Mammography in New Hampshire: Characteristics of the Women and the Exams They Receive

New Hampshire (NH) is one of two states that has developed a population-based mammography registry. The purpose of this paper is to describe what we have learned about mammography use in New Hampshire. After collecting data for 20 months, the database contains almost 110,000 mammographic encounters representing 101,679 NH women, who range in age from 18 to 97 with a mean of 56.7 years (SD=10.91). Education levels are high with 92% having a high school education and 59% with some college. Forty-six percent report their primary insurance is private, 29% report HMO/PPO coverage, and 25% receive federal health care assistance. Risk factors represented in the database include (categories not mutually exclusive) advancing age (60% over age 50), hormone replacement therapy use by menopausal women (40.6%), and a family history of breast cancer (29%). Penetration of mammography relative to the NH population is higher for younger age groups (40–48% for those aged 44–64) than older age groups (34–39% for those aged 65–84). The majority of mammographic encounters are routine screening exams (86%), often interpreted as negative or normal with benign findings (88%). Use of comparison films to interpret either diagnostic or screening mammography occurred in 86% of encounters. We have matched 3,877 breast pathology records to these mammographic encounters. The distribution of pathology outcomes for diagnostic exams was very similar to that for screening exams (approximately 65% benign, 17% invasive breast cancer, and 6% noninvasive breast cancer). Overall, we have designed a system that is well accepted by the NH community. Challenges include careful monitoring of data for coding errors, and a limitation of linking variables in mammography and pathology data. Data represented in this registry are a critical resource for research in mammographic screening and breast cancer early detection.     

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。     

宁德市2009-2018年农村妇女宫颈癌筛查结果分析

目的 分析福建省宁德市农村妇女宫颈癌检查项目数据,了解宁德市农村妇女宫颈癌检查项目落实及宫颈疾病发生情况.方法 收集2009-2018年宁德市农村妇女宫颈癌检查项目季报表数据,比较初筛阳性进一步接受检查落实、宫颈病变检出率的变化趋势及不同宫颈癌初筛方法宫颈病变检出率的变化.初筛方案根据卫生经济资源采用巴氏涂片或者液基薄...     

2014-2019年大连市农村地区宫颈癌筛查数据分析

目的分析2014-2019年大连市农村地区宫颈癌检查项目数据,了解大连市农村地区宫颈癌筛查情况,评价不同初筛方法的检出效果,为进一步做好宫颈癌防治工作提供科学建议。方法数据来源于妇幼重大公共卫生服务项目信息直报系统中2014-2019年大连市农村地区宫颈癌筛查数据,初筛方法包括宫颈细胞学检查(巴氏涂片、液基细胞学检查)和HPV检测,采用χ2检验比较不同初筛方法和不同年份的初筛阳性率、宫颈癌和癌前病变检出率、早诊率等指标。结果2014-2019年共有149918名35~64岁农村妇女进行了免费宫颈癌检查,初筛阳性人数8984人,阳性率为5.99%;共检出宫颈癌前病变799例,检出率为532.96/10万;宫颈癌41例,检出率为27.35/10万;检出早期宫颈癌9例,早诊率为96.19%。两种不同初筛方法比较:HPV检测初筛阳性率(10.13%)、低级别鳞状上皮内病变检出率(713.41/10万)、高级别鳞状上皮内病变检出率(675.02/10万)、宫颈癌前病变检出率(679.82/10万)均高于宫颈细胞学检查相应指标值[细胞学初筛阳性率(3.04%)、低级别鳞状上皮内病变检出率(609.83/10万)、高级别鳞状上皮内病变检出率(424.48/10万)、宫颈癌前病变检出率(427.91/10万)],且差异具有统计学意义(P<0.05)。结论2014-2019年大连市农村地区宫颈癌检查成效明显;与宫颈细胞学检查比较,以HPV检测为初筛方法的宫颈癌检查策略可以更好地发现宫颈癌前病变,便于更早进行随访管理。各区县应结合本地实际情况制定科学、高效和可行的宫颈癌检查方案。     

