漯河市农村妇女宫颈癌筛查结果分析

目的 了解漯河市农村妇女宫颈癌前病变及宫颈癌的发病情况。方法 应用液基细胞学检查技术并结合TBS分级系统,采用随机原则于2012年3月 - 6月对该市20个农村6 007例妇女进行免费宫颈癌筛查,在HPV分流下对ASC及其以上病变行阴道镜检查,取病理学活检并做相应处理。结果 共筛查6 007人,合格标本5 919例,异常439（7.42%）例,44～47岁组妇女患病率高。其中ASC:288例（4.87%）,LSIL:96例（1.62%）,HSIL:51例（0.86%）,SCC:4 例（0.07%）;根据HPV结果,对310例患者进行阴道镜及组织病理活检。结果发现正常或炎症163例（58.58%）,CINⅠ55例（17.74%）,CINⅡ28例（9.32%）,CINⅢ59例（19.03%）,浸润癌5例（1.61%）。结论 农村妇女是宫颈癌发病的高危人群,各级部门应重视农村妇女宫颈癌筛查工作。     

Mexican Immigrant Male Knowledge and Support Toward Breast and Cervical Cancer Screening

Background We conducted a focus group study to assess the influence of partner communication on breast and cervical cancer screening and the perceived existing and potential support from male partners in participating in cancer screening. Secondarily, Mexican male and female views on health care and cancer were explored. Methods Seven focus groups (two female-only, three male-only, and two couples) were conducted in Spanish. Results Findings suggest that knowledge about cervical cancer was significantly less than knowledge about breast cancer among both men and women. Barriers to cancer screening included language barriers, lack of health insurance, and lack of awareness of the need for screening. Male partners expressed willingness to support their female partners in cancer screening activities. Conclusion Cervical cancer education is desperately needed, including education on the availability of free and low cost screening services. Education efforts should include the male community members, especially as the males perceive themselves as responsible for the financial burden of care.     

Social Support Among Latina Immigrant Women: Bridge Persons as Mediators of Cervical Cancer Screening

New Latina immigrants face numerous linguistic, cultural, logistical, and material barriers to cervical cancer screenings. Promotoras (lay health advisors) are a proven strategy to promote utilization of care. Since the mid-1990s, interventions in North Carolina have aimed to connect Latina immigrants to a broader range of bridge persons. This study assessed the effect of bridge persons on utilization of cervical cancer screening by Latina immigrants in North Carolina. Women were recruited in Spanish-language churches in four counties (N = 223). Logistic regression results show that persons known through advocacy organizations appeared to increase probability of recent Pap screening by an average of 10.4 percentage points (p < 0.05).Promotoras remain more effective, increasing probability of screening by 12.9 percentage points (p < 0.05) but few women (14%) knew one. No association was found with other bridge person profiles. Interventions are needed to better engage all bridge persons in linking immigrants to preventive health services.     

宫颈癌筛查工作评价指标的比较研究

目的探讨将晚期宫颈癌患者的临床病历资料作为宫颈癌筛查工作质量评价指标的可行性。方法选择2007年1月至2010年12月2 092例北京市户籍新发宫颈癌患者（12-93岁）的临床病历资料（数据由北京市肿瘤防治研究办公室提供）以及从北京妇幼保健网络信息系统获得的2008-2009年（宫颈癌第1个筛查周期）北京市所管辖18个区县进行宫颈癌筛查的728 704例适龄妇女（25-64岁）的病历资料（其中确诊为宫颈癌患者为89例）为研究对象。采用回顾性调查法将2007-2010年北京市新发宫颈癌患者临床病历资料与同期北京市宫颈癌筛查登记记录进行比对,追踪筛查中漏诊晚期宫颈癌患者的临床病历资料。分析宫颈癌发生率、病死率、筛查早期诊断率、检出率、参与率及晚期宫颈癌检出率等指标作为宫颈癌筛查工作评价指标的适用条件及可行性。结果 2007年1月至2010年12月北京户籍新发宫颈癌患者中,有明确临床分期者为1 663例（79.49%,1 663/2 092）,其中晚期宫颈癌患者为442例（26.58%,442/1 663）。北京妇幼保健网络信息系统中显示,2008-2009年间确诊为晚期宫颈癌的98例患者中,参加北京市宫颈癌筛查者为24例,其中,筛查时宫颈细胞学检查未见异常,但筛查后4-20个月内确诊为晚期宫颈癌患者为5例,且主要集中在4个区县。按照目前北京宫颈癌筛查主要采用的评价指标（筛查早期诊断率、癌前病变及癌检出率、筛查参与率）,发生漏诊的4个区县的筛查效果排名位居18个区县前列。结论晚期宫颈癌发病数据与宫颈癌发生率、病死率、筛查早期诊断率、检出率、参与率等评价指标各有利弊,晚期宫颈癌患者临床病历资料较易获取,可作为评价开展宫颈癌筛查地区及岗位人员筛查工作质量的考核指标。     

