Effectiveness of Co-Testing in Cervical Cancer Screening Program in Macao SAR

Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.

Evaluation of HPV Molecular Tests in Primary Screening for Cervical Cancer in Brazil

Background: Incorporation of HPV tests into cervical cancer screening programs may be advantageous over conventional cytology, especially in developing nations, where the largest burden of cervical cancer is observed. Objectives: To conduct an evaluation of commercially available molecular HPV tests in Brazilian women. Study design: Two groups were recruited: group A was composed of 511 women referred to the clinics because of a previous abnormal Pap test while group B consisted of 2464 subjects under routine screening. Cervical samples were collected using SurePath liquid cytology (LBC) device, and split into aliquots which were submitted to molecular testing by Hybrid Capture and cobas HPV. Colposcopy and biopsies were made according to the standard guidelines, directed by cytological diagnosis. Results: Prevalence of HSIL was 5.97% and 0.7% in Group A and B respectively. High-Risk HPV DNA was found in about 9% of group B women, while in group A this frequency was 24%. Having CIN3+ as the study end-point, the negative predictive values for molecular methods were above 99.8%. All “in-situ” and invasive cervical carcinomas were detected by both HPV nucleic acid assays. Conclusion: Use of HPV DNA testing was feasible and highly sensitive in cancer screening settings of Brazil.

Reconsidering Primary HPV Testing in Cervical Cancer Screening

Inappropriate testing for HPV types on healthy subjects increases costs without benefit and potentially results in overtreatment. HPV testing also has a negative psychosocial impact on women, increasing anxiety, stress, and concerns on sexual relationships. Giving the fact that HPV testing has been shown to have similar sensitivity but more overdiagnosis than cytology, and also giving the fact that false negative results may be higher than previously suspected, primary screening with HPV tests in European countries should be reconsidered. Resources saved in molecular testing may well be addressed in implementing vaccination strategies which are still underused, and may possibly include males as well as women.

Perceived Barriers to Cervical Cancer Screening Using Pap Smear Test among Women Attending Saad Abu Al Ella Hospital in Khartoum State, 2022

Background: Cervical cancer is the second common cancer among women worldwide. It is a preventable cancer, and early detection of precancerous conditions through the Papanicolaou cytology screening (Pap smear) is a key aspect of prevention;it is accepted worldwide as an efficient tool for secondary prevention. While the PS test is simple, inexpensive, and relatively reliable as a method of diagnosing cervical cancer, most women do not take the test. Therefore, this study is sought to describe the barriers to pap smear uptake among Sudanese women. Materials and Method: This total coverage observational, analytical and cross sectional, hospital-based study was conducted in Saad Abu El Ella Hospital in April 2022. The study was conducted using an anonymous questionnaire to assess the perceived barriers of 93 participants. All data were computerized using Microsoft Excel’17 and the data were described and analyzed using statistical package for social science (SPSS23). Results: The findings revealed that the mean age of the participants was 39.5 years and only 3.2% had ever undergone a pap smear test. Identified barriers were lack of information, not knowing where to go, and fear of pain. The majority, 72% are willing to routinely perform a pap smear test if well informed about it. The study also demonstrates that there is a significant correlation between perceived barriers score and willingness to perform the pap smear test (p value = 0.008), and between the perceived barriers score and the sociodemographic factors: Age (p value = 0.006), educational level (p value = 0.028) and occupation (p value = 0.040), but no association with the economic status was found (p value = 0.378). Conclusion: The detection rate is too low compared to the national target of over 70%. Therefore, more work is needed to reduce perceived barriers to cervical cancer screening by providing education/raising for popular awareness;addressing misconceptions and false beliefs;informing women about the necessity and importance of Pap smear;and health promotion using mass media such as national television, social media, radio, billboards, and newspapers and other print media.

