在发展中国家与地区开展子宫颈癌防治的前景

子宫颈癌是危害全世界妇女健康的第二大恶性肿瘤,发展中国家妇女受其危害尤其严重。如何找到适合发展中国家使用的简单、快速、有效并且便宜的筛查方法成为子宫颈癌防治中亟待解决的问题。由于资金和合格的细胞学专业技术人员等方面的短缺,醋酸/碘染色后肉眼观察法(VIA/VILI)是目前WHO推荐在发展中地区子宫颈癌筛查的替代手段。随着子宫颈癌HPV病因关系的揭秘,人类研制出了筛查子宫颈癌的快速检测方法和能够预防子宫颈癌的有效疫苗。子宫颈癌将有望成为人类通过注射疫苗、筛查和早诊早治等综合措施来预防以致消除的第一个恶性肿瘤。     

农村地区醋酸/碘染色法筛查子宫颈癌的3年结果分析

背景与目的:我国至今还没有一个系统的子宫颈癌防治计划,尤其是广大农村地区更缺乏子宫颈癌的防治技术和经验。本研究报道山西省襄垣县子宫颈癌早诊早治示范基地的人群筛查资料,评价基层医生采用醋酸或碘染色法(VIA/VILI)在农村地区筛查子宫颈癌及其癌前病变的效果。方法:采用醋酸染色法(VIA)和碘染色法(VILI)在山西省襄垣县30～59岁的妇女人群中开展子宫颈癌筛查,VIA或VILI阳性者进行阴道镜检查,阴道镜检异常者在病变处取活检进行病理学诊断。采用同样的程序对人群进行复查,通过比较1年筛查、连续2年筛查和连续3年筛查的结果,评价该方案的筛查效果。结果:在2005～2008年期间,有7145名适龄妇女参加了筛查,平均年龄为42.16岁,筛查人群平均参与率为74.75%。其中2005～2007年期间,对1287人连续筛查了3年,第1轮筛查CIN2、CIN3及子宫颈癌的检出率分别为0.70%(9例)、1.01%(13例)、0.23%(3例);第2轮(976人)筛查检出率分别为0.22%(2例)、0.11%(1例)、0;第3轮筛查仅增加了1例CIN2病例。2006～2007年期间对3490人连续筛查了2年,第1轮(3...     

2008年-2010年四省7个筛查点子宫颈癌早诊早治实施情况介绍

在启动“两癌”筛查(子宫颈癌、乳腺癌)重大公共卫生项目前, 我国一直无全国性的、系统的子宫颈癌防治计划, 尤其是广大农村地区更缺乏子宫颈癌的防治技术和经验。2006年卫生部疾病控制局以中央财政转移支付形式在山西襄垣、江西靖安等全国6个高发地区采用肉眼观察法进行子宫颈癌筛查, 2008年始在全国范围内扩大到了43个县市。本研究的实施为之后开始的国家重大公共卫生服务项目“两癌”筛查提供了子宫颈癌筛查方案选择的依据和经验。      

山西襄垣县子宫颈癌及部分妇科疾病的现患率调查

目的：了解山西省襄垣县子宫颈癌、子宫颈癌前病变的患病率以及其他妇科疾病的既往患病状况，从而对当地妇女子宫颈癌的有效防治提供依据。方法：研究属于以人群为基础的大规模的横断面调查研究。结果：癌及癌前病变的患病率分别为子宫颈癌0．27％，CIN3级1．73％，CIN2级2．19％，CIN1级3．85％。正常妇女占受检妇女的91．96％。子宫颈糜烂、慢性炎症和息肉的既往患病率为37．5％，阴道滴虫感染的既往患病率为22．68％。结论：进一步证实了山西襄垣是子宫颈癌的高发地区，同时也是妇科疾病的高发地区。加强对该地区适龄妇女的子宫颈癌防治知识的宣传教育，对子宫颈癌发病的影响因素的控制和建立、组织有力的早诊早治体系刻不容缓。     

我国首批癌症早诊早治示范基地确定

为贯彻落实《中国癌症预防与控制规划纲要(20014—2010)》，卫生部疾病控制司确定了我国首批子宫颈癌和食管癌早诊早治示范基地。食管癌早诊早治示范基地：河南省林州市(河南省林州市食管癌防治研究所、肿瘤医院)，河北省磁县(河北省肿瘤研究所、磁县肿瘤医院)；子宫颈癌早诊早治示范基地：深圳市(深圳市妇幼保健院、北京大学深圳医院、深圳慢性病防治院)，     

