ImportanceThe World Health Organization has called for eliminating cervical cancer as a public health problem. Accurate and up-to-date estimates of population-based cervical cancer incidence are essential for monitoring progress toward elimination and informing local cancer control strategies, but these estimates are lacking for the US-Affiliated Pacific Islands (USAPI).ObjectiveTo calculate age-standardized incidence rates for cervical cancer in the 6 USAPI and compare these rates with rates in the US (50 states and the District of Columbia).Design, Setting, and ParticipantsThis cross-sectional study used population-based data from the Pacific Regional Central Cancer Registry for women aged 20 years or older who were diagnosed with invasive cervical cancer from January 1, 2007, to December 31, 2020. The registry comprises data on all cervical cancers from the USAPI, which include 3 US territories (American Samoa, Commonwealth of the Northern Mariana Islands, and Guam) and 3 freely associated states (Federated States of Micronesia [FSM], Republic of the Marshall Islands [RMI], and Republic of Palau). Data were analyzed from July 10, 2023, to November 28, 2023.Main Outcomes and MeasuresThe main outcome was age-standardized cervical cancer incidence rates, stratified by age, stage, and histologic code for the USAPI using population estimates from 3 different sources (US Census Bureau International Database, United Nations Population Division, and Pacific Data Hub). Rate ratios were calculated to compare incidence rates between the USAPI and the US.ResultsFrom 2007 to 2020, 409 cases of cervical cancer were diagnosed in the USAPI (median age at diagnosis, 46.0 years [25th-75th percentile, 39.0-55.0 years]), with an age-standardized incidence rate ranging from 21.7 (95% CI, 19.6-23.9) to 22.1 (95% CI, 20.0-24.4) per 100 000 women, depending on the population estimate. Incidence rates were highest in RMI, ranging from 58.1 (95% CI, 48.0-69.7) to 83.4 (95% CI, 68.3-101.0) per 100 000 women, followed by FSM, ranging from 28.7 (95% CI, 23.4-34.9) to 29.8 (95% CI, 24.3-36.3) per 100 000 women. Compared with the US, incidence rates were highest in RMI (rate ratio, 5.7 [95% CI, 4.7-6.8] to 8.2 [95% CI, 6.7-9.9]) and FSM (rate ratio; 2.8; 95% CI, 2.3-3.4). Of all cases in the USAPI, 213 (68.2%) were diagnosed at a late stage.Conclusions and RelevanceIn this cross-sectional study, cervical cancer remained a major public health issue in some USAPI, with RMI reporting the highest incidence rates. The findings suggest that improvements in human papillomavirus vaccination and cancer screening coverage through efforts tailored to the unique geographic, sociocultural, economic, and health care landscape of the USAPI may reduce the burden of cervical cancer.

中文翻译：

---

美国附属太平洋岛屿的宫颈癌发病率


重要性世界卫生组织呼吁消除宫颈癌这一公共卫生问题。基于人群的宫颈癌发病率的准确和最新估计对于监测消除进展和为当地癌症控制策略提供信息至关重要，但美国附属太平洋岛屿 （USAPI） 缺乏这些估计。目的计算 6 个 USAPI 的宫颈癌年龄标化发病率，并将这些发病率与美国 （50 个州和哥伦比亚特区） 的发病率进行比较。设计、设置和参与者这项横断面研究使用了太平洋地区中心癌症登记处的基于人群的数据，这些数据适用于 2007 年 1 月 1 日至 2020 年 12 月 31 日期间被诊断患有浸润性宫颈癌的 20 岁或以上的女性。该登记处包括来自 USAPI 的所有宫颈癌数据，其中包括 3 个美国领土（美属萨摩亚、北马里亚纳群岛联邦和关岛）和 3 个自由联系国家（密克罗尼西亚联邦 [FSM]、马绍尔群岛共和国 [RMI] 和帕劳共和国）。主要结果和措施主要结果是年龄标准化宫颈癌发病率，使用来自 3 个不同来源（美国人口普查局国际数据库、联合国人口司和太平洋数据中心）的人口估计，按年龄、分期和 USAPI 的组织学代码分层。计算比率以比较 USAPI 和美国之间的发病率。结果从 2007 年到 2020 年，USAPI 诊断出 409 例宫颈癌 （诊断时中位年龄为 46.0 岁 [第 25-75 个百分位，39.0-55.0 岁]），年龄标化发病率为 21 岁。每 100 000 名女性中有 7 例（95% CI，19.6-23.9）至 22.1（95% CI，20.0-24.4），具体取决于人口估计。RMI 的发病率最高，范围为每 100 000 名女性 58.1 （95% CI，48.0-69.7） 至 83.4 （95% CI，68.3-101.0），其次是 FSM，范围为每 100 000 名女性 28.7 （95% CI，23.4-34.9） 至 29.8 （95% CI，24.3-36.3）。与美国相比，RMI （率比，5.7 [95% CI，4.7-6.8] 至 8.2 [95% CI，6.7-9.9]）和 FSM （率比;2.8;95% CI，2.3-3.4） 的发病率最高。在 USAPI 的所有病例中，有 213 例 （68.2%） 是在晚期诊断的。结论和相关性在这项横断面研究中，宫颈癌仍然是一些 USAPI 的主要公共卫生问题，其中 RMI 报告的发病率最高。研究结果表明，通过针对 USAPI 独特的地理、社会文化、经济和医疗保健景观量身定制的努力，提高人瘤病毒疫苗接种和癌症筛查覆盖率，可能会减轻宫颈癌的负担。