浙江省农村试点地区妇女宫颈癌筛查结果及成本效果分析

摘 要：［目的］ 分析浙江省农村妇女宫颈癌筛查试点项目的筛查结果和成本效果情况。［方法］ 收集2009至2011年浙江省农村4个开展宫颈癌筛查试点地区（嵊州市、武义县、台州市黄岩区、丽水市莲都区）的工作数据以及直接成本,分析筛查结果和成本效果。［结果］ 试点地区完成筛查231 702人,共确诊癌前病变1342例（检出率为579.19/10万）,宫颈癌69例（检出率为29.78/10万）,合计1411例（检出率为608.97/10万）;不同地区合计检出率差异具有统计学意义。此外,还发现56 817例（24.52%）生殖道感染、11 205例（4.84%）子宫肌瘤和11 148例（4.81%）其他良性病变。浙江省农村试点地区宫颈癌筛查成本效果比为18 996.00元/例,早期发现成本系数为0.477。［结论］ 浙江省开展宫颈癌筛查具有较好成本效果,宫颈癌疫苗接种暂不影响现行宫颈癌筛查的必要性。     

新疆维吾尔族妇女宫颈癌筛查方法横断面比较研究

[目的]探讨适合新疆维吾尔族妇女宫颈癌的筛查方法。[方法]于2006～2007年采用整群抽样方法,选择新疆维吾尔族妇女883名,采用自我采样HPV检测,液基细胞学检查,医生采样HPV检测,肉眼筛查(VIA)进行宫颈癌筛查。分析和比较不同筛查方法的灵敏度、特异度、阳性预测值、阴性预测值。[结果]医师采样HPV检测的灵敏度和特异度均为最高(P<0.01),自我采样的灵敏度与细胞学检查相似(P>0.05),但自我采样HPV检测的特异度高于细胞学检查(P<0.01),与医生采样HPV检测相似(P>0.05)。肉眼筛查的灵敏度和特异度为最低。[结论]新疆维吾尔族妇女的宫颈癌筛查方案应首选医生采样HPV检测,自我采样HPV检测是比较适合于新疆民族地区妇女的方案,在偏远和缺少设备的地区,肉眼筛查也是一种可行的筛查方法。     

卫生资源匮乏地区绝经后妇女宫颈癌筛查方法的探讨

目的:探讨适合于卫生资源匮乏地区绝经后妇女的宫颈癌筛查策略.方法:选择已绝经女性405例,所有筛查对象均进行宫颈薄层液基细胞学检测(liquid-based cytology test,LBC)、高危型人乳头瘤病毒DNA检测(high-risk human papilloma virus test,HR-HPV)及P1...     

肉眼观察(VIA、VILI)在中国农村地区宫颈癌筛查中的应用评价

目的评价醋酸、碘着色肉眼观察在中国农村地区宫颈癌筛查中的应用价值及可行性。方法对子宫颈癌高发区江西省修水县大桥乡妇女进行以人群为基础的研究,对2499例年龄为30～49岁农村已婚妇女进行了人乳头瘤病毒(HPV)的检测,薄层液基细胞学(TCT),醋酸、碘染色后肉眼观察(VIA、VILI)以及电子阴道镜检查。各种方法独立进行,均为双盲。对VIA、VILI或电子阴道镜中任何一项存在阳性病变进行宫颈组织活检,或行颈管刮术(ECC),另HPV或TCT阳性的妇女也给予活检。宫颈组织病理诊断均经国际癌症研究所病理检查确诊,将CIN2以上(含CIN2)病变纳入阳性结果。结果2499例受检妇女中有2432例列入研究,共检出CIN237例,CIN359例,宫颈癌3例。HPV,TCT,HPV TCT,VIA,VILI,VIA VILI和阴道镜检查等筛查方法的敏感度分别是96.67%,89.47%,97.98%,56.57%,36.36%,63.64%和39.39%;特异度分别为85.00%,96.91%,86.97%,94.60%,96.23%,92.97%和98.14%。结论VIA、VILI的灵敏度低于HPV或TCT,但因其简单、廉价、易掌握等特点,故更适合在农村地区推广应用。     

