A Retrospective Analysis Of Cervical Cancer Screening In Women Younger Than 30 Years

ObjectivesTo investigate primary and triage strategies for cervical cancer screening in women younger than 30 years.MethodsClinicopathological data of women aged 21 to 29 years who underwent cervical cancer screening test from January 2013 to October 2018 in women’s hospital,school of medicine,Zhejiang university were collected,which included the results of HPV test,cytology and histopathological findings of cervix detected by coloscopy.We divided all the participants into 21-24 age group and 25-29 age group.Comparing diagnostic value of HPV test,cytology and co-testing as primary strategies,and also comparing diagnostic value of HPV with cytology triage and cytology with HPV triage as triage strategies.Results69042 women were enrolled and the positive rate of HPV test was 21.78% and 18.49%(P<0.05)in 21-24 age group and 25-29 age group,respectively.The proportion of NILM or LSIL between two age groups has no significant difference,but the proportion of HSIL was 13.82% and 18.74%(P<0.05).The pathologic results were all adenocarcinoma in situ in 2 patients diagnosed as cervical cancer in 21-24 age group,while there were 9 adenocarcinoma in situ or adenosquamous carcinoma in 21 patients diagnosed as cervical cancer in 25-29 age group.Detection of CINⅢ+ as diagnoses endpoints,HPV test has higher sensitivity(96.67% vs.66.67%)but lower specificity(16.77% vs.48.67%)than cytology and the positive rate was also higher(84.01% vs.52.22%),coloscopies per CINⅢ+ was 13.55 and 15.03(P>0.05)in HPV test and cytology,respectively,co-testing was as effective as cytology.Detection of HSIL+ as diagnoses endpoints,HPV test has higher sensitivity and negative predictive value(97.44% vs.71.79%,96.63% vs.88.26%),but lower specificity and positive predictive value(19.13% vs.55.15%,23.87% vs.29.40%)than cytology and the positive rate was also higher(84.29% vs.50.41%),coloscopies per HSIL+ was 4.19 and 3.41(P<0.05),coloscopies per cancer was 95.53 and 65.92(P<0.05)in HPV test and cytology,respectively,and co-testing has similar sensitivity but higher specificity than cytology(61.38% vs.55.15%),and a lower positivity(45.41% vs.50.41%).The differences in effectiveness between two triage strategies in 21-24 age group were approximately similar when high-grade lesion was identified.In 25-29 age group,however,compared with cytology with HPV triage,HPV with cytology triage has equivalent sensitivity but better specificity(65.97% vs.61.38%)and lower positive rate(41.53 vs.45.41).Conclusions1.The infection rate of HPV was higher in 21-24 years than that in 25-29 years.2.Primary HPV test is a feasible strategy of cervical cancer screening for women aged 25-29 years,particularly in districts which were lack of cytologists.