新疆农村妇女宫颈癌筛查效果分析
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摘要
目的评价新疆维吾尔族自治区宫颈癌及乳腺癌检查项目(以下简称两癌项目)中宫颈癌筛查的实施效果,为国家两癌项目的优化提供依据。方法利用全国重大公共卫生项目两癌检查项目信息直报系统,对2015—2016年新疆438 712名农村妇女宫颈癌检查上报数据进行分析。结果 2015和2016年分别完成227 509和211 203名妇女的宫颈癌筛查任务,分别检出305例(134.06/10万)、308例(145.83/10万)中度及以上宫颈上皮内瘤样病变(CIN2+);细胞学阳性率分别为3.61%和5.62%(P <0.001);阴道镜异常率分别为37.47%和32.13%(P <0.001);人乳头瘤病毒(HPV)阳性率分别为7.52%和6.66%(P=0.001)。根据新疆不同地区进行分层发现,新疆南、北、东疆3地区间宫颈癌及癌前病变现患率有统计学差异(P <0.001),以南疆妇女患病率较高;3地区间常见妇科疾病包括滴虫性、细菌性阴道炎等现患率差异也具有统计学意义(P <0.001),以北疆妇女患病率较高。常规巴氏涂片法、液基细胞学检测(TCT)及HPV初筛法对宫颈上皮内瘤样病变II级及以上病变者(≥CIN2+)的检出率分别为0.09%、0.14%和0.21%,HPV初筛法优于TCT或常规巴氏涂片法初筛效果。结论宫颈癌筛查项目在新疆地区取得了一定成效。只有对基层医生充分培训的高质量TCT可以作为筛查方案,HPV初筛可以作为新疆地区宫颈癌筛查的优选方法。
Objective To evaluate implementation effectiveness of cervical cancer screening in Xinjiang Uygur Autonomous Region(Xinjiang) for optimizing cervical cancer screening programs. Methods We extracted and analyzed the data on cervical cancer screening among 438 712 women in rural Xinjiang during 2015 and 2016 from National Cervical and Breast Cancer Screening Information Reporting System. Results Among the 227 509 and 211 203 women participating cervical cancer screening in 2015 and 2016, the detection rate of cervical intraepithelial neoplasia grade II and above(CIN II+) was 134.06/100 000(305 cases) and 145.83/100 000(308 cases); the positive rate of cytology inspection was3.61% and 5.62%; the abnormal rate of colposcopy examination was 37.47% and 32.13%; the human papillomavirus(HPV)positive rate was 7.52% and 6.66%; there were significant between year differences in the positive rate of cytology inspection(P < 0.001), HPV detection(P = 0.001), and abnormal rate of colposcopy examination(P < 0.001). Significant regional differences in prevalence rate of cervical cancer and precancerosis were observed(P < 0.001) and the rates were higher among the women in southern Xinjiang compared to those in northern and eastern Xinjiang; there were also significant regional differences in prevalence rates of common gynecological diseases such as trichomonas and bacterial vaginitis(P <0.001), with higher rates among the women in northern Xinjiang. The detection rate of CIN II+ was 0.09%, 0.14%, and0.21% for the screening with conventional pap smear, thin-prep cytology test(TCT) and HPV preliminary screening,respectively and HPV preliminary screening is superior to other two methods. Conclusion Certain progress was made in cervical cancer screening program in Xinjiang; thin-prep cytology test performed by well trained medical professionals at grassroots could be adopted in screening program and HPV preliminary screening is an optimal method for cervical cancer screening in the region.
Objective To evaluate implementation effectiveness of cervical cancer screening in Xinjiang Uygur Autonomous Region(Xinjiang) for optimizing cervical cancer screening programs. Methods We extracted and analyzed the data on cervical cancer screening among 438 712 women in rural Xinjiang during 2015 and 2016 from National Cervical and Breast Cancer Screening Information Reporting System. Results Among the 227 509 and 211 203 women participating cervical cancer screening in 2015 and 2016, the detection rate of cervical intraepithelial neoplasia grade II and above(CIN II+) was 134.06/100 000(305 cases) and 145.83/100 000(308 cases); the positive rate of cytology inspection was3.61% and 5.62%; the abnormal rate of colposcopy examination was 37.47% and 32.13%; the human papillomavirus(HPV)positive rate was 7.52% and 6.66%; there were significant between year differences in the positive rate of cytology inspection(P < 0.001), HPV detection(P = 0.001), and abnormal rate of colposcopy examination(P < 0.001). Significant regional differences in prevalence rate of cervical cancer and precancerosis were observed(P < 0.001) and the rates were higher among the women in southern Xinjiang compared to those in northern and eastern Xinjiang; there were also significant regional differences in prevalence rates of common gynecological diseases such as trichomonas and bacterial vaginitis(P <0.001), with higher rates among the women in northern Xinjiang. The detection rate of CIN II+ was 0.09%, 0.14%, and0.21% for the screening with conventional pap smear, thin-prep cytology test(TCT) and HPV preliminary screening,respectively and HPV preliminary screening is superior to other two methods. Conclusion Certain progress was made in cervical cancer screening program in Xinjiang; thin-prep cytology test performed by well trained medical professionals at grassroots could be adopted in screening program and HPV preliminary screening is an optimal method for cervical cancer screening in the region.
