农村地区醋酸/碘染色法筛查子宫颈癌的3年结果分析

背景与目的:我国至今还没有一个系统的子宫颈癌防治计划,尤其是广大农村地区更缺乏子宫颈癌的防治技术和经验。本研究报道山西省襄垣县子宫颈癌早诊早治示范基地的人群筛查资料,评价基层医生采用醋酸或碘染色法(VIA/VILI)在农村地区筛查子宫颈癌及其癌前病变的效果。方法:采用醋酸染色法(VIA)和碘染色法(VILI)在山西省襄垣县30～59岁的妇女人群中开展子宫颈癌筛查,VIA或VILI阳性者进行阴道镜检查,阴道镜检异常者在病变处取活检进行病理学诊断。采用同样的程序对人群进行复查,通过比较1年筛查、连续2年筛查和连续3年筛查的结果,评价该方案的筛查效果。结果:在2005～2008年期间,有7145名适龄妇女参加了筛查,平均年龄为42.16岁,筛查人群平均参与率为74.75%。其中2005～2007年期间,对1287人连续筛查了3年,第1轮筛查CIN2、CIN3及子宫颈癌的检出率分别为0.70%(9例)、1.01%(13例)、0.23%(3例);第2轮(976人)筛查检出率分别为0.22%(2例)、0.11%(1例)、0;第3轮筛查仅增加了1例CIN2病例。2006～2007年期间对3490人连续筛查了2年,第1轮(3...     

山东省肥城市上消化道癌早诊早治项目可持续发展

摘 要：山东省肥城市上消化道癌筛查及早诊早治在癌症防治工作发展过程中走出了“肥城模式”,显著改善肥城市“因癌致贫,因癌返贫”现象,依托癌症早诊早治筛查项目,搭建系统化健康服务管理平台,开启全民健康之路,助力全面小康。     

上海地区人群大肠癌筛查的研究和实践

以人群为基础的筛查可以降低大肠癌的死亡率,是控制我国大肠癌疾病负担的有效措施,制定和实施人群筛查策略应列入区域性癌症控制规划之中.上海于2011年在全国率先将“社区大肠癌筛查”列入重大公共卫生项目.全文就大肠癌筛查列入公共卫生项目后如何实施人群筛查所涉及的技术性和实施性问题进行介绍和讨论,为大肠癌筛查的政策制定和实施提供依据,也为其他癌症防治项目提供借鉴.     

贲门癌筛查和早诊早治的经验

[目的]总结在食管癌高发区居民中贲门癌筛查和早诊早治的效果和经验。[方法]分析2006～2009年在7个省的9个县(市)居民中,开展内镜筛查贲门癌和早诊早治的资料,包括筛查结果和经验,特别是总结贲门癌高发位点的发现对贲门癌早期诊断的贡献。[结果]4年内镜筛查共53911人,发现贲门癌524例(包括癌前病变),检出率为0.97%。其中早期癌416例,早诊率为79.4%。[结论]内镜筛查可发现大量贲门癌和癌前病变,现阶段作为贲门癌防治措施是可行的和成功的。     

深圳市子宫颈癌早诊早治初步研究

目的研究深圳城市人群子宫颈癌早诊早治的适宜方式。方法2006～2007年采取整群随机抽样方法获得福田区教育局和龙岗区龙城街道紫薇社区样本人群及2005～2008年深圳市妇幼保健院妇科门诊机会性筛查人群。以上人群分别由学校工会和社区居委会、计划生育服务站宣教和组织;机会性筛查人群由妇科门诊护士和医师宣教和推荐。采用细胞学检查、HPV—DNA检测的筛查方法,异常者转诊阴道镜及病理诊断,病理诊断为金标准。采用筛查率、早诊率、早治率和行政费用率进行评价。结果2006年福田区教育局系统中小学教职工筛查率77．32％,紫薇社区人群筛查率18．56％,差异有统计学意义（X^2=3005．435,P=Q000）;两组人群早诊率100％,治疗率均在90％以上。2005～2008年深圳市妇幼保健院子宫颈癌机会性筛查干预后有连续增长趋势（X^2=1588．5503,P=nooo）。2004—2008年子宫颈癌早诊率年平均89．85％,5年早诊率差异无统计学意义（X^2=6．513,P=0．164）。2006～2008年治疗率明显增高（X^2=123．090,P=0.000）。机会性筛查行政费用率明显低于组织性筛查（X^2=30．626,P=0．000）。结论城市人群子宫颈筛查以工作单位或社区居委会计划生育服务站组织为佳;机会性筛查可做为城市人群子宫颈癌组织性筛查的重要补充,门诊医师的宣教可提高机会性筛查率;城市人群子宫颈癌筛查宜提倡组织性筛查与机会性筛查相结合。     

