Diagnostic Yield and Performance of a Large Population-Based Cervical Cancer Screening Program in High-Risk Rural China

Abstract

Primary cervical cancer screening by liquid-based cytology alone or with adjunctive HPV testing are available worldwide. However, little if any information is available about cervical cancer diagnostic yield of population-based cervical cancer screening in China. In response to it, we conducted a large prospective study on 40,000 women cervical cancer screening within six-month period in rural Shanxi Province, where has been reported as the highest cervical cancer rates in China. A standard cross-sectional survey by self-completed questionnaire was collected and followed by the liquid-based cytology screening. Follow-up biopsy with the diagnosis of cervical intraepithelial neoplasia 2 or higher lesion (CIN2+) were analyzed. Of initial 40,000 women participating in this study, 6.76% (2702/40,000) women had ASC-US or higher cytology screening results with ASC/SIL ratio at 6.14 (2381:388). Among them, 1.96% (782/40,000) women were found CIN lesions (95% CI, 1.68-2.23%) on confirmatory biopsies, including 0.55% (218/40,000) CIN2+ and 19 SCCa (47.5/100,000, 95% CI, 29-74/100,000). Women in Yangqu County had lower ASC/SIL ratio, but higher CIN2+ detection rate in comparison with that of Jiexiu County (6.69 vs. 8.84 and 56.7% vs. 43.9%), which reflects the cervical cancer distribution in different populations and regions. Analysis in age-stratified cytology results indicated women aged 60-65 years had the highest incidence of cytologic abnormality among all the age group; likewise, women aged >50 years were at higher risk in developing cervical high grade dysplasia or cancer than women aged <50 years (0.82% vs. 0.49%). This large-scale cervical cancer screening study provided important references as the instructive for establishing the nation-wide cervical cancer screening strategy.

Populations at high risk of cervical cancer in Guangxi Province: Findings from two screening projects in a minority area of South China

“…We hypothesize that although Guangxi is a developing region with low economic conditions, the regional economic differences among counties in Guangxi are not as large as those reported in previous studies between developed and developing countries. The positive rate of HSIL (0.60%) in Guangxi was higher than that reported in recent studies (0.48%-0.56%) in China [29][30][31] but lower than that reported in other developing counties or areas. 31,32 Notably, this study was based on cervical cytological results rather than histological results, which is similar to some population-based studies on CC screening.…”

“…The positive rate of HSIL (0.60%) in Guangxi was higher than that reported in recent studies (0.48%–0.56%) in China 29 – 31 but lower than that reported in other developing counties or areas. 31 , 32 Notably, this study was based on cervical cytological results rather than histological results, which is similar to some population-based studies on CC screening. In this study, we found that being female over 64 and being from an urban area were common risk factors for CC and HSIL.…”

The Potential of circRNA as a Novel Diagnostic Biomarker in Cervical Cancer

“…Cervical intraepithelial neoplasia and cervical cancer are mainly closely related to sexually transmitted high-risk human papillomavirus (HPV) infection, which can cause more than 99% of the incidence of cervical cancer [4]. e current screening methods for cervical cancer mainly include cytology and HPV nucleic acid testing [5]. Conventional cytology and liquid-based thin-layer cell testing (TCT) have high sensitivity and specificity for cervical precancerous lesions; although HPV screening and cytology have the same or better results, the specificity of HPV testing is low.…”

The lifetime cost estimation of human papillomavirus-related diseases in China: a modeling study

“…Accordingly, we speculate that this result may be related to implementation of the CC screening program in China. [53,54] This program targets Chinese women of the appropriate age to detect patients with early CIN in a timely manner and prompt patients with mild disease to seek medical treatment as early as possible; as a result, patients consume fewer medical resources and bear lower treatment costs. [55]…”