A Retrospective Analysis Of Enormous Sample Cervical Cancer Screening Among Rural Area Married Women In Lixia District In Jinan

Background:Since 2009,the nationwide screening of cervical cancer and breast cancer program for women in rural areas has played an important role in reducing the incidence and mortality of cervical cancer.Lixia district in Jinan started the program of screening of cervical cancer and breast cancer for women in rural areas in 2012.Objective:Through the retrospective analysis of enormous cervical cancer screening samples of married women in rural areas in Lixia district in Jinan,the Lixia District cervical cancer screening database was further improved,and the development trend of cervical lesions in Lixia District was mastered,to guide the introduction of policies to respond actively;to summarize the past work experience and lack of cervical cancer screening,and put forward specific recommendations to further explore the establishment of a government-led,multi-sectoral collaboration,regional health care resource integration model.Methods:The data of cervical cancer screening among rural married women in Lixia District in Jinan from 2012 to 2020 were retrospectively analyzed.From 2012 to 2020,52,634 samples of cervical cancer were being tested,data collected varied from year to year,which means the average samples collected were 5,848.Among those,49,516 samples were selected in the final analysis.Primary cervical cancer screening is performed by using a combination of routine gynecologic testing,and Thinprep cytologic test（TCT）.When the tests turned positive,secondary screening would be conducted by using Human papillomavirus（HPV）,and colposcopy.A multi-point biopsy is performed to complete the pathological examination and further treatment is given to the confirmed patient,if necessary.The positive criteria of HPV,colposcopy and cervical biopsy were further determined by searching the patients with positive cytology.The 49516 cases were divided into groups and analyzed.（1）According to the type of TCT,HPV and pathology,TCT was divided into two groups:Negative for Intraepithelial Lesion or Malignant Nancy（NILM）and Atypical Squamous Cells US（ASC-US）,Low-grade Squamous intraepithelial neoplasia（LSIL）,High-grade Squamous intraepithelial neoplasia（HSIL）,Squamous-cell Carcinoma（SCC）and Adenocarcinoma（AC）;Colposcopy and biopsy were divided into non-Cervical intraepithelial neoplasia,Cervical intraepithelial neoplasia（CIN）（low-grade Squamous intraepithelial neoplasia and high-grade Squamous intraepithelial neoplasia）,SCC,AC.（2）According to the age groups,divide the age groups into ≤25 years old,26-30 years old,31-35 years old,36-40 years old,41-45 years old,46-50 years old and ≥ 51 years old.The results of TCT,HPV and pathology were analyzed.All data in this study were processed by SPSS26.0.Results:1.TCT screening positive results were 2664,the positive rate was 5.38%.The top three TCT types were:ASC-US,LSIL and HSIL（67.12%,15.69%and 8.37%,respectively）.2.2,180 of 2,664 patients with positive primary screening were recalled for further examinations.The recall rate was 81.83%.There was statistically significant difference in recall rate of different types of TCT（χ2=49.861,p=0.000）.3.Further HPV testing was performed in 2,180 recalled positive primary screening cases,and 1,492 cases were abnormal,accounting for 68.44%of the patients with TCT positive recall,the positive rates of HPV in different TCT types were statistically significant（χ2=80.149,p=0.000）.The positive rates of HPV in HSIL,SCC and AC were the highest,89.40%in HSIL,100%in SCC and AC,it indicates that there is a close relationship between cervical lesion and HPV infection.4.A total of 696 cases of negative and non-cervical intraepithelial neoplasia,including 1,903 cases of Cin1 2,343 cases of Cin2 220 cases of Cin3 17 cases of SCC and 1 case of AC were detected by colposcopy.5.According to the time distribution,the positive rate of TCT was 5.97%in 2012,4.85%and 4.73%in 2019 and 2020.This shows that the free cervical cancer screening for married women in rural Lixia District,a livelihood policy,has a significant effect on reducing the incidence of cervical cancer in the region.The positive coincidence rate of HPV test in the recalled population was different from year to year,the total coincidence rate was 68.44%;6.According to the age group distribution,the positive incidence of TCT was 7.26%and 7.35%in 41-45 years old and 46-50 years old respectively,the positive rate of TCT was statistically significant in different age groups（χ2=216.953,p=0.000）,the positive rate of HPV was 17.49%and 27.21%in 41-45 years old and 46-50 years old respectively,and there was significant difference among different age groups（χ2=643.133,p=0.000）.Conclusion:Based on the retrospective analysis of an enormous sample of rural area married women with cervical cancer screening in Lixia District in Jinan,the epidemiological survey on the prevalence of cervical cancer in Lixia District in Jinan was further improved,the formulation and implementation of prevention and treatment strategies provided the theoretical basis and helped to perfect the cervical cancer screening model of multi-sectoral collaboration and regional integration of medical resources in Lixia District.