| Objective:To understand the status in knowledge about cervical cancer among rural women, discuss the risk factors of cervical cancer, explore a scientific, efficient, and appropriate program on cervical cancer screening, and to analyze the trends and influence factors of direct economical burden. This will provide basic data and scientific basis for control and prevention strategy of cervical cancer.Methods:(1) A baseline survey and cervical cancer screening:A total of 2053 rural women aged 30～49 in a town of Longnan city of Gansu Province were sampled by cluster random sampling. The data about knowledge and risk factors of cervical cancer was collected by questionnaire. Then these women sequentially received human papillomavirus (HPV)DNA test, liquid-based thinprep cytology test(TCT), visual inspection with acetic acid(VIA), visual inspection with iodine(VILI), colposcopy respectively. The efficacy of different screening tests was compared by Sensitivity, Specificity, Youden’S index based on the pathology as the gold standard. (2) Trend and prediction of disease burden:The cluster sampling method was conducted to collect medical record data of patients with cervical cancer from 1996 to 2006 in a certain general hospital and a special hospital in Gansu province. The average growth rate was used for analyzing the trend of hospital ization expenses, and used the EAPC to predict five years expenses in the future.Results:(1) The awareness rate about cervical cancer and HPV was 22.21% and 5.56% respectively. About 40.96% women are not willing to take physical check-up if need to pay for themselves, and 74.87% women believe that the reason of some woman did not want to receive screening is they felt asymptomatic. How to increase the number of women to receive screening that 88.99% women believe the government should reinforce health education. (2) The HPV infection is a key risk factor of cervical cancer. OR=85.773, OR95%CI:20.365-361.261. (3) A total of 2 053 women took the screening and found 162 women who were diagnosed as HPV positive.59 women with abnormal cervical cytology. According to the pathological findings, there were 66 women diagnosed as cervical intraepithelial neoplasia (CIN), including 33 cases with CIN1,21 cases with CIN2 and 11 cases with CIN3. The sensitivity of HPV. TCT. VIA, VIL1 and colposcopy was 78.13%,75.00%,56.25%,35.71% and 43.75%, and the specificity was 93.20%, 98.26%,89.87%,96.02% and 82.80% respectively. While the sensitivity and specificity of HPV-DNA combined with liquid-based cytology test was 87.50%,92.80% respectively. (4) The main age of cervical cancer patient was 45～54 years old, and accounts for about 34.87% of all cervical cancer cases. The number of cervical cancer cases age of 35～45 was increasing fast, the average annual growth rate was 14.72%. The peak age of the disease changed from 45～54 to 34～44. The main cervical cancer cases were farmers, accounts for about 51.84% of all cervical cancer cases. It was over 80% of cervical cancer patients have to pay for themselves. (5) The daily costs and the average hospitalization expenses of cervical cancer was Y257.04 and Y6025.60 with the average annual growth rate of 13.15% and 8.06%. The estimated annual percentage change (EAPC) of the daily costs and the average hospitalization expenses was 14.00% and 10.96% respectively. Till 2011 the daily costs and average hospitalization expenses will arrive at￥699.08 and￥13766.77 predicted by EAPC. Medicine cost accounted for a dominant proportion of the whole cost, was 35.12%. During the period of 1996 to 2006, the average growth rate of operation fee was increasing fast with the average annual growth rate of 27.05%. During the period of 1990 to 1992 and 2004 to 2005, the WYPLL of cervical cancer patients show a downward trend, but the AWYPLL, and the indirect economic burden were￥19678.10 and￥84426.53. The adjusted death rate of cervical cancer was 11.88/100,000 and 5.70/100,000 during 1990 to 1992 and 2004 to 2005, which exhibited reducing tendency. From 1990 to 1992 the PYLL and APYLL of cervical cancer were 7985.50 person-years and 18.40 person-years, but 1291.88 person-years and 14.68 person-years during 2004 to 2005.Conclusion:The rural women have a low level of awareness about cervical cancer. HPV infection is a key risk factor of cervical cancer. HPV-DNA combined with liquid-based cytology test is a scientific and efficient program for cervical cancer screening, but VIA and VILI is more appropriate for screening in rural areas. The cervical cancer generated a large economical burden for patients, and with an aggravating trend. |
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