宫颈癌筛查方法及其新进展

宫颈癌是威胁女性最主要的恶性肿瘤之一,近年来发病率不断上升,尤其是年轻化趋势现象(≤35岁)的出现引起了广大研究者的关注,而早期宫颈癌的治疗效果和5年生存率也位于恶性肿瘤的前列,这一特点使宫颈癌的筛查具有了非凡的意义.自多种筛查方法应用于临床以来,宫颈癌的发病率和死亡率都有显著改善.除传统的宫颈涂片细胞学检查以外,目前宫颈癌的筛查方法主要有:薄层液基细胞学检查、阴道镜检查、HPV-DNA检查和肉眼观察等.根据不同地区的经济条件和人群特征,这些筛查方式单独或联合使用对宫颈癌及癌前病变的检出均具有很大的临床意义.     

宫颈癌筛查方案的选择

宫颈癌是最常见的妇科恶性肿瘤之一,在发展中国家,发病率居首位,严重威胁着妇女的健康。宫颈癌的发生发展存在较长的癌前病变阶段,通过早期筛查并予以适当的干预措施可以明显降低其发病率。因而重视并选择科学的筛查方法,对宫颈癌及其癌前病变的防治有重要价值。     

初善仪子宫颈癌筛查系统在宫颈病变筛查中的应用

宫颈癌是最常见的女性生殖道恶性肿瘤之一,是导致妇女死亡的第二大癌症,随着宫颈癌筛查的开展,宫颈癌的发病率及死亡率可明显下降。初善仪(TruScreen)是一种新型的宫颈病变筛查方法,它具有与病理学诊断的一致性好、敏感性特异性较高、简单无创、易携带、客观性和实时性等特点,还可以联合其它筛查方法[宫颈涂片、新柏式薄层液基细胞学技术(ThinPrep liquid-based cytology test,TCT)、液基细胞薄层涂片(liquid-based cytology test,LCT)、人乳头状瘤病毒检测(human papilloma virus test,HPV-test)等提高宫颈疾病的检出率,在宫颈癌及癌前病变筛查及预后判断具有重大的临床应用价值。     

宫颈癌筛查的新进展

宫颈癌是继乳腺癌之后妇女死亡的第二大原因,严重威胁女性身体健康。近年来大量的研究已经表明宫颈癌是一种完全可以预防的疾病,早期宫颈癌的治愈率非常高。因此临床上越来越重视对于宫颈癌的早期筛查,制定更完善的筛查方案,以期早期发现宫颈癌及其癌前病变并及时治疗,降低宫颈癌的发生率和死亡率。     

2012年麻城市农村妇女宫颈癌筛查结果分析

目的对我市农村妇女宫颈癌筛查结果进行分析,探讨宫颈癌筛查对提高农村妇女健康水平的重要意义。方法2012年对本市36 462名农村妇女进行宫颈癌筛查,采用液基薄层细胞检测技术检测宫颈细胞,并对其进行子宫颈细胞学Bethesda报告系统(TBS)的细胞学诊断,对宫颈细胞学检查发现ASCUS及以上者行阴道镜及组织活检。结果普查对象中查出CINⅠ31例,CINⅡ35例,CINⅢ7例,宫颈癌5例。结论农村妇女积极开展宫颈癌普查,有助于癌前病变的早发现、早诊断、早治疗,对宫颈癌的预防有重要意义。     

The German cervical cancer screening model: development and validation of a decision-analytic model for cervical cancer screening in Germany

BACKGROUND: We sought to develop and validate a decision-analytic model for the natural history of cervical cancer for the German health care context and to apply it to cervical cancer screening. METHODS: We developed a Markov model for the natural history of cervical cancer and cervical cancer screening in the German health care context. The model reflects current German practice standards for screening, diagnostic follow-up and treatment regarding cervical cancer and its precursors. Data for disease progression and cervical cancer survival were obtained from the literature and German cancer registries. Accuracy of Papanicolaou (Pap) testing was based on meta-analyses. We performed internal and external model validation using observed epidemiological data for unscreened women from different German cancer registries. The model predicts life expectancy, incidence of detected cervical cancer cases, lifetime cervical cancer risks and mortality. RESULTS: The model predicted a lifetime cervical cancer risk of 3.0% and a lifetime cervical cancer mortality of 1.0%, with a peak cancer incidence of 84/100,000 at age 51 years. These results were similar to observed data from German cancer registries, German literature data and results from other international models. Based on our model, annual Pap screening could prevent 98.7% of diagnosed cancer cases and 99.6% of deaths due to cervical cancer in women completely adherent to screening and compliant to treatment. Extending the screening interval from 1 year to 2, 3 or 5 years resulted in reduced screening effectiveness. CONCLUSIONS: This model provides a tool for evaluating the long-term effectiveness of different cervical cancer screening tests and strategies.     

