数码电子阴道镜在宫颈病变诊断中的应用

宫颈疾病是妇科的常见病、多发病,而宫颈癌在我国的发病率高,居世界第二位,是妇科肿瘤死亡的第一位原因,严重威胁着广大妇女的健康。近年来,虽然我国开展了妇女宫颈癌筛查工作,使宫颈癌病死率有所下降,但每年仍有13.7万新发病例,并以2%～3%的速度增长,且发病率呈年     

关于宫颈癌疫苗——你要知道的一些知识

正宫颈癌是最常见的妇科肿瘤。据统计,全球每年新发癌症约8%为宫颈癌,在中国,每年宫颈癌的新发病例约有13.15万人,死亡病例约3万人,约占世界新发病例数的28.8%。人类乳头瘤病毒(HPV)感染是导致女性宫颈癌的元凶。宫颈癌疫苗是世界上首支预防肿瘤的疫苗,所以一经问世便引起了广泛关注。目前,世界上很多国家都在应用宫颈癌疫苗预防HPV     

宫颈癌:不宜迷信“疫苗万能”

宫颈癌是常见的妇科恶性肿瘤之一.发病率在我国女性恶性肿瘤中居第二位。据世界范围内统计,全球每年约冇50万的宫颈癌新发病例,占所有癌症新发病例的5%;其中80%以上的病例发生在发展中国家。人乳头瘤病毒(HPV)是引发宫颈癌元凶,约80%有性行为的女性在一生中可能感染人乳头状瘤病毒,而持续感染会极大增加癌变的风险。因此.预防宫颈癌最好方法是注射疫苗。     

浅谈人群宫颈细胞学筛查与随访

宫颈癌是妇女最常见的恶性肿瘤之一,其发生率仅次于乳腺癌。据估计,每年大约有50万的宫颈癌新发病例,占所有癌症新发病例的5%;我国每年有新发病例13.15万,占世界子宫颈癌新发病例总数的28.8%[1]。世界卫生组织（WHO）推荐,在世界范围内,     

农村妇女宫颈癌筛查结果分析

<正>据世界卫生组织统计,我国每年新增宫颈癌13.15万例,约占世界宫颈癌新发病例的28.8%[1]。为保障妇女身体健康,龙游县开展了农村已婚妇女子宫颈癌自愿免费筛查,现将该县52843名农村已婚妇女宫颈癌筛查结果分析如下。对象与方法1对象凡户籍在龙游县的农村妇女,由当地妇幼保健人员按户向已婚妇女发放免费宣传资料,同     

预防宫颈癌5项必读

宫颈癌已成为威胁女性生命的第二位癌瘤杀手，仅次于乳腺癌。据报导，全世界每年新发病例约46万，在我国，每年宫颈癌的新发病例数超过13万，这也使得众多女性视宫颈癌为生命终结者。其实，宫颈癌是可以预防、可以早期发现和治愈的。[编者按]     

阴道镜检查206例临床分析

据中国肿瘤防治数据库统计,我国宫颈癌每年新发病例约13.15万,占世界宫颈癌新发病例总数的28.8%.     

宫颈病变筛查的进展（综述）

子宫颈癌是妇科常见的恶性肿瘤之一,其发病率仅次于乳腺癌,居女性恶性肿瘤第二位.据世界范围统计,每年约有46.6万宫颈癌新发病例,其中80%的病例发生在发展中国家.中国的新发病例为每年13万以上,占1/4～1/3,每年约有2～3万妇女死于宫颈癌.近年来宫颈癌患病的"年轻化"十分明显,特别是在20～30岁之间,且呈上升趋势,并有全球普遍性.据德国、美国、挪威、澳大利亚等国报道,在过去的20年里,发病年龄从53岁推早到45岁.我国吉林省的一项调查表明,<35岁的年轻宫颈癌患者由1975～1984年间的4.8%(占全部宫颈癌患者)升至目前的34.1%[1].这使得规范化筛查宫颈病变极具重要性.本文就近年来宫颈病变筛查手段和方法的进展综述如下:     