Perceptions of Cervical Cancer Threat,Benefits, and Barriers of Papanicolaou Smear Screening Programs for Women in Iran

ABSTRACT

Objectives: The main purpose was to assess associations between HBM variables and participation in cervical cancer screening programs in a sample of Iranian women.

Methods: A total of 333 married women of childbearing age were recruited with cluster sampling. The study was conducted from spring 2002 to spring 2003 and a self-report questionnaire and structured interview were designed to measure the four HBM constructs and Iranian women's knowledge about Pap smear screening.

Results: A total of 68.5% reported having undergone at least one Pap test. Women were more likely to participate in Pap smears when they had access to knowledge about cervical cancer and screening programs. Furthermore, the perceived benefit and barrier variables of the Health belief model were two factors related to participation in Pap smear testing.

Conclusions: Health care professionals must provide women with more information about cervical cancer and the benefits of participating in cervical cancer screening programs.     

对宫颈癌早期筛查患者实施护理干预的效果观察

目的探讨对接受宫颈癌早期筛查后的宫颈炎患者实施护理干预的效果。方法选取2013年6月至9月294例在我院妇产科门诊首次接受宫颈液基细胞学检查(thinprep cytologic test,TCT)+人乳头瘤样病毒(HPV)检查、年龄<50岁的宫颈炎患者。采用自制问卷对患者接受干预措施前后对宫颈癌早期筛查的认知进行对比。结果患者接受干预措施前后对宫颈癌早期筛查的认知的差异有统计学意义(P<0.01或P<0.05)。结论护士以健康信念模式为指导的个性化健康教育,利用各种宣传方式和途径做好患者宫颈癌防治知识普及和指引,能有效提高患者对宫颈癌早期筛查的认知程度,使患者树立健康的信念并改善患者参与宫颈癌早期筛查行为,最终达到及时发现、及时诊断、及时治疗的宫颈癌防治目的。     

十堰市农村妇女宫颈癌和乳腺癌筛查满意度分析

目的 了解十堰市受检妇女对宫颈癌和乳腺癌筛查项目的满意度评价,为今后开展工作提供参考.方法 采用电话访谈的方式对受检者进行满意度调查,内容包括是否知晓宫颈癌和乳腺癌相关知识、是否会继续参加类似的免费筛查活动以及对检查环境、检查过程、操作的专业规范性、工作态度和服务水平这5个方面的满意情况.结果 受检者"两癌"知识知晓率为85.66%,有90.31%的受检者表示会继续参加类似的免费筛查活动;宫颈癌和乳腺癌筛查满意率最高的环节为工作态度(71.71%),其次是服务水平(69.77%),满意率最低的环节为检查环境(56.20%),不满意率最高的环节为过程便捷(12.02%);郧县、竹山县和郧西县分别在工作态度、检查环境和操作规范上的满意率高于其余各县,竹溪县在过程便捷和服务水平两个环节上的满意率高于其余各县,房县5个环节的满意率均较其余各县低.结论 建议各县对满意率较低的环节采取针对性措施,同时加强项目的监管和质量控制,为受检者提供优质的筛查服务.     