Cervical cancer screening program based on HPV testing and conventional Papanicolaou cytology for jail inmates

Background: To assess the validity of Human Papillomavirus (HPV) testing in a group of women at high risk for developing cervical cancer, a screening intervention was applied to a population of jail inmates in Rome, Italy. This cross-sectional study provided also new insights on the risk factors and on the HPV genotype distribution. Methods: We have invited 350 inmates to the preliminary stage of the screening program and 98 inmates decided to participate to the study and filled out a questionnaire for the history of attendance to previous cervical screening and for the known risk factors for cervical malignancies. HPV DNA test, conventional Pap smear and HPV genotyping were performed. Results: The percentage of women with High Risk (HR) HPV positivity were 19.3%. The inmates with LSIL/ HSIL status showed a significantly higher pre- valence of HR-HPV positivity (100% vs. 16.3%;p < 0.001) and of multiple HPV types (60% vs. 1.2%;p < 0.001) compared to women with normal/ASCUS Pap smear. HPV16 was the predominant genotype in either single or multiple infections. Conclusions: The results indicated that HPV DNA-based approach is a strategy useful for incarcerated women which do not have the opportunity or the social and cultural environment to receive preventive care.

Assessing the Effectiveness of a Cervical Cancer Screening Program in a Hospital-based Study

This study compared HPV testing and liquid-based cytology （LCT） as performance indicators for cervical cancer screening in a hospital-based study. A total of 61,193 outpatients were screened initially by LCT. Samples with screening results showing atypical squamous cells of undetermined significance （ASC-US） or worse were referred for colposcopy, and some samples were tested for high-risk HPV types with the Hybrid Capture II system （HC II）. Data on LCT （n=61,193） and HC II （n=1056） results were analysed. Overall test positivity for LCT was 2.53% using an ASC-US threshold, 3.11% using a low-grade squamous intraepithelial lesion （LSIL） threshold, and 0.67% using a high-grade squamous intraepithelial lesion （HSIL） threshold. A total of 1839 women （84% of the 3893 patients with abnormal cytology） underwent colposcopy-directed biopsy. HPV was positive in 80.3% of women with cervical intraepithelial neoplasia 1 （CIN1）, 88.3% of those with CIN2, 79.2% of women with CIN3 and 50% （2 of 4） of women with invasive cancer. There was a significant increase in the detection of CIN2 or worse with adjunct HPV testing of women with ASC-US and LSIL However, there were detection of CIN2＋ cases no differences in the with adjunct HPV testing of women with HSlI.. The results indicate that HPV testing for HSlL triage should not be recommended in cervical cancer screening.

Preventive Oncology International:A brief history of HPV self-collected vaginal specimens for cervical cancer screening

Since 1998,Preventive Oncology International,Inc.(POI)has been at the forefront of studying human papillomavirus(HPV)self-collection for cervical cancer screening,with a significant focus in China.Through multiple clinical trials over the past 25 years,POI has explored various aspects related to self-collection methodologies.In 2004–2006,POI established that self-collection could be equivalent to direct endocervical samples.Subsequently,a large randomized trial involving 10,000 patients in 2010 further confirmed that self-collected vaginal specimens,tested for high-risk HPV(hrHPV)using a PCR-based assay with high analytic sensitivity,could effectively replace endocervical specimens with minimal loss of sensitivity and a slight decrease in specificity.Throughout the years,POI's research has encompassed several crucial topics,including patient acceptance,the development of new cost-effective,simpler,and faster assays,exploring different collection devices,devising efficient methods of specimen transport,and implementing population-based screening systems.The findings strongly support the integration of self-collection methodologies into cervical cancer control programs worldwide,particularly in medically underserved regions.As HPV self-collection continues to evolve,ongoing research and innovations are expected to play a pivotal role in achieving the global mission of combating cervical cancer.

液基细胞学、Aptima HPV E6/E7 mRNA、Cobas 4800 HPV在不同宫颈癌筛查模式下的效果比较

目的探索最优的宫颈癌筛查模式,为制订宫颈癌前病变的临床管理方案提供依据。方法回顾性分析联合应用液基细胞学(liquid-based cytology,LBC)和人乳头瘤病毒(human papillomavirus,HPV)检测方法进行宫颈癌筛查的结果及随访资料。符合纳入标准者5974例,其中联合应用LBC和Aptima HPV E6/E7 mRNA(AHPV)方法1798例,联合应用LBC和Cobas 4800 HPV DNA(CHPV)方法4176例。分析不同筛查模式的效果。结果LBC、AHPV、CHPV、AHPC初筛+LBC分流、CHPV初筛+LBC分流的AUC曲线下面积分别为0.918、0.934、0.911、0.941、0.919。单一筛查模式中,LBC的阴道镜转诊率最低、漏诊率最高。联合筛查模式中,AHPV初筛+LBC分流阴道镜转诊率显著低于CHPV初筛+LBC分流,二者的漏诊率无显著差异。结论在诸多种宫颈癌筛查模式中,AHPV初筛+LBC分流联合筛查可获得最优的筛查效果。

