宫颈癌筛查研究进展

随着宫颈癌发病病因的阐明,早期规范、有效的筛查可降低宫颈癌前病变、宫颈癌的发病率及死亡率.目前宫颈癌筛查的主要方法有巴氏涂片法、醋酸肉眼观察法(VIA)和碘染色肉眼观察法(VILI)、液基细胞学、人乳头瘤病毒(HPV)-DNA检测等方法.不同地区及国家的因经济发展不平衡,采取的筛查技术、策略均有所不同.     

宫颈癌早诊早治农村示范基地研究报告

[目的]通过对9176名妇女采用醋酸或碘染色肉眼筛查方法（VIA/VILI）筛查宫颈癌的早诊早治结果分析,评价在农村高发区宫颈癌采用该筛查方式推广应用的可行性。[方法]以山西省襄垣县30～59岁的妇女作为研究对象进行以自然人群为基础的宫颈癌筛查,用醋酸染色后肉眼观察（VIA）和碘染色后肉眼观察（VILI）进行宫颈检查,VIA或VILI阳性者进行阴道镜检查,阴道镜异常者在病变处取活检进行病理学诊断。采用同样方法对该人群连续复查两年。[结果]首次筛查人群参与率为73.92%,二次复查率为84.3%。2005年首次筛查了1287例妇女,最终经病理确诊的CINⅠ10例、CINⅡ9例、CINⅢ13例、宫颈癌3例。该方法与已往该地区采用液基细胞学和HPV检测联合筛查方法相比较,CINⅡ和≥CINⅢ病变的检出率略低,但差异无统计学意义。连续两年复查出5例CINⅠ,3例CINⅡ,1例CINⅢ。2006～2008年共筛查7889例,首次筛查最终病理确诊116例CINⅠ,36例CINⅡ,35例CINⅢ,4例早期浸润癌,浸润性鳞癌5例。第二次复查,经病理确诊75例CINⅠ,24例CINⅡ,15例CINⅢ,1例早期浸润癌。[结论]在资源有限．经济不发达的农村地区．用VIA／VILI方法对宫颈癌及其癌前病变的筛查是可行的．建议进一步在农村地区进行推广。     

新疆维吾尔族妇女宫颈癌筛查方法横断面比较研究

[目的]探讨适合新疆维吾尔族妇女宫颈癌的筛查方法。[方法]于2006～2007年采用整群抽样方法,选择新疆维吾尔族妇女883名,采用自我采样HPV检测,液基细胞学检查,医生采样HPV检测,肉眼筛查(VIA)进行宫颈癌筛查。分析和比较不同筛查方法的灵敏度、特异度、阳性预测值、阴性预测值。[结果]医师采样HPV检测的灵敏度和特异度均为最高(P<0.01),自我采样的灵敏度与细胞学检查相似(P>0.05),但自我采样HPV检测的特异度高于细胞学检查(P<0.01),与医生采样HPV检测相似(P>0.05)。肉眼筛查的灵敏度和特异度为最低。[结论]新疆维吾尔族妇女的宫颈癌筛查方案应首选医生采样HPV检测,自我采样HPV检测是比较适合于新疆民族地区妇女的方案,在偏远和缺少设备的地区,肉眼筛查也是一种可行的筛查方法。     

肉眼观察(VIA、VILI)在中国农村地区宫颈癌筛查中的应用评价

目的评价醋酸、碘着色肉眼观察在中国农村地区宫颈癌筛查中的应用价值及可行性。方法对子宫颈癌高发区江西省修水县大桥乡妇女进行以人群为基础的研究,对2499例年龄为30～49岁农村已婚妇女进行了人乳头瘤病毒(HPV)的检测,薄层液基细胞学(TCT),醋酸、碘染色后肉眼观察(VIA、VILI)以及电子阴道镜检查。各种方法独立进行,均为双盲。对VIA、VILI或电子阴道镜中任何一项存在阳性病变进行宫颈组织活检,或行颈管刮术(ECC),另HPV或TCT阳性的妇女也给予活检。宫颈组织病理诊断均经国际癌症研究所病理检查确诊,将CIN2以上(含CIN2)病变纳入阳性结果。结果2499例受检妇女中有2432例列入研究,共检出CIN237例,CIN359例,宫颈癌3例。HPV,TCT,HPV TCT,VIA,VILI,VIA VILI和阴道镜检查等筛查方法的敏感度分别是96.67%,89.47%,97.98%,56.57%,36.36%,63.64%和39.39%;特异度分别为85.00%,96.91%,86.97%,94.60%,96.23%,92.97%和98.14%。结论VIA、VILI的灵敏度低于HPV或TCT,但因其简单、廉价、易掌握等特点,故更适合在农村地区推广应用。     