Adoption of Liquid-Based Cervical Cancer Screening Tests by Family Physicians and Gynecologists

Objective. To examine reasons for the adoption of liquid-based cervical cancer screening tests.
Data Sources/Study Setting. A mailed survey of 250 family physicians and 250 gynecologists in Maryland in 2000. Additional data were obtained from the AMA Master File of Physicians.
Study Design. Key outcome variables in this cross-sectional survey were early adoption of a liquid-based test by the end of 1997 and overall adoption by the time of the survey. Adoption was viewed in terms of a supply and demand theoretical framework with marketing influencing physician and patient demand as well as supply by insurance companies and laboratories.
Data Collection. Random samples of family physicians and gynecologists were selected from the AMA Master File of Physicians. The overall response rate was 61.9 percent.
Principal Findings. By 2000, 96 percent of gynecologists and 75 percent of family physicians in Maryland were using liquid-based cervical cancer screening tests, most commonly the ThinPrep® Pap Test™. Gynecologists were more likely than family physicians to have been early adopters (34 percent versus 5 percent, p <.01). Part of this variation in adoption was due to aggressive marketing to gynecologists, who were more likely than family physicians to receive information in the mail from the test manufacturer (89 percent versus 56 percent, p <.01) and to have been informed by the manufacturer that a patient had inquired about physicians' use of the test (22 percent versus 8 percent, p <.01).
Conclusions. The rapid diffusion of liquid-based cervical cancer screening tests occurred despite general agreement that the Pap smear has been one of the most successful cancer prevention interventions ever. Commercial marketing campaigns appear to contribute to the more rapid rate of diffusion of technology among specialists compared with generalists.     

Previous Cancer Screening Behavior as Predictor of Endoscopic Colon Cancer Screening Among Women Aged 50 and Over, in NYC 2002

Colon cancer screening rates in women are low. Whether screening for breast and cervical cancer is associated with colon cancer screening behavior is unknown but could provide linkage opportunities. To identify the extent to which both breast and cervical cancer screening increases uptake of colon cancer screening among women in New York City. Women at least 50 years old completed questionnaires for the New York Cancer Project. Analyses compared rates of endoscopic colon cancer screening with adherence to screening recommendations for breast and cervical cancer. Of the 3,386 women, 87.8% adhered to breast and cervical cancer screening guidelines, yet only 42.1% had received endoscopic colon cancer screening. Most women with colon cancer screening (95%) also reported past mammogram and Pap-smear. In multivariable analysis, women who adhered to the other two procedures were more likely to have had colon cancer screening than women with no prior history (OR = 4.4; CI = 2.36, 8.20), after accounting for age, race/ethnicity, insurance status, family history of cancer and income. Significant predictors of endoscopic colon cancer screening included: age over 65 years (OR = 1.63; CI = 1.23, 2.15) with 50–65 years old as the reference, any health insurance (OR = 2.18; CI = 1.52, 3.13) and a family history of cancer (OR = 1.38; CI = 1.17, 1.61). Colorectal cancer screening remains low, even among women who undergo other cancer screening tests. Opportunities to link cancer screening tests to encourage colon cancer screening merit closer attention.     

Breast and Cervical Cancer Screening Among South Asian Women in New York City

The purpose of this paper is to document the breast and cervical cancer screening practices of a community sample of South Asian women living in the New York City area. A convenience sample of 98 women was engaged in face-to-face interviews regarding their socio-demographic characteristics and cancer screening utilization. Sixty-seven percent of women had ever had a Pap test; 54% had one in the last 3 years. Seventy percent of women over 40 had ever had a mammogram; 56% had one in the last 2 years. Sixty-six percent of women had knowledge of breast self-exam (BSE); 34% of women ever practiced BSE. Multiple logistic regression analysis indicated that insurance status was a significant predictor of ever having a Pap test or mammogram, receiving timely Pap tests, and ever practicing BSE. Education was a significant predictor of ever having a Pap test and having knowledge of BSE. Marital status was a predictor of receiving timely Pap tests, and having spent more time in the U.S. was a predictor of ever practicing BSE. The study concludes that increased educational efforts must be developed targeting immigrant South Asian women of low socioeconomic status with limited access to healthcare.     

