Wen-Chung Lee

Emerging trends in cervical cancer incidence among younger Taiwanese generations: an urban–rural comparison

Despite global declines in cervical cancer incidence, certain regions observe unexpected rising trends among younger generations. This study uses the age-period-cohort model to examine long-term incidence trends of invasive cervical cancer in Taiwan. Data were sourced from the Taiwan Cancer Registry. From 2000 to 2019, both urban and rural areas of Taiwan saw a marked decrease in incidence rates, a trend largely attributed to the cytology-based screening program introduced in 1995. Yet, rising incidence rates emerged in younger Taiwanese generations, specifically those born post-1975 in urban and post-1980 in rural settings. The 1990-born urban cohort faced a risk 1.9 times higher than their 1975-born counterparts, while the risk for the 1990-born rural cohort was 1.4 times greater than those born in 1980. In addition, post-1980 urban cohorts exhibited greater risks than their rural counterparts. The rising trends in cervical cancer incidence among younger Taiwanese generations may be influenced by factors such as increased sexual permissiveness and urbanization. Although current prevention efforts, such as human papillomavirus vaccination, are noteworthy, there is a need for ongoing surveillance and improved strategies that specifically target recent cohorts.

Association between screening history and prognosis of cervical carcinoma in situ and invasive cervical cancer: A population-based cohort study

Cervical cancer remains a significant public health challenge worldwide. This study examines the impact of screening history on the prognosis of cervical carcinoma in situ and invasive cervical cancer among Taiwanese women. Data from the National Cervical Cancer Screening Registry and Taiwan Cancer Registry were analyzed, encompassing 13,552 cases of cervical carcinoma in situ and 6853 cases of invasive cervical cancer diagnosed between 2009 and 2013. The study examined the relationship between screening history and five-year cumulative probability of death using the Kaplan-Meier method and Cox regression model, adjusting for factors like age, cancer stage, histological type, urbanization level, and treatment received. Screening history was an independent prognostic factor for both invasive cervical cancer and cervical carcinoma in situ, even after adjusting for key confounders. Compared to patients diagnosed within six months of a positive screening result, those diagnosed later or with a negative screening had higher post-diagnosis mortality (adjusted hazard ratios [95 % confidence interval]: 1.42 [1.26-1.59] for invasive cervical cancer and 1.74 [0.52-5.83] for cervical carcinoma in situ), while never-screened patients had even higher mortality (1.61 [1.42-1.81] for invasive cervical cancer and 5.62 [1.29-24.51] for cervical carcinoma in situ). More advanced age at diagnosis, certain histological types, and living in less urbanized areas correlated with an increased risk of post-diagnosis death. Additionally, the absence of treatment post-diagnosis was significantly associated with worse outcomes. Screening history is a crucial independent prognostic factor for cervical carcinoma in situ and invasive cervical cancer. Patients with a recent positive screening result have a markedly better prognosis than those diagnosed later, those with negative screenings, or unscreened individuals. This study emphasizes the importance of regular and timely cervical cancer screenings in improving prognosis and underscores the need to enhance awareness and accessibility of screening programs.

The association of different body weight classes and survival outcomes in patients with cervical cancer

The relationship between different weight class and mortality risk remained uncertain in cervical cancer patients. Thus, we conducted the study to assess the association between different body weight classes and survival outcomes in patients with cervical cancer. This was a retrospective cohort study including 6908 cervical cancer patients from the Taiwan Cancer Registry database. A COX regression model was used to evaluate the relationship between different weight classes and time-to-event outcomes of overall survival and cancer-specific survival at three years. The median follow-up time was 4.64 ± 2.55 years. Our study revealed that the underweight group had a significantly higher risk of overall death [hazard ratio (HR) = 1.65, 95 % confidence interval (CI) = 1.37, 1.99] than the normal-weight group. Overweight patients had a significantly lower risk of overall death (HR = 0.81, 95 % CI = 0.71, 0.93), whereas the obesity group had an insignificant lower risk of overall death (HR = 0.92, 95 % CI = 0.75, 1.13) compared with the reference group. After controlling for confounding factors, underweight patients with cervical cancer had a higher risk of overall death than normal-weight patients with cervical cancer. Our study indicates that underweight cervical cancer patients had a higher risk of overall death compared with normal-weight cervical cancer patients. Furthermore, the overweight patients had a significantly lower risk of overall death. More strategies are needed to be addressed especially in public health field regarding women's weight class and cancer mortality issues.

Projected Time for the Elimination of Cervical Cancer Under Various Intervention Scenarios: Age-Period-Cohort Macrosimulation Study

Background The World Health Organization aims for the global elimination of cervical cancer, necessitating modeling studies to forecast long-term outcomes. Objective This paper introduces a macrosimulation framework using age-period-cohort modeling and population attributable fractions to predict the timeline for eliminating cervical cancer in Taiwan. Methods Data for cervical cancer cases from 1997 to 2016 were obtained from the Taiwan Cancer Registry. Future incidence rates under the current approach and various intervention strategies, such as scaled-up screening (cytology based or human papillomavirus [HPV] based) and HPV vaccination, were projected. Results Our projections indicate that Taiwan could eliminate cervical cancer by 2050 with either 70% compliance in cytology-based or HPV-based screening or 90% HPV vaccination coverage. The years projected for elimination are 2047 and 2035 for cytology-based and HPV-based screening, respectively; 2050 for vaccination alone; and 2038 and 2033 for combined screening and vaccination approaches. Conclusions The age-period-cohort macrosimulation framework offers a valuable policy analysis tool for cervical cancer control. Our findings can inform strategies in other high-incidence countries, serving as a benchmark for global efforts to eliminate the disease.