http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Female-Genital-Organ/#cervix
2015年まで、検診は20歳から。2016年から25歳に引き上げ。
上皮内がん
子宮頸がん
上皮内がん 20歳～24歳 1992年から2015年 （最大ピークが2009年）
上皮内がん 15歳～19歳 1992年から2015年 （横軸１９のピークが2006年）
子宮頸がん 20歳～24歳 1992年から2015年 （横軸２５のピークが2012年）
子宮頸がん 15歳～20歳 1992年から2015年 （2004年、2008年、2012年各1人、2011年は10歳～14歳で1人）
スコットランドの接種率 下記の表 1995年生まれ以降は、90%前後と報告されている
例えば、2015年に20歳～24歳になるのは、1995年生まれから1991年生まれ、接種率は90％、80%、70％、70％、50%である。
2010年に20歳～24歳になるのは、1990年生まれから1986年生まれ、接種率は30％、0%、0％、0％、0%である。
ワクチン接種が効果があるなら、2010年以降、子宮頸がんの発症は減少するはずであるが、その傾向はない。
上皮内がんでは、2010年ころからの減少が観察されている。
20歳から24歳の接種率
2010年 6％
2011年 20%
2012年 30%
2013年 44%
2014年 60%
2015年 72%
2016年 80%
2017年 84%
2018年 88%
2019年以降 90%
生年 接種率 24.5歳になる年 20歳になる年
1991年生まれ 50% 2015年 2011年
1992年生まれ 50% 2016年 2012年
1993年生まれ 60% 2017年 2013年
1994年生まれ 70% 2018年 2014年
1995年生まれ 75% 2019年 2015年
1996年生まれ 80% 2020年 2016年
1997年生まれ 85% 2021年 2017年
20歳から24歳の女性の接種率
2010年以前 ０％
2011年 13%
2012年 25%
2013年 40%
2014年 58%
2015年 64%
2016年 70%
2017年 78%
20から24.5歳の子宮頸がん
2010年から2012年 30人
2013年 25人
2014年 20人
2015年 24人
接種している人がほとんどいないと考えられる2010年から2012年の間の発症率が30人
ワクチンが100%有効な場合、64%が接種している2015年の発症率は、30人の（100－64）％で、11人と期待されるが、実際には24人
2015年の24.5歳の50%がワクチンを接種している
24.5歳から25歳の発症率は 2013年と2014年の41人、61人はワクチン接種なし、2015年は50%接種しているが、子宮頸がんの発症は減少していない
https://www.sciencedirect.com/science/article/pii/S0091743517304802#f0010
The age of cervical screening should be reduced
AGAINST: The required evidence does not exist
The age of the first invitation for cervical screening should not be reduced because there is no evidence to justify overturning the decision made by the English Advisory Committee on Cervical screening in 2003, ratified by an extraordinary meeting in 2009 and independently upheld by the UK National Screening Committee in 2012. Moreover, with over 80% of women born since 1995 protected by vaccination against HPV 16 and 18 infection, the burden of disease in women aged 20–24 is due to reduce substantially over the next 4 years. Indeed an argument could be made for raising the age of first screening in those vaccinated at age 11–15 (i.e. starting from 2020).
To re-introduce cervical screening for women aged 20–24 one would need strong evidence that screening at that age is effective in preventing cancer. No such evidence exists. On the contrary, there is sufficient evidence to justify stopping screening in women aged 20–24.
The case against cervical screening in women aged 20–24 is threefold.
- Cytology-based screening is ineffective at preventing cervical cancer in women aged 20–24 (Sasieni et al. BMJ 2009;339:b2968) and there are no data showing that HPV testing would be more effective in this age group.
- Cervical abnormalities are common in this age group and the vast majority would not progress to cancer by age 25 (Sasieni et al. Int J Cancer 2009;124:461–4). Indeed, CIN2 in young women often regresses. Further, although small volume loop excisions of the transformation zone are probably safe, there are strong observational data linking deep (and large volume) excision to increased risk of preterm delivery. Undoubtedly, if the age of cervical screening were lowered, additional young women would deliver prematurely as a result of over-treatment of screen-detected CIN (Castanon et al. BMJ 2014;349:g6223).
- Cervical cancer is rare in women aged 20–24. Even if screening were effective in young women, the incidence of cancer would not justify the (cost and) harms of screening (Landy et al. BJC 2014;110:1841–6).
