A Study On Cervical Cancer Screening Using CareHPV As Primary Testing In Wushen,Erdos

Objectives:Study the effect of cervical cancer screening using careHPV as primary testing and VIA/VILI as triage method.Observe the cervical cancer screening strategy in Wushen district,Ordos,Inner Mongolia.To enhance cervical cancer prevention,early detection and early treatment,and improve women's health awareness.Provide evidence-based information for cervical cancer screening strategy making and implementation in low-resource areas.Methods:During Jan,2018 to Dec,2019,with the support from Wuhen government and local Maternal and Child Care Center,we provided local female residents aged between 35-64 with cervical cancer screening using careHPV testing as primary screening tool,and VIA/VILI as triage methods.The results of VIA/VILI are divided into three categories,whose testing result was abnormality or suspicious carcinoma.would undertake colposcopy and biopsy.Pathohistological results was the golden standard.All the data were analyzed by SPSS 26.0,?2-test and t-test were used for comparison.Pvalue<0.05 were considered as significantly different.Results:5237 women were screened during Mar 2018 to Dec 2019,5228 were included in final analysis after excluding 5 for not meeting inclusion criteria and 4 of other minorities,among which 986(18.8%)were Mongolia Chinese,4244(81.1%)were Han Chinese.All participants were divided into 6 groups based on age:35-39 years old,40-44 years old,45-49 years old,50-54 years old,55-59 years old,60-64 years old.The average age of menarche,average age of menopause,average age,average age of first live birth were 15.86±1.718?49.98±4.301?48.26±8.243?23.21±3.189,respectively.The average number of sex partners,frequency of sex,number of pregnancy,number of live birth were 1.04±0.085?1.43±0.994?2.87±1.256?1.99±0.784,respectively.616 were tested HPV positive,Women aged between 60-64 years had the highest infection rate(15.1%),the distribution of HPV infection rate were different among age groups(?2=16.421,P<0.05).Though the HPV infection rate in Mongolia Chinese were slightly higher then that in Han Chinese population,its not statistically significant.636 were diagnosed as abnormality or suspicious carcinoma by VIA/VILI,Women aged between 40-44 years old had the highest rate(18.4%),the rate of VIA/VILI abnormality or suspicious carcinoma were different among age groups.The rate of VIA/VILI abnormality or suspicious carcinoma in Mongolia Chinese women was slightly higher than that in Han Chinese women(14.8%vs 13.1%),but not statistically significant(?2=8.895,P>0.05)A total of 99 women were diagnosed as HPV negative but VIA/VILI abnormality or suspicious carcinoma,the rate in Han Chinese population(4.1%)was higher then that in Mongolia Chinese women.In comparison with total rate,Mongolia Chinese women(2.6%)was higher than Han Chinese women(1.7%).94 women were transferred to undertaking colposcopy,among which 16 were Mongolia Chinese women,78 were Han Chinese women,Mongolia Chinese women had greater chance to be diagnosed as low grade cervical intraepithelial neoplasia(LSIL)or suspicious invasive carcinoma than Han Chinese women,while had lower chance of being diagnosed as other types oflesions by colposcopy.There is no statistical significance in cervical precancerous lesion and cervical cancer between Mongolia Chinese women and Han Chinese women by ?2 test.Among those who were diagnosed as HPV negative but VIA/VILI suspicious carcinoma,and HPV positive but VIA/VILI abnormality or suspicious carcinoma,19 were diagnosed as LSIL by pathology,8 were high grade intraepithelial neoplasia(HSIL),5 were suspicious invasive cervical cancer.Among those who were HPV negative but VIA/VILI suspicious carcinoma,3 were diagnosed as suspicious invasive cervical cancer by pathology,no LSIL or HSIL were found in those women.Among those who were HPV positive but VIA/VILI abnormality or suspicious carcinoma,19 were LSIL,8 were HSIL,2 were suspicious invasive cervical cancer,the diagnostic rate were 65.5%,27.6%,6.9%,respectively.There is no linear relationship between these two screening methods(Kappa=0.045).Conclusions:In Wushen district,Ordos,Inner Mongolia,Mongolia Chinese women had higher HPV positive rate and VIA/VILI abnormality or suspicious carcinoma rate then Han Chinese women.Using careHPV as primary screening method and VIA/VILI as triage method,we observed significant difference of HPV positive rate and VIA/VILI abnormality or suspicious carcinoma rate among different age groups,but no significant difference were found between Mongolia and Han Chinese women.There are lot of cervical cancer screening methods in China,our study showed VIA/VILI testing is cost effective.Some studies have shown careHPV can be used for cervical cancer screening in low resource areas.Our study also provide evidence for further use of these technics in cervical cancer screening,and reduce cervical cancer incidence and mortality.