Self-Sampling for Human Papillomavirus Testing among Non-Attenders Increases Attendance to the Norwegian Cervical Cancer Screening Programme

Increasing attendance to screening offers the best potential for improving the effectiveness of well-established cervical cancer screening programs. Self-sampling at home for human papillomavirus (HPV) testing as an alternative to a clinical sampling can be a useful policy to increase attendance. To determine whether self-sampling improves screening attendance for women who do not regularly attend the Norwegian Cervical Cancer Screening Programme (NCCSP), 800 women aged 25–69 years in the Oslo area who were due to receive a 2^nd reminder to attend regular screening were randomly selected and invited to be part of the intervention group. Women in this group received one of two self-sampling devices, Evalyn Brush or Delphi Screener. To attend screening, women in the intervention group had the option of using the self-sampling device (self-sampling subgroup) or visiting their physician for a cervical smear. Self-sampled specimens were split and analyzed for the presence of high-risk (hr) HPV by the CLART® HPV2 test and the digene® Hybrid Capture (HC)2 test. The control group consisted of 2593 women who received a 2^nd reminder letter according to the current guidelines of the NCCSP. The attendance rates were 33.4% in the intervention group and 23.2% in the control group, with similar attendance rates for both self-sampling devices. Women in the self-sampling subgroup responded favorably to both self-sampling devices and cited not remembering receiving a call for screening as the most dominant reason for previous non-attendance. Thirty-two of 34 (94.1%) hrHPV-positive women in the self-sampling subgroup attended follow-up. In conclusion, self-sampling increased attendance rates and was feasible and well received. This study lends further support to the proposal that self-sampling may be a valuable alternative for increasing cervical cancer screening coverage in Norway.     

Mobile Unit for Screening for Cervical and Breast Cancer

In 12 months'' use of a mobile unit for cervical and breast cancer screening in Gloucestershire 3,211 women attended at an average of five sessions a week. Clinic sessions were organized and the running costs of the service met by a voluntary organization. The keeping of records, provision of laboratory facilities, and the follow-up of patients were carried out in close cooperation with the county health department.     

子宫颈癌筛查方法的应用及研究进展

子宫颈癌是妇科常见恶性肿瘤之一,发病率居女性恶性肿瘤第二位。建立可持续、合理、有效的普查方法,早期发现癌前病变是防治宫颈癌的关键。目前宫颈癌筛查方法有宫颈细胞学筛查(巴氏涂片、液基薄层细胞学检测、细胞DNA定量分析技术)、肉眼观察辅以醋酸白和Lugol碘溶液检测法、阴道镜检查、病毒-HPV检测,本文就当前各种筛查方法的应用及研究进展进行概括。     

Cervical Cancer—Use of a Non-Physician Health Team for Screening Procedures

A team of non-physician personnel has been trained in cytologic screening for cervical cancer. In a county hospital clinic setting among low income women whose annual pelvic examinations were being by-passed by physicians, this three-person team has performed pelvic examinations and screening under physician supervision for one year.Results of the first year''s experience, measured in cancer detection and in recognition and referral of benign gynecological disease as well, would suggest that a non-physician team, with a registered nurse doing a pelvic examination of screening type, can screen for cervical cancer and other pelvic disease efficiently and without a significant lowering of the quality of medical care.The training and use of teams of allied health care personnel directed by physicians is suggested as a practical means of overcoming the increasing shortage of physician services in annual screening for cervical cancer among low income women.     

高危人乳头瘤病毒基因型与宫颈癌筛查

应用第二代基因杂交捕获技术（HC-Ⅱ）对7068例21-58岁妇女官颈细胞进行13种高危型人乳头瘤病毒（HPV）DNA的检测。该人群中13种高危型HPVDNA的总检出率为23．45％。在检出的1440例HPV阳性者中,宫颈癌、官颈上皮内高度病变（CINⅡ／Ⅲ）及宫颈上皮内低度病变（CINⅠ）的高危型HPVDNA检出率分别为100％、100％、65．06％。女性生殖道高危型HPV感染是宫颈癌及CIN流行的主要危险因素,提示言颈癌的防治应重点预防HPV感染,而对HPV感染的筛查和密切监测应是已感染高危型HPV的对象;     

