食管癌高发区上消化道癌整体高发对病因及预防的启示

目的：探讨食管癌高发区食管癌和贲门癌集中高发对病因和预防的启示作用。方法：通过分析涉县、林州、阳城、磁县1988年1月至2002年12月年男女性食管、贲门、非贲门胃癌发病率的分布，揭示太行山南部食管癌高发区上消化道癌整体高发的特点，然后根据既往移民研究的结果、亚硝胺类动物诱癌的特点以及表观遗传流行病学和生物进化论的原理，对该地域上消化道癌的病因形成假说，并探讨通过改良饮水进行病因学预防的重要性。结果：涉县、林州、阳城、磁县食管、贲门、非贲门胃癌三者发病率的合计均占全身恶性肿瘤的70%～80%。纯山区的涉县以贲门和非贲门的胃腺癌多见，占上消化道癌60%以上；而山区、丘陵、平原各1/3的磁县以食管鳞癌多见，占70%以上；林州和阳城大部分为山区，食管鳞癌和胃腺癌各占约50%。高发区这种上消化道癌的部位构成随地势变化的现象与亚硝胺类动物诱癌实验的结果相似，可能与不同地势下亚硝胺的种类或丰度的差别有关。亚硝胺可通过先天启动、后天积累、二次促癌，以片起源或多点起源的方式导致上消化道癌整体高发。结论：太行山南部食管癌高发区存在环境致癌因素，在该地域寻找能标定个体风险或早期事件的生物学指标是一个今后应致力研究的方向，但通过先期改良饮水等病因预防措施也许有助于更快地把超额的发病率降低到国外人群的水平。     

光动力学疗法治疗上消化道癌的临床研究

Objective： To evaluate the clinical effectiveness and adverse effects of photodynamic therapy （PDT） for the upper gastrointestinal tract cancers. Methods： 56 patients with upper gastrointestinal cancers in different clinical stages were treated with PDT. Diode laser （630 nm） was used as the light source and the parameters were as follows： power density 200 to 400 mW/cm, energy density 100 to 300 J/cm. PHOTOFRIN was used as photosensitizer, which was given in a dose of 2 mg/kg intravenously 12-24 h before irradiation. Results： Evaluation of the 56 patients＇ therapeutic effectiveness showed that 6 patients （10.7%） had a complete response （CR）, 33 patients （58.9%） partial response （PR）, 12 patients （21.4%） mild response （MR）, and 5 patients （8.9%） no response （NR）. The total response rate （CR＋PR） was 69.6%. No patients had severe adverse effects in this group. Conclusion： PDT is an effective and safe palliative modality for upper gastrointestinal tract cancers.     

乌鲁木齐市40~69岁上消化道癌高危人群内窥镜筛查结果分析

[目的]对2014～2015年度乌鲁木齐市上消化道癌高危人群进行筛查,探讨筛查的依从性、内窥镜和病理活检对上消化道疾病的检出率,以及上消化道癌和癌前病变的早诊率.[方法]在40～69岁乌鲁木齐市居民中,采用问卷调查法筛查出上消化道癌高危人群;经知情同意后,进行内窥镜检查并取活检,对检查结果进行分析.[结果]问卷调查共筛查出上消化道癌高危人群9978人,实际完成筛查1548例,依从性为15.5％;其中,女性依从性(16.4％)高于男性(14.5％),60～69岁年龄组的依从性最高(17.0％),差异有统计学意义(P＜0.05).内窥镜检出胃部病变338例(21.8％),食管病变106例(6.8％).病理检出胃部病变655例(42.3％),食管病变60例(3.9％).上消化道癌及癌前病变检出率为0.26％,早诊率为25％;其中胃癌及癌前病变检出1例,食管癌及癌前病变检出3例.[结论]以问卷调查为基础,结合内窥镜及病理检查,能提高早期发现、早期诊断和早期治疗的比例,降低上消化道癌发病率和死亡率,从而提高患者生活质量,减轻个人和社会经济负担.     

