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。     

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.     

山西省农村妇女宫颈癌筛查结果分析

[目的]评价2014年山西省农村妇女宫颈癌检查结果,探讨宫颈癌流行趋势与特点,为进一步推进宫颈癌筛查工作提供科学依据.[方法]回顾性分析2014年宫颈癌筛查项目35～64岁农村已婚妇女的筛查数据资料.[结果]2014年共计完成408 618例农村妇女的免费宫颈癌筛查,检出宫颈癌前病变721人,检出率为176.44/10万;检出宫颈癌215人,检出率为52.62/10万.[结论]进行育龄妇女人群的健康教育,加强高危人群管理,重点培训参加宫颈癌筛查的基层医师,是提高宫颈癌早诊早治的关键.     

2012—2017年山西省农村妇女宫颈癌筛查结果分析

摘 要：［目的］ 分析山西省2012—2017年两个周期宫颈癌检查项目的筛查结果,评价项目实施情况及工作质量。［方法］ 收集山西省2012—2014年（第2周期）与2015—2017年（第3周期）115个项目县（区）、筛查人数2 587 229人次的宫颈癌筛查项目数据;采用χ2检验比较第2周期和第3周期不同宫颈癌初筛方法阳性病例检出情况,以及进一步检查后宫颈癌前病变、宫颈癌等检出情况。［结果］ 在第2、3周期项目实施中,运用宫颈细胞学进行初筛的比例逐年上升,由第2周期的30.54%上升到第3周期的65.40%;细胞学初筛阳性率提高,由第2周期的4.2%上升到第3周期的4.8%;阴道镜检查异常率提高,由第2周期的39.64%上升到第3周期的44.33%;组织病理学检查异常率提高,由第2周期的18.99%上升到第3周期的32.11%;χ2值分别为1455.13、278.23、1154.15（Ｐ均＜0.001）。宫颈癌前病变检出率由第2周期的156.44/10万增至第3周期的283.15/10万,宫颈癌检出率由第2周期的47.83/10万增至第3周期的54.52/10万,早期诊断率由第2周期的83.83%增至第3周期的87.63%。［结论］ 山西省宫颈癌筛查方案在2012—2017年2个周期中逐步优化,筛查的有效性、准确性明显提升。宫颈癌前病变、宫颈癌的检出率及早期诊断率逐年提高。     

2006-2009年山西省襄垣县VIA/VILI筛查宫颈癌的检出效果评价

目的：通过对2006—2009年山西省襄垣县宫颈癌筛查早诊早治结果分析,评价醋酸或碘染色肉眼观察法（visual inspection with acetic acid/Lugol’s iodine,VIA/VILI）宫颈癌筛查方案在农村高发区推广应用的可行性。方法2006—2009年在山西省襄垣县对30~59岁的妇女进行宫颈癌筛查。用VIA和VILI作为初筛方法,VIA/VILI阳性者进行阴道镜检查,阴道镜异常者在病变处取活检进行病理诊断。对VIA和VILI阴性、VIA/VILI阳性但阴道镜检查正常、VIA/VILI阳性同时阴道镜检查异常且病理活检结果为轻度宫颈上皮内瘤样病变（cervical intraepithelial neoplasia grade 1,CIN1）或正常的妇女一年后用与初筛同样的方法进行复查。结果2006—2010年累计筛查16703人次,其中初筛9618人,复查7085人。4年初筛人群累计阴道镜转诊率、中度CIN及以上（CIN2+）检出率、重度CIN及以上（CIN3+）检出率分别为4.6%（438/9618）、0.9%（82/9618）、0.5%（44/9618）;复查人群上述指标分别为3.1%（221/7085）、0.6%（42/7085）、0.2%（19/7085）;筛查人群累计（包括初筛和复查）上述指标分别为4.0%（659/16703）、1.3%（124/9618）、0.7%（63/9618）。初筛人群阴道镜转诊率、CIN2+检出率和CIN3+检出率均随方案的持续开展呈升高趋势（P<0.001）;复查阴道镜转诊率、CIN2+检出率则呈下降趋势（P<0.001）。结论随着VIA/VILI筛查方案在示范基地的推广,筛查效果越来越显著。VIA/VI-LI是一种经济有效的宫颈癌及其癌前病变筛查方法,适宜在资源有限、经济欠发达的农村地区推广。持续的培训和实践是VIA/VILI筛查方案有效实施的关键措施。     