“区域性子宫颈癌早诊早治中心”开展宫颈癌防治的成效

[目的]对宫颈癌早诊早治工作实施有效的管理,探索城市宫颈癌的综合防治方法。[方法]建立＂区域性子宫颈癌早诊早治中心＂,培训宫颈癌专业人员,建设宫颈癌防治队伍,建立宫颈癌筛查点,组建区域性宫颈癌筛查网络,建立阴道镜质量控制体系,对＂区域性子宫颈癌早诊早治中心＂防治宫颈癌进行效果观察。[结果]自建立＂区域性子宫颈癌早诊早治中心＂后,开展机会性筛查及早诊早治人数呈明显上升趋势,妇女健康体检进行宫颈癌筛查增加,筛查率提高到91.49%。网络单位宫颈癌筛查、诊断和治疗人数逐年上升,转诊我院治疗的病人占转诊单位应治病人的20.86%～100.00%,二级核查将初筛的阳性率由11.36%～13.91%降到4.83%～5.26%。[结论]建立＂区域性子宫颈癌早诊早治中心＂可为区域性宫颈癌防治提供技术保障,为本区域妇女提供宫颈癌诊治的优质服务。     

“四联早期诊断法”在子宫颈癌普查早治中的实用价值

定期连续性进行子宫颈癌普查早治,能显著降低其发病率和死亡率,这已被国内外学者所公认。进行宫颈癌普查,方法很重要,选择得当,能进一步提高宫颈间变和癌的检出率,取到事半功倍之效。江西省靖安宫颈癌防治研究所,自1974年以来,应用“四联早期诊断法”下简称“四联法”对当地30岁以上的已婚妇女进行了两年为一轮的宫颈癌普查早     

浙江省海宁市结直肠癌早诊早治筛查

探索海宁市结直肠癌早诊早治筛查一体化模式,为癌症防控工作提供参考依据.通过海宁市中医院、海宁市肿瘤医院、海宁市肿瘤防治研究所的“两院一所”合并和资源整合,海宁市具备了癌症筛查一体化模式的基础.2005年海宁被国家卫生部批准为“大肠癌早诊早治示范基地”,海宁市中医院承担了项目实施工作任务,结直肠癌早诊早治筛查项目从现场初筛到肠镜精筛、临床治疗均由一家医院完成,在全国癌症筛查项目点是少见的.筛查工作以政府为主导进行组织发动,医院选派相关学科专业技术骨干组建项目团队,从结直肠癌防治知识健康教育,提高群众防癌意识着手,使筛查工作目的、意义真正做到家喻户晓,从而提高广大老百姓对筛查工作的依从性.多年来筛查实践证明:结直肠癌筛查方法简便、成效显著,推广以政府为主导、医防研结合、全社会广泛参与的结直肠癌筛查一体化模式切实可行.     

从试点到重大公共卫生项目：广州市首轮社区人群结直肠癌筛查实施及成效

摘 要：结直肠癌是严重危害我国居民健康的重要癌症之一,筛查可以降低结直肠癌的死亡率,是结直肠癌防治的有效措施。广州市通过前期试点实践、科学论证,于2015年将结直肠癌筛査列入重大公共卫生项目,在全市范围向符合条件的居民免费提供结直肠癌筛査。本文回顾了该项目从区域试点到被列为重大公共卫生项目在人群中大规模推广实施的历程,讨论了如何基于循证的方法解决相关技术性和实施性问题,可为其他城市开展结直肠癌筛查以及其他癌种的人群筛查提供参考。     

筑牢基层防癌阵线 惠及百姓砥砺前行

摘 要：磁县肿瘤防治工作走过了48年,从基层肿瘤登记及肿瘤流行病学调查逐步发展为集防、治、研为一体的综合防治体系。肿瘤登记跃上国际舞台,成为国际癌症登记协会（IACR）会员;扩建肿瘤专科医院,解决当地癌症患者就诊实际问题,惠及当地百姓健康;承担了国家多项重大科研课题,积极实施癌症“三早”,持续开展高危人群上消化道癌筛查及早诊早治工作,成为全国“肿瘤登记示范中心”和首批“食管癌早诊早治示范基地” “上消化道癌早诊早治示范基地”。为降低食管癌、胃癌发病率和死亡率,提高患者生存率,积极落实筛查及早诊早治,加强防治结合,筑牢基层防癌阵线,以全民健康助力全面小康。     