杨浦区恶性肿瘤发病生存状况20年分析

杨浦区是上海市人口最多（109万）和地域较大（52km）的一个行政区,也是上海较早开展肿瘤防治工作的地区之一。早在70年代初,这里就开始在工厂和街道建立肿瘤防治网,培训基层肿瘤防治医生,定期在居民中进行防癌健康教育,在工厂开展“常见恶性肿瘤计划防治”,并成立了区级肿瘤防治领导组织和建立了一所以“癌症预防”为中心任务的肿瘤专科医院。最近,上海市肿瘤研究所和杨浦区肿瘤防治院共同对该区20年来肿瘤防治工作进行了总结与分析。1食管癌、子宫颈癌、胃癌标化发病率大幅度下降食管癌、子宫颈癌、胃癌是构成我区肿瘤发病的主要病…     

VIA、VILI在农村宫颈癌筛查中的应用

目的 寻找适合农村地区子宫颈癌及其癌前病变的筛查方法,为降低子宫颈癌的发病率及病死率提供科学方法.方法 以湖北省五峰县（宫颈癌早诊早治项目县之一）长乐坪镇30-59岁的已婚妇女作为对象,进行以人群为基础的子宫颈癌筛查,对符合条件的妇女进行危险因素、癌症及子宫颈癌认知情况的问卷调查,5%醋酸染色后肉眼观察（VIA）和2%的卢戈氏碘染色后肉眼观察（VILI）结果异常者,进行阴道镜下活组织检查并得到最终的病理学诊断,将病变检出率与同年在五峰县其它乡镇的宫颈刮片细胞学筛查结果进行比较.结果 该次筛查人群参与率为70%,最终经活检病理确诊的CINⅠ患病率为0.5%（10例）,CINⅡ0.5%（11例）,CINⅢ1.0%（20例）,子宫颈癌0.1%（2例）;宫颈癌及其癌前病变有年轻化趋势;该次单纯由肉眼观察对CINⅠ、CINⅡ的病变检出率,与同年在当地其它乡镇宫颈刮片细胞学普查结果相当,差别无统计意义,但对≥CINⅢ的病变检出率高于宫颈刮片细胞学筛查结果,有统计学意义.结论 肉眼观察是一种经济有效的宫颈癌筛查方法,适宜在农村地区推广,能使更多贫困地区的妇女及时得到子宫颈癌的早诊早治.     

推进农村地区癌症早诊早治 提高居民健康水平

摘 要：对癌症高危人群实行筛查策略是降低癌症负担的重要方式。为降低农村地区消化道恶性肿瘤负担,我国于2007年启动了一项人群为基础的癌症筛查项目,针对项目地区符合纳入标准的高危人群开展消化道恶性肿瘤的筛查与早诊早治工作。在党中央和各级政府的领导下,农村地区癌症防治体系逐步完善,癌症筛查与早诊早治水平显著提升,居民生活质量也大幅度提升。     

靖安县宫颈癌防治基地的发展

20世纪60～70年代江西省靖安县建立了我国第一个农村宫颈癌防治研究所,其现场防治工作在近30年来取得了一定的成绩。目前作为国家宫颈癌早诊早治示范基地,它将在整合、利用和开发潜在资源,探索筹资模式的转变以及开创多种医疗服务模式方面发挥更大的作用。     

“区域性子宫颈癌早诊早治中心”开展宫颈癌防治的成效

[目的]对宫颈癌早诊早治工作实施有效的管理,探索城市宫颈癌的综合防治方法。[方法]建立＂区域性子宫颈癌早诊早治中心＂,培训宫颈癌专业人员,建设宫颈癌防治队伍,建立宫颈癌筛查点,组建区域性宫颈癌筛查网络,建立阴道镜质量控制体系,对＂区域性子宫颈癌早诊早治中心＂防治宫颈癌进行效果观察。[结果]自建立＂区域性子宫颈癌早诊早治中心＂后,开展机会性筛查及早诊早治人数呈明显上升趋势,妇女健康体检进行宫颈癌筛查增加,筛查率提高到91.49%。网络单位宫颈癌筛查、诊断和治疗人数逐年上升,转诊我院治疗的病人占转诊单位应治病人的20.86%～100.00%,二级核查将初筛的阳性率由11.36%～13.91%降到4.83%～5.26%。[结论]建立＂区域性子宫颈癌早诊早治中心＂可为区域性宫颈癌防治提供技术保障,为本区域妇女提供宫颈癌诊治的优质服务。     

