近日，英国伦敦卫生与热带医学院团队研究了2015年至2018年癌症、宫颈癌和卵巢癌护理模式和初始治疗时间的全球变化（VENUSCANCER）：对39个国家和地区103个基于人口的癌症登记处275792名妇女个人记录的二次分析。该研究于2025年10月22日发表在《柳叶刀》杂志上。

乳腺癌、宫颈癌和卵巢癌是世界范围内的一个主要公共卫生问题。通过使用基于人群的癌症登记处的个人高分辨率数据来评估与临床治疗指南的一致性是一个强有力的帮助工具。VENUSCANCER项目旨在评估被诊断患有这三种常见癌症之一的女性在护理模式和初始治疗时间方面的全球差异。

在这项对基于人群的癌症登记处（VENUSCANCER）匿名个人记录的二次分析中，来自全球39个国家的103个登记处提供了2015-18年期间诊断患有乳腺癌、宫颈癌或卵巢癌的女性的高分辨率数据。高分辨率数据包括诊断时的癌症分期；暂存手续；肿瘤分级；生物标志物（ER、PR和HER2）；每种治疗方式（手术、放疗、化疗、内分泌治疗或抗HER2治疗）的第一个疗程及相关日期。研究组按国家或地区检查了预后因素、与国际临床治疗指南（ESMO、ASCO和NCCN）一致性的关键指标以及诊断和治疗之间的中位时间。还分析了高收入国家（HICs）和低收入和中等收入国家（LMICs）中接受符合指南治疗的妇女的几率，控制了年龄和肿瘤亚型。

研究组收到了275792名被诊断患有乳腺癌的女性的匿名个人记录(214111例[77.6%])，宫颈(44468[16.1%]，包括原位)，或卵巢（17.1%）。213(6·2%))。在高收入国家，早期淋巴结阴性癌症占乳腺癌和宫颈癌的40%以上，但不到卵巢癌的20%。相比之下，在中低收入国家，这三种癌症的比例普遍低于20%，但在古巴（乳腺癌为30%）和俄罗斯（宫颈癌为36%，卵巢癌为27%）较高。与主要国际指南的一致性差异很大，特别是早期乳腺癌的手术和放疗（从格鲁吉亚的13%到法国的82%），晚期宫颈癌的化疗（从蒙古的18%到加拿大的90%），以及转移性卵巢癌的手术加化疗（从古巴的9%到美国的53%）。

高收入国家中78%的妇女和低收入国家中56%的妇女接受了某种类型的手术，但与乳腺癌相比，宫颈癌和卵巢癌更统一地遵循符合早期肿瘤临床指南的初始治疗。在高收入国家和中低收入国家中，老年妇女（70-99岁）接受符合临床指南的初始治疗的几率低于50-69岁妇女。在一些高收入国家，早期癌症的诊断和治疗之间的中位时间不到1个月，但蒙古的宫颈癌和厄瓜多尔的卵巢癌长达4个月，蒙古的乳腺癌长达1年。

研究结果表明，VENUSCANCER项目首次提供了女性三种最常见癌症的全球护理模式。这些发现提供了重要的现实证据，支持实施和监测癌症控制全球倡议，如世界卫生组织的全球癌症倡议和癌症消除倡议。尽管在LMIC中，被诊断为早期肿瘤的女性更容易获得符合指南的治疗，但这些女性早期诊断的比例仍然太低。

附：英文原文

Title: Global variation in patterns of care and time to initial treatment for breast, cervical, and ovarian cancer from 2015 to 2018 (VENUSCANCER): a secondary analysis of individual records for 275792 women from 103 population-based cancer registries in 39 countries and territories

Author: Claudia Allemani, Pamela Minicozzi, Bozena Morawski, Carlos A Lima, Damien Bennett, Donsuk Pongnikorn, Dafina Petrova, Kaire Innos, Fabio Girardi, Yaima Galán Alvarez, Robin Schaffar, Luigino Dal Maso, Florence Molinié, Mikhail Valkov, Karen Phillips, Sabine Siesling, Annemarie Schultz, Laetitia Daubisse-Marliac, Rafael Marcos-Gragera, Veronica Di Carlo

Issue&Volume: 2025-10-22

Abstract:

Background

Cancers of the breast, cervix, and ovary are a major public health problem worldwide. Evaluating the consistency with clinical guidelines for treatment by use of individual high-resolution data from population-based cancer registries is a powerful tool to help interpretation of global inequalities in cancer survival. The VENUSCANCER project aims to assess the worldwide variation in patterns of care and time to initial treatment for women diagnosed with one of these three common cancers.

Methods

In this secondary analysis of anonymised individual records from population-based cancer registries (VENUSCANCER), 103 registries from 39 countries worldwide contributed high-resolution data for women diagnosed with cancer of the breast, cervix, or ovary for a single year of incidence during 2015–18. High-resolution data included cancer stage at diagnosis; staging procedures; tumour grade; biomarkers (ER, PR, and HER2); and the first course of each treatment modality (surgery, radiotherapy, chemotherapy, endocrine treatment, or anti-HER2 therapy) and related dates. We examined prognostic factors, key indicators of consistency with international clinical guidelines for treatment (ESMO, ASCO, and NCCN), and median time between diagnosis and treatment, by country or territory. We analysed the odds of women receiving treatment consistent with guidelines in high-income countries (HICs) and low-income and middle-income countries (LMICs), controlling for age and tumour subtype.

Findings

We received 275792 anonymised individual records for women diagnosed with a cancer of the breast (214111 [77·6%]), cervix (44468 [16·1%], including in situ), or ovary (17213 [6·2%]). In HICs, early-stage, node-negative cancers comprised over 40% of breast and cervical cancers, but less than 20% of ovarian cancers. By contrast, in LMICs, these proportions were generally below 20% for all three cancers, but higher in Cuba (30% for breast), and Russia (36% for cervix and 27% for ovary). Consistency with main international guidelines was highly variable, particularly for surgery and radiotherapy in early-stage breast cancer (from 13% in Georgia to 82% in France), chemotherapy in advanced cervical cancer (from 18% in Mongolia to 90% in Canada), and surgery plus chemotherapy in metastatic ovarian cancer (from 9% in Cuba to 53% in the USA). Some type of surgery was offered to 78% of women in HICs and 56% of women in LMICs, but initial treatment that is consistent with clinical guidelines for early-stage tumours was followed more uniformly for cervical and ovarian cancer than for breast cancer. Older women (aged 70–99 years) had lower odds of receiving initial treatment consistent with clinical guidelines than women aged 50–69 years in both HICs and LMICs. The median time between diagnosis and treatment for early-stage cancers was less than 1 month in several HICs, but up to 4 months for cervical cancer in Mongolia and ovarian cancer in Ecuador, and up to 1 year for breast cancer in Mongolia.

Interpretation

The VENUSCANCER project provides the first global picture of patterns of care for three of the most common cancers in women. These findings offer crucial real-world evidence to support the implementation and monitoring of global initiatives on cancer control such as WHO's Global Breast Cancer Initiative and Cervical Cancer Elimination Initiative. Although guideline-consistent treatment has become more accessible for women diagnosed with early-stage tumours in LMICs, the proportion of these women diagnosed early remains far too low.

DOI: 10.1016/S0140-6736(25)01383-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01383-2/abstract