中国4个食管癌高发区上消化道癌的流行现状

[目的]描述我国食管癌高发区食管癌和胃癌亚部位的流行特征,为高发区上消化道癌的病因研究提供依据。[方法]对河北省磁县、涉县、河南省林州和山东省肥城4个食管癌高发区2006~2008年的登记资料进行重新复核,分析食管癌、胃癌的亚部位分布及流行趋势。[结果]4个肿瘤登记处2006~2008年食管癌新发病例7025例,男性4267例(60.7%),女性2758例(39.3%);胃癌新发病例共计5473例,其中男性3778例(69.0%),女性1695例(31.0%)。食管癌亚部位以食管中段较多,共2707例,占38.5%;胃癌亚部位以贲门癌发病为主,共2935例,占全部胃癌新发病例的53.6%。食管癌、胃癌3年的发病变化相对稳定;而亚部位发病中,贲门癌在胃癌中所占的比例逐年升高。[结论]贲门癌在食管癌高发区比例较高,且发病有上升趋势,应加强对高发区贲门癌病因学的研究。肿瘤亚部位提供重要信息,应在肿瘤登记处加强对亚部位的收集。     

上消化道癌家族史发病年龄与食管鳞状上皮癌预后的研究

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Differences of Onset Age and Survival Rates in Esophageal Squamous Cell Carcinoma Cases with and without Family History of Upper Gastrointestinal Cancer from a High-incidence Area in North China

Background Gene expression analyses indicate that there are 152 genes of which the expression differs significantly in esophageal squamous cell carcinoma (ESCC) cases with positive as opposed to those with negative family history of upper gastrointestinal cancer (FHUGIC) in the high-incidence area for ESCC in northern China. However, the question as to whether there is any difference of onset age or survival rates in the familial and sporadic cases of ESCC in the area is unknown.Aims To investigate the differences of onset age or survival rates in the familial and sporadic cases of ESCC for surgically treated ESCC patients from the high-incidence area.Methods Retrospective analyses were performed on the clinicopathologic and survival data of ESCC cases (N = 1715) who had undergone surgery alone from 1985 to 1994 in Hebei Cancer Center, a provincial cancer center established primarily to treat esophageal cancer in the high-incidence area, to investigate the differences. All the patients had been native residents of the high-incidence area in northern China. Student’s t-test was used to test the difference of onset ages, and Cox Proportional Hazard Model was used to examine the differences of survival rates in the familial and sporadic cases of ESCC.Results Although the familial cases of ESCC had had a significantly earlier onset than the sporadic cases (P < 0.00), they experienced relatively lower survival rates than the sporadic cases after surgery. The differences of survival rates in the familial and sporadic cases were significant for patients above the age of 50 years (P _Wald = 0.04) and for the T_{is, 1} N₀M₀ group (P _Wald = 0.04), the differences were bigger for early-staged than for the later-stage groups, and the differences persisted when adjusted for or stratified by confounding factors such as sex, age (under versus above the age of 50 years), smoking, drinking, cancer segment location, surgery year (calendar year), stage (UICC 4th Ed, 1987), and Resection category. Overall, cases under the age of 50 years old showed a higher survival curve than cases above the age of 50 years old, and this was especially true for the familial case group where the difference was significant (P _Wald = 0.03). Conclusion The findings suggest that the familial ESCC may develop earlier, and may have a poorer prognosis than the sporadic ESCC. Both earlier onset and poorer outcome may be important features for the familial as opposed to the sporadic cases of ESCC. The association between younger onset age and higher survival rates found for the familial cases may indicate some survival benefit for early discovery for people with positive FHUGIC in the high-incidence area.This work was partially supported by Grants from Hebei Provincial Natural Scientific Foundation (No. C2005000797), from Hebei Scientific Research (032761100D-1), and from the Key Project of Hebei Province (No.03276198D)     

牙齿缺失与上消化道肿瘤关系前瞻性研究

[目的]探讨牙齿缺失与食管癌、贲门癌、胃癌发病的关系.[方法]采用前瞻性队列的研究方法.研究对象为1986～1991年林州市营养干预试验研究中的普通人群组,随访11年,观察牙齿缺失与食管癌、贲门癌、胃癌发生的关系,资料采用SPPSSl0.0多因素非条件Logistic回归分析.[结果]男性牙齿缺失与食管癌、贲门癌发病有统计学关联,相对危险度(RR)分别为1.265(95%CI=1.115～1.435,P=0.000);1.170(95%CI=1.009～1.356),P=0.037.女性牙齿缺失与胃癌发病有统计学关联,RR值为1.470(95%CI=1.042～2.074),P=0.027.经调整年龄、吸烟、体质指数、家族史等混杂因素后,男性牙齿缺失增加食管癌发病、女性牙齿缺失增加胃癌发病的危险性.牙齿缺失与上消化道肿瘤发病存在剂量-反应关系.[结论]在林州市男性牙齿缺失增加食管癌、贲门癌发病的危险,女性牙齿缺失增加胃癌发病的危险.     