北京市某高校社区妇女宫颈癌和乳腺癌筛查结果分析

目的 对北京市海淀区某高校社区4 171例妇女官颈癌和乳腺癌筛查结果进行分析,了解该地区妇女生殖健康状况,为今后制定妇女病防治措施提供依据.方法 对社区25～65岁妇女采用妇科常规检查和官颈液基脱落细胞学(TCT)检查的方法进行官颈癌筛查;对40 ～ 60岁妇女采用乳腺彩色多普勒超声的方法进行乳腺癌筛查.可疑病例转至定点医院进行复诊,并由专人负责随访.结果 参加官颈癌筛查4 171人,筛查率10.67％;妇科疾病患病率23.66％,其中子宫肌瘤患病率最高(11.00％);宫颈癌可疑转诊病例实访率98.53％.官颈上皮内瘤变患病率16.78/万;宫颈浸润癌患病率2.40/万.参加乳腺癌筛查3 110人,筛查率13.58％;乳腺疾病患病率28.01％,其中乳腺增生患病率最高,为14.05％;乳腺癌可疑转诊病例实访率为96.43％.乳腺癌患病率96.5/10万.结论 北京市某高校社区妇女官颈癌和乳腺癌筛查率均不高,定期进行筛查,对降低两癌的发病率和死亡率具有重要意义.     

Inference on cancer screening exam accuracy using population‐level administrative data

This paper develops a model for cancer screening and cancer incidence data, accommodating the partially unobserved disease status, clustered data structures, general covariate effects, and dependence between exams. The true unobserved cancer and detection status of screening participants are treated as latent variables, and a Markov Chain Monte Carlo algorithm is used to estimate the Bayesian posterior distributions of the diagnostic error rates and disease prevalence. We show how the Bayesian approach can be used to draw inferences about screening exam properties and disease prevalence while allowing for the possibility of conditional dependence between two exams. The techniques are applied to the estimation of the diagnostic accuracy of mammography and clinical breast examination using data from the Ontario Breast Screening Program in Canada. Copyright © 2015 John Wiley & Sons, Ltd.     

子宫颈癌筛查大样本数据引发的思考

子宫颈癌是全球女性生殖道最常见由高危型人乳头瘤病毒(high-risk human papillomavirus, hrHPV)致病的恶性肿瘤,对其病变过程筛查,能够早期发现与治疗,有效遏制其发病率和死亡率。当前的筛查方法包括细胞学检查、高危型HPV检测和联合筛查(细胞学检查+高危型HPV检测)。采取何种筛查方案,对子宫颈癌的防治极为重要。目前我国对子宫颈癌筛查方案的选择存在一些困惑和争议。针对各种筛查方案的优劣性,我们对子宫颈癌筛查中获得的大样本数据进行分析,发现细胞学能有效筛查出子宫颈癌和癌前病变,高危型HPV检测的阳性检出率较高,在部分正常人群中亦可检出HPV阳性,且检测出HPV的不同型别可为临床分类管理患者和疫苗研发提供参考依据。而按筛查效果分析,细胞学联合高危型HPV检测仍是目前最佳的筛查方案。     

Why worry about awareness in choice problems? Econometric analysis of screening for cervical cancer

The decision to undertake a screening test is conditional upon awareness of screening. From an econometric perspective there is a potential selection problem, if no distinction is made between aware and unaware non-screeners. This paper explores this problem through analysis of the determinants of cervical screening in Australia. Cervical cancer is one of the most preventable and curable forms of cancer. Since 1991 there has been a concerted effort in Australia to recommend and encourage women to have Pap smears every two years. The success of this program can be partly gauged by exploring the determinants of screening for cervical cancer. Using unit record data from the 1995 National Health Survey, an econometric model is developed for whether women have ever screened or not. A proportion of women in the sample contend that they have never heard of a Pap test. The analysis characterizes this group of women and accounts for their presence in the modelling. The paper demonstrates failing to model awareness can result in inconsistent parameter estimates even when the degree of censoring in the sample is relatively small.     

Men's experiences of physical exams and cancer screening tests: a qualitative study

BACKGROUND: American men have lower overall rates of cancer screening than women. This study was designed to elicit men's health care experiences and knowledge of testicular, prostate, and colorectal cancer (CRC) screening. METHODS: Fifty-three men participated in eight physician-led semistructured focus groups in Rhode Island and New Hampshire. Four groups (ages 18-35; N = 20) discussed testicular cancer screening. Four groups of older men (ages 40-79; N = 33) discussed prostate and colorectal cancer screening. RESULTS: Men in this study prefer physicians who establish interpersonal relationships with male patients. Lack of explanations during physical exams resulted in negative experiences. Men were eager to learn more about their health, but commonly complained that they received neither appropriate cancer screening nor sufficient explanations from their physicians. When PSA screening was offered, discussion was often inadequate. Although men expressed interest in participating in the PSA decision, sole responsibility for this complex decision was seen as undesirable. These men desired more discussion and better sources of health information during medical encounters. CONCLUSIONS: Clinician attention to communication, relationship building, patient education, and consideration for patient privacy and modesty are important for the care of male patients especially with sensitive exams and topics important to men's cancer screening.     