2010~2012年杭州市拱墅区已婚育龄妇女宫颈癌筛查结果分析

[目的]了解杭州市拱墅区49周岁以下的已婚育龄妇女宫颈癌和癌前病变,为制定妇女卫生保健政策提供了科学参考依据。[方法]对杭州市拱墅区49周岁以下的已婚育龄妇女开展以宫颈液基细胞学检查为基础的宫颈癌筛查,49周岁以下户籍已婚育龄妇女2010年为58 571人,2011年为55 880人,2012年为55 820人。[结果]2010-2012年杭州市拱墅区辖10个街道49周岁以下户籍已婚育龄妇女TCT共检查40 651人,检查率为23.87%。TCT报告正常者39 326人,占96.74%。TCT报告异常者1325人,占3.26%。其中ASCUS病变630人,占47.55%;ASC-H病变84人,占6.34%;LSIL病变446人,占33.66%;HSIL病变145人,占10.94%,SCC病变2人,占0.15%;AGC病变18人,占1.36%。在需进一步手术治疗的妇女152例中,病理诊断结果为CINⅠ35人,CINⅡ51人,CINⅢ61人,宫颈癌5人。[结论]杭州市拱墅区为已婚育龄妇女开展免费宫颈癌筛查,筛检了TCT异常的妇女,并对高危因素的癌前病变患者进行相应的治疗和医学指导。宫颈癌筛查的成效不仅限于早期发现和治疗少数癌症患者,更重要的是发现大量癌前病变患者,为制定妇女卫生保健政策提供了科学参考依据。     

山西省农村妇女生殖道感染和宫颈癌筛查情况调查

[目的]通过对山西省农村妇女生殖道感染（RTI）和宫颈癌初级筛查暨基层妇保院服务能力进行调查分析,探索适合山西省基层低收入人群的将生殖道感染防治和宫颈癌筛查相整合的妇女病普查普治模式。[方法]采用整群抽样的方法抽取山西省3县2503例20～59岁农村已婚妇女作为研究对象,进行了生殖道感染实验室检测和宫颈癌醋酸（VIA）筛查和碘染色（VILI）初级筛查,并对其中VIA阳性或VILI阳性的妇女进行阴道镜检查,异常者取活检进行病理诊断。同时,对21所基层妇幼保健院生殖道感染防治和宫颈癌筛查服务能力进行了调查分析。[结果]2503例调查对象中84.58%从未做过妇女病普查,经检查发现生殖道感染患病率达67.96%,宫颈癌及癌前病变患病率1.56%。而基层妇幼院服务能力普遍低下,宫颈细胞学筛查覆盖面小,仅有少数单位可开展阴道镜和病理诊断技术。[结论]基层妇幼机构生殖道感染检测和宫颈癌筛查技术亟待提高。应积极培训人员,在基层单位推广WHO推荐的RTI防治和宫颈癌初级筛查相结合的妇女病普查模式。     

湖南省长沙市2012~2015年女性乳腺癌筛查结果分析

摘 要：［目的］ 了解长沙市城市妇女乳腺癌发病情况,探讨乳腺癌筛查模式价值。［方法］2012~2015年对长沙市40~69岁城市女性进行乳腺癌筛查,采用乳腺癌高危评估系统初筛出高危人群,40~44岁高危人群采用彩色超声检查,45岁及以上采用彩色超声检查结合X线摄影检查,以BI-RADS为Ⅳ级和Ⅴ级作为阳性结果。［结果］ 共有69 532人参加了乳腺癌危险因素问卷调查,13 805例(19.9%)被评为高危人群。1906人接受了单独彩色超声检查,4133人接受了彩色超声结合X线摄影检查。超声阳性检出率为774/10万;X线摄影阳性检出率为560/10万。两种筛查方法一致性检验Kappa系数为0.394（P<0.05）。［结论］ 采用高危风险评估系统进行初筛,按照不同年龄特点选择不同的筛查方法的乳腺癌早诊早治模式为我国的乳腺癌防控工作提供了经验。     

修水县宫颈癌筛查结果分析

宫颈癌是最常见的女性生殖道恶性肿瘤,近年来发病年龄有年轻化趋势。由于宫颈癌有较长癌前病变阶段,因此开展以宫颈癌筛查为主的妇科病普查,可使宫颈癌得到早期诊断与早期治疗,有效降低宫颈癌发病率与死亡率。     