Economic aspects of cervical cancer screening

The results of a cost-effectiveness analysis of cervical cancer screening in The Netherlands are reported, emphasizing the analysis of the costs of screening and consequent diagnosis and treatment. Many organized screening policies are evaluated, differing in age-range and interval between screens. The cost estimates are based on organization charts, file studies and tariffs. The costs of screening itself are by far the most important cost component. Screening increases the costs of diagnosis. Costs for primary treatment only rise for large screening policies. Screening causes savings in costs of terminal treatment, but these are small compared with the costs of screening. The costs per life-year gained for the most efficient policies amount to DFL 24,000 for the policy with 7 invitations per woman in a lifetime and rise considerably in case of more than 10 invitations. Cervical cancer screening appears to be less cost-effective than breast cancer screening, but compared with other services the results are comparatively good. Implementing one of the efficient organized screening policies and discouraging spontaneous screening beyond that schedule leads to considerable savings. Moreover, many organized policies which are not efficient are still superior to spontaneous screening.     

A feasibility study of organised cervical screening in southern New Zealand

The 1985 electoral roll was used as a register to invite 1013 women to participate in a screening program. Appointment times and a choice of venues for having a smear were not provided. Overall, 26 per cent of the women sent invitations registered with the program. After adjustment for the prevalence of hysterectomy, the proportion who registered with the program was about 32 per cent. The low level of registration and difficulties experienced in tracing registrants and nonregistrants over time using the electoral roll resulted in the cessation of the program after 3 years. An assessment of the original invitation was made using a small case-control study, and associations between the screening history stated at interview and screening over the duration of the program were examined in nonregistrants.     

人群大样本子宫颈癌筛查中宫颈涂片的质量控制

目的探索人群大样本子宫颈癌筛查中宫颈涂片质量控制的方法,提高涂片质量和细胞学检查灵敏度。方法概率比随机抽样,常规加跟踪质量控制,肉眼加镜下观察。观察指标:涂片膜厚度、涂片膜面积、血液成分、鳞状上皮细胞数、有无颈管细胞。结果①2008年项目点的后期涂片质量好于前期。肉眼观察涂片膜厚度、血液成分过多、涂片膜面积<40%3项指标后期较前期分别下降0.25%、4.33%、1.51%;镜下观察鳞状上皮细胞数、血细胞过多2项指标分别下降11.79%、11.95%,未见颈管柱状细胞或化生细胞上升3.51%。②2009年项目点涂片质量高于2008年。肉眼观察血液成分过多、涂片膜面积<40%2项指标分别下降0.55%、0.43%,涂片膜厚上升0.58%;镜下观察鳞状上皮细胞数、未见颈管柱状细胞或化生细胞、血细胞过多3项指标分别下降9.61%、4.71%、1.01%。结论建立简便、易行、科学的质量控制方法,能全面监控宫颈癌筛查的涂片质量,及时发现问题提高宫颈涂片质量。     

Cervical cancer in Bangladesh: community perceptions of cervical cancer and cervical cancer screening

We investigated the awareness of, and the attitude towards screening for, cervical cancer in Bangladesh. We performed a qualitative study using focus group discussions (FGD). The framework approach to qualitative analysis was used. The study was performed in the catchment areas of Addin Hospital, Jessore, Southern Bangladesh (peri-urban) and LAMB hospital, Parbatipur, North West Bangladesh (rural). A total of 220 men, women and adolescents participated in 28 FGDs. Awareness of cervical cancer was widespread. Knowledge about causes was often inadequate. The perceived consequences of cervical cancer were numerous and awareness of the need for cervical cancer treatment was present. Barriers to accessing care include: low priority for seeking help for symptoms, limited availability of health services and cost. Most women were unaware of the possibility of screening via speculum examination, which was considered acceptable to women (and men), as long as the examination was done by a female healthcare provider in an environment with sufficient privacy. In conclusion, adequate gynaecological services are not available or accessible for most women in rural and peri-urban Bangladesh. However, awareness of cervical cancer is widespread. Screening for cervical cancer in these communities is acceptable if done by a female healthcare provider under conditions with sufficient privacy.     