中国大陆宫颈细胞学筛查技术实施的现状及缺憾

细胞学筛查技术在宫颈病变及宫颈癌的防治中起着举足轻重的作用。从传统的巴氏涂片发展到现今以液基细胞学(liquid-based cytology,LBC)技术为基础的伯塞斯达诊断系统(the bethesda system,TBS),宫颈病变的检出率得到了明显的提高,宫颈癌的死亡率也大大降低。全球宫颈癌总体的发病率与死亡率虽然有所下降,但在欠发达国家和地区,由于资源、技术和人才的缺乏,其发病率与死亡率仍比发达国家高许多,少数地区甚至有上升趋势,以细胞学筛查技术为首的筛查模式遇到了发展的瓶颈期。细胞学筛查作为宫颈病变"三阶梯"筛查模式第一阶梯,仍然起着至关重要的作用。LBC技术是目前最优化的细胞学筛查技术,但TBS技术在中国大陆的应用因细胞病理学医师奇缺,而仍存在"不确定性、不稳定性、不标准性"等缺憾,宫颈病变及宫颈癌的防治工作仍任重道远。本文将综述目前细胞学筛查技术在中国大陆应用现状及局限性,并对该技术未来的发展进行讨论。     

Resistance through risk: Women and cervical cancer screening

This paper explores how individual women deal with, and react to, the very general information on cervical cancer risks they receive when invited to attend for cervical screening, and the general ‘at risk’ position that is suggested to them through the official discourse on screening and re-enforced by the uniform approach taken by the UK programme. By presenting data from a qualitative interview study it demonstrates how women respond to the presentation of risk in diverse and dynamic ways, and engage in a process of ‘self-positioning’ that individualises cervical cancer risk and makes it relevant to them as individuals. Within this process women draw on a range of risk themes that they regard as relevant to cervical cancer and implicated in its development. These are discussed in a range of ways, indicating that such risk themes do not exist in a vacuum but are situated within particular social and cultural contexts. I argue that, while the conceptualisation of risk as one of the strategies employed within neo-liberal forms of government to create particular kinds of individuals is useful, it is in danger of focusing too much attention on how individuals are controlled instead of how they respond to such attempts.     

Community-based cancer screening programs in older populations: making progress but can we do better?

BACKGROUND: Older individuals have higher rates of most types of cancer. Community-based cancer screening programs offer one avenue for addressing the need to prevent or detect cancers in early stages in this population. Identifying characteristics of successful interventions can assist researchers in the development of future studies. METHODS: A comprehensive literature review of community-based cancer screening interventions was undertaken and 114 behavioral interventions for breast, cervical and colorectal cancer screening published prior to 2000 and 42 studies published during 2000-2003 were identified. From these, 17 studies were identified as model interventions that were effective in significantly increasing screening rates among older populations. RESULTS: Effective interventions employed a variety of strategies including the use of social networks and lay health care workers, mass media, community-based education, reminder notices/behavioral cues, and health care provider assistance. CONCLUSION: Although subgroups of individuals still have lower rates of screening, the results indicate that older populations can be encouraged to engage in appropriate cancer screening behaviors through community-based interventions. The next round of interventions could be strengthened by evaluating intervention components, integrating theory and community participation into designs, focusing on those most at need, and considering program sustainability and costs.     

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。     

Human Papillomavirus Prevalence and Herd Immunity after Introduction of Vaccination Program,Scotland, 2009–2013

In 2008, a national human papillomavirus (HPV) immunization program using a bivalent vaccine against HPV types 16 and 18 was implemented in Scotland along with a national surveillance program designed to determine the longitudinal effects of vaccination on HPV infection at the population level. Each year during 2009–2013, the surveillance program conducted HPV testing on a proportion of liquid-based cytology samples from women undergoing their first cervical screening test for precancerous cervical disease. By linking vaccination, cervical screening, and HPV testing data, over the study period we found a decline in HPV types 16 and 18, significant decreases in HPV types 31, 33, and 45 (suggesting cross-protection), and a nonsignificant increase in HPV 51. In addition, among nonvaccinated women, HPV types 16 and 18 infections were significantly lower in 2013 than in 2009. Our results preliminarily indicate herd immunity and sustained effectiveness of the bivalent vaccine on virologic outcomes at the population level.     