Clinical application of DNA ploidy to cervical cancer screening: A review

Screening for cervical cancer with DNA ploidy assessment by automated quantitative image cytometry has spread throughout China over the past decade and now an estimated 1 million tests per year are done there. Compared to conventional liquid based cytology, DNA ploidy has competitive accuracy with much higher throughput per technician. DNA ploidy has the enormous advantage that it is an objective technology that can be taught in typically 2 or 3 wk, unlike qualitative cytology, and so it can enable screening in places that lack sufficient qualified cytotechnologists and cytopathologists for conventional cytology. Most papers on experience with application of the technology to cervical cancer screening over the past decade were published in the Chinese language. This review aims to provide a consistent framework for analysis of screening data and to summarize some of the work published from 2005 to the end of 2013. Of particular interest are a few studies comparing DNA ploidy with testing for high risk human papilloma virus(hrH PV) which suggest that DNA ploidy is at least equivalent, easier and less expensive than hrH PV testing. There may also be patient management benefits to combining hr HPV testing with DNA ploidy. Some knowledge gaps are identified and some suggestions are made for future research directions.

A study on service capacity of primary medical and health institutions for cervical cancer screening in urban and rural areas in China

Objective: To provide a decision-making basis for sustainable and effective development of cervical cancer screening.Methods: This cross-sectional study assesses the service capacity to conduct cervical cancer screening with a sample of 310 medical staff, medical institutions and affiliated township health centers from 20 countylevel/district-level areas in 14 Chinese provinces in 2016.Results: The county-level/district-level institutions were the main prescreening institutions for cervical cancer screening. More medical staff have become engaged in screening, with a significantly higher amounts in urban than in rural areas(P<0.05). The number of human papillomavirus(HPV) testers grew the fastest(by 225% in urban and 125% in rural areas) over the course of the project. HPV testing took less time than cytology to complete the same number of screening tasks in both urban and rural areas. The proportion of mid-level professionals was the highest among the medical staff, 40.0% in urban and 44.7% in rural areas(P=0.406), and most medical staff had a Bachelor’s degree, accounting for 76.3% in urban and 52.0% in rural areas(P<0.001). In urban areas, 75.0% were qualified medical staff, compared with 68.0% in rural areas, among which the lowest proportion was observed for rural cytology inspectors(22.7%). The medical equipment for cervical pathology diagnosis in urban areas was better(P<0.001). HPV testing equipment was relatively adequate(typing test equipment was 70% in urban areas, and non-typing testing equipment was 70% in rural areas).Conclusions: The service capacity of cervical cancer screening is insufficient for the health needs of the Chinese population. HPV testing might be an optimal choice to fill the needs of cervical cancer screening given current Chinese medical health service capacity.

Awareness, Attitude and Practices Regarding Cervical Cancer Screening and Vaccination among North Indian Women Population

Cervical cancer is the most common cancer associated with women in developing countries with 80% cases reported every year and could be prevented by proper screening and vaccination. The objective of this study was to explore the knowledge, attitudes, and practices of North Indian women visiting Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow for cervical cancer screening. This was a cross-sectional study of 300 women attending the Out-patient department (OPD) at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow. We used a validated questionnaire tool comprised of 24 items to collect data through face-to-face interviews between January 2018 and October, 2019. Results are expressed in percentage form for each question in this article. The mean age ± SD of the participants was 34 ± 10.34 years, they were mostly married (198;66%), and had a high school or higher education (235;78.3%). Over 66% (198 participants) were aware of cervical cancer as a disease and had heard about it from various sources like their family, friends, television, print media, radio etc. Most of these participants (66%) who were aware of Cervical cancer (CX CA) had been able to identify the various established risk factors, signs and symptoms of the disease but only 20% were aware with Pap smear procedure while almost 70% didn’t know that early detection of this disease is possible. Nearly 53% (158 participants) believed that CX CA vaccination will protect them against cervical cancer. After explaining all the signs, symptoms, possible modes of transmission and dangers related to the ignorance of cervical cancer screening, 68.3 percent of the women participants agreed to allow their female relatives for CX CA screening and vaccination while 32% still had certain hesitations related to the screening and vaccination program. The need of the hour is a better-planned program to generate awareness and allow the women candidates to explore the CX CA issue and get themselves and their relatives prepared for screening and vaccination from the deadly disease.

