Research And Evaluation Of Opportunistic Cervical Cancer Screening

Objective:The aim of this study was to explore the movement pattern and the feasibility of opportunistic cervical cancer screening through understanding the compliance and different age distribution of cervical lesions in opportunistic screening for outpatient, comparing with different screening programs; comparing the crowd participation rate and the disease detection rate before and after carrying out opportunistic cervical cancer screening; carrying out the preliminary health economic evaluation to opportunistic cervical cancer screening .Methods:1 Study object: Firstly we carried out various propaganda, then registered 1969 outpatients in the Jiangxi Maternal and Child Health Hospital from September, 2007 to December, 2007, who had no malignant tumor history, no other serious diseases, no womb excision history, non-menstrual, non-pregnancy woman, the sex life history. They attended voluntarily cervical cancer screening and could accept inspected Through themselves choice or by obeying doctor's suggest, they chose one or several screening methods from visual inspection, the Pap smear test, HPV-HCⅡ, LPT ,finally were invited for colposcope inspection and were subjected to cervical biopsy and endocervical curettage (if necessary).Each kind of inspection was adopted with double blind method. Take the pathological diagnosis as the golden standard and take CINⅡand above pathological change as pathology positive.2 To explore the compliance, the average cost of the pathological positive cervical lesions screened in opportunistic cervical cancer screening3 Through studying different age groups of cervical cancer and precancerous lesions in the opportunistic screening group ,we can discuss the target age.4 To select the appropriate screening program through compared each kind of screening program's sensitivity, specificity, accuracy, the positive predictive value, the negative predictive value, and Youden's index in the opportunistic screening group and according to the local medical resources and the screening object conditions . 5 To compare the crowd participation rate and the disease detection rate before and after carrying out opportunistic cervical cancer screening;6 To investigate the opportunistic screening feasibility through decision tree analysis.Results:1 In opportunistic cervical cancer screening, screening compliance was 98.66% (1983/2010) and the average cost of the pathological positive cervical lesions screened was 6552 Yuan。2 In the opportunistic screening group in various age section , before the age of 25 years, ages 25 -54 years, over 55 years, the prevalence of different cervical lesions respectively were: CINⅠ(6.13%, 5.10%, 1.22%), CINⅡor worse dysplasia (0.61%, 5.63%, 1.22%), CC (0,0.58%, 6.10%). The comparison of the various cervical lesions prevalence rate respectively were CINⅠ(X2 =2.93, P=0.231), CINⅡor worse dysplasia ((X2 = 10.436, P= 0.005), CC (X2=32.885, P =0.000).3 Each screening method's sensitivity, specificity, accuracy, the positive predictive value, the negative predictive value, the Youden's index respectively were: Pap smear test (66.1%, 93.9%, 92.6%,36.3%, 98.2%, 0.6), LPT test (63.3%, 91.3%, 87.1%, 37.3%, 96.8%, 0.55), visual inspection (57.1%, 67.7%, 67.5%, 3.8%, 98.6%, 0.25), HPV-HCⅡtest (91.5%, 63.3%, 71.2%, 49.4%, 95.0%, 0.54), cervical cytology paralleled HPV-HCⅡtest (95.7%, 62.5%, 71.9%, 50%, 97.0%, 0.58). There were statistically significant difference (P<0.05) during indexes besides the negative predictive value. While there was no statistically significant difference (P>0.05) between Pap smear test and LPT test . Visual inspection could be screening out more than half of high degree of cervical lesions. The cervical cytology paralleled HPV-HCⅡtest's sensitivity was the highest. There was no statistically significant difference (P>0.05) between cervical cytology paralleled HPV-HCⅡtest and HPV-HCⅡtest. However, there were two cases confirmed CINⅡ, CINⅢby pathology, which were of negative HPV-HCⅡtest and of positive cervical cytology .4 At September, 2007 to December and at 2006 same time ,the cervical cancer screening participation rate respectively is 27.45% (24816/90405),20.83% (18463/88650),CC detection rate respectively is 0.48%(120/24816), 0.5% (109/18463), CINⅢdetection rate respectively is 0.75% (186/24816), 0.56% (104/18463),CINⅡdetection rate respectively is 0.57% (141/24816), 0.38% (70/18463), CINⅠdetection rate respectively is 0.8% (198/24816), 0.23% (42/18463). There was statistically significant difference (P<0.05) besides CC detection rate (P>0.05) during two years .5 Through the decision tree analysis, the implementation opportunity screening's benefit surpassed cost.Conclusions:1 Opportunistic cervical cancer screening in the hospital outpatient service implementation was feasible.2 The opportunistic cancer cervical screening had high screening compliance.3 The pathological positive case screen cost of organized screening group was 6552 Yuan.4 The target ages of opportunistic cervical cancer screening were ages 25-54 years mainly.5 The opportunistic cancer cervical screening in different screening programs suited different rank hospitals and different screening object.