Involving the General Practitioner In Screening For Cervical Cancer

In the Leiden region, the cervical cancer screening programme for the age group 35–54 years shifted in 1989 from one in which the smears were taken by specially trained paramedical personnel in health centres to a programme where the general practitioner is the smear taker. Hence, it is possible to compare the results of the two types of screening to evaluate whether involvement of general practitioners leads to better uptake of screening. In the 6 year period evaluated in this paper, the 3-yearly cytological rate per thousand for severe dysplasia or worse increased from 1.00 to 3.40; when stratified by age the positive rates were significantly higher. the histological rate per thousand for severe dysplasia increased from 0.60 to 2.09, and for carcinoma in situ from 0.35 to 1.36. All six invasive carcinomata were detected in the GP programme (0.31%). the general practitioner is clearly more able to attract the ‘high-risk’groups. Dans la reéion de Leiden, le programme de dépistage du cancer du col pour les tranches d'âge de 35–54 ans a été modifié en 1989. Le programme était initialement basé sur des frottis faits dans des centres de santé, par un personnel paramédical ayant suivi une formation particulière. Après 1989, le médecin généraliste est devenu le préleveur. II est done possible de comparer les résultats de ces 2 types de dépistage et d'apprécier si la participation des médecins généralistes a pour conséquence un meilleur dépistage. Au cours de la période d'étude, les taux pour 1000 de positivité cytologique pour les lésions graves (de type dysplasie sévère et plus) et par période de 3 ans ont augmenté de 1,00 à 3,40. Lorsque l'on stratifie sur l'âge, les taux de cas positifs sont significativement supérieurs. Le taux histologique des dysplasies sévères pour 1000 passe de 0,60 à 2,09 et celui du carcinome in situ de 0,35 à 1,36. Les 6 cas de carcinome invasif ont été détectés par le programme impliquant les médecins généralistes (0,31%). II est clair que le médecin généraliste est mieux placé pour dépister les patientes à“haut risque”. Im Bezirk von Leiden wurden die Abstriche der 35- bis 54 jährigen vor 1989 von speziell ausgebildeten Hilfskräften in Gesundheitszentren hergestellt, während diese Aufgabe dann von den Allgemeinmedizinern übernommen wurde. Dies erlaubt einen Vergleich zwische den Präparaten von zwei jeweils 3 Jahre umfassenden Perioden. Der Anteil schwerer Dysplasien und stärkerer Veränderungen nahm von 1.00 auf 3.40 pro Tausend zu. Der histologische Anteil der schweren Dysplasien erhöhte sich von 0.60 auf 2.09 und der der Carcinomata in situ von 0.35 auf 1.36. Alle 6 nachgewiesenen invasiven Carcinome wurden in den Abstrichen der Allgemeinmediziner entdeckt (0.31%_o). Damit ist klar, daß die Allgemeinmediziner die Risikogruppen besser zu erfassen vermögen.     

薄层液基细胞学检测及HPV检测对宫颈癌筛查价值的系统评价

目的：系统评价薄层液基细胞学检查（TCT）及人类乳头状病毒（HPV）检查在子宫颈癌筛查中的应用价值。方法：检索收集2000年以来,Cochrane数据库、Pubmed、MEDLINE、Webofscience、EMBASE、万方数据库、清华同方数据库、维普数据库中与TCT及HPv检测在宫颈癌筛查（癌前病变及早期宫颈癌）诊断方面的相关文献,参照Cochrane系统评价的方法对资料进行统计分析。结果：共有12篇文献纳入研究,TCT合并的敏感性0．65（95％CI,0．62-0．68）,特异性0．93（95％CI,0．92-4）．93）,阳性预测值8．25（95％CI,5．65-12．04）,阴性预测值0．27（95％CI,0．18-0．41）,合并SROC曲线下面积AUC=0．889,Q值0．819。HPV合并敏感性0．69（95％CI,O．67~0．71）,特异性O．91（95％CI,0．90-0．91）,阳性预测值3．93（95％CI,2．99-5．18）,阴性预测值0．17（95％CI,0．09～0_31）,合并SROC曲线下面积AUC=0．871,Q值0．801。结论：薄层液基细胞学检查在宫颈癌筛查中具有较高的诊断准确度,与HPV联合检测可提高诊断的准确性。     