DNA倍体分析和TCT对宫颈癌检出的对比研究

宫颈癌已成为威胁妇女健康的常见疾病,位居全球女性癌症发病之首。每年我国女性宫颈癌新发病例约有13.15万人,约有3万名妇女死于宫颈癌。早期筛查和早期干预是预     

吸烟增加女性宫颈癌风险

正宫颈癌是一种严重危害女性健康的恶性肿瘤,在我国女性恶性肿瘤死亡排名中占第二位,患病率居女性生殖道恶性肿瘤的首位。有统计显示,全球每年宫颈癌新发病例可达50万例,我国每年新发病例约13万以上,是名副其实的宫颈癌高发国。近20年发病明显呈年轻化趋势,因此宫颈癌的预防与治疗越来越受到人们的重视。     

Epidemiology and burden of HPV infection and related diseases: implications for prevention strategies

Human papillomavirus (HPV) infection is a necessary, although not sufficient cause of cervical cancer. Globally, HPV infection accounts for an estimated 530,000 cervical cancer cases (~270,000 deaths) annually, with the majority (86% of cases, 88% of deaths) occurring in developing countries. Approximately 90% of anal cancers and a smaller subset (<50%) of other cancers (oropharyngeal, penile, vaginal, vulvar) are also attributed to HPV. In total, HPV accounts for 5.2% of the worldwide cancer burden. HPVs 16 and 18 are responsible for 70% of cervical cancer cases and, especially HPV 16, for a large proportion of other cancers. Prophylactic vaccination targeting these genotypes is therefore expected to have a major impact on the burden of cervical cancer as well as that of other HPV-related cancers. Over the past 50 years, organized or opportunistic screening with Papanicolaou (Pap) cytology has led to major reductions in cervical cancer in most developed countries. However, due to lack of resources or inadequate infrastructure, many countries have failed to reduce cervical cancer mortality through screening. HPV DNA testing recently emerged as a likely candidate to replace Pap cytology for primary screening. It is less prone to human error and more sensitive than Pap in detecting high-grade cervical lesions. For countries with national vaccination programs, HPV testing may also serve as a low cost strategy to monitor long term vaccine efficacy. Introduction of well organized vaccination and screening programs should be a priority for all countries. Increased support from donors is needed to support this cause.     

Effect of financial incentives on breast,cervical and colorectal cancer screening delivery rates: Results from a systematic literature review

Preventive care, such as screening, is important for reducing the risk of cancer, a leading cause of death worldwide. Indeed, some type of cancers are detected through screening programs, which in most countries run for colorectal, breast, and cervical cancers. In this context, general practitioners play a key role in increasing the participation rate in cancer screening programs. To improve cancer screening delivery rates, performance incentives have increasingly been implemented in primary care by healthcare payers and organizations in different countries. The effects of these tools are still not clear.We conducted a systematic literature review in order to answer the following research question: What is the evidence in the literature for the effects of financial incentives on the delivery rates of breast, cervical and colorectal cancer screening in general practice?We performed a literature search in Web of Science, PubMed, Cochrane Library and Google Scholar, according to the PRISMA guidelines. 18 studies were selected, classified and discussed according to the health preventive services investigated.Most of studies showed partial or no effects of financial incentives on breast and cervical cancer screening delivery rates. Few positive or partial effects were found regarding colorectal cancer screening.Ongoing monitoring of incentive programs is critical to determining the effectiveness of financial incentives and their effects on the improvement of cancer screening delivery rates.     

2012年新疆农村妇女宫颈癌和乳腺癌筛查项目结果分析

目的：分析2012年度新疆农村妇女宫颈癌和乳腺癌检查结果,探讨新疆“两癌”流行趋势与特点,为在新疆推广筛查工作提供科学依据。方法对筛查项目结果进行描述性分析。结果妇科常见疾病检出患病人数20．1万人（56．10％）,检出率较高依次为塔城地区（74．56％）、阿克苏地区（64．35％）和伊犁州（61．42％）。新疆农村妇女宫颈癌和癌前病变检出率为0．10％,宫颈癌早诊率为85．05％,检出率高的为巴州（0．26％）和博州（0．18％）。妇女乳腺癌检出率为0．05％,检出率高的为吐鲁番地区（0．27％）和克州（0．25％）。结论新疆妇女宫颈癌和乳癌检出率高于全国同期平均水平,加强重点人群“两癌”防治知识健康教育,积极参加“两癌”筛查,是提高“两癌”早诊早治的关键。     

