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。     

宫颈病变与人乳头瘤病毒感染临床病例分析

目的评价人乳头瘤病毒(Human Papillomavirus,HPV)感染在宫颈病变早期筛查中的作用,为进一步诊断和判断预后提供依据。方法来我院进行宫颈癌筛查,因宫颈液基薄层细胞学检查存在异常细胞妇女413例,均进行阴道镜下组织活检和HPV-DNA分型。结果上皮内瘤样病变(CIN)I患者中以ASCUS检出符合率最高,CIN II患者中以LSIL检出符合率最高,CIN III患者中以HSIL检出符合率最高。慢性宫颈炎患者一种或多种高危型HPV(HR-HPV)感染率要低于CIN患者(χ2=32.105,P=0.000),宫颈癌HR-HPV感染率为100%;慢性宫颈炎患者与CIN患者低危型HPV(LR-HPV)感染率比较,差异无统计学意义(χ2=0.205,P=0.650)。宫颈病变患者以单一HR-HPV亚型感染更常见。结论宫颈癌及癌前病变与HPV感染密切相关,HR-HPV基因检测及分型在宫颈病变的预后判断、疗效监测等方面具有重要价值。     

宫颈癌的免疫治疗进展

随着免疫学与分子生物学的发展 ,宫颈癌的免疫治疗研究也迅速进展 ,免疫治疗从多个方面进行 ,包括人乳头瘤病毒疫苗 ,树突状细胞免疫治疗 ,表面CD的单克隆抗体治疗等 ,该文就此作一简要综述     

人群大样本子宫颈癌筛查中宫颈涂片的质量控制

目的探索人群大样本子宫颈癌筛查中宫颈涂片质量控制的方法,提高涂片质量和细胞学检查灵敏度。方法概率比随机抽样,常规加跟踪质量控制,肉眼加镜下观察。观察指标:涂片膜厚度、涂片膜面积、血液成分、鳞状上皮细胞数、有无颈管细胞。结果①2008年项目点的后期涂片质量好于前期。肉眼观察涂片膜厚度、血液成分过多、涂片膜面积<40%3项指标后期较前期分别下降0.25%、4.33%、1.51%;镜下观察鳞状上皮细胞数、血细胞过多2项指标分别下降11.79%、11.95%,未见颈管柱状细胞或化生细胞上升3.51%。②2009年项目点涂片质量高于2008年。肉眼观察血液成分过多、涂片膜面积<40%2项指标分别下降0.55%、0.43%,涂片膜厚上升0.58%;镜下观察鳞状上皮细胞数、未见颈管柱状细胞或化生细胞、血细胞过多3项指标分别下降9.61%、4.71%、1.01%。结论建立简便、易行、科学的质量控制方法,能全面监控宫颈癌筛查的涂片质量,及时发现问题提高宫颈涂片质量。     

ILK在宫颈癌组织中的表达及宫颈癌细胞侵袭能力的影响

目的：探讨整合素链接激酶（ ILK）在宫颈癌组织中的表达情况及其与宫颈癌细胞的侵袭能力的相关性。方法采用免疫组化法对湖南省益阳医专附属医院妇产科收集的59例宫颈上皮瘤变（ CIN）标本、44例术后病例确诊的宫颈癌标本及30例病理检查为正常宫颈组织的标本进行检测,分析ILK在上述几种组织标本中的表达水平,并分析ILK表达与宫颈癌患者的临床病理特征的关系。结果宫颈癌组织中的ILK表达阳性率（86．36％）显著的高于CIN I级标本的（62．5％）、CIN Ⅱ～Ⅲ级标本的（65．71％）及正常宫颈组织标本的（23．33％）（χ2值分别为5．144、4．725、29．737,均P＜0．05）。 CINⅠ级标本患者的ILK表达阳性率（62．5％）、CINⅡ～Ⅲ级标本的（75．71％）均显著的高于正常宫颈组织标本（23．33％）（χ2值分别为8．472、11．675,均P＜0．05）。 ILK在宫颈癌组织中的表达与宫颈癌的低分化程度、发生淋巴结转移、深度的肌层浸润具有相关性（χ2值分别为5．173、4．810、4．020,均P＜0．05）,与年龄、FIGO分期、组织学类型无显著相关性（χ2值分别为0．275、1．991、0．129,均P＞0．05）。结论 ILK在宫颈癌组织中显著的高表达,同时与宫颈癌的分化程度、发生淋巴结转移、深度的肌层浸润具有相关性。     