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。     

Cervical cancer screening: spatial associations of outcome and risk factors in Rotterdam

OBJECTIVE: Obtaining insight into the geographic distribution of attendance and smear test results at the cervical cancer screening program in Rotterdam neighbourhoods, associated with socio-economic status, marital status and the percentage migrants. DESIGN: Ecological analysis was carried out on data on cervical cancer screening outcome and population figures, provided by the Rotterdam Local Health Information System, in which health information is collected at neighbourhood level. SETTING: The cervical cancer screening program in the city of Rotterdam. PARTICIPANTS: Fifty-three neighbourhoods, with overall 569,105 inhabitants, of whom 70,621 women between 1992 and 1994 were invited for the screening program. MAIN RESULTS: Between neighbourhoods a large difference in attendance rate and the percentage positive smears exists. A high socio-economic level of a neighbourhood, and a low percentage migrants, single or divorced women correspond with high attendance. A high socio-economic status of a neighbourhood and a low percentage migrants correspond with a low percentage smear test Pap 3B or higher. Socio-economic status, percentage migrants and marital status are highly interrelated on neighbourhood level. Multivariate analysis showed a negative correlation between the attendance rate and the percentage of single and divorced women, and a positive correlation between the percentage migrants and the percentage of positive smears (Pap 3B or higher). CONCLUSION: Various risk groups, showing low attendance or a high percentage of positive smears, are clustered in neighbourhoods and can be identified by socio-economic status, marital status and nationality. Activities to improve attendance can be focused towards these neighbourhoods.     

How to screen for cervical cancer after HPV16/18 vaccination in The Netherlands

In The Netherlands, vaccination against HPV16/18 has been recommended for all 12-year-old girls. Because screening of vaccinated women remains important, we evaluated the model-based cost-effectiveness of cervical cancer screening strategies. We considered cytology and the HPV DNA test as primary screening instrument, varied the number of screening rounds from 7 to 4, and set the screening starting age at 30 and 35 years. Our model predicted reductions in cervical cancer mortality between 60 and 81% (from 199 deaths to 37–79) when adding screening to vaccination (assumptions for vaccination: 95% efficacy, 100% compliance, lifelong protection). Screening 5 times with HPV DNA (€11,133/QALY) or 7 times with cytology (€17,627/QALY) were scenarios with comparable costs and effects and incremental cost-effectiveness ratios below the threshold in The Netherlands (€20,000 per QALY).     

Incidental Findings in a Federally-Sponsored Cancer Screening Program

The volume of non-cancer related clinical services and referrals for medical care of women as a consequence of their enrollment in a federally-sponsored breast and cervical cancer screening program was examined. We randomly sampled 100 medical records from among 389 individuals who received cancer screening services through the Connecticut Breast and Cervical Cancer Early Detection Program. Medical record audits tabulated occasions when women were offered or received diagnostic or therapeutic procedures as a by product of their program participation. Breast screening was provided to 100 women and 49 individuals received cervical cancer screening. In addition, 87 percent of the sample were offered or received one or more non-cancer related health services. Physical exams were provided to 86 women, laboratory tests were ordered for 11 individuals and 55 referrals were made to address a myriad of specific medical needs that were uncovered incidental to breast and cervical cancer screening. Among 26 women who did not heed recommendations for follow-up care, cost, inconvenience and beliefs that medical problems were not immediate concerns were cited. Local screening program sponsors should be cognizant that the health care needs and limited resources of some target populations may be substantial. Mechanisms to assure that needed health care is available to individuals should be built and into all categorical health service programs.     

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。     

大肠癌系统筛查方案的设计与应用

目的总结大肠癌系统筛查方案的设计和应用,分析筛查成本。方法对一组大肠癌系统筛查资料进行回顾总结。用全人口进行问卷调查和粪隐血试验,检出大肠癌危险人群,进行结肠镜检查,以组织学诊断作为确诊大肠癌的金标准来评价筛查方案的价值。结果患大肠癌的危险人群约占全人口的5%。在大肠癌危险人群中,大肠肿瘤检出率约为23%,大肠癌的检出率为0.3%。如果选择乙状结肠镜检查,发现远端大肠肿瘤才进行全结肠镜检,将有72%的远端大肠肿瘤漏诊。计算从全人口和高危人群中每检出1例大肠癌的成本分别约20万元和5万元。首次筛查从高危人群中每检出1例大肠腺瘤的成本0.25万元。结论系统筛查可有效地从自然人口中检出大肠肿瘤,免疫法FOBT和全结肠镜检查可作为粪隐血试和肠镜检查的首选方法。每检出1例大肠癌的成本,系统性筛查是机会性筛查的4倍。