农村不发达地区妇女宫颈癌筛查方法的比较

目的评价多种宫颈癌筛查方式,为农村欠发达地区优选一种较适宜的筛查方法。方法在宫颈癌高发区山西省阳城县对744名年龄为20￣59岁已婚妇女,进行宫颈癌危险因素的流行病学问卷调查、阴道醋酸染色(VIA)、碘染色(VILI)及阴道镜检查并进行13种高危型HPVDNA的检测、收集阴道脱落细胞进行液基细胞学诊断,宫颈有病变者取可疑组织病检。数据用FoxPro6.0录入和整理后,运用SAS软件进行统计学处理和分析。结果CINI以上病例73人,普查人群检出率9.81%(73/744),其中CINⅠ41例,CINⅡ18例,CINⅢ13例,腺癌1例。HPV人群感染率15.99%(119/744)。以病理组织学为金标准(≥CINⅡ为阳性),各检查方法灵敏度和特异度分别为VIA(10.53,82.44),VILI(53.13,82.44),阴道镜检查(56.25,79.35)、液基细胞学(68.75,97.29)和HPV(93.75,87.50)。结论从经济性、适用性综合考虑,VILI在农村不发达地区是一种可行的筛查手段。     

山西省襄垣县2009~2015年农村女性宫颈癌筛查项目结果分析

[目的]通过分析襄垣县2009～2015年农村妇女宫颈癌筛查结果,为国家宫颈癌筛查项目的评价和优化提供理论依据.[方法]对襄垣县35～64岁妇女开展宫颈癌筛查.2009～2013年采用醋酸/碘染色后肉眼观察(VIA/VILI),2014年开始部分引入人乳头状瘤病毒(HPV)检测,2015年又引入新柏氏液基细胞学(TCT)检测,根据卫生资源情况在不同人群中分别使用三种方法.任意筛查结果阳性者转诊阴道镜,镜下有病变时取活检,以病理诊断为金标准.通过评价不同方法对宫颈上皮内瘤变(CIN)2级及以上病变的检出率评价不同方法对宫颈癌的筛查效果.[结果] 2009～2015年共筛查62 618名女性,其中CIN2级及以上(CIN2+)病变的患病率为0.76％,早诊率为90.53％,下生殖道感染率为25.68％,其中滴虫性阴道炎、细菌性阴道炎和宫颈炎与HPV感染相关.根据2014及2015年数据,VIA/VILI的CIN2+病变检出率为0.74％,TCT的病变检出率为0.70％,两者相似,但均低于HPV检测,其病变检出率为1.37％.[结论]HPV检测是首选的宫颈癌初筛方法,在资源匮乏地区,培训合格的基层医生使用VIA/VILI或TCT方法对适龄妇女开展宫颈癌筛查是有效的备选方案.     

醋酸染色法联合碘染色法在宫颈癌筛查中的应用

[目的]评价醋酸染色法（VIA）联合碘染色法（VILI）对农村地区宫颈癌筛查的可行性和价值。[方法]采用VIA/VILI在杭州市萧山区农村28-55岁的妇女人群中开展宫颈癌筛查。VIA或VILI阳性者行阴道镜检查,阴道镜检查阳性者转送上级医院进一步检查。[结果]2007-2009年期间,总筛查1697人次,其中低级别CIN17例、高级别CIN10例、浸润癌2例。[结论]在资源、设备有限的农村地区,VIA/VILI方法对妇女开展宫颈癌及癌前病变的筛查是可行的,有利于宫颈癌的早发现及早诊早治。     