A Community-based Cervical Cancer Screening Program among Women of Delhi using Camp Approach

Background:

Cervical cancer is the commonest malignancy among women in developing countries. Cytological screening (Pap smear) have been claimed to reduce incidence and mortality of carcinoma cervix significantly for which sensitization of women is required through community-based approach.

Objectives:

To find out number of cervical cancer cases among patients reporting to a general health care camp through screening program and study the prevalence of perceived morbidity and its confirmation.

Settings:

Cross-sectional study among women attending cancer awareness camps.

Materials and Methods:

A total of 435 women attending cancer awareness camps were screened for carcinoma cervix. The findings of history and clinical examination were recorded. Pap smears of all the symptomatic patients were collected and cytological diagnosis was confirmed by a pathologist.

Results and Conclusions:

The perceived gynecological morbidity was observed to be 59.8%. The smear of the women who were suspected of carcinoma on clinical examination was confirmed to be the cases of carcinoma-in-situ (7.8%) and high-grade neoplasia (2.9%) on laboratory investigations. The findings of the study highlight the utility and need of cancer cervix screening among the women at regular intervals through camp approach in the community.     

北京市朝阳、西城、怀柔妇女宫颈癌筛查研究

目的了解北京市朝阳区、怀柔区、西城区适龄妇女生殖健康状况。方法 2008年1月-2009年2月在朝阳区、怀柔区、西城区,对25~65岁当地户籍妇女进行妇科及宫颈细胞学检查,并记录个人基本信息及个人病史。结果三个区县实际筛查148 989人,宫颈癌筛查率20.94%;妇科筛查结果异常者59 834人,异常检出率40.16%;其中妇科异常最常见的情况是宫颈炎,检出率为341.35‰;阴道炎74.48‰;子宫肌瘤29.24‰;组织病理诊断宫颈上皮内瘤变333例（CINⅠ158例;CINⅡ87例;CINⅢ88例）,宫颈浸润癌31例,其他妇科恶性肿瘤7例。结论适龄妇女生殖健康状况不容忽视,定期开展宫颈癌筛查,早期发现并治疗癌前病变,提高妇女健康水平。     

宫颈癌与乳腺癌筛查信息系统设计与实现

目的将现代信息技术引入宫颈癌、乳腺癌筛查工作,以提高两癌筛查工作的服务和管理水平。方法基于北京市妇幼保健信息系统二期开发建设,对两癌筛查子系统进行升级改造。结果两癌筛查信息系统可以实现从个人基本信息采集、筛查及诊断结果录入,到可疑病例确诊、治疗、随访等全过程的信息化,实现信息共享,提高了工作效率,提升了两癌筛查系统管理水平,为各级管理者提供及时有效的信息数据。结论将信息技术引入两癌筛查工作领域有其必要性,两癌筛查信息管理系统可以优化工作流程,提升妇幼保健信息管理层次,提高工作效率和质量。     