Recent data (Castanon et al. Br J Cancer 2013;109:35–41) show an increase in stage 1 cervical cancer when women are first screened at age 25, but there is no evidence of an increase in stage 2 or worse cancer. Given the small numbers and the fact that all should be cured by fertility sparing surgery alone, the case for lowering the age of screening is hard to justify, particularly considering the huge impact such a change would have on colposcopy services.
We should not be complacent. In one study, 40% of women aged <25 with symptomatic cervical cancer delayed presentation. Cervical cancer control could be made more effective by: (i) improving HPV vaccination uptake, particularly in ethnic minorities; (ii) using HPV as the primary screening test; (iii) offering self-sampling to improve screening participation among non-attendees; and (iv) using cervical cytology (to rule-in rapid referral) in women (from age 20) with gynaecologic symptoms (Landy et al. Cytopathology 2015; doi: 10.1111/cyt.12259). Lowering the age of screening is not the answer.
Disclosure of interests
Full disclosure of interests available to view online as supporting information.
The age of cervical screening should be reduced
FOR: Invite them all by 25; use clinical judgement rather than refusing them below that age
Should the lower age limit of 25 for cervical screening be reduced? Or is it too late, now that 80% of women aged 20–24 will have been vaccinated by 2016? My answers to these questions are, respectively, yes and no.
- Women aged 20–24 should not be refused screening, although invitations need not start at age 20. Before the intervals were changed in 2003, only 50% accepted invitations by age 25. Invitations at age 23 would allow all women to be screened before 25. Refusing to carry out screening tests before that age is contrary to GP's ‘open access’ for laboratory tests, good clinical practice and the evidence of prevalent cervical cancer and its precursors.
- The indications for screening will be no different for the 20% of women who have not been vaccinated, for many who enter the country from places where vaccination has not been implemented or for lesions caused by non-16/18 HPV.
CIN3 and the less frequent CGIN are the lesions at greatest risk of progression to invasion. CIN3 spreads laterally and into crypts before invasion develops (Tidbury et al. BJOG 1992;99:853–6) at a rate estimated as ~1% per year. The risk of preterm delivery is related to depth of excision (Castanon et al. 2014;349:g6223). Small lesions are more likely to be treated adequately by a <10-mm-deep LLETZ (with no significant risk) than are larger lesions left untreated for several years.
In 2003, 4000 cases of CIN3 (20% of all cases) were detected at age 20–24 and registrations in that age band were increasing. Increases in the same birth cohorts 5 years later (age 25–29) suggest a higher risk of disease in women born since about 1975 (Herbert et al. reply to Castanon et al. Br J Cancer 2013; 109:35–41). Recent figures do not suggest regression of untreated CIN3 in women aged 20–24; rather they suggest rates of progression greater than estimated because registrations of cancer below 30 years of age have increased proportionately more than CIN3 (100% compared with 50%).
The downside of screening women aged 20–24 is the potential unnecessary treatment of CIN2: although progression to CIN3 takes place in 20–25%, around half regress spontaneously (Holowaty et al. 1999. J Natl Cancer Inst 91:252–8; Castle et al. Obstet Gynecol 2009; 113:18–25). Protocols for selective treatment of CIN2 could be implemented, equally relevant at age 25–29, which is the peak age band for CIN3.
Uptake of young women for cervical screening has fallen during the last decade and less than two-thirds of women aged 25-29 are now screened (http://www.hscic.gov.uk/catalogue/PUB15968/cerv-scre-prog-eng-2013-14-rep.pdf). Abandoning the conflicting message that screening is harmful below 25 but essential above that age might help reverse this trend. There is little excuse for cancer developing in a young woman, who may have been sexually active since before the age of consent and who has been refused screening in an overly restrictive programme. Doctors should be allowed to use their clinical judgement when carrying out cervical cytology tests in women below 25 years of age – by which age all women should at least have been invited.
Disclosure of interests
None declared. Completed disclosure of interests form available to view online as supporting information.
イングランドの24歳の女性の人口 約400,000人
25歳になるまえに検診お知らせの手紙を受け取った人 20歳～24歳の子宮頸がん罹患人数 ワクチン接種率
2010年 35,000万人 45人 基準 0%
2011年 36,000万人 43人 13%
2012年 84,000万人 48人 +3 25%
2013年 178,000万人 66人 +21 40%
2014年 190,000万人 82人 +37 58%
2015年 ?万人 73人 +18 64%