Mass screening for cervical cancer in Norway: evaluation of the pilot project

The Norwegian Department of Health and Social Affairs initiated a national screening program for cervical cancer in 1990, with all women aged 25 to 70 years to be offered cervical screening every three years. During the first three years of the program (November 1991–October 1994), all spontaneous cervical cytology in Norway was recorded at the Norwegian Cancer Registry. In addition, women in the counties of Vestfold and Sør-Trøndelag were invited individually to be screened. The aim of the present study was principally to evaluate the organizational aspects of a nationwide, population-based screening program for cervical cancer in Norway. Special attention was paid to the coverage, the attendance rate, and the cytologic findings in the two-county study area. A total of 1,581,379 Pap smears were recorded from November 1991 to October 1994. Most smears were taken from women under age 30 years (31.7 percent). About 25 percent of the women aged 25 to 29 years had more than one normal smear. In the study area, a coverage of about 71 percent in the age group 25 to 69 years was achieved. The pilot project also has shown that it is possible to recruit elderly women into screening. However, no difference was noted between the study and the reference area with regard to findings per smear of precursor lesions (CIN 3, modified SNOMED coding system). The experiences from three years of recording and the implementation of the pilot project have provided useful guidelines for the national screening which began in January 1995.This work was funded by grant no. 95034/001 from the Norwegian Cancer Society.     

Community-Based Health Education has Positive Influence on the Attitude to Cervical Cancer Screening among Women in Rural Nepal

The main purpose of this study was to assess the knowledge of cervical cancer among women in rural Nepal and explore the feasibility and impact of a community-based awareness program on cervical cancer. Community-based educational meetings on cervical cancer and its prevention were conducted among women’s groups in rural Nepal. Through a questionnaire, the women’s baseline knowledge of risk factors, symptoms, and perceived risk of cervical cancer were identified. The willingness to participate in cervical cancer screening was compared before and after the educational meeting. The meetings were followed by a cervical cancer screening program. Among the 122 participants at the educational meeting, only 6 % had heard of cervical cancer. Their baseline knowledge of risk factors and symptoms was poor. The proportion of women willing to participate in cervical screening increased from 15.6 to 100 % after attending the educational meeting. All the study subjects participated in the screening program. Additionally, the study participants recruited a further 222 of their peers for screening. Poor knowledge of cervical cancer among women in rural Nepal highlights the urgency of public awareness programs for cervical cancer at a national level. A community-based awareness program can change women’s attitude to cervical screening, and women’s groups can play a major role in promoting participation in cervical cancer screening programs.     

Cervical cancer screening in Denmark

Denmark is divided into 15 counties and it is up to regional politicians and the health authority in each county to organise the cervical screening programmes. The National Board of Health issued national guidelines and recommendations for the cervical cancer screening back in 1986, and these guidelines are now, in 1998, almost fully implemented. In this study, a literature review on cervical cancer screening in Denmark, review of local guidelines, personal interviews with pathologists and collection of information about the education of cytotechnologists in Denmark was carried out. In Denmark in 1997 90% of women aged 23-59 years and 46% of women aged 60-74 years were covered by organised screening. A total of 650000 smears were taken annually. This figure corresponds to screening of all Danish women aged 25-59 years on average, every second year. The national recommendation is screening every third year. Thus, as the incidence of cervical cancer in Denmark is decreasing, we could probably move towards a longer screening interval. However, before the Danish recommendations are changed, more detailed data on the actual performances of screening programmes are warranted.     

Effective cervical cytology screening programmes in middle-income countries: the Chilean experience

OBJECTIVE: To demonstrate that an effective cervical cancer screening programme based on the Papanicolaou (Pap) smear can be organized in a middle-income country, such as Chile. METHODS: The cervical cytology screening programme in Chile is evaluated by comparing process measures and cervical cancer mortality before and after its reorganization in 1987. FINDINGS: Two decades of opportunistic annual screening for cervical cancer from the mid-1960s to the mid-1980s did not reduce cervical cancer mortality in Chile. In 1987, a public health oriented program was launched, based on screening women aged 25-64 every 3 years, rather than the annual screening of low risk women attending family planning clinics that gathered mainly women less than 25 years of age. The reoriented program emphasized the optimization of existing resources, the timeliness of diagnosis and treatment, reliability of the Pap smear and low cost screening promotion strategies at the community level. More than 80% of women with abnormal Pap smears received prompt medical attention and 100% of the public laboratories were subject to external quality control. According to biannual national surveys, coverage by Pap smear screening in the target group rose from 40% in 1990 to 66% in 1996. The age adjusted cervical cancer mortality rate decreased from 12.8 in 1980 to 6.8 per 100,000 women in 2001. CONCLUSIONS: Improved organization of the national cervical cancer screening programme in Chile and more efficient use of existing resources resulted in a decrease of cervical cancer mortality.     

Recommendations for a national agenda to substantially reduce cervical cancer

Purpose

Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease.

Methods

In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA.

Results

Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal.

Conclusions

Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women—particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts can lead the way towards a dramatic reduction in this preventable disease in our country.     

