台灣1995至2019年子宮體癌及卵巢癌發生率的年齡-年代-世代分析

Abstract

台灣子宮體癌及卵巢癌年齡標準化發生率的長期趨勢皆快速上升,於最近 25 年間分別增為 5 倍及 2 倍。且分別於 2010 年及 2014 年超過子宮頸癌,成為目前台灣婦科癌症的前兩名。本研究收錄1995 年至 2019 年間被診斷患有原發性子宮體癌及卵巢癌的病例,利用年齡-年代-世代模型分析發生率的年齡,年代,及世代效應。我們發現兩種癌症的發生率在 25 年間迅速上升,子宮體癌年齡標準化發生率平均年百分比增加 6.5 %,卵巢癌則增加 2.8 %。兩種癌症發生率最初隨著年齡的增長而迅速上升,在大約 50 歲時放緩上升速度而趨近平緩,形成一個鉤。年代效應隨年代推進而增加,子宮體癌的增加較卵巢癌快。世代效應方面亦是子宮體癌較卵巢癌大:出生世代從 1915 至 1995,子宮體癌發生率增為百倍,卵巢癌發生率增為 8 倍。本研究首度在子宮體癌與卵巢癌以及其各組織型態(黏液型卵巢癌除外)的發生率年齡效應觀察到與女性乳癌相似的克萊門森鉤。西方化過程可能是此兩婦科癌症發生率隨世代快速增加的原因。

The long-term trends of age-standardized incidence rates of the uterine corpus and ovarian cancers are rapidly increasing by five and twofold in the last 25 years, respectively, in Taiwan. The two cancers surpassed cervical cancer in 2010 and 2014, respectively, and became Taiwan’s first two leading gynecological cancers. We included cases diagnosed with primary uterine corpus and ovarian cancers between 1995 and 2019. We used the age-period-cohort model to analyze the incidence trends for both cancers. We found that the age-standardized incidence rates of both cancers increased rapidly over 25 years, with an average annual percentage change of 6.5 % for uterine corpus cancer and 2.5% for ovarian cancer. The incidence rate of both cancers quickly rosed with age, slowed down at around 50, and showed a hook. The period effect increases with time, and uterine corpus cancer is faster than ovarian cancer. In terms of cohort effect, uterine corpus cancer is also growing faster than ovarian cancer: from 1915 to 1995, the incidence rate of uterine corpus cancer increased by 100 folds, and ovarian cancer increased by eight folds. In this study, we found Clemmesen's hook on the age effect for the uterine corpus and ovarian cancer incidence rates, similar to female breast cancer. It is speculated that the progress of westernization may also be the reason for the rapid incidence increase of these two estrogen-related cancers with the birth cohort effect.