2009—2018年中国农村妇女宫颈癌检查项目数据分析

Analysis of the reported data of National Cervical Cancer Screening Program in Rural Areas in China from 2009 to 2018

目的分析我国农村妇女宫颈癌检查项目实施效果。方法资料来源于全国30个省份(不包含中国香港、澳门和台湾地区数据)开展农村妇女宫颈癌检查项目县上报的2009—2018年季度统计表数据(西藏开展项目但未上报数据)。纳入35~64岁、有性生活史、具有本地区农村户籍且自愿接受筛查的女性,排除非宫颈癌或非宫颈病变原因行子宫全切除术者。分析2009—2018年宫颈癌不同初筛方法的阳性率、阴道镜异常检出率、组织病理学异常检出率、宫颈癌前病变和癌检出率、宫颈癌早期诊断比例等指标。结果共有85041490人次适龄农村妇女接受宫颈癌免费筛查并获得最后诊断,宫颈细胞学异常率为3.71%(2567610例次),人乳头瘤病毒(HPV)阳性率为9.91%(331158例次),醋酸/复方碘染色检查(VIA/VILI)阳性率为10.10%(1167930例次),阴道镜异常检出率为28.85%(1420847例次),组织病理学异常检出率为21.20%(303068例)。2009—2018年宫颈癌前病变检出率为153.88/10万,并由2012年的106.85/10万逐年上升至2018年223.89/10万(P<0.001),且东部(207.37/10万)高于中部(177.65/10万)、中部高于西部(108.65/10万)(均P<0.001)。宫颈癌检出率为21.58/10万,由2012年的18.02/10万上升到2018年的26.54/10万(P<0.001),且中部(25.46/10万)高于东部(19.62/10万)和西部(19.30/10万)(均P<0.001)。宫颈癌早期诊断比例为91.24%(136140例),并由2012年的89.60%(11883例)上升到2018年的92.80%(26962例)(P<0.001);且东部早期诊断比例(94.02%,37600例)高于中部(91.06%,56488例),中部高于西部(89.12%,42052例)(均P<0.001)。结论我国农村妇女宫颈癌检查项目宫颈癌前病变检出率、早期诊断比例等体现筛查技术水平的指标在东、中、西部间存在差异,间接反映服务公平性存在地区差异;中西部地区特别是西部地区仍是未来关注的重点。

Objective To analyze the effectiveness of the National Cervical Cancer Screening Program in Rural Areas(NCCSPRA)in China.Methods Data were collected in the form of quarterly statistical tables reported by NCCSPRA counties in 30 provinces(Hong Kong,Macao and Taiwan province of China were not included into the NCCSPRA,and Tibet Autonomous Region carried out the program but did not reported the data)from 2009 to 2018.The women aged 35-64 years with sexual behavior and the identity(Hukou)of rural area in these project counties were included into the NCCSPRA,and women receiving hysterectomy for non-cervical cancer or non-cervical lesions were excluded.The following indicators were analyzed:the positive rates of different screening methods,the abnormality rates of colposcopy and histopathology,the detection rate of precancerous lesions,the detection rate of cervical cancer and the rate of early diagnosis.Results A total of 85041490 women aged 35-64 in rural areas received free cervical cancer screening and diagnosis if necessary.On the whole,the abnormality rate of cytology,HPV testing,VIA/VILI,colposcopy and histopathology was 3.71%(2567610),9.91%(331158),10.10%(1167930),28.85%(1420847),and 21.20%(303068)respectively.The detection rate of cervical precancerous lesions was 153.88/100000,and increased from 106.85/100000 in 2012 to 223.89/100000 in 2018(P<0.001).Regionally,the east(207.37/100000)reached higher rate than the middle(177.65/100000),and the middle higher than the west(108.65/100000)(P<0.001).The detection rate of invasive cervical cancer was 21.58/100000,and increased from 18.02/100000 in 2012 to 26.54/100000 in 2018(P<0.001).Regionally,the middle of China(25.46/100000)reached the higher rate than the east(19.62/100000)and the west(19.30/100000)(P<0.001).The rate of early detection was 91.24%(136140),which increased from 89.60%(11883)in 2012 to 92.80%(26962)in 2018(P<0.001).Regionally,the east of China(94.02%,37600)reached the higher rate than the middle(91.06%,56488),and the middle higher than the west(89.12%,42052)(P<0.001).Conclusions There are obvious difference in terms of the detection rate of cervical precancerous lesions and the rate of early diagnosis reflecting cervical cancer screening capacity among the eastern,middle and western regions,which showed service inequity among different areas indirectly.The middle and western regions,especially the western regions,are still the focus of future works.