HPV基因分型检测在宫颈癌筛查中的应用

目的:探讨人乳头瘤病毒(human papilloma virus,HPV)基因分型技术在宫颈癌筛查中的临床应用价值。方法:采用反向斑点杂交法对HPV基因型进行分析,包括低危型(如6、11、42、43、44型等)和高危型(如16、18、31、33、35、MM4型等)共23个型别。结果:98例样本中检出HPV阳性者38例,23种基因型中共检出15种HPV型别,HPV总感染率38.8%(38/98)。慢性宫颈炎患者中HPV感染率30.4%(14/46),检测到的HPV亚型主要是HPV43,11,6,42,31和51(其中HPV6,42,31,51检出率一致)。CINI患者HPV感染率15.4%(4/26),最常见的HPV亚型为HPV35,其次为HPV16,52,53和59(其中16,52,53,59检出率一致)。CINⅡ患者HPV感染率71.4%(10/14),以HPV16,6,11,51等亚型最常见。CINⅢ患者HPV感染率75%(6/8),HPV亚型以HPV16,18,31,53为主。SCC患者HPV阳性率为100%(4/4),HPV16检测率最高,其次为HPV52,18,33,58,59和66。结论:持续的HPV感染与宫颈疾病有着密切的关系。HPV基因型的检测为临床进行宫颈疾病的筛查、诊断、治疗以及预后观察提供了较大的帮助。     

HPV-DNA 亚型检测联合液基细胞学对宫颈癌 筛查的临床价值

目的:探讨HPV-DNA亚型检测联合液基细胞学对宫颈癌筛查的临床价值.方法:对自愿接受宫颈癌筛查的女性1462例作为研究对象,分别对其进行HPV-DNA亚型检测以及液基细胞学的检查,对于出现阳性的患者进行病理组织学检查.结果:HPV+TCT对宫颈癌早期病变以及癌变的检出率为69.67％明显高于HPV检查的56.28％以及TCT检查的63.89％(P＜0.05);HPV+TCT对GIN Ⅰ、CIN Ⅱ、CINⅢ、癌的检出率分别为91.67％,92.86％、91.67％以及100％.结论:采用HPV-DNA亚型检测联合液基细胞学对宫颈癌筛查,可明显提高其对癌前病变的检出率,是一种高效、简单的检测方法.     

Knowledge about Cervical Cancer and Barriers of Screening Program among Women in Wufeng County,a High-Incidence Region of Cervical Cancer in China

Purpose

Cervical cancer screening is an effective method for reducing the incidence and mortality of cervical cancer, but the screening attendance rate in developing countries is far from satisfactory, especially in rural areas. Wufeng is a region of high cervical cancer incidence in China. This study aimed to investigate the issues that concern cervical cancer and screening and the factors that affect women’s willingness to undergo cervical cancer screening in the Wufeng area.

Participants and Methods

A cross-sectional survey of women was conducted to determine their knowledge about cervical cancer and screening, demographic characteristics and the barriers to screening.

Results

Women who were willing to undergo screenings had higher knowledge levels. “Anxious feeling once the disease was diagnosed” (47.6%), “No symptoms/discomfort” (34.1%) and “Do not know the benefits of cervical cancer screening” (13.4%) were the top three reasons for refusing cervical cancer screening. Women who were younger than 45 years old or who had lower incomes, positive family histories of cancer, secondary or higher levels of education, higher levels of knowledge and fewer barriers to screening were more willing to participate in cervical cancer screenings than women without these characteristics.

Conclusion

Efforts are needed to increase women’s knowledge about cervical cancer, especially the screening methods, and to improve their perceptions of the screening process for early detection to reduce cervical cancer incidence and mortality rates.     

高危型HPV筛查与TCT 联合检查在宫颈癌筛查中的临床应用

目的:探究液基薄层细胞学检测(TCT)与高危人乳头瘤病毒(HR-HPV)筛查联合检查在宫颈癌(CC)筛查中的临床价值。方法:选择2013年4月~2015年4月期间我院就诊疑似CC患者318例为研究对象;研究对象均进行HR-HPV筛查、TCT检查及阴道镜下病理活检,评价三种筛查结果的临床应用价值。结果:318例可疑CC患者中,病理学诊断炎症患者162例(50.94%),宫颈上皮内瘤样变(CIN)患者151例(47.48%),鳞癌(SCC)患者5例(1.57%);HR-HPV、TCT及HPV+TCT联合对诊断结果与病理诊断的符合率分别为78.30%、85.22%和99.37%;HR-HPV与TCT单独检测的符合率随患者病情进展呈现升高趋势(P0.05);TCT、HR-HPV检测单独进行诊断的敏感度、特异度均低于联合诊断(P0.05);HR-HPV与TCT联合检测诊断CC的敏感度为98.71%、特异度100%。结论:TCT检查HR-HPV筛查联合检查CC的敏感性、特异性及准确性高,为CC筛查的有效方式,值得在临床应用推广。     

Human Papillomavirus Types Distribution in Organised Cervical Cancer Screening in France

Background

Knowledge of prevalence rates and distribution of human papillomavirus (HPV) genotypes prior high HPV vaccine coverage is necessary to assess its expected impact on HPV ecology and on cervical lesions and cancers.