城市社区妇女参加宫颈癌筛查行为意向结构方程模型分析

目的建构具有态度、主观行为准则等概念的"城市社区妇女接受宫颈癌筛查行为意向整合模型",探讨影响城市社区妇女接受宫颈癌筛查(宫颈涂片检查)行为的因素。方法用结构式问卷调查1591名上海某社区妇女参加宫颈癌筛查相关知识、态度和行为意向。验证性因子分析建立测量模型,再构建结构方程模型。最大似然法(ML)估计参数,通过评价修正来确定最佳结构模型。结果社区妇女既往参加过宫颈癌筛查的占42.1%,其中三年内参加过宫颈癌筛查的占56.7%。结构方程模型拟合较好,正向影响参加筛查行为意向的因素包括对象个体主观行为准则、对家庭社会责任的感知、对筛查促进因素的感知、参与筛查的自我效能和对宫颈涂片的态度。宫颈癌相关知识对行为意向无影响。对象对行为改变障碍的感知对参与筛查行为意向的作用是负向的。结论要提高社区妇女宫颈癌筛查项目的覆盖率,不能仅提供免费筛查服务和健康知识的培训,还需要构建筛查环境,包括家属的动员,社区妇女较易接受的女性筛查医师的配备、医师检查技能的提高等,同时筛查对象本身信念层面对筛查必要性的感知和改变也是重要的。     

Encouraging Underscreened Women to Have Cervical Cancer Screening: The Effectiveness of a Computer Strategy

Background.Computers that collect data from patients and provide both patients and practitioners with printed feedback on a range of health risks are a tool for assisting general practitioners with preventive care. This study assessed the impact of computer-generated printed feedback on cervical screening among women who were underscreened for cervical cancer.Method.Female attenders at two Australian general practices were randomly allocated to Experimental or Control groups. Women in both groups completed a health risk survey on a touch screen computer prior to their consultation. Those in the Experimental group received printed pages summarizing their results, including their eligibility for cervical screening and last Pap test, for themselves and their doctor. The number and proportion of underscreened women who had a Pap test in the 6 months after completing the computer survey, as determined by pathology records, were examined.Results.Of the 679 participants, 139 were classified as underscreened on the basis of self-report (74 Experimental, 65 Control) and 272 on the basis of their pathology records (148 Experimental, 124 Control). Overall about one-third of women had a test in the 6-month period, and the differences between the groups were not significant for women overall (18–70 years) or for women 18–49 years. Among women 50–70 who were underscreened based on self-report, those receiving the printout were more likely to have a Pap test in the next 6 months (P< 0.05). This pattern was also evident, but did not reach statistical significance, for older women who were underscreened based on pathology records.Conclusions.We are unable to draw conclusions regarding the effectiveness of the computer system due to the modest proportions of women screened, the small numbers, and the fact that the computer survey may have created an intervention effect in the Control group. As the study suggests the computer system is acceptable to women and may be effective for encouraging screening among older women, further exploration of the system is desirable.     

不同检测方法在宫颈癌筛查中的应用

目的研究评价几种常用的诊断方法在宫颈癌筛查中的作用。方法2005年10月～2006年3月共为756名符合标准的妇女进行普查,分别进行子宫颈照相,巴氏涂片或液基细胞学筛查,部分对象行高危型HPV—DNA检测,根据细胞学。HPV—DNA结果阳性及阴道镜图象异常情况,在阴道镜下取活检行病理学检查。结果液基细胞学的诊断效果最好,灵敏度,特异度,阴性预测值,阳性预测值,符合率,分别为：75．0％、96．9、75．0％、96．9％、94．9％,液基细胞学对子宫颈癌前病变的检出率高于巴氏涂片,差异有显著性（P〈0．05）。结论最佳方案：液基细胞学（LCT）联合高危型HPV—DNA检测可提高筛查效果。     

海南省农村妇女宫颈癌认知和筛查行为及影响因素分析

目的了解海南省35~64岁农村妇女宫颈癌防治知识认知和检查行为状况及相关影响因素,为开展宫颈癌健康教育及筛查提供参考依据。方法采取多阶段分层抽样方法对海南省18个市县的10800名农村妇女进行宫颈癌防治知识问卷调查,采用描述性分析、多因素Logistic回归等方法进行统计分析。结果调查对象普遍对宫颈癌的危险因素和预防措施了解不足,49.3%的调查对象主动做过临床宫颈癌检查,53.4%的妇女参加过国家宫颈癌筛查服务。Logistic回归分析结果显示,文化程度越高(OR=0.818)、收入越高(OR=0.694)、未患慢性病(OR=2.053)、参加过宫颈癌筛查项目(OR=2.054)、职业为个体户(OR=0.714)和教师(OR=0.872)的调查对象防治知识得分较高;年龄越大(OR=0.817)、少数民族(OR=0.577)、已婚(OR=0.452)、文化程度越高(OR=0.913)、职业为教师(OR=0.602)、收入越高(OR=0.744)、具备宫颈癌防治知识(OR=0.1.951)的调查对象越会主动进行宫颈癌检查。结论海南省农村妇女宫颈癌防治知识掌握程度不高,应进一步采取有效方式开展广泛深入的健康教育,提高宫颈癌防治知识水平,促使农村妇女主动进行宫颈癌检查。     

