对照干预措施与宫颈癌发病率变化之间的关系.有关人乳头瘤病毒（HPV）疫苗接种的数据从Staten血清研究所检索；根据丹麦卫生局的筛查建议，关于丹麦宫颈癌筛查质量数据库的筛查性能；以及Nordcan和丹麦癌症登记处的宫颈癌发病率。我们报告了HPV疫苗接种覆盖率（1+剂量）；宫颈细胞样本覆盖率；初次HPV检测的女性人数；未及时随访的非正常细胞样本比例；锥化次数；和宫颈癌发病率。2022年，所有年龄≤29岁的女性都接受了儿童HPV疫苗接种，覆盖率为80％-90％。到2020-2022年，20-29岁女性的宫颈癌发病率为3/10万；处于疾病消除水平。2017年，70岁以上的女性接受了一次性HPV筛查，到2020-2022年，宫颈癌发病率的老年高峰已基本消失。从2009年到2022年，未及时随访的非正常细胞样本比例从20%下降到10%，SurePath液基细胞学在很大程度上取代了传统细胞学;这些因素可以解释宫颈癌发病率的稳步下降。2021年在30-59岁的女性中实施了初级HPV筛查，可能是暂时的,2022年宫颈癌发病率上升。总之,与儿童HPV疫苗接种相结合的干预措施;对老年妇女进行一次性HPV筛查;以及更好的筛查管理打破了宫颈癌发病率之前的停滞.