Guidelines for cervical cancer screening in China

In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies,a collaborative effort was undertaken by seven Chinese medical associations to develop this guideline for cervical cancer screening.The guideline recommends high-risk human papillomavirus(hr-HPV)testing as the preferred method for primary screening,which should have been approved by authoritative institutions and clinically validated for primary screening.In areas without access to HPV testing,cytology can be used as an alternative.However,it is recommended to replace cytology with HPV-based screening as conditions permit.Cotesting(HPV testing in combination with cytology)is recommended for areas with sufficient medical resources,opportunistic screening populations,and partial special populations.The guideline recommends that individuals with a cervix initiate cervical cancer screening at the age 25 years and undergo HPV testing alone or cotesting every five years,or cytology alone every three years.Women over the age of 65 who have had documented adequate negative prior screening in the past may terminate screening.Corresponding screening programs are proposed for different special populations.The development of these guidelines is an important step in the effort to eliminate cervical cancer in China.

cobas 4800 HPV检测在宫颈癌筛查中的应用价值

目的:评价cobas 4800 HPV检测技术在宫颈癌及癌前病变筛查中的可行性及应用价值。方法:对河南省新密市856例年龄>21岁有性生活的妇女进行宫颈癌筛查。每位妇女均接受了cobas 4800 HPV检测、高危型HPV第二代杂交捕获试验(hy brid capture 2 technology,HC2)检测、ThinPrep液基细胞学和阴道镜检查。阴道镜下在可见病变处直接取活检;任意筛查结果阳性但无可见病变时,于宫颈外口鳞柱交界处行四象限随机活检和宫颈管搔刮术(endocervical curettage,ECC)。结果:cobas 4800HPV检测与HC2检测对宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)2级以上(CIN2、CIN3及宫颈癌)患者的灵敏度均为94.4%(34/36),特异度分别为63.2%(516/817)和63.9%(522/817);一致率为83.4%(711/853),两者具有高度一致性(Kappa=0.65)。cobas 4800 HPV检测对于液基细胞学检查漏诊的患者具有100%检出率。cobas 4800 HPV16及18分型检测对于CIN2以上患者的阳性预测值21.9%为HC2检测10.3%的2.13倍。妇女感染HPV16及18型患CIN2以上病变的年龄比感染其他类型平均小5.4岁。结论:cobas 4800 HPV检测与HC2检测具有相似的准确性和良好的一致性,比ThinPrep液基细胞学检查更为灵敏,并且能鉴别HPV16及18两种高风险类型HPV感染,利于医生更有针对性地随访宫颈病变中的高危病例。

国产HPV分型检测与Cobas4800 HPV检测用于宫颈癌联合筛查检测效能的对比分析

目的:评价国产HPV分型检测试剂在宫颈癌筛查中的临床应用价值。方法:对招募的1083例女性进行HPV和TCT(Thinprep)的联合筛查;分别采用三家国产HPV检测试剂进行HPV检测,并采用Cobas 4800 HPV检测进行对比。对HPV和TCT结果满足转诊阴道镜指征的人群进一步行阴道镜检查,以活检病理结果提示高级别鳞状上皮内病变或宫颈癌为研究终点。结果:共有1076例受试者的结果纳入研究分析,Cobas、亚能、之江、中生方政四家公司HPV检测阳性率分别为15.15%、17.94%、17.01%和15.24%。三家国产HPV分型检测试剂与Cobas检测试剂的HPV检测结果一致性均较好,总体一致率分别为95.72%、95.82%、95.82%(Kappa=0.839、0.844、0.838)。三家国产HPV检测试剂检出高级别病变的灵敏度均为100%。结论:HPV全分型的两种国产HPV检测试剂较16/18型部分分型的检测试剂显示出对HPV更高的检测灵敏度。国产HPV分型检测试剂与Cobas有较好的一致性,对宫颈高级别病变的检出具有很高的灵敏度,初步验证了国产HPV分型检测试剂用于宫颈癌联合筛查的临床检测效能,其可否真正用于我国人群的宫颈癌筛查尚需更大样本量、更长时间随访的研究数据进一步证实。