海南省农村妇女宫颈癌认知和筛查行为及影响因素分析

目的了解海南省35~64岁农村妇女宫颈癌防治知识认知和检查行为状况及相关影响因素,为开展宫颈癌健康教育及筛查提供参考依据。方法采取多阶段分层抽样方法对海南省18个市县的10800名农村妇女进行宫颈癌防治知识问卷调查,采用描述性分析、多因素Logistic回归等方法进行统计分析。结果调查对象普遍对宫颈癌的危险因素和预防措施了解不足,49.3%的调查对象主动做过临床宫颈癌检查,53.4%的妇女参加过国家宫颈癌筛查服务。Logistic回归分析结果显示,文化程度越高(OR=0.818)、收入越高(OR=0.694)、未患慢性病(OR=2.053)、参加过宫颈癌筛查项目(OR=2.054)、职业为个体户(OR=0.714)和教师(OR=0.872)的调查对象防治知识得分较高;年龄越大(OR=0.817)、少数民族(OR=0.577)、已婚(OR=0.452)、文化程度越高(OR=0.913)、职业为教师(OR=0.602)、收入越高(OR=0.744)、具备宫颈癌防治知识(OR=0.1.951)的调查对象越会主动进行宫颈癌检查。结论海南省农村妇女宫颈癌防治知识掌握程度不高,应进一步采取有效方式开展广泛深入的健康教育,提高宫颈癌防治知识水平,促使农村妇女主动进行宫颈癌检查。     

人乳头状瘤病毒感染与宫颈癌年轻化的关系探讨

目的探讨35岁及以下宫颈癌的发病趋势及与人乳头状瘤病毒（HPV）感染的关系。方法共收集浙江省肿瘤医院妇瘤科1990年1月至2007年7月底9519例新发宫颈癌患者病例，分析1990年起每两年35岁及以下宫颈癌患者占宫颈癌总人数的构成比的变化趋势；利用导流杂交基因芯片定性检测了其中910例宫颈浸润癌患者宫颈涂片中21型人乳头状瘤病毒感染情况。SPSS12．0软件，妒检验统计分析35岁及以下宫颈浸润癌患者（年轻组）和35岁以上宫颈浸润癌患者（对照组）HPV感染率及其分布的差异。结果35岁及以下宫颈浸润癌新发病例每两年的构成比呈上升趋势。910例宫颈浸润癌患者HPV总感染率为75．38％（686／910），年轻组和对照组分别为82．05％（96／117）和74．40％（590／793），两组比较差异无统计学意义；910例宫颈浸润癌患者中HPV高危型、中国人常见亚型和低危型感染率分别是73．96％、3．41％和1．65％。HPV感染常见亚型无论在宫颈浸润癌的年轻组还是对照组均为HPV16亚型，其感染率分别为58．97％（69／117）和46．03％（365／793），但两组比较差异有统计学意义（P=0．01），其他各亚型的阳性率比较两组差异无统计学意义（P〉0．05）。结论年轻宫颈癌患者发病率呈上升趋势，高危型HPV感染和宫颈浸润癌的发生密切相关。虽然年轻组宫颈癌患者的HPV总感染率并不高于对照组，但HPV16亚型感染率在年轻组明显高于对照组，HPV16亚型感染可能是宫颈浸润癌年轻化的主要原因。