Risk of Invasive Cervical Cancer Among Immigrants in Ontario, Canada

Cervical neoplasia in relation to socioeconomic and demographic factors - a nationwide cohort study (2002-2018)

INTRODUCTION

Cervical cancer is a major cause of mortality and morbidity. We aimed to estimate the association between sociodemographic factors and cervical neoplasia.

MATERIAL AND METHODS

In this Swedish nationwide open cohort study, 4 120 557 women aged ≥15 years at baseline were included between January 1, 2002 and December 31, 2018. The two outcomes were cervical cancer and carcinoma in situ identified in the Swedish Cancer Register. Sociodemographic factors (age, education level, family income level, region of residency, country of origin) were the main predictors. Incidence rates per 10 000 person-years were calculated. Cox regression was used to estimate hazard ratios. Sensitivity analyses were conducted, including parity, urogenital infections, alcohol- and drug-use disorders, and chronic obstructive pulmonary disease (used as a proxy for tobacco abuse).

RESULTS

In 38.9 million person-years of follow-up, 5781 (incidence rate: 1.5, 95% confidence interval [CI] 1.4-1.5) and 62 249 (incidence rate 16.9, 95% CI 15.9-16.1) women were diagnosed with cervical cancer and carcinoma in situ, respectively. Women from Eastern Europe had a hazard ratio of 1.18 (95% CI 1.05-1.33) for cervical cancer compared with Swedish-born women, while women from non-Western regions were inversely associated with cervical cancer and carcinoma in situ. Women with a low education level had a hazard ratio of 1.37 (95% CI 1.29-1.45) for cervical cancer compared with women with a high education level.

CONCLUSIONS

Women from the Middle East and Africa living in Sweden seem to suffer less from cervical neoplasia, whereas women with low education and women from Eastern Europe seem to suffer more from cervical cancer.

Cancer Incidence in Migrants in Australia: Patterns of Three Infection-Related Cancers

BACKGROUND

Australia provides an ideal population-base for cancer migration studies because of its multicultural society and high-quality cancer registrations. Among migrant groups there is considerable variability in the incidence of infection-related cancers; thus, the patterns of three such cancers were examined among migrant groups relative to Australian-born residents.

METHODS

Using national incidence data for cancers of the stomach, liver, and cervix diagnosed during 2005 to 2014, incidence rates were compared for selected migrant groups with the Australian-born population using incidence rate ratios (IRR), from a negative binomial regression model.

RESULTS

Wide variations in incidence between countries/regions of birth were observed for all three cancers (P < 0.0001). The patterns were similar for cancers of the stomach and liver, in that migrants from countries/regions with higher incidence rates maintained an increased risk in Australia, with the highest being among South American migrants (IRR = 2.35) for stomach cancer and among Vietnamese migrants (5.44) for liver cancer. In contrast, incidence rates of cervical cancer were lower for many migrant groups, with women from Southern Asia (0.39) and North Africa (0.42) having the lowest rates. The rate of cervical cancer was higher in migrants from New Zealand, Philippines, and Polynesia.

CONCLUSIONS

Several Australian migrant groups were found to experience a disproportionate burden of infection-related cancers; further studies of associated risk factors may inform the design of effective interventions to mediate these disparities.

IMPACT

By identifying these migrant groups, it is hoped that these results will motivate and inform prevention or early detection activities for these migrant groups. See related commentary Dee and Gomez, p. 1251.

Cervical cancer incidence by ethnic group in Scotland from 2008 to 2017: A population-based study

BACKGROUND

There is limited information on cervical cancer incidence among different ethnic groups. This study used a name classification system to describe recent patterns of cervical cancer by ethnic group in Scotland.

METHODS

Data on incident cases of cancer of the cervix and carcinoma in situ diagnosed in Scotland from 2008 to 2017 were extracted from the Scottish Cancer Registry. Onomap was applied to ascribe ethnicity to each patient. Ethnic groups were categorised as White, Black, South-Asian, Chinese and Other. Age-standardised rates (ASRs) were calculated for each year, as well as cumulatively for the 10-year time period.

RESULTS

The Cumulative Age-standardised rate (CASR) of invasive cancer was 2.45 times higher in the White ethnic group (CASR 125.45 (95% CI 121.2-129.8) per 1,00,000) compared to the non-white ethnic groups combined (CASR 51.16 (95% CI 31.05-77.36) per 1,00,000). The highest age-specific rates within the White patients were in the 30-34 age group (18.34 per 1,00,000), whereas the highest age specific rates for the non-white patients were in the 60-64 age group (9.59 per 1,00,000).

CONCLUSION

Ethnic minority populations in Scotland had lower incidence of cervical cancer compared to the White population between 2008 and 2017.