河南省新密市2010~2013年农村女性宫颈癌筛查结果分析

摘 要：［目的］ 根据2010～2013年河南省新密市农村地区宫颈癌筛查数据,分析当地女性宫颈癌筛查的参与率,宫颈炎、宫颈癌前病变及宫颈癌的检出率,为当地制定宫颈癌筛查策略提供依据。［方法］ 2010～2013年对新密市35～64岁农村妇女进行宫颈癌筛查,绝经前女性使用醋酸/碘染色肉眼观察法（VIA/VILI）初筛,绝经后女性使用巴氏涂片法初筛。VIA/VILI异常及巴氏涂片结果≥ASC-US者召回行阴道镜检查,并对镜下检查异常处取活检。病理结果为金标准,CIN2及以上妇女转诊进行手术治疗。［结果］ 2010~2013年共筛查115 789名农村女性,总体顺应性为59.50%;VIA/VILI筛查84 762人,阳性率为20.0%;巴氏涂片筛查31 027人,阳性率为4.81%。13 914人进行阴道镜检查,取活检4438例(31.90%)。病理诊断宫颈炎症3830例(3.31%),CIN1 126例(0.11%),CIN2 125例(0.11%),CIN3/原位癌204例(0.18%),宫颈癌67例(0.06%),另发现5例内膜癌(0.004%)、2例外阴癌(0.002%)。［结论］ 2010~2013年新密市CIN2+的整体检出水平较高。农村女性参加筛查的整体顺应性不高,VIA/VILI筛查的假阳性率高,应加强对基层医生技术水平的培训。     

重庆市宫颈癌机会性筛查方法研究

[目的]分析重庆市宫颈癌机会性筛查的基本现状,探索适合重庆市宫颈癌机会性筛查方法。[方法]收集分析2009年重庆市8家医院机会性筛查资料,筛查方法包括液基细胞学、巴氏涂片、HPVDNA检测,以及专家推荐的三种筛查方案,Ⅰ方案：HPV检测和液基细胞学组合;Ⅱ方案：传统巴氏涂片和HPV检测;Ⅲ方案：仅用肉眼观察（醋酸或碘染色法,VIA/VILI）。病理确诊宫颈病变及宫颈癌,并对受检妇女进行流行病学调查。[结果]筛查过程中医生实际使用液基细胞学2390例（64.26%）,Ⅲ方案2300例（61.84%）,巴氏涂片194例（5.22%）,Ⅰ方案103例（2.77%）,Ⅱ方案52例（1.40%）,HPVDNA检测17例（0.46%）,最普遍采用的方法是液基细胞学、肉眼观察。检出CIN217例,检出率为9.68%;宫颈癌22例,检出率为0.98%。对受检妇女进行流行病学调查显示,愿意选择液基细胞学所占比例（69.69%）最高,其次分别为阴道镜（47.26%）、VIA/VILI（40.04%）、巴氏涂片（4.35%）,所占比例最低为HPVDNA（3.54%）,而经济欠发达、文化程度低、年长者、家人未患有肿瘤者更愿意选择传统筛查方法。[结论]不管是筛查过程中医生实际使用,还是受检妇女的选择,均是以细胞学为重庆市宫颈癌的主要检测手段,液基细胞学正逐步被广泛使用;而肉眼观察仍为重庆市经济欠发达地区宫颈癌筛查的另一主要检测手段。     