Prognostic Value of PLCE1 Expression in Upper Gastrointestinal Cancer: a Systematic Review and Meta-analysis

Background: A number of studies have identified a shared susceptibility locus in phospholipase C epsilon 1(PLCE1) for esophageal squamous cell carcinoma (ESCC) and gastric cardia adenocarcinomas (GCA). However,the results of PLCE1 expression in esophageal and gastric cancer remain inconsistent and controversial.Moreover, the effects on clinicopathological features remain undetermined. This study aimed to provide aprecise quantification of the association between PLCE1 expression and the risk of ESCC and GCA throughmeta-analysis. Materials and Methods: Eligible studies were identified from PubMed, Wanfang Data, ISI Web ofScience, and the Chinese National Knowledge Infrastructure databases. Using RevMan5.2 software, pooled oddsratios (ORs) with 95% confidence intervals (CIs) were employed to assess the association of PLCE1 expressionwith clinicopathological features relative to ESCC or GCA. Results: Seven articles were identified, including761 esophageal and gastric cancer cases and 457 controls. Overall, we determined that PLCE1 expression wasassociated with tumor progression in both esophageal cancers (pooled OR=5.93; 95%CI=3.86 to 9.11) and gastriccancers (pooled OR=9.73; 95%CI=6.46 to 14.7). Moreover, invasion depth (pooled OR=3.62; 95%CI=2.30 to5.70) and lymph node metastasis (pooled OR=4.21; 95%CI=2.69 to 6.59) were linked with PLCE1 expressionin gastric cancer. However, no significant associations were determined between PLCE1 overexpression andthe histologic grade, invasion depth, and lymph node metastasis in esophageal cancer. Conclusions: Our metaanalysisresults indicated that upregulated PLCE1 is significantly associated with an increased risk of tumorprogression in ESCC and GCA. Therefore, PLCE1 expression can be appropriately regarded as a promisingbiomarker for ESCC and GCA patients.     

Geographic Variation in Cancer Incidence and its Patterns in Urban Maharashtra , 2001

In this paper an attempt has been made to study the geographic variations in cancer incidence and its pattern inUrban Maharashtra. Data collected by Mumbai, Poona, Nagpur, and Aurangabad, Population based CancerRegistries, for the year 2001 have been utilized. The incidence patterns by sex, age, and religion has been comparedbetween these four agglomerations. Besides this childhood cancers and tobacco related cancers for each registry arealso described. Age specific cancer incidence rates show increasing trend with increasing age in all the four populations.The curves for Mumbai, Poona, Nagpur are closed together with fluctuations, indicating similarities in the rise. Inall the four registries, amongst males, cancers of the lung, larynx, oesophagus, tongue and prostate while in femalesbreast, cervix, ovary, oesophagus, mouth and leukemias occupy places in ten leading sites. The praportion of childhoodcancers varies from 1.9% in females in Poona to 4.5% in males in the Nagpur populations. The proportion oftobacco related cancers varies in males from 38.9% in Poona to 54.4% in Aurangabad, where as in females from14.1% in Nagpur to 21.7% in Aurangabad. Considerable variations was observed in the incidence of cancer ofvarious sites in both the sexes, professing different religious faiths within this populations. The findings of this papercan be used to estimate the incidence and prevalence of cancer for future for whole Maharashtra state and studies incancer etiology and control can be planned.     

Spatial Analysis of Esophageal Cancer Mortality in a High-risk Population in China: Consistent Clustering Pattern in 1970-74 and 2011-13

Purpose: Almost half of the global esophageal cancer (EC) deaths occurred in China. This study aims to examinethe geographic spread of EC mortality in two periods in a large Chinese population. Methods: Age-standardizedmortality rates (ASMRs) for 140 county-level units in Shandong Province during the periods 1970-74 and 2011-13were derived using data from the First National Cause-of-Death Survey and the Shandong Death Registration System,respectively. ASMRs were smoothed using Area-to-Area Poisson kriging technique. Spatial scan statistics were used todetect spatial clusters with higher EC mortality and clusters with greater temporal changes in EC mortality. Results:The provincial average ASMR decreased from 13.0 per 100,000 in 1970-74 to 5.8 in 2010-13. Almost all counties ordistricts have experienced a decrease in EC mortality, while the reduction was particularly pronounced in the mid-westregion. This study has identified a geographical cluster with much higher EC mortality rates and the clustering patternhas largely unchanged over the past 40 years. Residents living in the cluster during 1970-74 were 2.7 (95% CI: 2.2-3.4)times more likely to die from EC than the rest of the province. The corresponding risk ratio for the 2011-13 cluster was3.7 (95% CI: 2.8-5.0). Conclusions: This study detected a geographically defined subpopulation in Shandong, Chinawith much higher risk of dying from EC. This spatial pattern has been consistent over the past few decades. The resultssuggest the key drives for geographic variations in esophageal cancer may not have changed.     