Science friction: cervical cancer and the contesting of medical beliefs

This paper describes the ways in which beliefs about cervical cancer became contested within the medical profession in New Zealand from the late 1960s to the late 1980s. Medical dissenters who contested orthodox beliefs about cervical cancer during this period challenged the medical profession in a number of ways. In particular, professional unity and authority were called into question and threatened to turn professional uncertainties into public anxieties. Professional strategies were employed to cope with knowledge claims that threatened existing medical beliefs. The work of Ludwik Fleck forms the basis of a discussion of the ways in which medical knowledge is located and negotiated within a social context. This case study shows that closure of disputes over knowledge claims about cervical cancer occurred largely as a result of an inquiry into medical practice presided over by the laity and through an appeal to the moral as well as the scientific-technical.     

HPV分型检测在宫颈癌及其癌前病变筛查中的应用分析

目的分析人乳头瘤病毒（Human papilloma virus,HPV）分型检测在宫颈癌及其癌前病变筛查中的应用价值。方法对5358例女性进行HPV分型检测,对阳性病例进行液基薄层细胞学（Thin-prep cell test,TCT）检查,分析不同基因分型与疾病的相关性。结果 HPV检测阳性率为21.72%（1164/5358）;HPV阳性且TCT检查≥ASCUS占19.84%（231/1164）;感染率排名前5位的HPV基因类型为16型、52型、58型、33型、18型、56型;病理活检确诊NLM2例,CINⅠ级67例,CINⅡ级89例,CINⅢ级55例,SCC18例,高危型感染组≥CINⅡ发病率高于低危型感染组（P〈0.01）。结论宫颈异常患者HPV阳性检出率高,高危型HPV感染发展成为CINⅡ级以上疾病的几率较大,HPV分型检测对于宫颈癌及癌前病变筛查具有重要参考意义。     

Breast and cervical cancer screening: Knowledge, attitudes and behaviour among schoolteachers in Italy

The study explores knowledge, attitudes and behavior regarding screening for breast and cervical cancers. All female teachers in primary and secondary schools in Crotone and in Cassino (Italy) received a questionnaire on demographic and socioeconomic characteristics, clinical history, knowledge, behavior and attitudes about breast and cervical cancer and related screening procedures. A response rate of 65% was achieved. Knowledge on effectiveness of mammography and pap test in finding related cancers was widely spread in the sample. Only about 30% and 50% had respectively undergone their last mammogram and pap test according to the recommended time interval. Having been examined by a physician in the previous year and having had a screening CBE or a screening pap smear in the past three years were significantly more likely in women who underwent mammography for screening purposes in the past two years. Pap smear in the previous three years was significantly more likely in women in their forties, with a higher family income and in those who had been examined by a physician in the previous year. The results strongly recommend continued emphasis of physicians on education of women regarding mammography and pap smear.     

端粒及端粒酶与宫颈癌及癌前病变的关系

近年来,有关端粒和端粒酶及其与肿瘤之间关系的研究已成为各科研究的热点,认为人类端粒酶与恶性肿瘤的发生和发展有密切的关系,研究已取得了长足的进展.该文就端粒酶在宫颈癌及癌前病变方面的研究、进展情况及端粒酶活性与宫颈癌的诊断及预后的关系进行了综述.     

