Introduction. Currently, in developed countries, virological screening is used as the main screening tool, and the Papanicolaou cytological control service is used as an auxiliary one. For countries with limited financial resources, WHO has recommended various options for an imaging screening strategy called «screening, diagnosis and treatment». Aim. The choice of the optimal model for the use of cytological studies, economically justified for our country, against the background of the expanding population-based visual screening of cervical cancer. Material and methods. The data of official statistics and the results of the pilot design of the WHO screening and treatment strategy in the Kushoniyon district of the Khatlon region and B. Gafurov district of the Sughd region were used. Results. As this study has shown, over the past decades in the Republic of Tajikistan, cytological screening for cervical cancer has fallen into complete decline and in recent years provides only 4.73% of women of reproductive age. Cytological examinations of cervical smears in the country are performed only as an additional test in cases of suspected cervical intraepithelial neoplasia. Due to the existing economic problems in the country, since 2016, the visual screening recommended by WHO for countries with limited resources has been introduced in a pilot way. The first results of the pilot implementation of visual screening have shown its high efficiency at a low economic cost. However, the question of the role of cytological studies against the background of coverage of the population with visual screening remains unclear. The economic feasibility and scale of the reorganization of cytomorphological support for cervical cancer screening in the Republic of Tajikistan was confirmed. Conclusions. In the conditions of the Republic of Tajikistan, as a result of the widespread coverage of the population with visual screening, Papanicolaou cytological studies will serve as an auxiliary tool and can be reorganized on the basis of the Republican Cancer Research Center and its regional and interdistrict divisions.
Objective: To assess the clinical results of cervical intraepithelial neoplasia (CIN) treatment following the outcomes of the first pilot implementation of visual screening in the Republic of Tajikistan. Methods: The study was conducted from 2016 to 2020. The piloting included the population of two large districts of Kushoniyon and B. Gafurov, with a total number of 608,700 people, which is 6.74% of the country's total population. The target group of this screening included healthy women aged 30-49 years, numbering 72574 people. As a result of communication campaigns with the target group of both districts, 69391 women participated in visual screening; the overall screening coverage was 94.2%. Of the 2958 women referred for diagnosis, in 164 cases (0.24%) CIN was identified and morphologically confirmed. Results: Tajikistan, along with piloting imaging screening, has adopted a "detection-diagnosis-treatment" strategy, which involves treatment after histological confirmation of CIN. Additionally, electrosurgical loop excision/conization was adopted as the primary method, regardless of the degree of CIN involvement. Patients with CIN in 136 (82.9%) cases underwent electrosurgical loop excision, in 21 cases – conization (12.8%), and in 7 (4.3%) cases, at the insistence of the women themselves – hysterectomy. In the long-term follow-up period from 6 months to 2 years, in 159 (96.9%) cases, a favorable course of CIN was noted after the above procedures, and in 5 (3.1%) cases, relapse occurred. Patients with relapses received re-surgical treatment using electrosurgical excision/conization with a satisfactory outcome. Conclusion: The "detection-diagnosis-treatment" strategy adopted by Tajikistan has shown its high efficiency in detecting precancerous pathology and the success of CIN treatment by electrosurgical excision/conization, which contributes to the healing of the population from precancerous pathology. Keywords: Cervical intraepithelial neoplasia, visual screening, VIA/VILI visual method, colposcopic examination, electrosurgical loop excision/conizatio.
Введение. По экспертным прогнозам проекта GLOBOCAN, к 2050 г. ожидается рост заболеваемости раком шейки матки на 50%, что свидетельствует о необходимости коррекции стратегии активного его выявления и лечения на ранних стадиях. В связи с этим рекомендуется незамедлительное внедрение оптимизированных алгоритмов профилактики, активного скрининга и своевременного лечения данной патологии. Цель исследования. Изучить эпидемиологию предраковых заболеваний по данным визуального скрининга рака шейки матки в пилотном исследовании в двух районах Республики Таджикистан. Материалы и методы. Визуальный скрининг впервые был проведен в рамках пилотного исследования в двух районах Республики Таджикистан с численностью населения 608,7 тыс. человек. В целевую группу были включены здоровые женщины в возрасте 30-49 лет. Визуальным скринингом было охвачено 68,4 тыс. человек, охват составил 94,2%. В основу проведения скрининга был положен визуальный тест Шиллера с использованием раствора Люголя. Результаты. В обоих районах были выявлены 164 случая цервикальной интраэпителиальной неоплазии. Среди населения района Кушониён показатель заболеваемости предраковой патологией рака шейки матки составил 30,6 на 100 тыс. женского населения, в районе Б. Гафуров – 71,2, совокупный показатель по обоим районам – 55,6. По данным скрининга частота заболеваемости цервикальной интраэпителиальной неоплазией в 8,2 раза превысила показатель заболеваемости раком шейки матки. Показатели учитывали по данным обращаемости статистическими методами до проведения скрининга. Заключение. Первый пилотный проект по внедрению визуального скрининга в Республике Таджикистан продемонстрировал высокие показатели заболеваемости предраковой патологией, значительно превышающие показатели заболеваемости раком шейки матки. Полученные данные свидетельствуют о высоком потенциале методов активного выявления предраковых заболеваний шейки матки, направленных на оздоровление населения и снижение частоты заболеваемости раком шейки матки.
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