Temporal Variations of Dietary Habits in a High-Risk Area for Upper Gastrointestinal Cancers: a Population-Based Study from Northern Iran

Background: Nutrition transition is a global health problem, especially in developing countries. It is knownas an important factor for development of different types of health conditions including cancers. Objectives:We aimed to assess the pattern of nutrition transition in a high-risk area for upper gastrointestinal cancersin Northern Iran during the last decade. Materials and Methods: This cross-sectional study was conductedon households of Golestan province, Iran. Data on household food consumption between 2001 and 2010 wereobtained from the Statistical Center of Iran. The proportions of households with medium/high consumption ofmain foods were calculated for each year. Joint point software was used for assessing trends. Annual percentchanges (APCs) and 95%CIs were calculated. Results: In total, 12,060 households were recruited. The APCs(95%CI) of the proportion of households medium/high consumption of cereals, vegetables, legumes, fish, dairyproducts and meats were -3.1 (-4.1 to -2.2), -2.9 (-3.8 to -2.1), -2.3 (-3.2 to -1.4), -2.8 (-3.3 to -2.4), -1.9 (-3.0 to-0.9) and 2.7 (1.2 to 4.3), respectively. Conclusions: We found significant increase in meat consumption amongour population between 2001 and 2010. Our results also suggested significant decreasing trend in consumptionof so-called healthy foods including, plant foods, fish, and dairy products. Regarding its correlation with healthconditions including cancers, nutrition transition should be considered as a priority in health policy making inour region as well as other high-risk populations. It is recommended to conduct community level interventionsto increase consumption of plant foods, fish, and dairy products.     

乌鲁木齐市部分地区上消化道癌高危人群癌症防治知识水平及影响因素分析

[目的]了解乌鲁木齐市部分地区上消化道癌高危人群对癌症防治知识的知晓情况,并分析其影响因素.[方法]采用面对面问卷调查法,对乌鲁木齐市4个区癌症风险评估系统评估的40～69岁上消化道高危人群进行癌症防治知识的问卷调查,用序次Logistic多因素回归分析癌症防治知识的影响因素.[结果]共调查1150名上消化道癌高危人群,平均年龄(53.31±7.57)岁.上消化道癌高危人群癌症防治知识得分平均为11分.高危人群对癌症早期阶段的知晓率为11.0％.40～49岁组、50～59岁组人群癌症防治知识得分均高于60～69岁组人群(OR=2.312、1.766).大专及以上人群的癌症防治知识得分高于高中/中专、初中、小学及以下文化程度人群(OR=0.511、0.296、0.144),文化程度高是癌症防治得分的保护因素.有肿瘤家族史的人群癌症防治知识得分高于无肿瘤家族史的人群(OR=1.461),有肿瘤家族史是癌症防治得分的保护因素.[结论]上消化道癌高危人群对癌症防治早期阶段的知晓率较低,应着重对年龄较大、文化程度低的人群开展有关癌症防治知识的宣传教育.     

肿瘤标志物GW112在胃癌及结直肠癌等消化道肿瘤中的研究进展

GW112是近年来发现的嗅觉介导素相关蛋白家族的新成员,在神经发育、细胞间黏附、细胞周期调控及肿瘤发生等多种细胞功能中起重要作用。GW112调节肿瘤细胞增殖、凋亡、黏附,并对关键信号转导通路起调控作用。GW112在消化道肿瘤中异常表达,且在早期胃癌及结直肠癌中呈高度特异性表达,提示其可能成为新的早期诊断胃癌及结直肠癌的靶点基因。     

Epidemiological Characteristics and Prediction of Esophageal Cancer Mortality in China from 1991 to 2012

