Age‐period‐cohort analysis of cervical cancer mortality in Taiwan, 1974‐1992

OBJECTIVES: To develop a hypothesis about the carcinogenesis of cervical cancer from a descriptive analysis. METHODS: The mortality data of cervical cancer were analyzed over the period from 1974 to 1992 among Taiwanese women using a log-linear Poisson model modified from the method of Osmond and Gardner to examine the effects of age, calendar period of death, and birth cohort on cervical cancer mortality. RESULTS: This age-period-cohort model provides a summary guide for interpretation of cancer mortality trends. According to this model, age was found to be the strongest factor predicting cervical cancer mortality. Women in 50-54 age group have 89.3-fold risk of cervical cancer compared to those in the 30-34 age group. The cohort effect is also of particular interest because the generation at greatest risk for cervical cancer is the one born between 1893 and 1938, and a dramatically declining trend is observed thereafter for 1938-1963 birth cohort. Interest has emerged about the increasing trend in recent cohorts (after 1963 birth cohort). However calendar time only has a slight effect in the APC analysis. The model also identified a possible role of female sex hormones as the age effect, promiscuous sexual activity as the period effect (promoter) and the change in reproductive behavior as the cohort effect (initiator). CONCLUSIONS: These results may help to develop a hypothesis of carcinogenesis of cervical cancer in Taiwan.