The impact of cytology screening and HPV vaccination on the burden of cervical cancer

Aim: To evaluate the impact of different strategies of human papillomavirus (HPV) vaccination on the burden of cervical cancer in Singapore. Methods: The incidence of cervical cancer was calculated using a Markov model with inputs based on Singapore data for the prevalence of HPV infection, socioeconomic characteristics and screening prevalence. The evaluation was performed for 10 scenarios: no screening, current opportunistic cytology screening, ideal optimal screening, universal adolescent HPV vaccination at 12‐years old alone and with catch‐up cohorts and combinations of screening and vaccination. Results: (1) The model prediction showed that cervical cancer cases were reduced by 6.5% using opportunistic screening, by 34.3% using optimized screening and by 63.9% with a universal HPV vaccination at 12 years of age. (2) Adding optimized screening, but not opportunistic screening, to a universal adolescent HPV vaccination program caused a moderate further reduction in cervical cancer cases. (3) No difference was discernable in the impact of vaccination introduction between the age groups <20, 20–24 and 25–29 years old. (4) The time required to halve the incidence of cervical cancer was 42 years for universal vaccination at the age of 12 but could be shortened by including catch‐up cohorts of women up to 40‐years old. Conclusion: A universal HPV vaccination program introduced between the ages of 12–29 is superior to cytology screening in reducing the burden of cervical cancer. However, in the next four decades of post‐vaccination era, optimizing the screening program remains the most important measure for cervical cancer prevention.     

HPV Vaccination and Cervical Cancer Screening Policies and Practices in 18 Countries,Territories and Entities across Eastern Europe and Central Asia

Background: To assess readiness to achieve the WHO Global Strategy targets for HPV vaccination and cervical screening and to guide capacity building, the current status of these services in 18 Eastern European and Central Asian countries, territories and entities (CTEs) was evaluated. Methods: In order to assess the current status of HPV vaccination and cervical cancer screening in these 18 CTEs, a 30 question survey tool was developed, covering: national policies, strategies and plans for cervical cancer prevention; status of cancer registration; status of HPV vaccination; and current practices for cervical cancer screening and treatment of precancerous lesions. As cervical cancer prevention comes within the mandate of the United Nations Fund for Population Development (UNFPA), the UNFPA offices in the 18 CTEs have regular contact with national experts who are directly involved in cervical cancer prevention actions and are well placed to provide the data required for this survey. Working through the UNFPA offices, the questionnaires were sent to these national experts in April 2021, with data collected from April to July 2021. All CTEs returned completed questionnaires. Results: Only Armenia, Georgia, Moldova, North Macedonia, Turkmenistan and Uzbekistan have implemented national HPV vaccination programmes, with only the last 2 of these reaching the WHO target of 90% of girls fully vaccinated by age 15, while rates in the other 4 range from 8%-40%. Cervical screening is available in all CTEs but only Belarus and Turkmenistan have reached the WHO target of 70% of women screened once by age 35 and again by age 45, while rates elsewhere range from 2%-66%. Only Albania and Turkey follow the WHO recommendation to use a high-performance screening test, while the majority use cervical cytology as the main screening test and Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan use visual inspection. No CTEs currently operate systems to coordinate, monitor and quality assure (QA) the entire cervical screening process. Conclusions: Cervical cancer prevention services in this region are very limited. Achieving the WHO Global Strategy targets by 2030 will require substantial investments in capacity building by international development organisations.     

Exploring the Barriers to Cervical Cancer Screening through the Lens of Implementers and Beneficiaries of the National Screening Program: A Multi-Contextual Study

Background: Cervical cancer is a major reason for morbidity and mortality in Low and Middle income countries. The National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) sets out broad national guideline to implement Cervical cancer screening. However, an implementation strategy for cervical cancer screening is not in place for districts. Although opportunistic screening takes place, implementation is hindered by psychological and physical barriers for women, as well as insufficient capacity on the part of implementers. This qualitative study aims to identify the specific barriers that prevent the uptake of cervical cancer screening. Methods: Women who could benefit from cervical cancer program were interviewed to explore the factors that influenced their uptake of the cervical screening offered. Key informant interviews were conducted with implementers of the NPCDCS and with public health staff of three States (Himachal Pradesh, Meghalaya and Karnataka), to understand their perception of determinants of the utilization of screening services. Results: The general health concern among the participants was low, and routine check-ups were considered unimportant. Poor knowledge about cervical cancer, benefits of screening service availability, as well as a general sense of well-being, embarrassment or anxiety related to the screening procedure, fear of being judged for lack of modesty, and stigma were common barriers to screening uptake. In addition to a general unawareness of cervical cancer geographical inaccessibility of screening as a barrier to participate in cervical cancer screening, in certain regions. Conclusion: It is essential to increase the knowledge on cervical cancer and on the benefits of screening among Indian women. Providing information and cues to action by health workers and professionals can facilitate the decision to participate. Implementers need to be involved to ensure context specific implementation of the National programme to overcome these barriers.