Study On Cervical Cancer Screening And The Requirement Of HPV Vaccine

Objective:We conducted a cross-sectional analysis to assess the distribution of human papillomavirus(HPV)types and explored an acceptable strategy for cervical cancer screening in Shenzhen,China.On this bases,we also investigated the HPV vaccine requirement among Chinese population,such as the awareness and knowledge of HPV vaccine and to explore the acceptability of vaccination by an evidence-based medicine analysis.Methods:Clinical sensitivity and specificity as well as positive(PPV)and negative(NPV)predictive values of cervical cancer screening of Shenzhen were estimated.A triage strategy was regarded as acceptable when the NPV was at least98.0%.The analysis of HPV vaccine requirement among Chinese population was conducted across two English electronic database and three Chinese electronic database:PubMed,EMBASE,China National Knowledge Infrastructure(CNKI),Wan Fang Database and VIP Database for Chinese Technical Periodicals(VIP)to search HPV vaccine studies in mainland China.We conducted and reported the analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Results:(1)15.9%participants presented HPV positive.The five most prevalent HPV types were HPV52(22.9%),HPV16(12.7%),HPV53(10.0%),HPV51(8.6%),and HPV58(8.1%).Women demonstrating positivity for a single HPV genotype accounted for 75.2%(325/432),whereas 24.8%(107/432)of women were positive for multiple types.We observed that the prevalence of HPV positivity was significantly lowerinmarriedwomen(385/2510,15.3%)thaninsingle/divorced women(47/207,22.7%)(P=0.005).For the age of first sexual intercourse,the prevalence of HPV infection was significantly different between groups of≤20 years and≥21years(P=0.025),with the higher prevalence in women aged≤20 years(18.0%).HPV infection prevalence was significantly lower among women who have medical insurance(14.9%)than among those without(18.7%)(P=0.018).The HPV positive prevalence was 25.3%in NILM cases,whereas the prevalence was 75.0%in women with abnormal cervical cytology(P﹤0.001).As expected,HPV positivity increased with the severity of the pathological result(P﹤0.001).The CIN2+risks for each HPV type were 40.0%for HPV33,32.4%for HPV16,18.2%for HPV58,13.3%for HPV56,and 11.1%for HPV68 in descending order.Baseline cytology testing combined with HPV16/33/52/58 genotyping met the NPV thresholds at 98.6%with a PPV of 17.9%.(2)The pooled awareness rate and knowledge rate of HPV vaccine was 15.95%(95%CI:12.87-19.29,I~2=98.90%),and 17.55%(95%CI:12.38-24.88,I~2=99.80%),respectively.The meta-analysis identified the willingness rate of 67.25%(95%CI:58.75-75.21,I~2=99.80%)among participants to HPV vaccination for themselves,compared with 60.32%(95%CI:51.25-69.04,I~2=99.20%)for their daughters.Safety(50.46%,95%CI:40.00-60.89,I~2=96.60%)was the main obstacles for vaccination for themselves.Safety and efficacy(68.19%,95%CI:53.13-81.52,I~2=98.60%)were the main reasons for unwillingness to vaccination for their daughters.Conclusions:(1)In conclusion,triaging HPV-positive women by baseline cytology combined with HPV16/58/33/52 genotyping is an acceptable strategy for cervical cancer screening in Shenzhen,China.(2)The analysis of HPV vaccine requirement shows low HPV vaccine awareness and knowledge and high acceptability of HPV vaccination among Chinese people.