Background: To analyze the mortality distribution of esophageal cancer in China from 1991 to 2012, to forecast the mortality in the future five years, and to provide evidence for prevention and treatment of esophageal cancer. Materials and Methods: Mortality data for esophageal cancer in China from 1991 to 2012 were used to describe its epidemiological characteristics, such as the change of the standardized mortality rate, urban-rural differences, sex and age differences. Trend-surface analysis was used to study the geographical distribution ofthe mortality. Curve estimation, time series, gray modeling, and joinpoint regression were used to predict the mortality for the next five years in the future. Results: In China, the incidence rate of esophageal cancer from 2007 and the mortality rate of esophageal cancer from 2008 increased yearly, with males at 8.72/105 being higher than females, and the countryside at 15.5/105 being higher than in the city. The mortality rate increased from age 45. Geographical analysis showed the mortality rate increased from southern to eastern China, and fromnortheast to central China. Conclusions: The incidence rate and the standardized mortality rate of esophageal cancer are rising. The regional disease control for esophageal cancer should be focused on eastern, central and northern regions China, and the key targets for prevention and treatment are rural men more than 45 years old. The mortality of esophageal cancer will rise in the next five years.     

中国东部与中西部地区恶性肿瘤发病率的比较研究

[目的]描述中国东部和中西部肿瘤登记地区恶性肿瘤发病率水平,比较分析东部与中西部发病率差异。[方法]利用2009年中国72个肿瘤登记处(东部44个,中西部28个)的恶性肿瘤发病及人口数据,按地区、性别和城乡分别计算发病率、标化发病率。运用负二项回归模型,以发病数为应变量,地区分类为自变量(中西部为参照),调整年龄、性别和城乡分类计算恶性肿瘤发病率比值及95%可信区间。[结果]2009年中国东部地区恶性肿瘤发病率、中标率与世标率分别为306.07/10万、149.22/10万和194.60/10万。中西部地区的恶性肿瘤发病率、中标率与世标率分别为231.53/10万、139.64/10万和182.27/10万。东部与中西部前6位主要恶性肿瘤相同,分别为肺癌、胃癌、结直肠癌、肝癌、乳腺癌和食管癌,但顺位略有不同。东部的结直肠癌和乳腺癌发病率和标化率均高于中西部地区,肺癌、胃癌、肝癌和食管癌的发病率高于中西部,标化率低于中西部地区。东部男性恶性肿瘤发病率是中西部的1.13倍,发病率差异最大的前3位恶性肿瘤依次为甲状腺癌、前列腺癌和肾癌,发病率比分别为1.89(95%CI:1.64~2.17)、1.66(95%CI:1.52~1.80)和1.42(95%CI:1.30~1.54)。东部女性恶性肿瘤发病率比为1.19(95%CI:1.08~1.31)。差异最大的前3位恶性肿瘤依次为甲状腺癌、肾癌和淋巴瘤,发病率比分别为1.98(95%CI:1.83~2.15)、1.48(95%CI:1.32~1.66)和1.47(95%CI:1.33~1.62)。[结论]中国东部与中西部地区恶性肿瘤发病率存在明显差异,科学评估恶性肿瘤发病率的地域差异可为肿瘤防治研究提供有价值的信息。     

Time Trend of Upper Gastrointestinal Cancer Incidence in China from 1990 to 2019 and Analysis Using an Age–Period–Cohort Model

The aim of this study was to investigate the upper gastrointestinal cancer incidence trend in China from 1990 to 2019 with Joinpoint software and to evaluate the age effect, cohort effect, and period effect using the age–period–cohort model, with the data obtained from the Global Burden of Disease, Injuries, and Risk Factors Study. The crude incidence rate (CR) of upper gastrointestinal cancer in China increased from 41.48/100,000 in 1990 to 62.64/100,000 in 2019, and the average annual percent change (AAPC) was 1.42 (p < 0.05). The age-standardized incidence rate (ASIR) decreased from 50.77/100,000 to 37.42/100,000, and the AAPC was −1.12 (p < 0.05). The net drift was −0.83 (p < 0.05), and the local drifts in the 35–79 age groups of males and all age groups of females were less than 0 (p < 0.05). The age effect showed that the upper gastrointestinal cancer onset risk gradually increased with age, the period effect was fundamentally manifested as a downward trend in onset risk after 2000, and the cohort effect indicated the decreased onset risk of the overall birth cohort after 1926. The ASIR of upper gastrointestinal cancer in China from 1990 to 2019 showed a downward trend, and the onset risk indicated the age, period, and cohort effects.     