云南省肿瘤登记地区2011—2015年宫颈癌发病和死亡特征及时间趋势

目的 了解云南省肿瘤登记地区2011—2015年宫颈癌的发病和死亡特征及时间趋势,为开展宫颈癌防治提供参考。方法 收集整理2011—2015年云南省肿瘤登记地区宫颈癌(ICD-10编码为C53)的发病死亡病例。分城乡统计宫颈癌的发病率、死亡率、标化发病率、标化死亡率、截缩率、累积率(0~74岁)、趋势变化年度百分比(Annual percentage change,APC)。结果 云南省肿瘤登记地区2011—2015年宫颈癌发病粗率为17.39/10万,中标率为16.41/10万,世标率为12.41/10万,累积率(0~74岁)为1.27%,截缩率为30.28/10万。农村地区发病率为22.54/10万,中标率22.01/10万,城市地区发病率为14.65/10万,中标率13.60/10万。云南省肿瘤登记地区2011—2015年宫颈癌死亡粗率为5.14/10万,中标率为4.68/10万,世标率为3.56/10万,累积率(0~74岁)为0.39%,截缩率为8.87/10万。农村地区死亡率为7.73/10万,中标率7.50/10万,城市地区死亡率为3.77/10万,中标率3.31/10万。年龄别发病率和死亡率均在0~24岁处于较低水平,25岁以后迅速升高。发病率和死亡率的APC分别为-1.4和5,中标发病率和死亡率的APC分别为-29.8和0.1,变化趋势差异均无统计学意义(P＞0.05)。结论 云南省2011—2015年肿瘤登记地区宫颈癌发病/死亡总体高于全国和西部地区水平,农村尤为明显,发病率和死亡率的年度变化无明显上升或下降趋势。应做好宫颈癌,尤其是农村地区的三级预防工作。     

湖北省肿瘤登记地区2012年宫颈癌发病及死亡分析

目的 分析湖北省肿瘤登记地区2012年女性宫颈癌发病及死亡情况。方法 运用描述流行病学研究,对2012年湖北省肿瘤登记地区的宫颈癌发病及死亡资料进行分析,计算城乡之间肿瘤发病率和标化率,并进行比较。结果 2012年湖北省肿瘤登记地区的女性宫颈癌发病率为20.88/105,中标率为14.85/105,世标率为14.54/105,累积率（0~74岁）为1.36%。20岁以上女性宫颈癌各年龄段发病率农村地区高于城市。宫颈癌的死亡率为5.50/105,中标率为3.60/105,世标率为3.75/105,累积率（0~74岁）为0.37%。农村地区死亡粗率、中标率,世标率等均高于城市地区。年龄别死亡率总体呈上升趋势,在80岁组达到死亡率最高峰值（22.48/105）。7个肿瘤登记地区中,死亡率最高的是五峰县,最低是钟祥市,五峰县中标死亡率是钟祥市的11.62倍。结论 湖北省肿瘤登记地区宫颈癌发病农村高于城市,不同地域发病差别较大,应积极开展宫颈癌防治知识的健康教育,同时继续推进宫颈癌高危人群的筛查工作。     

中国子宫颈癌1987-2014年死亡趋势的Joinpoint回归分析

背景与目的:子宫颈癌是女性生殖系统最常见的恶性肿瘤之一,严重威胁着女性的健康.密切掌握中国女性子宫颈癌死亡现况及近30年间的变化趋势,为子宫颈癌的防控策略提供科学依据.方法:汇总1987—2014年中国女性子宫颈癌死亡率数据,描述年龄标化率和截缩率的特征及趋势,利用Joinpoint回归模型估计子宫颈癌死亡率的变化趋势.结果:1987—2014年,农村女性子宫颈癌死亡率整体高于城市,城市及农村年均变化均呈现下降趋势,且农村平均下降速度显著快于城市,城市平均每年下降1.79％(P<0.01),农村平均每年下降3.94％(P<0.01).城乡差距逐渐减小,2010年之后城市截缩率超过农村.城市30～54岁女性子宫颈癌死亡率随年份上升,城市高龄女性及农村30～54岁女性随年份下降.结论:1987—2014年,中国女性子宫颈癌死亡情况整体好转,但城市中青年人群持续上升,城乡高龄人群在近10年也出现明显的上升趋势.     