江西农村人群宫颈癌、乳腺癌和生殖道感染筛查

[目的]调查江西省靖安县农村地区妇女宫颈癌、乳腺癌和生殖道感染（RTI）患病情况,并初步评价农村地区对同一人群多疾病同时筛查的意义及可行性。[方法]对江西省靖安县30～59岁年龄段的妇女整群抽样,并采用宫颈肉眼观察、乳腺临床检查、生殖道临床检查结合实验室检查进行筛查。[结果]进行筛查1767人,纳入研究队列1750人,宫颈癌前病变、乳腺良性疾病和生殖道感染的检出率分别为0.46%、3.03%和29.26%,未检出宫颈癌和乳腺癌。分组统计表明,年龄、受教育程度及家庭收入为,影响因素。[结论]该地区宫颈癌早诊早治的开展已初见成效,但生殖道感染（RTI）的防治效果有待提高。与单一疾病筛查方案相比,对同一人群进行多疾病筛查在节约成本,节省耗时的同时,更加人性化、多方面地预防疾病发生发展,值得在农村地区尝试。     

宫颈癌早期筛查方法研究进展

宫颈癌是严重威胁妇女健康的恶性肿瘤之一。近年来宫颈癌发病率逐年增加,且宫颈癌患者日益年轻化,因此,寻找宫颈癌的早期筛查方法尤为重要。本文主要就目前比较常用的方法和近年出现的新方法加以介绍,包括宫颈细胞涂片形态检测、人乳头瘤病毒检测、阴道镜检测、分子细胞遗传学检测、宫颈癌筛查系统。     

适宜农村地区子宫颈癌筛查方法的研究

目的探索适合宫颈癌高发且经济欠发达地区子宫颈癌及其癌前病变的筛查方法,以最终降低子宫颈癌的发病率和死亡率。方法以山西省襄垣县下良乡35￣55岁的妇女作为对象,进行以人群为基础的宫颈癌筛查。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,用醋酸染色后肉眼观察(VIA)和碘染色后肉眼观察(VILI)进行宫颈检查,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。将该次筛查对不同级别病变的检出率与历年来的襄垣地区的筛查结果进行比较。结果该次筛查人群参与率为74.8%。患宫颈糜烂和滴虫感染的妇女分别占受检人群的48.3%和14.8%。最终经活检病理确诊的CINⅠ的现患率为0.8%(10例)、CINⅡ0.7%(9例)、CINⅢ1.1%(13例)、子宫颈癌0.2%(3例)。该次单纯肉眼观察对CINⅡ和对≥CINⅢ病变的检出率略低于已往当地普查项目,但差别无统计学意义。结论在资源有限,经济不发达的农村地区,由经过培训的医生进行肉眼观察的宫颈癌筛查是可行的,单纯肉眼观察是一种经济有效的筛查方法,建议进一步在农村地区进行推广。     

深圳市龙岗区龙岗街道妇女宫颈癌机会性筛查结果分析

[目的]探讨集中筛查及提高城市妇女宫颈癌筛查顺应性的方法.[方法]回顾和分析深圳市龙岗区龙岗街道计划生育服务中心2009年妇科病普查普治期间参与宫颈癌筛查的672人的资料及结果.[结果]社区妇女参加妇科病普查普治的参与率高,而宫颈癌筛查顺应性较低.6 630人中,有66.51％户籍妇女参与妇科病普查,共计有672人进行...     

Awareness of cervical cancer screening among nursing staff in a tertiary institution of rural India

Objective

To determine the baseline information about the knowledge of cervical cancer and explore attitude and practice of Pap smear screening among staff nurses.

Methods

A pretested structured self administered questionnaire based survey was done on 205 staff nurses working in Rural Institute of Medical Sciences & Research, Saifai, Etawah, containing mostly recognition and some recall type questions about demographics, knowledge about cervical cancer, its risk factors, screening techniques, attitudes towards cervical cancer screening and its practices.

Results

In this study, 74% knew that Pap smear is used for detection of cervical cancer, but only 59% knew that it can detect both cancerous as well as precancerous lesions of the cervix. Only 18% of the respondents knew about human papillomavirus vaccine. A 47% of respondents had never taken a Pap smear; 63% never referred patients for the screening. Most nurses (79%) thought that a speculum examination and Pap smear are procedures to be performed by the doctors. Among all the respondents, only 11% had ever undergone a Pap smear on themselves.

Conclusion

Despite knowledge of the gravity of cervical cancer and prevention by screening, attitudes and practices towards screening were negative.     

