内蒙古东部地区宫颈癌及宫颈癌前病变的人群筛查研究

Population-based screening of cervical cancer and precancerous lesions among women from Eastern Area of Inner Mongolia

目的探讨内蒙古东部地区妇女宫颈癌及宫颈癌前病变的疾病状况。方法本研究是以人群为基础的横断面筛查研究,2005—2010年间,选取内蒙古东部地区三个筛查点的18～69岁的妇女作为目标人群,采集其宫颈脱落细胞标本,细胞学诊断采用TBS2001分级系统,异常者进行阴道镜检,有病变者直接取活检明确诊断。细胞学阳性定义为意义不明确的非典型鳞状上皮细胞(ASCUS)以及更高度病变,以组织病理学为金标准,分析不同年龄组,地区和民族患者宫颈癌及宫颈上皮内瘤变(CIN)的发病趋势。结果①内蒙东部地区全人群、蒙族和汉族妇女异常细胞学(ASCUS+)的检出率分别为6.56%、8.03%和6.06%;其中蒙族妇女细胞学异常病变的检出率高于汉族妇女;②病理结果显示:内蒙东部地区宫颈上皮内瘤变(CIN1)的患病率为2.4%,>CIN2的患病率为1.47%,宫颈早浸癌的患病率为0.04%;蒙族妇女患病率较汉族高,通辽地区的患病率较呼盟和赤峰地区高。其中蒙族妇女各级病变的患病率分别为:CIN12.87%、>CIN21.80%、早期浸润癌0.10%;汉族分别为:2.25%、1.36%、0.03%。疾病年龄分布:CIN1现患率最高为35岁之前年龄组,>CIN2的高发年龄为40～49岁,宫颈癌的高发年龄为50～54岁。结论①内蒙东部地区蒙古族妇女宫颈癌及癌前病变的现患率高于汉族妇女;②在内蒙东部地区宫颈癌的筛查年龄段应涵盖30～55岁年龄组,其中40～55岁年龄组为重点人群,应在该年龄段加强宫颈癌的筛查。

Objective To investigate the prevalence of cervical cancer and precancerous lesions among women in eastern area of Inner Mongolia.Methods This is a population-based, cross-sectional screening study. Women aged 18yr to 69yr were recruited from May 2005 to May 2010.Cervical exfoliated cells were collected for Thinprep cytological testing （TCT） for each subject. Direct biopsies under colposcopy were taken if any abnormalities were found. TBS 2001 system was used for cytology diagnosIs, and positive results were defined as atypical squamous cell of undetermined significance （ASCUS） and more severe lesions. Disease burdens of cervical cancer and cervical intraepithelial neoplasia（CIN） were estimated by different age groups, areas and nationalities.Results ① The prevalence of abnormal cytological result（ASCUS＋）for general population, Mongolian women and Han women in East Inner Mongolia was 6.56%, 8.03% and 6.06%, respectively. Generally, Mongolian women showed a higher prevalence of abnormal cytological results than Han women. ② The pathological results showed that the prevalence of CIN1, CIN2＋ and early invasive carcinoma in East Inner Mongolia was 2.4%, 1.47% and 0.04%,respectively. Mongolian women suffered a heavier burden than Han women, and Tongliao showed a higher prevalence than Humeng and Chifeng areas. Specifically, the prevalence of CIN1, CIN2＋ and early invasive carcinoma was 2.87%, 1.80% and 0.10% for Mongolian women, and 2.25%, 1.36% and 0.03% for Han women. The highest prevalence of CIN1, CIN2＋ and early invasive carcinoma was observed in young age group before 35yr, 40-49yr group and 50-54yr group, respectively.Conclusions ① The prevalence of cervical cancer and cervical- precancerous lesions in Mongolian women were higher than Han Chinese women in East Inner Mongolia.② This study indicates that the age group of 30-55 yrs should be included into cervical cancer and precancerous lesions screening, and 40-55 ys should be the high-risk population for high grade precancerous lesions screening.