广州市2009-2017年农村妇女宫颈癌筛查结果分析

Analysis of the cervical cancer screening programme among women in rural areas of Guangzhou

目的广州市从2009年起开展农村妇女免费宫颈癌检查项目。本研究分析2009-2017年宫颈癌项目筛查结果,评价项目实施情况。方法收集2009-2017年广州市宫颈癌项目季度报表数据,采用χ~2及趋势χ~2检验比较不同周期宫颈病变检出率的变化趋势及特点。检查对象为本市35～64岁、农业户籍并自愿接受检查的妇女。宫颈癌筛查技术方案:第1个周期(2009-2011年)主要用醋酸/碘染色法;第2个周期(2012-2015年)主要用宫颈脱落细胞涂片法;第3个周期(2016-2017年)全部采用高危型人乳头状病毒检测优先的双检测法。初筛阳性个案转诊阴道镜检查、组织病理学检查,确诊采用病理学诊断。结果共有623 374人次接受了宫颈癌初筛。第1～3个周期,宫颈癌初筛阳性转诊率从6.90%(19 267/279 107)下降到2.57%(2 810/109 202),转诊阴道镜检查异常率从36.86%(7 091/19 239)上升到87.93%(2 265/2 576),转诊组织病理学检查异常率从27.96%(1 755/6 276)上升到59.65%(1 347/2 258),χ~2值分别为60.27、42.42及27.93,均P<0.001。低级别宫颈上皮内瘤变检出率从378.35/10万(1 056/279 107)上升到706.03/10万(771/109 202),高级别宫颈上皮内瘤变检出率从207.81/10万(580/279 107)上升到467.94/10万(511/109 202),宫颈癌前病变检出率从217.48/10万(607/279 107)上升到485.34/10万(530/109 202),χ~2值分别为11.87、12.80及12.87,均P<0.001。但原位腺癌、微小浸润癌及浸润癌检出率无升高趋势,均P>0.05。3个周期宫颈癌早诊率均>90%。结论广州市宫颈癌筛查方案逐步优化,筛查的有效性明显提升。宫颈上皮内瘤变检出率、癌前病变检出率及早期诊断率高,达到了早发现、早诊断的目的。

OBJECTIVE To evaluate the effect of a free cervical cancer screening programme which has been launched among women in rural areas of Guangzhou since 2009. METHODS Data were collected from the quarterly report of the cervical cancer screening programme in Guangzhou from 2009 to 2017. The participants were women aged 35 to 64 years old in the rural areas. Chi-square and trend Chi-square tests were used to examine the detection rate of cervical disea- ses during the three cycles of the programme：the first cycle mainly used the acetic acid/iodine staining（VIA/VILI）; the second cycle mainly used the smear of cervical exfoliative cells colposcopy;the third cycle used the double detection method for high risk human papillomavirus detection. In initial screening the positive cases would be referred to have the colposco- py and histopathology examination and then confirmed by pathology. RESULTS A total of 623 374 women received the initial screening of cervical cancer. From the first cycle to the third cycle, the positive rate of cervical cancer screening grad- ually decreased from 6.90% （19 267/279 107） to 2.57 % （2 810/109 202）, while the positive rate of colposcopy increased gradually from 36.86% to 87.93% （2 265/2 576） and positive rate of histopathology increased gradually from 27.96% （1 755/6 276） to 59.65%（1 347/2 258） ;trend Chi-square was 60.27,42.42 and 27.93,respectively,all P〈0. 001. The detection rate of low grade,high grade cervical squamous epithelial lesions and cervical precancerous lesions have also in- creased from207. 81 per 100 000（580/279 107）,378. 35 per 100 000（1 056/279 107） and 217. 48 per 100 000 （607/279 107） to 467.94 per 100 000（511/109 202） ,706.03 per 100 000（771/109 202） and 485.34 per 100 000（530/109 202）respectively, （ trend Chi-square was 11.87,12.80 and 12.87,respectively,all P〈0. 001）,but the detection rate of in situ adenocareinoma,micro invasive carcinoma and invasive carcinoma were not increased （P〈0.05）. The early detection rate of cervical cancer in three cycles was all higher than 90%. CONCLUSIONS The cervical cancer screening program in Guangzhou is gradually optimized,and the effectiveness of screening has been improved significantly. The detection rate of cervical intraepithelial neoplasia and precancerous lesion as well as early diagnosis rate were high, which may be helpful for the prevention of severe cervical diseases.