Cost–effectiveness of the prophylactic HPV vaccine: An application to the Netherlands taking non-cervical cancers and cross-protection into account

Despite an effective screening programme, 600–700 women are still diagnosed with cervical cancer in the Netherlands each year. In 2009 a prophylactic vaccine against HPV-type 16 and 18 was implemented in the national immunisation programme to decrease the incidence of cervical cancer. There is evidence that infections with several oncogenic HPV types other than the vaccine types 16 and 18 are also prevented by vaccination, also known as cross-protection. Besides cervical cancer, HPV can also cause cancers at other sites such as the oropharynx, vulva, vagina and the anus/anal area. In this study we estimated the maximum health and economic benefits of vaccinating 12-year old girls against infection with HPV, taking cross-protection and non-cervical cancers into account. In the base-case, we found an incremental cost ratio (ICER) of €5815 per quality adjusted life year (QALY). Robustness of this result was examined in sensitivity analysis. The ICER proved to be most sensitive to vaccine price, discounting rates, costs of cervical cancer and to variation in the disutility of cervical cancer.     

Updated estimate of the annual direct medical cost of screening and treatment for human papillomavirus associated disease in the United States

The annual direct medical cost attributable to human papillomavirus (HPV) in the United States over the period 2004–2007 was estimated at $9.36 billion in 2012 (updated to 2020 dollars). The purpose of this report was to update that estimate to account for the impact of HPV vaccination on HPV-attributable disease, reductions in the frequency of cervical cancer screening, and new data on the cost per case of treating HPV-attributable cancers. Based primarily on data from the literature, we estimated the annual direct medical cost burden as the sum of the costs of cervical cancer screening and follow-up and the cost of treating HPV-attributable cancers, anogenital warts, and recurrent respiratory papillomatosis (RRP). We estimated the total direct medical cost of HPV to be $9.01 billion annually over the period 2014–2018 (2020 U.S. dollars). Of this total cost, 55.0% was for routine cervical cancer screening and follow-up, 43.8% was for treatment of HPV-attributable cancer, and less than 2% was for treating anogenital warts and RRP. Although our updated estimate of the direct medical cost of HPV is slightly lower than the previous estimate, it would have been substantially lower had we not incorporated more recent, higher cancer treatment costs.     

Human papillomavirus and screening for cervical cancer: state of art and prospects

More than 99% of all cervical cancers contain high risk HPV. Only a persistent infection with high risk HPV of the cervical epithelium results in cervical cancer. Because the risk of cervical cancer is identical for all different HPV types, tests which detect all 14 high risk HPV types at one time are sufficient for clinical management. Testing for hr-HPV is mandatory for women with mild dyskaryosis and for the follow-up of women treated for CIN lesions. Based on efficiency to detect CIN3 and cervical cancer and preliminary cost benefit analysis, the combination of a high risk HPV test in conjunction with a cervical smear appears to be the best way of cervical cancer screening. A definite point of view on using high risk HPV testing for primary screening for cervical cancer will be obtained after the completion of a randomized trial of 44,000 women, in which the efficiency to detect CIN3 and cervical cancer by high risk HPV testing in conjunction with a cytomorphological smear is compared with screening by classical cytology.     

A nurse-delivered intervention to reduce barriers to breast and cervical cancer screening in Chicago inner city clinics.

An 18-month intervention was implemented to increase breast and cervical cancer screening among poor African-American women in Chicago. Breast and cervical cancer screening programs were set up in two public clinics, one community-based and the other hospital-based. Nurse clinicians and public health workers were used in these programs to recruit women in the clinics and in targeted community institutions to receive free breast and cervical cancer screening. The following barriers were specifically addressed by the intervention: accessibility of screening, knowledge about breast and cervical cancers, access to followup screening examinations, and access to treatment. A computerized followup system was specifically designed to track patients. During the 18 months of the intervention, 10,829 visits were made by 7,654 low-income women. A total of 84 cases of breast cancer and 9 cases of cervical cancer were detected. Awareness of the program, as measured by a survey after the completion of the intervention, increased in both clinics compared with baseline results. Knowledge about breast and cervical cancers also increased, as measured by scores on tests given before and after a class on breast and cervical cancers. Followup rates were 86 percent for women attending the programs. More than 90 percent of the women referred for evaluation of breast abnormalities kept an appointment. In summary, the intervention was successful in reducing barriers to breast and cervical cancer detection and in attracting a high-risk group of women.     

