| Introduction:It usually takes 10 to 15 years for the occurrence and development of cervical cancer from HPV persistent infection, to cervical precancerous lesions, and to uterine cancer. Because of the long process, it is very important for timely detection of precancerous lesions and effective intervention to block the occurrence of cervical cancer and to reduce the incidence of cervical cancer.Worldwide, incidence of cervical cancer ranks the second in female malignant tumor, and there are 275000 die of cervical cancer, mostly in developing countries where prevention strategies and screening system are still lacking. In developed countries, complete screening system reduces the incidence of cervical cancer by 30%to 60%, whereas in less developed regions, the morbidity and mortality is high. Each year new cases in China accounts for 14% of the world, and 12% in death rate. In 2009 "two cancer" screening across the nation covering rural area plays an important role in reducing the morbidity and mortality. However, the morbidity and mortality is still high and rising due to following reasons: opportunistic screening, lack of funds and professional staff, screening fail to cover the whole country. It can clearly be seen that to explore the large scale screening model and factors for the district is the precondition and the key.For this reason,under high attention and strong support of Zhongshan government, it began to establish a regional integration model of medical resources based on multi department cooperation in 2011. To explore the large scale screening model for the province of the District, liquid based cytology technology freely applied to women of childbearing age in Zhongshan City. Collection and analysis of a large number of data contributes to theoretical basis of our province cervical cancer screening and prevention strategies, and to further promote prevention and control work in our province, and to provide original data for effective reduce the morbidity and mortality in our province.Objective:To accumulate information of in-depth development and popularization for cervical cancer screening, and to find an effective method to detect cervical precancerous lesion, and to ivestigate a new screening modle, a large-scale screening of cervical cancer for women was conducted from Jan 2011 to Dec 2013 in Zhongshan City.Methods:1. Routine examination of gynaecology and Thinprep liquid-based cytology test (TCT) for cervical cancer screening were used in married women in Zhongshan city.2. Human papillomavirus (HPV) detection was carried out in some recalled women.3. Colposcopy and biopsy under colposcope were also carried out in recalled women.4. FISH method was used to amplificate hTERC gene for TCT positive samples.5. Cervical cancer screening was carried out in pregnant women.6. The information management and specification prevention mode of cervical cancer screening was to investigate.Results:1. 130,475 married women in Zhongshan city participated in screening from Jan 2011 to Dec 2013. The total number of positive TCT was 5559, of which 3337 were recalled. 3122 people recalled had received HPV test, of which 1993 were positive. 2060 and 1400 people had received colposcope and biopsy respectively. The colposcope rate is 61.73%, while biopsy rate is 67.96%.2. Total recall rate of three years was 60.03%. There are significant difference among twenty-three towns. Southern area (81.03%), Dongsheng (73.88%)and Tanzhou (69.41%) are the highest, while Shaxi (48.44%), Sanjiao(47.62%) and Henglan (35.94%) are the lowest. Comparison was made among geographical locations. Urban and southern are the highest, while the lowest is western(χ2 =88.345 P<0.001). The single factor and multiple factors analysis show that recall rate significantly correlate with education,address, occupation, suffering from cervical diseases (P<0.05), which are independent influence factors. There is no correlation between recall rate and age, menopausal status, relative suffering from cervical cancer (P>0.05).Of different TCT positive types, the people with HSIL and AC/SCC have the highest recall rate (χ2=72.092, P=0.008).3. Total positive of TCT screening of three years was 4.26% (3.14%, 5.17%,4.51% respectively). The highest are Nanlang (5.73%), Henglan (5.21%)and Banfu (5.15%), while the lowest are Minzhong (3.63%), Shaxi (3.44%)and Dachong(3.27%). Comparison was made among five parts (urban,eastern, southern, western and northern). There is no significant difference.The single factor analysis indicates that there are significant correlations between TCT and age, age at first sex , education, occupation, menopause,tools contraception(P>0.05), while no obvious correlations between TCT positive and living environment, family history , relative suffering from cervical cancer.4. HPV were detected in some women with TCT positive, and the total positive rate of HPV was 63.8%. Sanxiang (80.43%) is the highest, while Wuguishan(52.63%) is the lowest. But there is no significant difference among the twenty-three towns. Comparison was made among geographical locations. There is no significant difference. Important differences among the HPV-positive of TCT types are indicated, of which people with HISL,AC and SCC are the highest(x2=302.130,P=0.000).5. Pathologic results showed the total pathological positive rate was 72.93%(1021/1400) in those women with TCT positive(CIN1 144, CIN2 267,CIN3 293, CA 45, AC 5 ).6. Analysis value of TCT combined with HPV in cervical cancer screening shows that the pathological predictive rate of TCT positive was 72.93%, and that of TCT combined with HPV was 77.99%(χ2 =8.922 P=0.003).7. The positive rate of hTERC in different pathological types are significantly different,(χ2=358.015,P=0.000),with the rising of pathological grades,the positive rate of hTERC increased constantly.8. Compared with non-pregnant women, the total positive rate of cytology,incidence rate of precancerous lesions and cervical cancer in pregnant women showed no statistical difference (P>0.05)9. A regional integration model of medical resources based on multi department cooperation was established.Conclusion:The research provides basis and experience for cervical cancer screening in fairly developed area of China. In the course of TCT screening, early HPV detection is an effective method to find cervical precancerous lesions. Cervical cytology screening of pregnant women is safe and feasible. A regional integration model of medical resources based on multi department cooperation is worthy of promotion in our country. |
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