| Cervical cancer was the lethal disease of women in the world which was second only to breast cancer. The research reported there were530,000new cases every year,85%cases in the developing countries which were limited in screening and treatment of cervical cancer. In our country, the number of cervical cancer new cases was13,1500, and3000were died of it every year. In some areas of China, the morbidity and mortality of cervical cancer were higher than that of breast cancer. Recently, the patients of cervical cancer were younger and younger.The geographic distribution of cervical cancer in China is the central mountainous areas mainly, and the regions with high morbidity were the Tujia region in Yichang of Hubei province(Wufeng)(1073.34/100000)、Lueyang county in Shanxi province(1026.06/100000). Jin’an county in Jiangxi province(1020.81/100000); and the low morbility regions were Beijing(2.54/100000)、Shanghai(3.8/100000) etc. A lot of researches have proved the HPV (human papilloma virus, HPV) infection is closely related to the occurrence and development of cervical cancer and precancerous lesions. At present, the screening is the primary way to prevent and control cervical cancer. However, in many developing countries, because of the lack of screening programs, or financial insufficient, it is difficult to carry out. Therefore the incidence of cervical cancer in the backward areas has not been brought under control, even rising in some areas.The World Health Organization survey has shown in2002that only23%of women in China had a gynecological examination and cytology examination in the three years. Best cervical cancer screening program internationally recommended is thinprep cytologic test combined with HPV test. But in underdeveloped areas it is difficult to carry out due to the expensive price of this program. Domestic and foreign scholars have tried to find a simple, cheap and fast feasible detection method for a majority of women, including visual inspection with acetic acid (VIA) and visual inspection with lugol’s iodine(VILI). VIA/VILI method is recommended by the World Health Organization to screen cervical cancer in developing countries, and some developing countries have begun to evaluate its effectiveness. In our country, Ministry of Health issued a "Chinese Journal of Cancer Prevention and Control Plan (2004～2010)" notice,and special funds allocated by the central government was used in early detection and early treatment of cervical cancer in rural areas. The Tujia area of Yichang City is located in the central mountains, with the relatively backward economic conditions, with the high incidence of cervical cancer. Early screening in the region is an important method of early prevention.The first part of this study, we observed the effect of VIA/VILI method from the point of view of cost-effective, as the standard of the pathological, and evaluated the value as a primary screening tool for cervical cancer and precancerous lesions in poor areas, and explored risk factors of the cervical cancer. Our study will provid the basis for reducing the incidence of the cervical cancer in the region. A large number of epidemiological studies have confirmed that the trace element is a potential risk factor among many exposure factors causing cancer, which should attract attention. World Health Organization points19kinds of trace elements, including cadmium (Cd), lead (Pb), chromium (Cr), manganese (Mn), copper (Cu), zinc (Zn) and selenium(Se) etc, are very important to human health. The trace elements in the environment which go into the human body by the air, water, food, and other ways is relative balance. Imbalances of the trace elements will result in the occurrence of certain diseases, including cancers. The International Agency for Research on Cancer and the U.S. National Toxicology Program Group made it clear that:arsenic (As), cadmium(Cd) and nickel (Ni) are Class1carcinogens to increase the risk of cancer. Previous studies have demonstrated that arsenic (As) is the risk factors of cancer, mainly exposed through drinking water; Cd and Ni as a workplace exposure factors. For some cancer, Se, Zn plays an important protection role. But all trace elements exist in the environment, trace elements are closely related to the geographical regions of cancers. In different regions, due to environmental, people’s diet and habits, the relationship between the trace elements and cancers (even the same cancer) may be different. Taking the cervical cancer for example, in China’s Heilongjiang, Gansu, Shanxi and other high-prone areas, the study shows the trace element levels in the body is still not the same in different regions of patients of cervical cancer.Evaluating correlation of trace elements with the etiology of cancer, accumulation and exposure is very important. The effectiveness of various methods of detection trace elements depends on biological specimens, including: blood, urine, hair, nails(toenails). The serum and plasma was used to detect short-term exposure,and the red blood cells was used to detect long-term exposure, tumor tissue was better than other biological specimens, because it represents a more long-term exposure to more accurately reflect the relationship of the tumor and trace elements.The second part of this study, we detected the concentration of trace elements in the cervical cancer, the tissues besides the cancer and the normal cervical cancer tissues, could supply the experiment evidences on investigating the etiological factor of cervical cancer and finding the preventation and treatment methods.Method:Project1. We collected the cervical cancer samples in TuJia area of Yichang from2010to2012by VIA/VIL method,and evaluated the value of VIA/VIL method, and explored the risk factors of cervical cancer in the region, by questionnaires.Project2. Atomic absorption spectrometry (AAS) was employed to detect the concentrations of seven trace elements (cadmium, Cd; lead, Pb; chromium, Cr; manganese, Mn; copper, Cu; zinc, Zn; selenium, Se) in a test group (patients from the Tujia region in Yichang city with cancer, pericarcinoma, and normal cervical tissues, n=30), control group1(patients from other regions with cervical carcinoma, n=18), and control group2(women with cervical benign disease, n=10).Results:Project1. We had collected5720from2010to2012in our experiment screening. And during the first screening, the detection rates of CINⅠ, CINⅡ, CINⅢ and cervical cancer were2.69%,1.26%,1.33%and0.07%, respectively. During the second screening (review), the detection rates of CINⅠ, CINⅡ, CINⅢ and cervical cancer were10.17%,8.06%,2.11%and0, respectively. And the average age of of CINⅠ, CINⅡ, CINⅢ and cervical cancer were43.53year-old,45.76year-old,48.54year-old and51.50year-old respectively.Project2. In the test group, the contents of Cd, Pb, Cu, Zn, and Se in carcinoma, pericarcinoma, and healthy cervical tissues were significantly different (P<0.01).The concentrations of Cr and Mn in cancer, pericarcinoma, and healthy cervical tissues were not significantly different (P>0.05). Comparison of the trace elements contained in normal cervical tissues among the three groups indicated that:(1) No significant difference in Cr and Mn was found in the three groups (P>0.05), while significant differences were noted for Cd, Pb, Cu, Zn, and Se among three groups (P<0.01);(2) Significant differences were detected for Cd and Se between the test group and control group1(P<0.01), whereas no significant difference was found for Pb, Cu, and Zn (P>0.05);(3) Significant differences existed in Cd, Pb, Cu, Zn, and Se concentrations between the test group and control group2(P<0.01);(4) The contents of Cd, Pb, Cu, Zn, and Se in control group1were significantly different from those in control group2(P<0.01).Conclusion:1.VIA/VILI has the fortes that easy to grasp, low in price, simple procedure, quick results and never rely on the machines and so on. That’s the reason that it had good screening results in the TuJia area of YiChang. So it could be widely used in rural areas.2, The cervical cancer of the Tujia region in Yichang city is associated with multiple risk factors, such as smoking, age, menopause, pregnancy,childbirth, sex life and so on.It is very important that the women are educated to prevent cervical cancer,and it can contribute to early detection, early diagnosis, early treatment.3, There is no clear direct relationship between cervical cancer in the Tujia region in Yichang city and the trace element of Cr, Mn. There is a certain relationship between cervical cancer in the Tujia region in Yichang city and the trace element of Cd, Pb, Cu, Zn, Se, and Cd and Se have close geographical relationship,but Pb, Cu, Zn have not definite geographical relationship. |
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