引文
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[12]单玮,张涛,张铁军,等.我国女性人乳头瘤病毒(HPV)感染的流行病学现状[J].中华疾病控制杂志,2017,21(1):89-93.
[13]Zhao XL,Hu SY,Zhang Q,et al.High-risk human papillomavirus genotype distribution and attribution to cervical cancer and precancerous lesions in a rural Chinese population[J].Journal of Gynecologic Oncology,2017,28(4):e30.
[14]Sauvaget C,Fayette JM,Muwonge R,et al.Accuracy of visual inspection with acetic acid for cervical cancer screening[J].International Journal of Gynecology and Obstetrics,2011,113(1):14-24.
[15]Arbyn M,Sankaranarayanan R,Muwonge R,et al.Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India[J].International Journal of Cancer,2010,123(1):153-160.
[16]韩历丽,齐庆青,王朝,等.北京市18个区县宫颈癌、乳腺癌检出率比较[J].中国妇幼保健,2011,26(16):2426-2428.
[17]张斌,周爱芬,陈忠.武汉市20余万农村妇女宫颈癌和乳腺癌筛查情况分析[J].中国妇幼保健,2013,38(9):1398-1402.
[18]沈洁,高丽丽,张月,等.北京35~64岁妇女不同模式免费宫颈癌筛查结果分析[J].中国公共卫生,2018,34(7):942-945.
[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]赫捷,陈万青.2016中国肿瘤登记年报[M].北京:清华大学出版社,2017.
[4]顾美皎.TBS系统中异常上皮细胞的诊断和处理[J].中国实用妇科与产科杂志,2003,19(8):466-468.
[5]刘爱民.国际疾病分类(ICD-10)应用指导手册[M].北京:中国协和医科大学出版社,2001.
[6]魏丽惠,吴久玲.子宫颈癌检查质量保障及质量控制指南[M].北京:人民卫生出版社,2015.
[7]Zhao FH,Lin MJ,Chen F,et al.Performance of high-risk human papillomavirus DNA testing as a primary screen for cervical cancer:a pooled analysis of individual patient data from 17population-based studies from China[J].Lancet Oncology,2010,11(12):1160-1171.
[8]罗晓敏,宋莉,吴久玲,等.中国农村妇女宫颈癌检查项目2012和2013年上报数据结果分析[J].中华预防医学杂志,2016,50(4):346-350.
[9]王亚凡,刘晓旭,莫中福,等.河北省部分农村妇女宫颈癌、乳腺癌筛查结果分析[J].河北医科大学学报,2016,37(2):154-157.
[10]宋波,吴久玲,宋莉,等.2012年我国农村妇女宫颈癌检查状况分析[J].中国妇幼卫生杂志,2015,6(1):1-4.
[11]Pan QJ,Hu SY,Zhang X,et al.Pooled analysis of the performance of liquid-based cytology in population-based cervical cancer screening studies in China[J].Cancer Cytopathology,2013,121(9):473-482.
[12]单玮,张涛,张铁军,等.我国女性人乳头瘤病毒(HPV)感染的流行病学现状[J].中华疾病控制杂志,2017,21(1):89-93.
[13]Zhao XL,Hu SY,Zhang Q,et al.High-risk human papillomavirus genotype distribution and attribution to cervical cancer and precancerous lesions in a rural Chinese population[J].Journal of Gynecologic Oncology,2017,28(4):e30.
[14]Sauvaget C,Fayette JM,Muwonge R,et al.Accuracy of visual inspection with acetic acid for cervical cancer screening[J].International Journal of Gynecology and Obstetrics,2011,113(1):14-24.
[15]Arbyn M,Sankaranarayanan R,Muwonge R,et al.Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India[J].International Journal of Cancer,2010,123(1):153-160.
[16]韩历丽,齐庆青,王朝,等.北京市18个区县宫颈癌、乳腺癌检出率比较[J].中国妇幼保健,2011,26(16):2426-2428.
[17]张斌,周爱芬,陈忠.武汉市20余万农村妇女宫颈癌和乳腺癌筛查情况分析[J].中国妇幼保健,2013,38(9):1398-1402.
[18]沈洁,高丽丽,张月,等.北京35~64岁妇女不同模式免费宫颈癌筛查结果分析[J].中国公共卫生,2018,34(7):942-945.