液基细胞学筛查宫颈癌的临床分析

目的:评价液基薄层细胞学技术对妇科门诊人群子宫颈癌筛查的准确性,探讨宫颈癌患者年轻化的倾向。方法:对妇科门诊18340例宫颈脱落细胞标本,采用薄层细胞学检查(TCT)技术制片和TBS方案进行诊断,阳性者行阴道镜下病理组织学活检并按年龄分组。结果:TCT与病理组织学对照,TCT的阳性符合率:LSIL为29/54(53.70%),HSIL为22/25(88.00%),SCC为1/1(100.00%)。TCT检出的191例ASC经组织学证实143例为炎症或其它,48例为CIN和SCC。31~40岁年龄段是CIN的高发年龄段,几率为40/81(49.38%)。结论:TCT与病理组织学有一定的相关性,TCT作为无创伤检测,是门诊筛查子宫颈癌的有效方法,门诊筛查子宫颈癌要对年轻的妇女特别关注。     

人乳头瘤病毒检测在宫颈癌筛查中的作用

目的探讨人乳头瘤病毒(HPV)分型检测在宫颈癌筛查中的作用;了解该地区HPV感染情况,为未来HPV疫苗应用提供流行病学依据。方法应用流式荧光杂交技术对在该院妇科就诊的1 381例患者行宫颈脱落细胞HPV分型检测,对符合条件者行病理检查,探讨HPV分型检测在宫颈癌筛查中的作用。结果 HPV阳性率20.93%,HPV阳性率随宫颈病变程度加重明显增高,且宫颈癌及癌前病变的HPV阳性率与慢性宫颈炎比较差异有统计学意义(P0.05);以CIN1及以上宫颈病变(CIN1+)为标准计算HPV分型检测的敏感度、特异度、阳性预测值、阴性预测值、误诊率、漏诊率和诊断符合率分别为71.62%、84.31%、95.21%、40.57%、15.69%、28.38%和73.99%;就诊患者中高危型HPV感染率居前5位的依次是16、58、52、33、18型;低危型HPV以6和43型为主;不同年龄组HPV感染呈抛物线状分布,41~50岁组感染率最高。结论流式荧光杂交HPV分型检测技术具有较好的敏感度和特异度,在宫颈癌筛查中具有积极作用;HPV亚型分布存在地域和年龄特异性,未来承德地区HPV疫苗的选择和应用需考虑病毒亚型和年龄两个因素。     

Health economics analysis of cervical cancer screening

INTRODUCTION: To reduce the high mortality rate of cervical cancer there are organized, nation-wide mass-screening programmes. AIM: To assess the screening rate, the cost of screening and treatment and to calculate the expected epidemiological and economic gain and cost-effectiveness of mass-screening programme. METHODS: The data derive from the financial database of the National Health Insurance Fund of Hungary from 2001. To assess the screening rate the authors used the code "No. 29601 cytological examination for screening" of out-patient care. The cost of treatment includes the cost of out-patient care, the acute and chronic inpatient care, the subsidies of medicines' prices and the expenditure on disability to work (including sickness-pay). The expected benefits of the screening programme were modelled with changing the screening interval. RESULTS: The screening rates for 1999, 2000 and 2001 were 14.5%, 16.2% and 15.6% respectively, while the 3 year screening rate for 1999-2001 were 35.7%. The cost of treatment of cervical cancer were around 1 billion Hungarian forint in 2001. The cost of one life saved according to the current screening strategy was 16.6 million Hungarian forints (57.792 USD) with a successful screening programme, while with a less successful program it was 33.8 million Hungarian forint (118.093 USD). The cost of one life year gained according to the current screening strategy was 0.7 million Hungarian forints (2.513 USD) with a successful screening programme, while with a less successful program it was 1.5 million Hungarian forint (5.134 USD). CONCLUSION: It is important to increase the screening rate. With increasing the screening interval for women aged between 25-65 from 1 year to 2 or 3 years, it improves the cost-effectiveness of screening programme.     

HPV疫苗应用概述

本文综述我国女大学生对HPV疫苗的接种意愿及健康行为相关理论的应用,基于健康生态学模型分析大学生HPV疫苗接种意愿的影响因素,提出信息-动机-行为技巧理论在HPV疫苗行为学中应用的前景,从而进一步探索我国女大学生接种HPV疫苗的行为干预模型。     

Efficacy of cervical cytologic screening in the control of cervical cancer

Cervical cancer mortality in the U.S. has been declining, and this has been attributed to cervical cytologic screening. This report reviews data on the incidence and mortality of cervical cancer in order to evaluate the effect of cytologic screening. U.S. cervical cancer mortality has been declining consistently since 1946, with little change in the mortality trend after widespread cytologic screening. Incidence of invasive cervical cancer in specific geographic areas has also declined. However, the rate of diagnosis of carcinoma in situ has increased sharply and parallels increasing cytologic screening rates. A causal association of cytologic screening with the decreasing mortality and incidence of invasive cervical cancer cannot be established using current data, especially considering declining mortality prior to widespread screening and increasing removal of women from the population at risk by hysterectomy.