醋酸涂抹法在宫颈癌筛查中的应用价值

背景与目的：目前,宫颈癌发病率在我国一些经济落后地区仍较高。原因之一是在这些地区难以开展宫颈细胞学涂片检查宫颈癌的普查工作。本研究通过分析应用醋酸涂抹法检测宫颈上皮内瘤样病变(cervical intraepithelial neoplasia,CIN)及宫颈癌的敏感性和特异性,从而评价其在宫颈癌筛查中的应用价值。方法：对山西省襄垣县年龄为35-45岁的1997名妇女进行宫颈癌普查,首先应用5％醋酸涂抹法,同时对每名妇女均进行高危型人乳头状瘤病毒(human papillomavirua,HPV)DNA的检查、液基细胞学及阴道镜检查,在阴道镜下对病变区或每个正常象限的宫颈鳞柱上皮交界处的2、4、8、10点取活检,并行宫颈管刮出物病检,病理检查结果为金标准。结果：病理检查证实CINⅡ级43例,CINⅢ级31例,宫颈浸润癌12例。2例妇女仅颈管刮出物阳性,其中l例为CINⅡ级,另l例为CINⅢ级。醋酸涂抹法诊断结果为：正常1445例(72．4％),低度病变525例(26．3％),高度病变2l例(1．0％),宫颈癌6例(0．3％)。醋酸涂抹法诊断为低度病变或其以上病变者中,经病理检查证实为CINⅡ级及其以上病变的检出敏感性为70．9％(6l／86),特异性为74．3％(1420／1911),对小病灶的敏感性为64．9％(37／57),而大的病灶达88．9％(24／27)。阴道镜对高度病变的检出率为8l.4％(70／86),特异性为76．5％(1462／1911)。结论：醋酸涂抹法具有较高的特异性和敏感性。对CINⅡ级及其以上病变,醋酸涂抹法和阴道镜检查具有相似的特异性。由于醋酸涂抹法简便、费用低廉,对于经济落后地区不失为宫颈癌筛查中一种有效可行的初筛方法。     

检测尿中巯基筛诊宫颈癌与癌前病变的临床意义

目的：评价检测尿中巯基筛诊宫颈癌前病变、早期宫颈癌、中晚期宫颈癌的临床意义。方法：对1030例宫颈癌前病变、早期宫颈癌、中晚期宫颈癌、非宫颈部位的7种癌以及宫颈正常或宫颈良性炎症妇女,采用子宫颈癌快速自检试剂盒（fast self test—SH for screening cervical cancer,FST—SH）检测其尿中巯基。结果：特异度为94．86％;阳性率、准确度、阳性预测值、阴性预测值、约登指数、阳性似然比,在宫颈癌前病变组为35．71％、87．42％、50．00％、91．11％、0．31、6．95;在早期宫颈癌组为65．87％、87．77％、80．58％、89．78％、0．61、12．82;在中晚期宫颈癌组为80．54％、90．24％、88．17％、91．11％、0．75、15．67：在非宫颈部位的7种癌组为12．41％、60．78％、62．96％、60．59％、0．07、2．41。结论：采用子宫颈癌快速自检试剂盒测定尿中巯基筛诊宫颈癌前病变、早期宫颈癌、中晚期宫颈癌患者,阳性率显著高于非宫颈部位的7种癌（P〈0．01）,且灵敏度随着病情加重而升高（r=0．99,P〈0．05）。根据阳性结果判断为宫颈癌前病变或宫颈癌患者具有较高的准确度和阳性预测值及阳性似然比。根据阴性结果区分为非宫颈癌前病变或宫颈癌患者时具有很高的特异性和阴性预测值。因此,该方法适用于筛诊宫颈癌前病变和宫颈癌,但不适用于筛诊非宫颈部位的7种癌。     

The Korean guideline for cervical cancer screening

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).     