Colorectal Cancer Screening in High-risk Populations: a Survey of Cognition among Medical Professionals in Jiangsu,China

To investigate the cognition of medical professionals when following screening guidelines for colorectal cancer(CRC) and barriers to CRC screening. Between February 2012 and December 2012, an anonymous survey with19-questions based on several CRC screening guidelines was randomly administered to gastroenterologists,oncologists, general surgeons, and general practitioners in Jiangsu, a developed area in China where the incidenceof CRC is relatively high. The average cognitive score was 26.4% among 924 respondents. Gastroenterologistsand oncologists had higher scores compared with others (p<0.01 and p<0.01, respectively); doctor of medicine(M.D.) with or without doctor of philosophy (Ph.D.) or holders with bachelor of medical science (BMS) achievedhigher scores than other lower degree holders (P<0.05). More importantly, doctors who finished CRC relatededucation in the past year achieved higher scores than the others (p<0.001). The most commonly listed barriersto referring high-risk patients for CRC screening were “anxiety about colonoscopy without anesthesia”, “lackof awareness of the current guidelines” and “lack of insurance reimbursement.” Lack of cognition was detectedamong doctors when following CRC screening guidelines for high-risk populations. Educational programs shouldbe recommended to improve their cognition and reduce barriers to CRC screening.     

上消化道出血严重程度与幽门螺旋杆菌感染及胃癌前疾病的相关性研究

目的 探讨幽门螺杆菌(helicobacter pylori,H.P.)感染及胃黏膜癌前病变与上消化道出血严重程度的相关性.方法 收集确诊为消化性溃疡的患者263例,上消化道出血症状的严重程度参考Forrest分级标准进行分级,所有纳入研究的患者均接受胃镜检查判断上消化道出血症状严重程度并取胃黏膜活检检测及碳14呼气试验进行H.P.检测,比较患者的H.P.阳性检出率以及胃癌前疾病与上消化道出血症状严重程度的相关性.结果 上消化道出血症状分级越严重的H.P.检出率越高,Ⅰa组＞Ⅰb组＞Ⅱa组＞Ⅱb组＞Ⅲ组,组间差异具有统计学意义(P＜0.05);上消化道出血症状分级越严重的慢性胃炎伴不典型增生组的发病率明显增高,Ⅰa组＞Ⅰb组＞Ⅱa组＞Ⅱb组＞Ⅲ组,组间差异具有统计学意义(P＜0.05).结论 上消化道出血症状严重程度与H.P.感染及消化性溃疡伴胃黏膜不典型增生具有相关性.     

Spatial and Temporal Analyses of Cervical Cancer Patients in Upper Northern Thailand

Background: Cervical cancer is a major public health problem worldwide. There have been several studies indicating that risk is associated with geographic location and that the incidence of cervical cancer has changed over time. In Thailand, incidence rates have also been found to be different in each region. Methods: Participants were women living or having lived in upper Northern Thailand and subjected to cervical screening at Maharaj Nakorn Chiang Mai Hospital between January 2010 and December 2014. Generalized additive models with Loess smooth curve fitting were applied to estimate the risk of cervical cancer. For the spatial analysis, Google Maps were employed to find the geographical locations of the participants’ addresses. The Quantum Geographic Information System was used to make a map of cervical cancer risk. Two univariate smooths: x equal to the residency duration was used in the temporal analysis of residency duration, and x equal to the calendar year that participants moved to upper Northern Thailand or birth year for participants already living there, were used in the temporal analysis of the earliest year. The spatial-temporal analysis was conducted in the same way as the spatial analysis except that the data were split into overlapping calendar years. Results: In the spatial analysis, the risk of cervical cancer was shown to be highest in the Eastern sector of upper Northern Thailand (p-value <0.001). In the temporal analysis of residency duration, the risk was shown to be steadily increasing (p-value =0.008), and in the temporal analysis of the earliest year, the risk was observed to be steadily decreasing (p-value=0.016). In the spatial-temporal analysis, the risk was stably higher in Chiang Rai and Nan provinces compared to Chiang Mai province. According to the display movement over time, the odds of developing cervical cancer declined in all provinces. Conclusions: The risk of cervical cancer has decreased over time but, in some areas, there is a higher risk than in the major province of Chiang Mai. Therefore, we should promote cervical cancer screening coverage in all areas, especially where access is difficult and/or to women of lower socioeconomic status.