山西省襄垣县采用careHPV检测技术进行宫颈癌初筛的效果分析

[目的]评价careHPV检测技术在农村宫颈癌筛查中的应用情况.[方法]对山西襄垣县2270名35～64岁妇女采用careHPV检测技术进行官颈癌初筛,初筛阳性者接受液基细胞学分流,分流阳性者召回阴道镜检查及活检,以病理结果为金标准.[结果]参加筛查的妇女平均年龄45.7±6.8岁,careHPV阳性率为12.9％(292/2270),阴道镜转诊率为4.8％(109/2270),CIN1、CIN2+检出率分别为1.4％(31/2270)和1.7％(38/2270).在既往筛查史上,参加过筛查的妇女CIN2+的检出率要低于从未参加过筛查的妇女(x2=4.50,P=0.042).[结论]careHPV检测技术初筛细胞学分流的筛查策略有助于在降低阴道镜转诊率的同时,提高宫颈病变的检出率,扩大筛查覆盖面.该策略适用于资源相对贫乏的农村地区.     

Effectiveness of Cervical Cancer Screening among Chinese Women in North America

Background. Chinese North American women have high invasive cervical cancer rates and low screeningrates. The cost-effectiveness of strategies to improve Pap testing rates for Chinese women living in Seattle,Washington and Vancouver, British Columbia was examined. Objectives. To calculate the costs and costeffectivenessof implementing two strategies to motivate women to obtain a Pap smear. Research Design. Athree-armed randomized, controlled trial was conducted. Women in each of two interventions (high-intensityoutreach and low-intensity mailing intervention) were compared to a group of women who received usual care.Measures. Costs were captured via a group discussion of costs, accounting records, sampling of staff time logs,and estimation of costs and task times. Effectiveness was measured as the proportion of women in eachintervention arm who reported receiving a Pap smear since the trial began. Cost-effectiveness was calculated asthe incremental cost of screening each additional woman between an intervention arm and the control arm.Results. A greater percentage of women who received the outreach intervention had a Pap test than women whoreceived mailed materials or women who were in the usual care arm. The intent-to-treat cost for each additionalwoman to be screened for a Pap test was $ 415 in the Outreach arm and $ 676 for the Direct Mailing arm. Theoutreach worker intervention, though more expensive overall, was more cost-effective than the mailingintervention. Conclusions. Outreach intervention is cost-effective for sponsors and should be considered as astrategy to motivate Chinese women living in North America to seek cervical cancer screening.     

Obesity and Screening Compliance for Breast and Cervical Cancer in Korean Women

Purpose : This study was performed to assess whether the weight status is associated with screeningrates of breast and cervical cancer in Korean women. Methods: Study participants included women agedbetween 30 and 80 years from the 4th Korea National Health and Nutrition Examination Survey from 2007to 2009. Body mass index was classified into ~18.4 kg/m2 (underweight), 18.5~22.9 kg/m2 (normal), 23~24.9kg/m2 (overweight), 25.0~29.9 kg/m2 (moderate obesity) and 30.0 kg/m2~ (severe obesity) according to theAsia Pacific Standards of WHO recommended definition of obesity. Screening rates of breast and cervicalcancer were estimated by the recommendation of the National Cancer Screening Program of the NationalCancer Center, Korea. Results : The overall screening rates for breast and cervical cancer were 51.3% and50.1%, respectively. After covariate adjustment, the screening rates for breast cancer (adjusted odds ratio,0.70; 95% confidence interval, 0.51 to 0.97) and cervical cancer (adjusted odds ratio, 0.71; 95% confidenceinterval, 0.53 to 0.94) were significantly lower in the women with severe obesity. Conclusion: Obesity isassociated with lower compliance with breast and cervical cancer screening guidelines in Korean women.     

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。     

Factors Affecting Cervical Cancer Screening Uptake by Hmong Hilltribe Women in Thailand

Background: Cervical cancer is relatively common in Thai women, but the proportion of females receivingPap smear screening is still low. Objective: The purpose of this cross-sectional study was to study factors relatedto cervical cancer screening uptake by Hmong hilltribe women in Lomkao District, Phetchabun Province.Materials and Methods: Interview data were collected from 547 of these women aged 30-60 years living in thestudy area and analyzed using multiple logistic regression. Results: The results showed that 64.9% of the studysample had received screening, and that 47.2% had attended due to a cervical screening campaign. The mostcommon reason given for not receiving screening was lack of time (21.4%). The factors found to be positivelyassociated with uptake (p value <0.05) were as follows: number of years of school attendance (OR=1.56,95%CI:1.02-2.38), animistic religious beliefs (OR=0.55, 95%CI:0.33-0.91), a previous pregnancy (OR=6.20,95%CI:1.36-28.35), receipt of information about cervical cancer screening (OR=2.25, 95%CI:1.35-3.76), andperceived risk of developing cervical cancer (OR=1.83, 95%CI:1.25-2.67). Conclusions: To promote the uptakeof cervical screening, Hmong hilltribe women need to know more about cervical cancer and cervical cancerscreening, and access to screening services should be provided in conjunction with existing everyday services,such as family planning and routine blood pressure monitoring or diabetes services.     