Cost-effectiveness of primary HPV screening for cervical cancer in Germany--a decision analysis

Objectives

To systematically evaluate the long-term effectiveness and cost-effectiveness of HPV-based primary cervical cancer screening in the German health care context using a decision-analysis approach.

Methods

A Markov-model for HPV-infection and cervical cancer was developed for the German health care context, and applied to evaluate various screening strategies that differ by screening interval and test algorithms, including HPV-testing alone or in combination with cytology. German clinical, epidemiological, and economic data, and test accuracy data from international meta-analyses were used. Outcomes predicted included the reduction in cervical cancer cases and deaths, life expectancy and discounted incremental cost-effectiveness ratios (ICER). The analysis was performed from the perspective of the healthcare system adopting a 3% annual discount rate for costs and outcomes. Extensive sensitivity analyses were performed.

Results

HPV-based screening is more effective than cytology alone. It results in a 71-97% reduction in cervical cancer cases as compared to 53-93% for cytology alone. The ICER range from 2600 Euro/LYG (cytology, 5-year-interval) to 155,500 Euro/LYG (annual HPV-testing starting at age 30 years, cytology age 20-29 years). Annual cytology alone, the current recommended screening strategy in Germany, is dominated by HPV-strategies. Increasing the age at screening initiation from 20 to 25 years does not result in a relevant loss in effectiveness but results in lower costs.

Conclusions

Based on our analyses, HPV-based cervical cancer screening is more effective than cytology alone and could be cost-effective if performed at intervals of two years or longer. In the German context, an optimal screening strategy may be biennial HPV screening starting at age 30 years preceded by biennial cytology for women aged 25-29 years. Longer screening intervals may be considered in low-risk women with good screening adherence and in populations with low HPV-incidence.     

Determinants of participation of women in a cervical cancer visual screening trial in rural south India

The efficacy of a single round of screening of visual inspection with acetic acid (VIA) on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in south India. Women aged 30-59 years in 113 clusters in Dindigul District were randomized to VIA screening by nurses (57 clusters, 48,225 eligible women) and to a control group (56 clusters, 30,167 women). 30,577 (63.4%) eligible women participated in screening. Younger, educated, married, multiparous, low-income women and those who have had tubal sterilization had a higher compliance with screening. Of the 2069 women diagnosed with CIN and invasive cancer, 1498 (72.4%) received treatment. Young women, those who practiced contraception and women with high-grade precursor lesions and invasive cancers were more likely to comply with treatment. In summary, our study indicates that women accept screening with VIA by nurses and a moderate level of compliance with screening and treatment can be reached through appropriate service delivery systems including health education activities, personal invitations, clinics in proximity to the target women, and testing and treatment in the same session. Our results imply that integration of screening activities with primary health services seems to have the potential to replicate most of these service delivery conditions in routine programs.     

山西省襄垣县宫颈癌和乳腺癌联合筛查效果初探

目的 通过分析为国家宫颈癌和乳腺癌筛查提供基本评价数据.方法 2009～2010年山西省襄垣县妇幼保健院对该县30～59岁妇女通过醋酸/碘染色后肉眼观察方法开展宫颈癌筛查,阳性者转诊阴道镜,镜下有病变时取活检,以病理诊断为金标准.对35～59岁的妇女开展乳腺癌筛查,以临床检查法为初筛方法,怀疑阳性者通过超声或乳腺X线进行诊断.结果 2009年完成1993名妇女的宫颈癌筛查,其中宫颈上皮内瘤变2级(CIN2)及以上病变的患病率为1.6%,早诊率为100%,第2年复查率为91%,仅查出1例CIN2,未查出更高病变,早诊率达100%.完成1819名妇女的乳腺癌筛查,乳腺良性病变9例(4.02%),良性肿瘤3例(1.34%);2010年完成2026名妇女的乳腺癌筛查,良性病变103例(13.57%),良性肿瘤14例(1.84%),可疑恶性1例.结论 该县宫颈癌的筛查效果明显,乳腺癌筛查仍需加强技术培训.筛查体系和技术队伍建设是基层单位承担农村妇女健康保健服务的关键.