Cobas 4800 HPV检测对宫颈癌筛查的运用分析

目的:分析Cobas 4800人乳头瘤病毒(Human papillomavirus,HPV)检测对宫颈癌筛查的效果,为宫颈癌的早期诊断和干预提供理论依据。方法:选取2010年7月至2013年7月来我院行宫颈癌筛查的1031例妇女,均采用Cobas 4800、第二代杂交捕获法(HC-2)对HPV进行检测,对比两种检查方法的确诊结果。结果:1031例受检者中共检出CINⅠ级271例,CINⅡ级17例,CINⅢ级31例,检出率30.94%;Cobas 4800 HPV检测阳性率为40.35%(416/1031),灵敏度为95.83%(46/48),特异度为44.2%(434/983),PPV为11.06%(46/416),NPV为70.6%(434/615);而HC-2检测阳性率为38.70%,灵敏度为97.92%,特异度为49.8%,PPV为11.78%,NPV为77.5%,两种方法的阳性率、灵敏度、特异度、PPV及NPV均无明显统计学差异(P>0.05)。CINⅡ、CINⅢ患者Cobas 4800 HPV和HC-2检测结果灵敏度均为97.92%(47/48),一致率为95.83%(46/48)(Kappa=0.45);全部受检者中,两种检测方法的一致率为93.11%(Kappa=0.73),其一致率存在统计学意义(P<0.05);两种方法在宫颈癌癌前病变和HPV感染的检测灵敏度、特异性均无明显统计学差异(P>0.05)。结论:Cobas 4800 HPV检测与常用HC-2检测方法敏感度、特异度均无明显差异,其一致性较高,而Cobas 4800具有更广的HPV基因型检测范围,能够有效指导进一步检查或治疗,是预防和控制宫颈癌的有效方式,值得广泛推广应用于宫颈癌的早期筛查。

Cobas HPV检测在宫颈癌前病变及宫颈癌筛查的应用价值

目的探讨Cobas HPV检测在宫颈癌前病变及宫颈癌筛查中的应用价值。方法回顾性分析本院2015年6月~2017年6月接受手术治疗的80例疑似宫颈癌前病变及宫颈癌患者的临床资料,所有患者均于术前接受Cobas HPV检测、HC2检测及病理组织活检,以病理组织活检作为金标准,分析Cobas HPV检测对宫颈癌前病变及宫颈癌筛查的诊断价值,并将检查结果与HC2进行对比,分析二者对HPV16及18型阳性、CIN2以上宫颈病变的诊断价值;同时对比不同手段用于宫颈癌前病变及宫颈癌早期筛查的一致性。结果 80例患者中,经组织病理活检检出HPV16及18型阳性宫颈病变例数共39例。Cobas HPV阳性检出率55.00%;HC2阳性检出率38.75%;以组织病理活检作为金标准,Cobas HPV检测对HPV16型、18型诊断的灵敏度、特异度高于HC2,差异有统计学意义(P<0.05);80例患者经Cobas HPV与HC2检测后的总符合例数为65例,符合率为81.25%,其阳性符合率及阴性符合率分别为89.1%、77.8%;经病理学诊断出CIN及以上病例数为8例,在对CIN2以上的疾病诊断时,Cobas HPV检测与HC2检测总符合率为80%(c2=0.500)。结论宫颈癌前病变及宫颈癌患者采用Cobas HPV检测技术应用价值与HC2相当,在检测HPV16及18型高风险类型时应用Cobas HPV检测技术的价值更理想,同时可帮助临床早期发现CIN,为患者早期治疗提供合理依据,对改善患者预后有着积极的促进意义。

Setting Research Priorities for Cervical Cancer Prevalence, Prevention and Treatment in WHO Africa Region

Background: Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. Methods: We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. Results: “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. Conclusion: The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.