河南省新密市2010~2013年农村女性宫颈癌筛查结果分析

摘 要：［目的］ 根据2010～2013年河南省新密市农村地区宫颈癌筛查数据,分析当地女性宫颈癌筛查的参与率,宫颈炎、宫颈癌前病变及宫颈癌的检出率,为当地制定宫颈癌筛查策略提供依据。［方法］ 2010～2013年对新密市35～64岁农村妇女进行宫颈癌筛查,绝经前女性使用醋酸/碘染色肉眼观察法（VIA/VILI）初筛,绝经后女性使用巴氏涂片法初筛。VIA/VILI异常及巴氏涂片结果≥ASC-US者召回行阴道镜检查,并对镜下检查异常处取活检。病理结果为金标准,CIN2及以上妇女转诊进行手术治疗。［结果］ 2010~2013年共筛查115 789名农村女性,总体顺应性为59.50%;VIA/VILI筛查84 762人,阳性率为20.0%;巴氏涂片筛查31 027人,阳性率为4.81%。13 914人进行阴道镜检查,取活检4438例(31.90%)。病理诊断宫颈炎症3830例(3.31%),CIN1 126例(0.11%),CIN2 125例(0.11%),CIN3/原位癌204例(0.18%),宫颈癌67例(0.06%),另发现5例内膜癌(0.004%)、2例外阴癌(0.002%)。［结论］ 2010~2013年新密市CIN2+的整体检出水平较高。农村女性参加筛查的整体顺应性不高,VIA/VILI筛查的假阳性率高,应加强对基层医生技术水平的培训。     

肉眼观察法联合电子阴道镜检查在宫颈癌筛查中的应用

[目的]对新疆维吾尔族妇女肉眼观察宫颈（VIA,VILI）法联合电子阴道镜检查进行宫颈癌筛查,评价其对宫颈癌及癌前病变的应用价值。[方法]对新疆和田29～60岁的2005名维吾尔族农村妇女进行宫颈癌筛查。采取VIA、VILI法,对VIA、VILI异常者结合电子阴道镜检查,在异常阴道镜图象区取宫颈活检,病理诊断为金标准。[结果]2005名农村妇女中VIA阳性41例,占2.04%（41/2005）,其灵敏度、特异度、阳性预测值、阴性预测值分别为65.63%、98.98%、51.22%、99.44%;VILI阳性49例,占2.49%（49/1964）,其灵敏度、特异度、阳性预测值、阴性预测值分别为53.57%、98.24%、30.61%、99.32%;阴道镜转诊90例,占4.49%（90/2005）;宫颈活检65例,病理诊断为炎症33例、CIN24例、宫颈癌8例。[结论]在宫颈癌筛查中采用VIA、VILI法具有一定的阴性预测价值;结合阴道镜检查能够初步判断病变的程度,确保活检部位的准确性。     

山西省农村妇女生殖道感染和宫颈癌筛查情况调查

[目的]通过对山西省农村妇女生殖道感染（RTI）和宫颈癌初级筛查暨基层妇保院服务能力进行调查分析,探索适合山西省基层低收入人群的将生殖道感染防治和宫颈癌筛查相整合的妇女病普查普治模式。[方法]采用整群抽样的方法抽取山西省3县2503例20～59岁农村已婚妇女作为研究对象,进行了生殖道感染实验室检测和宫颈癌醋酸（VIA）筛查和碘染色（VILI）初级筛查,并对其中VIA阳性或VILI阳性的妇女进行阴道镜检查,异常者取活检进行病理诊断。同时,对21所基层妇幼保健院生殖道感染防治和宫颈癌筛查服务能力进行了调查分析。[结果]2503例调查对象中84.58%从未做过妇女病普查,经检查发现生殖道感染患病率达67.96%,宫颈癌及癌前病变患病率1.56%。而基层妇幼院服务能力普遍低下,宫颈细胞学筛查覆盖面小,仅有少数单位可开展阴道镜和病理诊断技术。[结论]基层妇幼机构生殖道感染检测和宫颈癌筛查技术亟待提高。应积极培训人员,在基层单位推广WHO推荐的RTI防治和宫颈癌初级筛查相结合的妇女病普查模式。     

Evaluation of Several Screening Approaches for Detection of Cervical Lesions in Rural Shandong,China

