Epidemiological Studies of Cervical Neoplasia in Taiwan

• Main Authors: You, San-Lin, 游山林
• Other Authors: Chen Chien-Jen, Hsieh Chang-Yao
• Format: Others
• Language: zh-TW
• Published: 1997
• Online Access: http://ndltd.ncl.edu.tw/handle/96084780571613560978

博士 === 國立臺灣大學 === 公共衛生學系 === 85 === This dissertation includes four parts to investigate epidemiologiccharacters and risk factors in Taiwan.Ⅰ﹑Cervical cancer incidence and mortality in Taiwan In order to investigate secular trend, age pattern, geographical variation, different cell type incidence, international comparison and migrate study ofcervical cancer, cervical cancer mortality between 1936 and 1995 in Taiwan andcervical cancer incidence between 1979 and 1993 at Taipei city, the cervicalcancer mortality during 1950-1992 and cervical cancer incidence during 1957-1987, WHO, were compared and analyzed. The APC method were also used to investigateage, period, cohort effect. The result of study is that the trend of age adjusted mortality rate ofcervical cancer steadily decrease except the age group upper than 70 years old.The decrease is not obvious in rural area. The cervical cancer mortality by APCmethod, is increased by age and decreased by period and young birth cohort. Thecervical cancer mortality rate in Taiwan, Middle South America and East Europeare all higher than other countries. During 1979-1993, the trend of cervicalinvasive cancer incidence rate had decreased at Taipei city, but the trend ofcarcinoma in situ incidence had increased steadily. The major cause of beinginvasive cancer is squamous cell. Using APC method, in the group who were upperthan 50 years old, the carcinoma in situ incidence rate would be decreased, butincreased by period. The risk of carcinoma in situ is increased in the latebirth cohort. Invasive cancer incidence rate would be increased by age, decreased by period and late birth cohort. The APC method can also prove thatsquamous cell and adenocarcinoma carcinoma are not obviously difference.Invasive cancer incidence rate, in Taiwan, South East Asia and Middle SouthAmerica, are significant higher than other countries. On the other side,Chinese invasive cancer incidence in Asia is higher than in the United States.In the United States, the incidence of Chinese is similar to non- Caucasianpeople.Ⅱ﹑The multiple risk factors case-control study of squamous cell carcinoma and adenocarcinoma of invasive cervical cancer The major target of this study is to investigates multiple risk factors ofsquamous cell carcinoma and adenocarcinoma in cervical cancer. This studyincludes 183 cases who had been confirmed by histologic, 134 cases are squamouscarcinoma and 49 cases are adenoma. 293 community based control cases had beenmatched by residency and age. Squamous cell carcinoma risk is low significantlyby adjusted multiple risk factors which those women had used diagram. Squamouscell carcinoma risk of those women, who had been vaginal delivery many times,had cervicities history, high CLT﹑HSV-2﹑HCMV antibody, is high significantly.Adenocarcinoma risk is significant high by adjusted multiple risk factors whichthose women have high antibody of HSV-2﹑HCMV and had been vaginal delivery manytimes.Ⅲ﹑The multiple risk factors case-control study of Cervical Intraepithelial Neoplasia This study also investigates multiple risk factors of CIN, 54 cases wereconfirmed to be LSIL by histologic, 101 cases were confirmed to be HSIL byhistological, 427 community based control were matched by residence﹑age andscreening time. In Taiwan, the study shows that the major risk factor of CIN isHPV. The HSIL OR of cervical cell HPV DNA positive is 53.1 times, 83% of HSILis attributed to cervical cell HPV DNA positive. The LSIL OR of cervical cellHPV DNA positive is 18 times, 58.1% of LSIL is attributed to cervical cell HPVDNA positive. Those are associated high significantly with HSIL risk byadjusted multiple risk factors, which are Waist/Hip ratio﹑Mycoplasma antibodypositive, different oncogenic HPV type positive. Those are associated highsignificantly with LSIL risk, which IUD were used, cervical cancer familyhistory and different oncogenic HPV type positive. Those have high risk byadjusted multiple risk factors, which are menopause﹑Mycoplasma antibodypositive﹑HCMV antibody positive. Those are associated high significantly withLSIL risk of HPV negative, which are long menstruation, IUD used and cervicalcancer family history. Menopause women have a low HPV positive HSIL risk afterusing multiple risk adjusted; different oncogenic HPV types have a high HPVpositive HSIL risk. HPV positive ISIL risk of menopause women is lower thannon- menopause. High oncogenic HPV type positive has a significant high HPVpositive LSIL risk. Comparing to LSIL and HSIL, they are easy to have high HSILrisk, who are 40-49 years old, Mycoplasma antibody positive, high and mediaoncogenic HPV positive, without taking Pap smear. After adding multiple riskfactors, those have significant HPV DNA positive risk among the control group,menopause﹑first sexual intercourse age. vaginal delivery many times﹑OC used﹑HSV-2 antibody high positive﹑Mycoplasma antibody positive.Ⅳ﹑HLA class 2 and Cervical Intraepithelial Neoplasia association study This study investigates the association between HLA class 2 and CIN. Thisis a case-control study being mentioned above, which are 38 LSIL cases﹑76 HSILcases and 301 control cases. The result is as following : haplotype DRB1*1302*DQA1*0102*DQB1*0604 (OR=4.5, 95%C.I.=1.3-1.5)﹑DRB1*1405*DQA1*0101*DQB1*0503 (OR=4.3, 95%C. I.=1.4-12.6) are significant high HPV DNA positive rate, DRB1*0405 alleles (OR=4.9, 95%C.I.=1.3-17.9)﹑DRB1*1401 alleles (OR=8.2, 95%C.I.=2.1-31.8)﹑DQA1 *0101 alleles (OR=3.6, 95%C. I.=1.3-9.6) and haplotype DRB1*1405*DQA1*0101*DQB1*0503 (OR=10.7, 95%C.I.=3.1-36.5) are significant high HPV 16associated type DNA positive rate. Haplotype DRB1*1101* DQA1*0501*DQB1*0301, (OR=16.6, 95%C.I.=2.8-97.1) is significant high HPV negative HSIL risk,alleles DRB1*DR2 (OR=3.1, 95%C. I.=1.4-6.9) and haplotype DRB1*1401*DQA1*0101*DQB1*0502 (OR=4.7, 95%C.I.=1.0-23.2) are significant high HPV negative LSILrisk.