Knowledge and Barriers Towards Cervical Cancer Screening Among Young Women in Malaysia

Objectives: This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. Methodology: A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty’s registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13. Results: The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents was having more than one sex partner (77.5%), whereas the lowest was the relationship between HPV and cervical cancer (51.2%). Age, marital status, ethnicity, monthly family income and faculty were significantly associated with knowledge of cervical cancer screening (p=0.003; p=0.001; p=0.002; p=0.002; p=0.001 & p=0.002; respectively). The most common barriers of cervical cancer screening were the Pap smear test will make them worry (95.8%) whereas the least common barrier reported among participants was no encouragement from the partner (8.8%). Conclusion: Some misconceptions and barriers in uptaking Pap smear test are still serious problems among young women. Although knowledge about cervical cancer screening is adequate they have a very poor practice of Pap smear test. The introduction of reproductive health subjects is warranted for all university students.     

Community-based Mobile Cervical Cancer Screening Program in Rural India: Successes and Challenges for Implementation

Background: The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India. Methods: Communities were mobilized through extensive peer education and by screening in existing community spaces using a mobile clinic model. An initial “screen and treat” protocol was transitioned to “screen, test, and treat” using Pap smears for confirmatory testing, and cryotherapy or Loop Electrosurgical Excision Procedure (LEEP) for treatment. We trained 50 Peer Educators and conducted 190 screening camps in 58 locations. Results: Of 3,821 registered women, 3,544 (92.8%) accepted screening. Overall, 440/3544 (12.4%, 95% CI 11.3-13.5%) women had VIA-positive lesions. Under “screen and treat”, 56/156 (35.9%) women accepted same-day treatment. Under “screen, test, and treat”, 555/762 (72.8%) women received a Pap smear. Overall, 83 women underwent cryotherapy (n=56) and LEEP (n=27). Of those, 49 (59.0%) participants were followed up, with normal VIA results up to two years after treatment. In summary, the peer educators promoted awareness of cervical cancer and helped in gaining buy-in from communities. Acceptance of same-day treatment was low and accompanied by loss to follow-up, limiting the utility of VIA in these studies. Conclusions: Mobile infrastructure utilized in community spaces brought screening directly to rural women. Culturally appropriate methods to increase linkage to treatment and additional screening options such as HPV DNA testing should be explored.     

Combined Screening of Cervical Cancer,Breast Cancer and Reproductive Tract Infections in Rural China

Objectives: To investigate the current prevalence and knowledge of cervical cancer, breast cancer andreproductive tract infections (RTIs) in rural Chinese women, and to explore the acceptance and feasibility ofimplementing a combined screening program in rural China. Methods: A population-based, cross-sectionalstudy was conducted among women aged 30 to 59 years old in Xiangyuan County, Shanxi Province from 2009 to2010. Socio-demographic characteristics, knowledge of cervical cancer, breast cancer and RTIs, and the attitudetoward single or combined screening were collected by an interview questionnaire. Each participant receiveda clinical examination of the cervix, breast and reproductive tract. Examinations included visual inspection,mammography, laboratory tests and pathological diagnosis. Results: A total of 1,530 women were enrolled inthis study. The prevalence of cervical precancerous lesions, suspicious breast cancer, suspicious benign breastdisease and RTIs was 1.4%, 0.2%, 14.0% and 54.3%, respectively. Cervicitis, trichomonas vaginitis, and bacterialvaginitis were the three most common RTIs among our participants. Television, radio broadcast, and publiceducation during screening were the major source of healthcare knowledge in rural China. Moreover 99.7%of women expressed great interest in participating in a combined screening project. The affordable limit forcombined screening project was only 50 RMB for more than half of the rural women. Conclusion: A combinedscreening program would be more effective and popular than single disease screening projects, while appropriateaccompanied education and a co-pay model for its successful implementation need to be explored, especially inlow-resource settings.