Cervical Cancer Mortality Trends in China, 1991-2013, and Predictions for the Future

Background: To analyze cervical cancer mortality trends in China from 1991-2013 and forecast the mortalitydistribution in future five years (2014-2018), and provide clues for prevention and treatment. Materials andMethods: Mortality data for cervical cancer in China from 1991 to 2013 were used to describe the epidemiologicalcharacteristics and distribution, including the trend of the standardized mortality rate, urban-rural differences,and age variation. Trend-surface analysis was used to analyze the geographical distribution of mortality. Curveestimation, time series, gray modeling, and joinpoint regression were performed to predict and forecast mortalitytrends. Results: In recent years, the mortality rate of cervical cancer has increased, and there is also a steadyincrease in the incidence from 2003 to 2013 in China. Mortality rates in rural areas are higher than in urbanareas. The mortality dramatically increases in the 40+ yr age group, reaching a peak in the >85 yr age group.In addition, geographical analysis showed that the cervical cancer mortality increased from the southwestto west-central and from the southeast to northeast of the country. Conclusions: The incidence rate and themortality rate are increasing from 1991 to 2013, and the predictions show this will continue in the future. Thus,implementation of prevention and management programs for cervical cancer are necessary in China, especiallyfor rural areas, young women in urban areas, and high risk regions (the west-central).     

2009—2015年甘肃省肿瘤登记地区宫颈癌流行特征及变化趋势分析

目的 分析2009—2015年甘肃省肿瘤登记地区宫颈癌发病与死亡现况及变化趋势,为制定宫颈癌防治策略提供依据。方法 根据全国肿瘤登记中心制定的审核方法,收集甘肃省10个肿瘤登记点上报的2009—2015年宫颈癌数据,计算发病粗率、死亡粗率、中标率及世标率,中标率和世标率分别采用2000年中国标准人口年龄构成和Segi′s世界标准人口年龄构成计算,运用Joinpoint 4.7.0.0软件计算年度变化百分比(APC)。结果 2009—2015年甘肃省肿瘤登记地区宫颈癌新发病例数3 454例,发病粗率为18.75/10万,中标发病率为15.81/10万,世标发病率为15.95/10万,城市地区发病率(18.86/10万)高于农村地区(18.34/10万);死亡病例数2 107例,死亡粗率为11.44/10万,中标死亡率为10.67/10万,世标死亡率为10.81/10万,城市地区死亡率(11.51/10万)高于农村地区(11.18/10万);2009—2015年宫颈癌年龄别发病率及年龄别死亡率随年龄增加而升高,发病率在50-岁年龄组达到高峰(52.64/10万),死亡率在80-岁年龄组达到高峰(47.29/10万);2009—2015年甘肃省宫颈癌发病粗率及死亡粗率呈下降趋势(APC=-0.9,P=0.9;APC=-4.3,P=0.5),趋势变化均无统计学意义。经年龄标化后,宫颈癌中标发病率及中标死亡率呈下降趋势(APC=-5.3,P=0.2;APC=-12.9,P=0.1),趋势变化均无统计学意义。结论 甘肃省宫颈癌发病率及死亡率虽有下降趋势,但仍对中老年女性生命健康构成严重威胁,应积极开展宫颈癌防治知识的健康教育,提倡健康的生活方式,实现对宫颈癌的有效防控。     

Cervical Cancer Screening Among Adult Women in China, 2010

Introduction.

Cervical cancer is one of the most commonly diagnosed cancers among women in China. The World Health Organization (WHO) recommends routine screening for cervical cancer, and the WHO Global Monitoring Framework suggests that every nation monitors cervical cancer screening. However, little information is available on cervical cancer screening behavior among women in China.

Methods.

We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 51,989 women aged 18 years and older. We report the proportion of women who reported ever having had a Papanicolaou (Pap) test, stratified by sociodemographic characteristics and geographic region. Multivariable logistic regression modeling was performed to adjust for potential confounders.

Results.

Overall, 21% of 51,989 women reported having ever had a Pap test. The highest proportion was reported among women aged 30–39 years (30.1%, 95% confidence interval, 26.8%–33.4%). In all geographic regions, women in rural areas were consistently less likely than women in urban areas to report having had a Pap test. Among women who reported ever having a Pap test, 82% reported having the most recent test in the past 3 years. Factors associated with reporting ever having a test were being aged 30–49 years, higher education, being married, and having urban health insurance.

Conclusion.

Our results indicate that screening programs need to be strengthened along with a more intense focus on specific demographic groups. National cervical cancer screening guidelines and comprehensive implementation strategies are needed to make screening services available and accessible to all women.