Purpose: The study was designed to: (1) investigate the prevalence of high-risk human papillomavirus (HRHPV)infection and cervical neoplasia; and (2) evaluate clinical performance of visual inspection with aceticacid/ Lugol’s iodine (VIA /VILI), Pap smear, high-risk human papillomavirus (HR-HPV) DNA test for detectingcervical intraepithelial neoplasia grade 2 or worse (CIN2+) and (3) explore appropriate screening approach inrural areas of Shandong Province. Materials and Methods: A total of 3,763 eligible women from Yiyuan Countyin Yimeng mountainous areas of rural Shandong, China, were enrolled and underwent Pap smear, HR-HPVDNA testing by Hybrid Capture 2 (HC2), and VIA /VILI tests. Women positive in any test were referred tocolposcopy and biopsy as indicated. Results: The prevalence of HR-HPV infection among all enrolled womenwas 11.1% and that in healthy women was 9.9%. In total 33 cases of CIN1, 16 cases of CIN2, 6 cases of CIN3 butnone of cervical cancer were detected and the crude prevalence of CIN2+ was 0.58%. For detecting CIN2+, thesensitivity of HR-HPV DNA testing, VIA/VILI, Pap smear was 90.9%, 77.3%, 81.8%, respectively. Pap smearhad the best specificity of 98.2%, followed by HR-HPV DNA testing with specificity of 89.4%, VIA/VILI hadthe lowest specificity of 81.2%. Colposcopy referral rate of HR-HPV DNA testing, VIA/VILI, Pap smear was11.1%, 18.5%, 2.3%, respectively. Conclusions: Our results suggest that HR-HPV DNA testing alone might beappropriate for primary cervical cancer screening in rural low-resource areas of Shandong Province, China.     

Opportunistic Screening for Cervical Cancer in a Tertiary Hospital in Karnataka,India

The incidence and mortality of cervical cancer remains high in India even after sixty years of introductionof the Pap smear (cervical cytology) which is an effective means of identifying preinvasive lesions of carcinomacervix. The morbidity and mortality due to cervical cancer has come down drastically in countries with wellestablished screening programmes at national level. This study aims at screening women for cervical canceropportunistically during their visit to hospital and to study various types of neoplastic and non-neoplastic lesionsof the cervix by cervical smear study (Pap smear study). In the present study, a total of 350 cervical smearswere studied. The age of patients ranged from 19 years to 80 years with mean age being 37.5 years. Out of 350cases, the diagnosis of neoplasia was given in 43 cases and 258 cases were diagnosed as inflammatory smears.Forty-cases were normal and 9 cases were inadequate to evaluate. Forty-three patients who were found to haveneoplastic lesions on cytology were referred for further investigations like colposcopy and biopsy to confirm thediagnosis and avail proper treatment. Limitation of the present study was small sample size as all female patientsaged between 20 and 60 years visiting hospital were not included in the screening, other screening tests like VIA(visual inspection with acetic acid test) and HPV DNA (human papilloma virus) tests were not done. Until thetime centrally organised screening programmes for cervical cancer are established in India, arrangements shouldbe made for hospital based opportunistic screening for all women attending hospital. The cost effectiveness ofdifferent screening tests for cervical cancer should be evaluated.     

Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India

The high burden of cervical cancer and inadequate/suboptimal cytology screening in developing countries led to the evaluation of visual screening tests, like visual inspection with acetic acid (VIA) and Lugol's iodine (VILI). We describe the performance of VIA, VILI and cytology, carried out in a multinational project called "Screening Technologies to Advance Rapid Testing" in 5,519 women aged 30-49 years, in detecting cervical intraepithelial neoplasia (CIN). VIA, VILI and cytology were positive in 16.9%, 15.6% and 6.1% women, respectively. We found 57 cases of CIN2, 55 of CIN3 and 12 of cervical cancer; 90% of CIN3 and 43% CIN2 cases were positive for p16 overexpression and high-risk HPV infection, indicating a high validity of histological diagnosis. The sensitivity of VIA, VILI and cytology to detect high-grade CIN were 64.5%, 64.5% and 67.7%, respectively; specificities were 84.2%, 85.5% and 95.4%. A high proportion of p16 positive CIN 3 (93.8%) and 2 (76.9%) were positive on cytology compared with visual tests (68.8% and 53.8%, respectively) indicating a higher sensitivity of cytology to detect p16 positive high-grade CIN. However, the immediate availability of the results from the visual tests permits diagnosis and/or treatment to be performed in the same sitting, which can potentially reduce loss to follow-up when women must be recalled following positive cytology. Organizing visual screening services in low-resource countries may facilitate the gradual building of an infrastructure committed to screening allowing the eventual introduction of more sensitive, highly objective, reproducible and affordable human papillomavirus screening tests in future.     

Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala,India

Simple and inexpensive methods based on visual examination of the cervix are currently being investigated as alternative methods of cervical screening. The test characteristics of visual inspection with 4% acetic acid (VIA), and Lugol's iodine (VILI) and conventional cytology were investigated in a cross-sectional study involving 4,444 women aged 25 to 65 years in Kerala, India. While detection of any acetowhite area constituted a low-threshold positive VIA, detection of well-defined, opaque acetowhite lesions close to or touching the squamocolumnar junction constituted a high-threshold positive VIA test. Detection of definite yellow iodine nonuptake areas in the transformation zone close to or touching the squamocolumnar junction constituted a positive VILI test. Cytology was considered positive if reported as atypia or worse lesions. All screened women were evaluated by colposcopy and biopsies were directed in 1,644 women (37.0%), which allowed the direct estimation of sensitivity, specificity and predictive values. The reference diagnosis was based on a combination of histology and/or colposcopy. True disease status was defined as CIN 2 and worse lesions. A total of 149 (3.4%) women had CIN 2 or worse lesions. The sensitivities of low-threshold VIA, high-threshold VIA, VILI and cytology to detect CIN 2 or worse disease were 88.6%, 82.6%, 87.2% and 81.9%, respectively; the corresponding specificities were 78.0%, 86.5%, 84.7% and 87.8%. Our results indicate that VIA and VILI are suitable alternate screening tests to cytology for detecting cervical neoplasia in low-resource settings.     

Comparing PAP smear cytology, aided visual inspection, screening colposcopy, cervicography and HPV testing as optional screening tools in Latin America. Study design and baseline data of the LAMS study

OBJECTIVES: This is a European Commission (EC)-funded ongoing study known as the LAMS (Latin American Screening) study, where PAP smear/liquid-based cytology and screening colposcopy were compared with i) three optional screening tools [visual inspection with acetic acid (VIA), or Lugol's iodine (VILI), cervicography] and with ii) Hybrid Capture II from a) conventional samples and from b) self-samples, in women at different risk for cervical cancer in Brazil and Argentina. STUDY DESIGN: During 2002-2003, a cohort of 12,107 women attending four clinics: Campinas (CA), Sao Paulo (SP), Porto Alegre (PA) and Buenos Aires (BA), were interviewed for risk factors, and examined using the 8 diagnostic arms. Colposcopy was performed for women positive in any test and for 5% of women with baseline PAP-negative and 20% of HCII-negatives. All high-grade lesions (CIN2/3) were treated, and low-grade CIN are prospectively followed-up. RESULTS: Of the 12,107 women, the following baseline data are available: epidemiological data (n=11,996), conventional PAP smears (n=10,363), LBC, SurePATH (n=320), LBC, DNA-Citoliq (n=1,346), VIA (n=12.067), VILI (n=3,061), cervicography (n=279), screening colposcopy (n=3,437), HCII conventional (n=4,710), HCII self-sampling (n=246) and cervical biopsies (n=1,524). The four sub-cohorts differ significantly in all their baseline data on the implicated risk factors of cervical cancer, consonant with their origin from regions with different cancer incidence. Around 95% of all PAP smears were negative, with slight variations in the prevalence of LSIL and HSIL between the four centers. Significant differences were found in the detection rates of abnormal findings in VIA, VILI and colposcopy between the four centers (p=0.0001). The prevalence of HPV was practically identical (16.5-18.8%) in all four cohorts (p=0.486), with no differences in the relative viral loads. Biopsy results were different depending on whether the women underwent screening colposcopy (BA) or elective colposcopy (others). CONCLUSION: Four cohorts with significantly different baseline data are available, and prospective follow-up of these women permits analysis of whether variations in cervical cancer incidence in these regions is due to i) different natural history of the precursor lesions, or ii) due to different levels of exposure to the known risk factors.     

