PDF(Pubmed)
Abstract：
Cervical cancer poses a significant health challenge in developing countries, emphasizing the need for appropriate screening strategies to accelerate the elimination of this disease. This study summarized the results of a large-scale community-based cervical cancer screening program conducted in Chengdu, China, to understand the prevalence of HPV infection and cervical lesions in the population, and to compare the real-world effectiveness of two different screening methods implemented in the program. From January 2021 to December 2022, a total of 363,376 women aged 35-64 years in Chengdu received free screenings. Among these participants, 70.1% received cytology screening and 29.9% received HPV testing combined with 16/18 genotyping and cytology triage. Ultimately, 824 cases of high-grade lesions and cervical cancer were detected, with a total detection rate of cervical cancer and precancerous lesions of 226.8 per 100,000. The follow-up rate of patients with high-grade lesions and above was 98.9%, and the treatment rate was 86.6%. The overall high-risk HPV infection rate was 11.7%, with the HPV 16/18 infection rate of 1.4%. The rate of abnormal cytology results was 2.8%. The attendance rates for colposcopy and histopathology were 71.6% and 86.1%, respectively. By calculating the age-standardized rates to eliminate the different age composition between the two group, the HPV-based screening strategy had a higher rate of primary screening abnormalities (3.4% vs. 2.8%, P<0.001), higher attendance rates of colposcopy (76.5% vs. 68.9%, P<0.001) and histopathological diagnosis (94.1% vs. 78.0%, P<0.001), higher percentage of abnormal colposcopy results (76.0% vs. 44.0%, P<0.001), and higher detection rate of cervical precancerous lesions and cancer (393.1 per 100,000 vs. 156.4 per 100,000, P<0.001) compared to cytology screening. Our study indicates that the combination of HPV testing with 16/18 genotyping and cytology triage has demonstrated superior performance in cervical cancer screening compared to cytology alone in large-scale population.
摘要：
宫颈癌在发展中国家构成了重大的健康挑战，强调需要适当的筛查策略来加速消除这种疾病。这项研究总结了在成都进行的大规模社区宫颈癌筛查计划的结果，中国,了解人群中HPV感染和宫颈病变的患病率，并比较该计划中实施的两种不同筛选方法的实际有效性。从2021年1月到2022年12月，成都共有363,376名35-64岁女性获得了免费筛查。在这些参与者中，70.1%接受了细胞学筛查，29.9%接受了HPV检测结合16/18基因分型和细胞学分诊。最终,共检出高级别病变及宫颈癌824例,宫颈癌及癌前病变的总检出率为226.8/100,000。高级别及以上病变患者的随访率为98.9%,治疗率为86.6%。整体高危型HPV感染率为11.7%,HPV16/18感染率为1.4%。细胞学结果异常率为2.8%。阴道镜检查和组织病理学的出勤率分别为71.6%和86.1%，分别。通过计算年龄标准化率，消除两组之间不同的年龄构成，基于HPV的筛查策略具有较高的初筛异常率（3.4%vs.2.8%，P<0.001)，阴道镜检查出勤率较高(76.5%vs.68.9%,P<0.001）和组织病理学诊断（94.1%vs.78.0%,P<0.001)，阴道镜检查结果异常的百分比更高(76.0%vs.44.0%,P<0.001)，和更高的宫颈癌前病变和癌症的检出率（每100,000比393.1156.4/100,000，P<0.001）与细胞学筛查相比。我们的研究表明，在大规模人群中，与单独的细胞学检查相比，HPV检测与16/18基因分型和细胞学分类相结合，在宫颈癌筛查中表现优异。