子宫颈癌早诊早治项目结果分析

目的：了解育龄妇女癌症综合知识和子宫颈癌防治知识的知晓情况,推广适宜农村地区的子宫颈癌筛查方法,促进子宫颈癌早诊早治,降低子宫颈癌的发病率和死亡率。方法：以35-55岁已婚妇女作为对象,进行以人群为基础的子宫颈癌筛查。对符合条件的妇女进行癌症综合知识及子宫颈癌防治知识知晓情况的问卷调查。受检妇女使用5％醋酸染色后肉眼观察（VIA）和2％碘染色后肉眼观察（VILI）宫颈改变,结果异常者进行阴道镜下活检并得到最终的病理学诊断。结果：有效问卷2029份,显示对吸烟、饮酒是癌症的主要危险因素等知晓率较高;而癌症的大多数危险因素、早诊早治方法和子宫颈癌的预防控制措施等许多方面知晓率较低。不同教育背景及不同年龄的知晓率存在较大差异,学历高、年龄轻的妇女知晓率高。2008年筛查适龄妇女2029人,96人采集了病理标本,最终病理确诊CINI（轻度宫颈上皮内瘤变）4人,CINⅡ（中度宫颈上皮内瘤变）1人,CINⅢ（重度宫颈上皮内瘤变）／原位癌1人,早期浸润癌1人。≥CINⅡ的检出率为1．48‰≥CIN总人数为7人,占VIA和VILI阳性人数的4．52％。2009年复查1760人,50人采集了病理标本,最终病理确诊CINI11人,CINⅡ2人,≥CINⅡ的现患率为l_14％o。≥CIN总人数为13人,占VIA和VII．I阳性人数的12．26％。两年累计检出≥CINⅡ5人,累计≥CINⅡ的检出率为2．46‰。结论：大丰市要针对不同对象进一步加大妇女生殖健康的宣传力度,积极开展预防子宫颈癌的健康教育,提高人群的癌症防治知识知晓率,同时有关部门应不断提高筛查水平,做到子宫颈癌的早发现、早诊断、早治疗。     

Knowledge differences between male and female university students about human papillomavirus (HPV) and cervical cancer: Implications for health strategies and vaccination

Knowledge about HPV and cervical cancer (CC) depends on several factors such as gender and education, which brings implications for health strategies and vaccination. A survey was conducted in Portugal with a representative sample of 1706 university students. Only 55.4% (n = 945) had already heard of HPV, although 88.3% (n = 834) from that know that is a risk factor for CC. 89% students (n = 841) wants to be vaccinated against it, but only 13.8% stated as main reason to be vaccinated “prevention of the disease”. Mean scores of knowledge were calculated. Statistical differences were found, regarding “CC knowledge”, in gender (p < 0.001) and between health sciences schools and non-health sciences schools (p < 0.001). Differences regarding the study area in “knowledge and beliefs of HPV” (p < 0.001) and in “relation between HPV and CC” (p < 0.001) were found. Therefore, these differences may help to develop effective strategies that lead to decline CC incidence and mortality.     

CDK8在宫颈癌及宫颈上皮内瘤变中的表达及意义

目的：初步探讨CDK8在宫颈癌及宫颈上皮内瘤变（ cervical intraepithelial neoplasia ,CIN）中的表达及意义。方法免疫组化法检测宫颈癌、CIN组织及正常宫颈组织中CDK8的表达水平,分析CDK8表达与宫颈癌病理特征,以及宫颈上皮内瘤变临床转归的关系。结果 CDK8表达水平：宫颈癌组＞高度宫颈病变组＞低度宫颈病变组＞正常组,组间差异均有统计学意义（P＜0．05）;宫颈癌组淋巴结转移者CDK8的表达高于无转移者,CIN中高度宫颈病变者持续组CDK8表达高于痊愈组,差异均有统计学意义（ P＜0．05）。结论 CDK8高表达可能与宫颈癌进展相关,CDK8检测有助于预测宫颈病变转归。     

