Significant variations in the cervical cancer screening rate in China by individual‐level and geographical measures of socioeconomic status: a multilevel model analysis of a nationally representative survey dataset

Bao, Heling; Zhang, Lei; Wang, Limin; Zhang, Mei; Zhao, Zhenping; Fang, Liwen; Cong, S; Zhou, Maigeng; Wang, Lınhong

doi:10.1002/cam4.1321

Cited by 74 publications

(73 citation statements)

References 43 publications

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“…We noticed 54.1% of WLHIV were coinfected with at least one STI Ther evidence displays potential risk of pregnancy adversities and HIV mother-to-child transmission among these reproductive age women. Regular cervical screening is recommended for all women aged over 25 in China, but the actual 3 year screening rate only hovers around 20% 9. Although diagnosed women have been linked to relevant ART care, the analysis further accentuates need to scale up screening of HPV as well as other STIs among these HR women and strengthen the importance of identifying HPV16/18 in cervical screening for WLHIV as preventive measure.…”

Section: Discussionmentioning

confidence: 99%

Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study

Wang

Zhang

et al. 2018

Sex Transm Infect

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ObjectiveWomen living with HIV (WLHIV) face disproportionately higher risks of acquiring human papillomavirus (HPV) compared with HIV negative counterparts. We aimed to investigate the prevalence of HPV in WLHIV in Chinese hospital setting and identify associated factors to the progression of late-stage cervical intraepithelial neoplasia (CIN2+) in this population.MethodThis retrospective study collected data from 183 WLHIV on antiretroviral treatment (ART), based on reproductive health questionnaires. Gynaecological examination results including serum (for HIV viral load, CD4 T-cell count, hepatitis B infections, syphilis) and vaginal swabs for common bacterial sexually transmitted infections (STIs). Multivariate-logistic regression was applied to analyze the contributing factors to CIN2+.ResultsHIV coinfection with other Sexually Transmitted Infections (STIs) were observed in 99 participants (54.1%, (99/183)). HPV (43.7% (80/183)) was the most prevalent STI. The three most prevalent HPV subtypes were all high-risk HPV (HR-HPV), including HPV52 (33.8% (27/80)), HPV58 (21.3% (17/80)) and HPV33 (13.75% (11/80)). About a third (37.5%, 30/80) of women with HPV had HR-HPV. Multiple HPV coinfections were common in HIV-HPV coinfected women (41.3%, 33/80). Cytological examinations revealed that 77.5% (62/80) HPV+ women had detectable cervical lesions. In comparison, only 4.9% (5/103) HPV negative womenwith Atypia and 1.0% (1/103) with CIN1 were diagnosed. Multivariate logistic regression revealed that HPV16 (OR=19.04, 2.53 to 122.92; p=0.004) and HPV18 (OR=11.54, 1.45 to 91.64; p=0.021) infections were significantly associated with CIN2+ in HIV-HPV coinfected women.ConclusionA high prevalence of HPV was found in women on ART. HPV16/18 infection are strong associated factors to CIN2+ in HIV-HPV coinfected women.

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Section: Discussionmentioning

confidence: 99%

Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study

Wang

Zhang

et al. 2018

Sex Transm Infect

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“…However, the uptake of the screening services in China is relatively low, varying from 28% to 63% in different regions . That screening rate is particularly lower for women living in rural and remote western areas, compared to women living in developed regions in China, like Beijing (44.19%) and Zhejiang (47.22%); additionally, it is lower than those in developed countries like America (80.5%) and Italy (79.0%) …”

Section: Introductionmentioning

confidence: 97%

“…Previous studies have showed that the low screening uptake in China is largely driven by the limited knowledge of cervical cancer risk and weak awareness on cancer screening, as well as a low educational level and discomfort associated with the screening procedure . In particular, Chinese rural women are heavily influenced by the traditional culture like Confucianism, as well as the low socioeconomic status and healthcare resources …”

Section: Introductionmentioning

confidence: 99%

Protection motivation theory in predicting cervical cancer screening participation: A longitudinal study in rural Chinese women