Comparison between Visual Inspection of Cervix and Cytology Based Screening Procedures in Bangladesh

Background: Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 newcases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid(VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-basedscreening is more often applied in developed countries where it has successfully reduced the prevalence of cervicalcancer. Objective: To compare the efficacy of VIA and cytology-based primary methods for cervical cancerscreening in Bangladesh. Materials and Methods: This hospital based comparative study was conducted at theVIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October2008 to October 2010. Results: Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalitiesin their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%)had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalitiesincluding two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificityof VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%,95.8%, 75.0% and 79.3%, respectively. Conclusions: VIA test should be used as the primary screening tool evenwith its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may begreater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.     

Visual inspection as a cervical cancer screening method in a primary health care setting in Africa

We evaluated the feasibility and performance of visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) for cervical cancer screening in a primary health-care setting in Kinshasa, Congo. Women (1,528) aged > or =30 years were screened independently by nurses and physicians by VIA and VILI and Pap cytology. Biopsy samples were obtained from women with abnormal colposcopies and from 290 randomly chosen women with normal colposcopy. Cytological and histological examinations were performed in Lyon and Montreal, respectively. The prevalence of cervical intraepithelial neoplasia (CIN) of grades 1, 2 and 3 was 4.5, 1.3 and 4%, respectively. Using biopsy as the reference, the sensitivity, specificity and negative predictive value (NPV) for > or =CIN 2 for VIA-nurse were 55.5% (95% CI: 34.7-76.2), 64.6% (95% CI: 62.0-67.1) and 96.8% (95% CI: 93.5-98.7), respectively. The corresponding values for VILI-nurse were 44.0% (95% CI: 24.2-63.8), 74.6% (95% CI: 72.3-76.9) and 96.7% (95% CI: 93.7-98.6). The equivalent parameters for physicians were 71.1% (95% CI: 46.7-95.5), 71.3% (95% CI: 68.9-73.6) and 98.6% (95% CI: 96.0-99.7) for VIA and 68.3% (95% CI: 42.5-94.0), 76.2% (95% CI: 74.0-78.4) and 97.2% (95% CI: 95.3-98.5) for VILI. The sensitivity of cytology ranged between 31 and 72%, depending on the abnormality threshold used to define positivity, with a corresponding specificity range of 94-99% and a NPV range of 97-99%. Our results show that VIA and VILI performed by nurses and physicians are slightly more sensitive but less specific than Pap cytology across multiple combinations of test and lesion thresholds. Given their lower cost and easy deployment, visual inspection methods merit further assessment as cervical cancer screening methods for low-resource countries.     

山西省襄垣县宫颈癌和乳腺癌联合筛查效果初探

目的 通过分析为国家宫颈癌和乳腺癌筛查提供基本评价数据.方法 2009～2010年山西省襄垣县妇幼保健院对该县30～59岁妇女通过醋酸/碘染色后肉眼观察方法开展宫颈癌筛查,阳性者转诊阴道镜,镜下有病变时取活检,以病理诊断为金标准.对35～59岁的妇女开展乳腺癌筛查,以临床检查法为初筛方法,怀疑阳性者通过超声或乳腺X线进行诊断.结果 2009年完成1993名妇女的宫颈癌筛查,其中宫颈上皮内瘤变2级(CIN2)及以上病变的患病率为1.6%,早诊率为100%,第2年复查率为91%,仅查出1例CIN2,未查出更高病变,早诊率达100%.完成1819名妇女的乳腺癌筛查,乳腺良性病变9例(4.02%),良性肿瘤3例(1.34%);2010年完成2026名妇女的乳腺癌筛查,良性病变103例(13.57%),良性肿瘤14例(1.84%),可疑恶性1例.结论 该县宫颈癌的筛查效果明显,乳腺癌筛查仍需加强技术培训.筛查体系和技术队伍建设是基层单位承担农村妇女健康保健服务的关键.