Study Of Cervical Cancer Screening Methods And Strategies In Less Developed Regions In China

Objectives:This study aims to compare and evaluate the screening effectiveness of VIA/VILI,cytology and HPV DNA test respectively as primary screening methods and also different triage methods for HPV DNA test in less developed regions in real world and to explore suitable screening strategies and provide scientific evidence for improving the screening strategy for cervical cancer and precancerous lesions.Materials and Methods:Since July to October in 2015,4526 female participants aged at 35 to 64 years were enrolled from Xiangyuan and Yangcheng in Shanxi Province.All the participants were divided into three groups randomly and equally,1506 in VIA/VILL group,1517 in cytology group and 1503 in HPV DNA test.Participants with positive VIA/VILI or cytology results were called back for colposcopy.The HPV positive ones were called back and further divided into three groups randomly in the proportion of 1:1:1,that is,82,83 and 83 in cytology group,VIA/VILI group and colposcopy group respectively.Biopsy was then required for participants with abnormal colposcopy results.Finally,positive rates,referral rate of colposcopy,positive predictive value and detection rate of CIN2+were compared between different primary screening methods and stratification strategies.Results:1.Clinical effects of different primary screening methods:The positive rate of VIA/VILI declined with the age trend(?~2=10.235,Ptrend<0.05),but cytology and HPV test were contrary to VIA/VILI(?~2=27.240,Ptrend<0.05;?~2=10.235,Ptrend=0.001).There were no obvious differences of the detection rate of CIN2+among the three groups(?~2=2.659,Ptrend=0.986;?~2=0.782,Ptrend=0.377;?~2=1.714,Ptrend=0.19).The positive rate of the two counties were similar,but the detection rate for CIN2+of Xiagyuan county was not higher than Yangcheng county(?~2=0.176,P=0.675;?~2=4.575,P=0.063).However,in the group of cytology,the positive rate and detection rate of CIN2+in Yangcheng were higher than Xiangyuan(?~2=47.330,P<0.05;?~2=4.575,P=0.032).There were no significant differences in HPV group.In our study,the positive rate of HPV group was higher among the three primary methods(?~2=84.083,P<0.05).The CIN2+detection rate was high in HPV group(1.50 vs.0.80 vs.1.01,?~2=3.347,P=0.188),but there are no significant differences in HPV group.The positive predictive value of the three primary were:13.79%?10.49%and 8.87%respectively,and there were no obvious differences(?~2=1.733,P=0.420).2.Triage strategy for HPV positive women of cervical cancer screening:The referral rate of colposcopy,detection rate of CIN2+and positive predictive value of cytology group were 19.75%,1.35%,11.1%,respectively,17.72%,3.80%,21.43%respectively for VIA/VILI group,and 10.00%,9.46%,9.46%for colpscopy group.There were no obvious difference in all the data of detection rates(?~2=4.354,P=0.098).3.Performance of different screening strategies:The positive rate of HPV as primary screening test was highest(16.50%,?~2=302.729,P<0.05);The estimated detection rate for CIN2+of HPV as primary screening test was highest among other 4 strategies(?~2=16.477,P=0.002);The positive predictive value of the screening strategies were:13.79%,10.49%,8.87%,21.43%and 11.11%respectively,and there were no obvious differences(?~2=7.120,P=0.130).Conclusions:1.HPV test(careHPV)is low cost and rapid,and it is a better alternative screening method in developing areas.2.careHPV as a primary screening method with triage of VIA/VILI is feasible in less development regions in China.Cytology as a triage method,it is limited by lack of experienced cytological doctors and their diagnose abilities.In a word,these two methods of triage are not quite better.3.In order to maintain and improve the accuracy of diagnosis,regular training local clinical doctors are very necessary.At the same time,we need to explore more objective technologies urgently.