A hidden Markov model for population-level cervical cancer screening data

The Cancer Registry of Norway has been administrating a national cervical cancer screening program since 1992 by coordinating triennial cytology exam screenings for the female population between 25 and 69 years of age. Up to 80% of cancers are prevented through mass screening, but this comes at the expense of considerable screening activity and leads to overtreatment of clinically asymptomatic precancers. In this article, we present a continuous-time, time-inhomogeneous hidden Markov model which was developed to understand the screening process and cervical cancer carcinogenesis in detail. By leveraging 1.7 million individual's multivariate time-series of medical exams performed over a 25-year period, we simultaneously estimate all model parameters. We show that an age-dependent model reflects the Norwegian screening program by comparing empirical survival curves from observed registry data and data simulated from the proposed model. The model can be generalized to include more detailed individual-level covariates as well as new types of screening exams. By utilizing individual screening histories and covariate data, the proposed model shows potential for improving strategies for cancer screening programs by personalizing recommended screening intervals.     

“Whilst you are here…” Acceptability of providing advice about screening and early detection of other cancers as part of the breast cancer screening programme

ObjectivesThis research aimed to assess women''s willingness to receive advice about cervical and bowel cancer screening participation and advice on cancer symptom awareness when attending breast cancer screening.MethodsWomen (n = 322) aged 60–64 years, living in the United Kingdom, who had previously taken part in breast cancer screening were recruited via a market research panel. They completed an online survey assessing willingness to receive advice, the potential impact of advice on breast screening participation, prospective acceptability and preferences for mode and timing of advice.ResultsMost women would be willing to receive information about cervical (86%) and bowel cancer screening (90%) and early symptoms of other cancers (92%) at a breast cancer screening appointment. Those who were not up to date with cervical cancer screening were less willing. Prospective acceptability was high for all three forms of advice and was associated with willingness to receive advice. Women would prefer to receive advice through a leaflet (41%) or discussion with the mammographer (30%) either before the appointment (27%), at the appointment (44%) or with their results (22%).ConclusionsWhile there is high willingness and high acceptability towards using breast cancer screening as a teachable moment for advice about prevention and early detection of other cancers, some women find it unacceptable and this may reduce their likelihood of attending a breast screening appointment.Patient or Public ContributionThis study focused on gaining women''s insights into potential future initiatives to encourage screening and early diagnosis of cancer. Members of the public were also involved in piloting the questionnaire.     

Sentinel Pap smears in 261 invasive cervical cancer patients in Italy

Although cervical cytology screening has dramatically reduced its incidence, cervical cancer still occurs. The clinical history of 261 cervical cancer patients referred to the European Institute of Oncology between 1996 and 2006 was analysed in depth to better understand the difficulties in the diagnosis and prevention of this neoplasia in Italy. Data concerning anagraphical characteristics, tumour type and stage, Pap smear history, colposcopic and histologic data, treatment outcome were reviewed. Patients who had taken Pap smear in the 3-year time span preceding diagnosis were 199 and 55 (27.7%) of these smears were negative. A negative Pap smear was observed in 62.5% of the women with a cancer at stage IV or III. One hundred and seventy-two patients were symptomatic at diagnosis: 43 (25%) had a negative Pap smear in the 3 years preceding diagnosis while 54 (31.4%) had never done a Pap smear or had one taken more than 3 years before. Eighty-nine women were asymptomatic at the time of diagnosis; 13 patients (14.6%) had a negative Pap smear while 8 had no smear taken in the 3 years preceding diagnosis or no smear at all. The present retrospective investigation indicates that the screening system still has some critical points. Although multiple techniques and approaches have been proposed to improve the general performance of the system, prophylactic vaccination may dramatically limit the failures in an easier, and possibly more cost-effective way. We also stress that history taking and clinical examination are important tools to diagnose cervical cancers. However a clinical diagnosis requires experience, which, with the advent of more efficient screening system and prophylactic vaccination, many of the newer practising gynaecologists might lack.