| Objective:Analysis the effect by using four screening strategies,which were VIA/VILI combined with Pap smear screening,HPV hybrid capture test(DH2),HPV test for primary screening and 16/18 types detection as a triage test,HPV test for primary screening and Pap smear as a triage test,finally evaluate the screening effectiveness of various cervical cancer screening strategies in rural areas of China,providing evidence for screening technologies and strategies,then improving screening quality to the local government and other parts of China.Methods: The premenopausal women aged 35~64 were screened by VIA/VILI,and postmenopausal women aged 35~64 were screened by Pap smear at 2010~2013.Colposcopy was conducted when VIA/VILI or Pap smear results were abnormal.Biopsies under colposcopy were taken if any abnormalities were found.Women aged 35~64 from 7 counties in Xin Mi received cervical cancer screening with HPV test at 2014.Colposcope was conducted on HPV test-positive women and HPV16/18 testing was also conducted on HPV test-positive women in order to know the detection rate of precancerous lesions of uterine cervix and cervical cancer when HPV16/18 as a triage testing.Women were received HPV test as primary cervical cancer screening at 2015.Pap smear was conducted on HPV test-positive women.Colposcopy would be taken if Pap smear results were above ASC-US.Pathology-confirmed biopsies were done for final diagnosis.Surgery is necessary for women getting pathological results above CIN2.Results:1.The participation rate was 59.50%(115789/194598)when using the strategy of VIA/VILI combined with Pap smear.There were 84762 women who received VIA/VILI screening,the positive rate was 20.0%(16949/84762);31027 women received Pap smear screening and the positive rate was 4.81%(1492/31027).The referral rate of women who accepted colposcopy was 11.94%(13914/110542),the participation rate was 71.55%(13914/18441).The result showed that there were 126(0.11%)cases of CIN 1,396(0.34%)cases of CIN 2+,and 271(0.25%)cases of CIN 3+.2.The overall HPV positive rate was 12.23%(1512/12358)when screened by DH2.The referral rate of women who accepted colposcopy was 10.24%(1238/12084),the participation rate was 81.88%(1238/1512).The detection number(rate)of CIN1,CIN2+ and CIN3+ were 78(0.65%),87(0.72%)and 50(0.41%),respectively.It reached the highest rate in Xin Mi over the latest years.The positive rate of women who were screened with HPV16/18 test was 2.66%(319/11981).HPV16/18 was performed as a triage testing that could detect 62 cases of CIN2+(0.52%)and 37 cases of CIN3+(0.31%),and could detect 73.81% CIN2+ and 77.08% CIN3+ from all cases.3.The HPV positive rate was 10.65%(1512/12358)when using the strategy of DH2 test as primary screening method and Pap smear as a triage testing.The referral rate of women who accepted colposcopy was 3.57%(150/4196),the participation rate was 100%(150/150).The detection number(rate)of CIN1?CIN2+ and CIN3+ were16(0.38%),29(0.69%)and 15(0.36%),respectively.There were no cervical cancer cases in this study.4.Compare the detection rate of cervical lesions among four screening strategies,the detection rate of cervical lesions was lowest by using VIA/VILI combined with Pap smear screening;when using DH2 test as primary screening method,the detection rate was increased obviously;when using 16/18 types detection as a triage test,it failed to detect part of the precancerous lesions;the detection rate of cervical lesions with DH2 test for primary screening and Pap smear as a triage test was lower than DH2 test for primary screening and without any triage tests.Compare the average cost of finding a case and the cost coefficient among four screening strategies,we found that VIA/VILI combined with Pap smear with the lowest cost of finding a case and the cost coefficient.DH2 test as primary screening method and Pap smear as a triage test with higher cost of finding a case and the cost coefficient then DH2 test only without any triage tests.DH2 as primary screening method and HPV16/18 was performed as a triage testing with the highest cost of finding a case and the cost coefficient.The age group of 35~44 has the lowest cost of finding a case and the cost coefficient,then was the age group of 55~64,women aged 45~54 was the highest one when using the strategies of DH2 test only and DH2 test as primary screening method,Pap smear as triage test;when using the stragety of DH2 test and followed by HPV16/18 test,the cost of finding a case and the cost coefficient was increased by age.Conclusions:1.The detection rate of cervical pre cancer and cancer and the participation rate were low when using the strategies of VIA/VILI combined with Pap smear.2.The detection rate of cervical pre cancer and cancer was high when using the strategy of DH2 test.Although HPV16/18 as a triage test decreased the colposcopy referral,it failed to detect part of the CIN2+ cases.As a result,for the undetected CIN2+ cases,the HPV genotyping is needed for future analysis.3.DH2 test as primary screening method and Pap smear as a triage test also decreased the colposcopy referral,but the detection rate of cervical pre cancer and cancer was lower,we should improve the technological level of clinical cytologic diagnosis among doctors in rural areas,and detect more cervical lesions.4.Compare all of the four screening strategies,the average cost of finding a case and the cost coefficient was lowest when using VIA/VILI combined with Pap smear,it can apply to women in rural areas with poor economic conditions.In the economical developed areas,HPV test as screening method should be recommended.According to the level of clinical cytologic diagnosis among local doctors,Pap smear as a triage test should be considered.Although HPV16/18 as a triage test decreased the colposcopy referral,it failed to detect part of the CIN2+ cases.As a result,we should explore HPV typing detection method which more suitable in local women. |
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