Rural Women Cervical Cancer Screening And Risk Factors Study In Wuhan

ObjectivesThis study aimed to explore the major risk factors for cervical cancer in Wuhan, and figure out the prevalence and characteristics of cervical cancer and precancerous lesion in rural women in Wuhan to provide new evidence for prevention and intervention of cervical cancer. At the same time, an analysis was made about cervical cancer screening methods based on the large sample database to understand the significance of every method in screening program in large population.MethodsDuring Jun.2011to Jul.2012,170401rural women aged25to64were recruited for cervical cancer screening and diagnosis by a cluster sampling method in16districts in Wuhan. Liquid-based thin-layer cytology technology (TCT) and DNA ploidy array were both taken for the initial screening. The positives of initial tests were preferred to HPV DNA testing, and cervical biopsy under colposcope. A unified self-made questionnaire was asked to fill out helped by trained investigators. The contents of the questionnaire includes seven aspects such as general demographic conditions, environmental factors, genetic factors, disease history, female personal health history, living and eating habits and social psychological factors. A matched case-control (1:1)was designed to study the risk factors for cervical cancer. SPSS13.0software package was used to make statistical analysis. Results1. The prevalence of cervical cancer and precancerous lesion:According to the rate of reexamination and adjusted by age, the prevalence of cervical cancer in rural women is34.71/100000.2. The characteristics of distribution for area and age:Jiangxia district is at the top position with prevalence of29.67per100000, and Hannan has no cervical cancer case while Caidian district has also low prevalence of4.95per100000.40-45years old group has the highest prevalence of precancerous lesions, while cervical cancer has the increasing trend along with the age. The prevalence of CIN1, CIN3and cervical cancer were statistically different between different age stratifications.3. HPV infection status and genotypes in positives in initial screening:The results showed1115cases infected HPV (57.03%). The HPV infection rates were statistically different between groups of cervicitis, CIN and cervical cancer, with rate of40.72%,89.64%å'Œ92.86%respectively. The most popular genotype is HPV16with18.16%positive in participants, and followed by HPV58(13.55%), HPV52(11.00%), HPV33(5.68%). HPV16was detected in64.29%of cervical cancer, and59%of CIN3. Simple infection accounted for72.65%in the HPV infection, and double to multiple genotypes infections were27.35%, there was no difference in proportions of simple genotype infection between various pathological grades.4. comparison of two initial screening methods:the sensitivity, specificity, positive prediction value, negative prediction value, accuracy rate of diagnosis of TCT and DNA ploidy array were:70.03%,51.52%,36.99%,80.88%,56.87%and80.26%,39.61%,35.02%,83.17%,51.33%. The sensitivity of TCT is lower than DNA ploidy array, but specificity is higher, and accuracy rate of diagnosis is higher than DNA ploidy array.5. HPV-DNA detect:the sensitivity of HPV-DNA detect in the positives at the first step is92.18%, which is distinctly higher than that of TCT and DNA ploidy array, and specificity of56.73%is also higher than that of TCT and DNA ploidy array. The accuracy of diagnosis in ASC-US group is relatively high as68.62%.6. Risk factors for cervical cancer and precancerous lesion:106factors of7aspects were taken to the univariate conditional logistic regression analysis. The results indicated that HPV infection, age at first marry, age at first intercourse, age at first pregnancy, age at first child birth, using cellphone or hair drier, noise and strong light, treatment of gynecological disease, duration of menstruation, IUD, using condom, and passive smoking were related to the cervical cancer and precancerous lesion. Then all these factors and some possible factors presented in some literatures were taken to the multivariate conditional Logistic regression analysis, and the results showed that family history of cervical cancer (OR=191.07) and HPV infection (OR=247.66) were the risk factors for cervical cancer and precancerous lesion, compared that menopause (OR=0.13) and older at first pregnancy (OR=0.30) were the protect factors for cervical cancer and precancerous lesion.ConclusionsThe cervical cancer incidence of rural women is34.71/100000in Wuhan, which is higher than that in the economic developed area but lower than that in underdeveloped regions of China western. The incidence of cervical cancer presents increasing tendency with age, which is obviously lower in Hannan and Caidian districts than that in other districts of Wuhan. HPV infection rate was57.03%in initial screening positive women. The high-risk HPV infection rate in the group of cervical cancer or cervical intraepithelial neoplasia is increasing sharply. HPV16is the main infection in women with cervical cancer. In addition,there is no synergistic effect in multiple infections of HPV subtypes.The sensitivity of TCT in screening cervical cancer is lower than DNA ploidy array, while specificity of TCT is high, and the overall diagnostic accuracy of TCT is higher than DNA ploidy array. Both the sensitivity and specificity of the HPV-DNA detection are higher than that of TCT and DNA ploidy array. However, HPV-DNA detection should not be used for the initial screening due to its low positive predictive value. it can be used to triage ASC-US patients who are screened out by TCT, which has strong clinical application value and screening value.HPV infection and family history of cervical cancer are risk factors for cervical cancer and precancerous lesions in rural women of Wuhan, while menopause and older at first pregnancy are protective factors.The innovations of this studyThe innovations of this study are as follows. First, this study confirmed the prevalence epidemiology and risk factors of cervical cancer for the first time in rural women of Wuhan. Second, large sample data was used to set up screening model for three screening methods and their combined use in our study, screening effect was also analyzed to make plan for the domestic large-scale screening for cervical cancer and provides scientific basis for clinical use.