Implications for Practice:

This study is the largest nationwide and population-based assessment of self-reported history of Pap test for cervical cancer screening in China. This article describes cervical cancer screening behavior among women and examines key demographic and geographic factors. Only one fifth of Chinese women reported having ever had a Pap test for cervical cancer screening. The results highlight the urgent need to develop national cervical cancer screening guidelines and strategies that make screening services widely available, accessible, and acceptable to all women, especially to those who reside in rural areas and those with no health insurance.     

Socio-demographic and behavioural risk factors for cervical cancer and knowledge, attitude and practice in rural and urban areas of North Bengal, India

Background: Cervical cancer is common among women worldwide. A multitude of risk factors aggravatethe disease. This study was conducted to: (1) determine the prevalence and (2) make a comparative analysis ofthe socio-demographic and behavioural risk factors of cervical cancer and knowledge, attitude and practicebetween rural and urban women of North Bengal, India. Study Design: Community-based cross-sectional study.Methods: A survey (first in North Bengal) was conducted among 133 women in a rural area (Kawakhali) and88 women in an urban slum (Shaktigarh) using predesigned semi-structured questionnaires. The respondentswere informed of the causes (including HPV), signs and symptoms, prevention of cervical cancer and treatment,and the procedure of the PAP test and HPV vaccination. Results: The prevalence of risk factors like multiparity,early age of marriage, use of cloth during menstruation, use of condom and OCP, early age of first intercoursewas 37.2%, 82%, 83.3%, 5.4%, 15.8% and 65.6% respectively. Awareness about the cause, signs and symptoms,prevention of cervical cancer, PAP test and HPV vaccination was 3.6%, 6.3%, 3.6%, 9.5% and 14.5% respectively.Chi-square testing revealed that in the study population, significant differential at 5% exists between rural andurban residents with respect to number of children, use of cloth/sanitary napkins, family history of cancer andawareness regarding causes of cervical cancer. Regarding KAP, again using chi-square tests, surprisingly, levelof education is found to be significant for each element of KAP in urban areas in contrast to complete absence ofassociation between education and elements of KAP in rural areas. Conclusions: A large number of risk factorswere present in both areas, the prevalence being higher in the rural areas. The level of awareness and role ofeducation appears to be insignificant determinants in rural compared to urban areas. This pilot study needs tobe followed up by large scale programmes to re-orient awareness campaigns, especially in rural areas.     

Incidence and mortality of colorectal cancer in China, 2011

Objective: Colorectal cancer is the third most common type of cancer and the fourth leading cause of cancer-related death in the world. This article provides the most up-to-date overview of colorectal cancer burden in China.Methods: Totally 234 cancer registries submitted data of 2011 to the National Central Cancer Registry(NCCR). Qualified data from 177 registries was pooled and analyzed. The crude incidence and mortality rates of colorectal cancer were calculated by age, gender and geographic area. The numbers of new cases and deaths were estimated using the 5-year age-specific cancer incidence/mortality rates and the corresponding populations. China census in 2000 and Segi’s world population were applied for age standardized rates.Results: The estimate of new cases diagnosed with colorectal cancer of China in 2011 was 310,244(178,404 for males and 131,840 for females, 195,117 in urban areas and 115,128 in rural areas), accounting for 9.20% of overall new cancer cases. The crude incidence of colorectal cancer ranked fourth in all cancer sites with rate of 23.03/100,000(25.83/100,000 for males and 20.08/100,000 for female, 28.25/100,000 in urban areas and 17.54/100,000 in rural areas). The age-standardized rates by China population and by World population were 16.79/100,000 and 16.52/100,000, respectively. The estimated number of colorectal cancer deaths of China in 2011 was 149,722(86,427 for males and 63,295 for females, 91,682 in urban areas and 58,040 in rural areas), accounting for 7.09% of overall cancer deaths. The crude mortality rate for colorectal cancer ranked fifth leading cause of cancer-related death in all cancer sites with rate of 11.11/100,000(12.51/100,000 for males and 9.64/100,000 for female, 13.27/100,000 in urban areas and 8.84/100,000 in rural areas). The age-standardized rates by China population and by World population for mortality were 7.77/100,000 and 7.66/100,000, respectively. For both of incidence and mortality, the rates of colorectal cancer were much higher in males than in females, and in rural areas than in urban areas. The rate of colorectal cancer increased greatly with age, especially after 40 or 45 years old.Conclusions: Colorectal cancer is a relative common cancer in China, especially for males in urban areas. Targeted prevention and early detection programs should be carried out.