At-home cancer screening:a solution for China and other developing countries with a large population and limited number of healthcare practitioners

Five-year survival rate for patients with all cancers combined, in China, is only 30.9%, which is much lower than those in developed countries. The three main reasons for the low cancer curative rates in China include differences in the spectrum of cancer types, in early detection rates, and in the percentage of cancer patients receiving standardized treatment between China and developed countries.The most important mechanism for improving the curative rate is to improve early detection rates of major cancers in China using novel and affordable technologies that can be operated at home by the patients themselves.This attempt could be helpful in setting up a practical example for other developing countries with limited medical resources and a limited number of healthcare practitioners.

Prevention of Cervical Cancer

Cervical cancer is the fourth most common cancer in women and is responsible for 275,000 deaths worldwide each year. The burden of this disease lies in the developing world. However it is arguably the most preventable cancer. The Human Papilloma Virus (HPV) is responsible for almost all cases of Cervical Cancer. HPV is sexually transmitted and has a lifetime cumulative risk of infection of 80%. National Cervical cytology screening programmes are used to detect cervical abnormalities, lesions and early cancers in as many eligible women as possible, saving lives and reducing morbidity. However uptake of screening is declining, and screening programmes have not been implemented in lower resource countries due to the cost and infrastructure required. Alternative screening methods have been implemented in such countries such as Visual Inspection with Acetic acid (VIA) but mortality and morbidity remain high. Since 2007, programmes of vaccination against the most oncogenic types of HPV have been rolled out internationally aiming to capture girls, and eventually potentially boys, before they become sexually active. These programmes have been largely successful, with good coverage and low adverse effects reported. Going forward, the vaccine and the advent of effective HPV screening and self testing mean that there needs to be a reorganisation of current cervical screening programmes.

APTIMA HPV E6/E7 mRNA和MALDI-TOF-MS HPV基因分型检测宫颈高度病变效果评价

目的：以HC-Ⅱ法HPV DNA为对照,评价APTIMA法HPV E6/E7 mRNA检测（A-HPV）和MALDI-TOF-MS HPV分型检测技术（M-HPV）用于宫颈癌与癌前病变筛查的临床价值。方法：深圳市25-59岁、3年内未行宫颈癌筛查、未接受过子宫切除和盆腔放疗的2095例未孕妇女参加了本次筛查。医生于患者宫颈外口处直接收集2份宫颈脱落细胞标本,一份用于液基细胞学检查,一份用于HC-Ⅱ、A-HPV和M-HPV检测。宫颈细胞学≥ASCUS及3种方法 HPV检测任一阳性结果者均回叫行阴道镜下定点或四象限活检及宫颈管诊刮（ECC）。以病理诊断为标准评价各种HPV检测方法用于宫颈癌筛查的价值。结果：2095例研究对象中各项检测数据齐全者1970例。1970例患者的平均年龄为（35.89±7.655）岁。细胞学≥ASCUS者占6.4%（127/1970）,CINⅡ＋者占1.3%（26/1970）,CINⅢ＋者占0.76%（15/1970）。HC-Ⅱ、A-HPV和M-HPV总的HPV阳性率分别是19.4%、12.1%和14.8%,差异有统计学意义（P〈0.05）。HC-Ⅱ、A-HPV和M-HPV对检出CINⅡ＋病变的敏感性分别为88.5%（95%CI为68.7-97.0）、100%（95%CI为84.0-100）和92.3%（95%CI为73.4-98.7）,特异性分别为81.5（95%CI为79.7-83.2）、89.1%（95%CI为87.6-90.4）和86.3%（95%CI为84.6-87.8）;A-HPV与HC-Ⅱ相比敏感性稍高（P〈0.05）,M-HPV敏感性和HC-Ⅱ相同（P〉0.05）,三者比较有统计学意义（P〈0.05）。结论：A-HPV和M-HPV用于宫颈癌筛查都有很好的敏感性和准确性,两者活检率明显低于HC-Ⅱ,可减少医疗负担和花费。HPV亚型分型和HPV E6/E7 mRNA结合有更好地预测宫颈癌患病风险的作用。