Liu

Chen

et al. 2019

Psycho-Oncology

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Objective To examine factors longitudinally associated with cervical cancer screening uptake among rural Chinese women, guided by protection motivation theory (PMT). Methods A large sample of women (n = 2408, aged 35‐65 years old) was randomly selected from a rural county in China in 2015 and followed up for 2 years. Data for demographic factors, knowledge of cervical cancer screening, screening outcome, and six PMT constructs measured at the baseline in 2015 were used to predict cervical cancer screening participation at the follow‐up in 2017 using structural equation model method. Results Among the 2408 women at the baseline, 1879 (78.03%) participated in the screening services at the follow‐up. In addition to significant direct effect of age, social status and baseline screening outcome, and three (perceived severity, fear arousal and response efficacy) of the six PMT subconstructs, four variables (age, social status, knowledge of cervical cancer screening, and baseline screening outcome) at the baseline were indirectly associated with screening participation, mediated by the three significant PMT subconstructs. Conclusions Findings of this study indicate that the rate of participating in cervical cancer screening for rural women needs to be further improved. In addition to the commonly reported influential factors, PMT subconstructs play important roles in encouraging rural women in China to participate in cervical cancer screening. These longitudinal findings provided data much needed for future research to develop evidence‐based intervention programs to enhance cervical cancer screening among rural women in China.

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“…In addition, there is no universal, well‐organized cancer screening program in China and screening currently is limited largely to occasional opportunistic screening in urban centers with efforts being initiated to extend screening to the underserved rural population . A recent nationwide cross‐sectional and large‐scale study demonstrated that only 21.4% of Chinese women aged ≥21 years reported having ever been screened and demonstrated significant geographic variations . Furthermore, recent publications have reported that China now is considered to be a “human papillomavirus (HPV)‐heavy burden” zone in some regions, with an overall HPV prevalence of between 19.8% and 26.0% .…”

Section: Introductionmentioning

confidence: 99%

Follow‐up with histopathology and HPV testing on LSIL cytology in China’s largest academic woman’s hospital

Tao

Zhang

et al. 2019

Cancer Cytopathology

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Background Cervical cancer remains a major health problem in China. To provide baseline data for establishing the appropriate screening strategy, the authors investigated the histopathologic follow‐up and human papillomavirus (HPV) testing results of low‐grade squamous intraepithelial lesion (LSIL) cytology in the Chinese Largest Women Hospital. Methods Women with LSIL cytology, human papillomavirus (HPV) testing, and immediate histopathologic follow‐up between 2011 and 2016 were analyzed. Results The frequency of LSIL among 1,095,022 Papanicolaou (Pap) tests was 1.4%, and was significantly higher in cases using liquid‐based cytology (LBC; 1.5%‐1.6%) compared with conventional Pap smears (CPS; 0.5%). The CPS method had performance for predicting cervical intraepithelial neoplasia (CIN) that was comparable to that of LBC (75% vs 69.1% and 71.9%). Among 8079 LSIL cases with an immediate histopathologic diagnosis, CIN‐2/3 or higher (CIN‐2/3+) was found in 11.9% of cases and carcinoma in 0.3% of cases. A total of 158 patients (15.7%) with HPV‐positive LSIL had a diagnosis of CIN‐2/3 compared with 18 patients (5.5%) with HPV‐negative LSIL. In postmenopausal women with LSIL cytology, the detection rate for CIN‐2/3 in HPV‐negative patients was significant lower than that in HPV‐positive patients. Furthermore, HPV type 16 (HPV‐16) was the most common genotype noted in patients with CIN‐2+ lesions, whereas HPV‐18 was the most common in patients with CIN‐1. Conclusions Although its reporting rate is lower than that of LBC, CPS is useful due to its low cost and comparable predictive value. HPV testing is helpful for stratifying postmenopausal women with LSIL into lower and higher risk groups. HPV‐16 is the most commonly identified genotype in CIN‐2+ lesions diagnosed in Chinese women with LSIL cytology, whereas HPV‐18 is the most commonly identified genotype in patients with CIN‐1 lesions.

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Significant variations in the cervical cancer screening rate in China by individual‐level and geographical measures of socioeconomic status: a multilevel model analysis of a nationally representative survey dataset

Cited by 74 publications

References 43 publications

Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study

Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study

Protection motivation theory in predicting cervical cancer screening participation: A longitudinal study in rural Chinese women

Follow‐up with histopathology and HPV testing on LSIL cytology in China’s largest academic woman’s hospital

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