Objective: In 2013, a cohort study aimed to clarify the positive and negative effects of introducing the human papillomavirus (HPV) testing for population-based cervical cancer screening has been launched in Japan. This study included four screenings during the subsequent 7-year follow-up period. We aim to describe the results of the first round of this study on cervical cancer screening here. Methods: This study began in September 2013 with recruitment completed in March 2016. Women aged 30-49 years were divided into 2 groups: those who received uterine cervical cytology alone in the first year (control group), or those who received a combination of cytology and HPV testing (intervention group), based on their age. After first screening, women with positive result of cytology or positive HPV test required referral. We summarized the results of the first round of cervical cancer screening. Results: Of the 25,074 women who were eligible for the study, 13,845 women (55.2%) were screened with cytology alone; 11,229 women (44.8%) received a combination of cytology and HPV testing. After screening, 407 women (2.9%) in the control group and 1,003 women (8.9%) in the intervention group required referral, respectively. Adding HPV testing increased referral rate significantly (p<0.001). Conclusion:After first screening, introduction of HPV testing appears to contribute to significantly higher referral rates, suggesting that the number of colposcopies as a detailed examination may increase. These preliminary findings suggest that if HPV testing is
Objective: To evaluate treatment patterns and surgical outcome of stage IA1 cervical cancer. Methods: Patients with stage IA1 cervical cancer diagnosed between January 2001 and June 2018 at Chiang Mai University Hospital were retrospectively reviewed. The analysis included treatment patterns, surgical types, and clinicopathologic variables, i.e., nodal metastasis, parametrial involvement, positive surgical margins, deep stromal invasion, lymph-vascular space invasion, adjuvant treatment, and 5-year disease-free survival and 5-year overall survival. All pathologic slides were reviewed by gynecologic pathologists. Kruskal-Wallis test and Fisher's exact test, Kaplan-Meier method, and log-rank test were used for statistical analysis. Results: One-hundred eighty-five patients were included in this study. Simple hysterectomy was the major treatment (57.3%) followed by modified radical hysterectomy and radical hysterectomy (27.6% and 9.7% respectively). Conization and radiation were chosen in few cases. At the median follow-up time of 40.8 months, the 5-year disease-free survival rate was 99.1% and the 5-year overall survival rate was 95.0%. Pelvic lymph node dissection was done in 62 cases (33.7%), but only one (0.54%) had pelvic lymph node metastasis. Conclusion: Surgical and survival outcomes of women with stage IA1cervical cancer are excellent. These could be effectively treated by conservative treatment (simple hysterectomy and conization). Lymph node metastasis is rare in this stage, therefore, the lymphadenectomy could be omitted.
Background The Ministry of Health, Labour and Welfare (MHLW) establishes screening recommendations specifying screening methods, age, and interval for gastric, colon, lung, breast, and cervical cancers. Screening programs are provided via local healthcare departments (LHD), who are responsible for managing programs and reporting the screening status through a survey annually. Methods We analyzed screening status provided by LHDs in fiscal 2017 in regards to appropriate screening age and interval. Briefly, current recommended screening age by MHLW is followed: colon, lung, breast cancer screening are age 40 years and older, and cervical cancer for aged 20 and older, and gastric cancer for aged 50 and older. Screening intervals are gastric, breast, and cervical cancer screening are two years, and colon and lung cancer screening are one year. Results The survey was completed by 1736 LHD (response rate: 99.9%). Regarding age-appropriate compliance, in cervical cancer, 96.4% of LHDs reported following recommended target age, while compliance was lower for lung, colon, breast, and gastric cancers at 79.4%, 75.7%, 60.2% and 4.2%, respectively. High compliance with recommendations for screening interval was identified for colon (99.7%) and lung (98.7%) cancers; this was substantially less for breast, cervical, and gastric cancer screening at 39.8%, 34.1%, and 4.6%, respectively. Conclusions In 2016, MLHW changed the starting screening age for gastric cancer from 40 to 50 years old, likely resulting in the lowest compliance in our analysis. Though it may take time for screening facilities to come into compliance with newer recommendations. Many LHDs provide screening without adhering to recommended starting ages, with a general tendency to provide screening at younger than recommended ages. This is a barrier to maximizing effectiveness and minimize harms of screening and warrants closer monitoring to promote efficiency in cancer screening programs. Key messages There is relatively low compliance with cancer screening guidelines in Japan. Establishing an environment of appropriate monitoring and support to achieve the goal of cancer screening is warranted.
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