上海市女性居民宫颈癌筛查知识和行为现状调查

[目的]了解上海市女性居民对宫颈癌筛查的知识和行为现状,为有针对性地开展健康教育和早期筛查工作提供科学依据。[方法]于2010年8—9月,对上海市7 909例15岁及以上女性居民的宫颈癌筛查知识和相关检查参与情况进行分析。[结果]对宫颈癌异常体征（7 908例）和宫颈细胞定期涂片筛查知识（7 907例）的知晓率：15岁及以上女性居民分别为54.29%和34.88%;居住于中心城区者知晓率较高（分别为59.49%和39.41%）;18～44岁年龄组的知晓率较高（分别为62.04%和40.30%）;大专及以上者的知晓率较高（分别为70.29%和49.33%）。18岁及以上的调查对象（6 973例）接受宫颈脱落细胞检查的比例为32.37%,不同年龄和文化程度者的差异均有统计学意义（P〈0.001）,其中18～44岁和未接受正规学校教育的女性受检比例较低（分别为26.96%和20.69%）。在曾经做过宫颈脱落细胞检查的2 223例女性居民中,最近一次检查距调查时的时间间隔中位数为2.00年。[结论]上海市女性居民对宫颈癌筛查的认知度较高,但参加相关筛查的比例相对较低。应加强该人群宫颈癌筛查知识的健康教育和行为指导,以提高其宫颈癌筛查的参与率及主动防癌健康检查的比例。     

电子阴道镜检查在宫颈癌普查中的应用

目的探讨电子阴道镜在社区内宫颈癌普查中的应用价值。方法通过2011年7-9月河南省省直第一医院妇科行妇女病普查病例1056例,其中455例行电子阴道镜检查,阴道镜图像可疑者阴道镜下宫颈活检,诊断异常病例24例,阳性率5. 27%;601例行宫颈刮片检查。结果可疑者行阴道镜下宫颈活检,诊断异常病例8例,阳性率1.33%。结论电子阴道镜检查相对宫颈刮片检查明显提高了宫颈疾病筛查的阳性率,可作为宫颈癌普查方法。     

Barriers and facilitators to cervical cancer screening in high incidence populations: A synthesis of qualitative evidence

ABSTRACT

Despite the efficacy and availability of screening and treatment for cervical cancer, it remains the leading cause of death for women in many low resource countries. The inability or reluctance of women to use screening and treatment is the largest contributor to cervical cancer morbidity and mortality. The aim of the author in this article is to determine knowledge, attitudes, and beliefs that facilitate or hinder women’s use of screening in high incidence countries through a synthesis of qualitative research. CINAHL, Medline, AnthroSource, Sociological Abstracts, Social Service Abstracts, GenderWatch, Ethnic News Watch, and ASSIA databases were queried for qualitative research published from 2008 to 2013. Ten studies meeting inclusion criteria were reviewed and analyzed using constant comparative analysis. Barriers to cervical cancer screening included fatalism, mistrust of non-traditional healthcare providers, masculine/feminine beliefs, limited knowledge, and misunderstandings of causes of cervical cancer. Facilitators included knowledge of sexual risk factors, recognition of signs and symptoms, and community/social support. Pragmatic solutions suggested by this synthesis, that may decrease barriers and enhance facilitators, involved cultural humility (a continual commitment to cultural competence), promotion of gender equality, collaboration among stakeholders, and the translation of evidence-based practices from low to high incidence populations.     

山东农村中老年妇女乳腺癌与宫颈癌筛查知晓情况

目的 了解农村中老年妇女乳腺癌与宫颈癌（以下简称两癌）筛查知晓情况,为制定可行的宣传策略提供科学依据。方法 于2014年采用分层随机抽样方法在山东省3县共抽取600名35~60岁妇女进行乳腺癌与宫颈癌知晓情况入户面访调查。结果 600名研究对象两癌筛查知晓率为67.7%（406/600）,其中莒南、梁山和平阴县分别为74.0%（154/208）、69.5%（137/197）和59.0%（115/195）（P=0.004）,校正其他因素影响后,研究对象知晓率莒南、梁山明显高于平阴（莒南：OR=1.839,95%CI=1.181~2.874,P=0.007;梁山：OR=1.546,95%CI=0.959~2.480,P=0.074）;知晓率影响因素分析结果显示,两癌筛查知晓率除受地区影响之外,还受使用节育环（OR=1.548,95%CI=1.070~2.240）及绝经（OR=0.545,95%CI=0.377~0.789）等因素影响;研究对象两癌筛查政策主要知晓途径为村委会通知,占85.4%（345/406）。结论 国家设立免费两癌筛查试点有助于提高农村妇女两癌筛查知晓率,并且在筛查政策落实中村委会起到良好宣传作用。