Methods

Residual specimens of cervical cytology (N = 6,538) were obtained from 16 sites participating in organised cervical cancer screening pilot programs throughout France, anonymised and tested for HPV DNA using the PapilloCheck® genotyping test. Samples were stratified according to age of women and cytological grades.

Results

The age-standardised prevalence rates of HPV 16 and/or 18 (with or without other high-risk types) was 47.2% (95% Confidence Interval, CI: 42.4–52.1) in high-grade squamous intraepithelial lesions (HSILs), 20.2% in low-grade SIL (95% CI: 16.7–23.7) and 3.9% (95% CI: 2.8–5.1) in normal cytology. Overall HR HPV were detected in 13.7% (95%I CI: 11.7–15.6) of normal cytology. In women below 30 years of age, 64% of HSILs were associated with HPV16 and/or 18. In our study population, HPV16 was the most commonly detected type in all cervical grades with prevalence rates ranking from 3.0% in normal cytology to 50.9% in HSILs. HPV16 was also detected in 54% (27/50) of invasive cervical cancers including 5 adenocarcinomas.

Conclusion

HPV16 was strongly associated with cervical precancer and cancer. The high prevalence rates of HPV16/18 infection among women below 30 years of age with HSILs suggests that the impact of vaccination would be primarily observed among young women.     

Program Spending to Increase Adherence: South African Cervical Cancer Screening

Background

Adherence is crucial for public health program effectiveness, though the benefits of increasing adherence must ultimately be weighed against the associated costs. We sought to determine the relationship between investment in community health worker (CHW) home visits and increased attendance at cervical cancer screening appointments in Cape Town, South Africa.

Methodology/Principal Findings

We conducted an observational study of 5,258 CHW home visits made in 2003–4 as part of a community-based screening program. We estimated the functional relationship between spending on these visits and increased appointment attendance (adherence). Increased adherence was noted after each subsequent CHW visit. The costs of making the CHW visits was based on resource use including both personnel time and vehicle-related expenses valued in 2004 Rand. The CHW program cost R194,018, with 1,576 additional appointments attended. Adherence increased from 74% to 90%; 55% to 87%; 48% to 77%; and 56% to 80% for 6-, 12-, 24-, and 36-month appointments. Average per-woman costs increased by R14–R47. The majority of this increase occurred with the first 2 CHW visits (90%, 83%, 74%, and 77%; additional cost: R12–R26).

Conclusions/Significance

We found that study data can be used for program planning, identifying spending levels that achieve adherence targets given budgetary constraints. The results, derived from a single disease program, are retrospective, and should be prospectively replicated.     

三种宫颈癌筛查方法的临床效果比较及筛查阳性者认知状况调查

摘要 目的：研究三种宫颈癌筛查方法的临床效果比较及筛查阳性者认知状况。方法：选取2018年3月～2019年12月有阴道镜检查指征并完成阴道镜检查和宫颈活检的287例患者作为研究对象。对所有研究对象在阴道镜检查前均开展宫颈液基细胞学（TCT）检查、人乳头瘤病毒-脱氧核糖核酸（HPV-DNA）检查以及细胞DNA定量检查。以活检后病理检查结果为金标准,分析上述三种宫颈癌筛查方式的灵敏度、特异度以及准确度。此外,采用自拟的调查问卷的方式明确宫颈癌筛查阳性患者的认知状况。结果：以病理学结果为金标准,宫颈上皮内瘤变2（CIN2）及以上为阳性,TCT检查宫颈癌前病变的灵敏度、特异度以及准确度分别为68.63%（35/51）、78.81%（186/236）、77.00%（221/287）。HPV-DNA检查宫颈癌前病变的灵敏度、特异度以及准确度分别为94.12%（48/51）、59.32%（140/236）、65.51%（188/287）。细胞DNA定量检查宫颈癌前病变的灵敏度、特异度以及准确度分别为72.55（37/51）、86.86%（205/236）、84.32%（242/287）。 HPV-DNA检查的灵敏度高于TCT检查和细胞DNA定量检查（P＜0.05）,细胞DNA定量检查的特异度及准确度均较TCT检查和HPV-DNA检查更高（P＜0.05）。了解宫颈癌筛查的人数占比为92.16%,了解定期筛查宫颈癌的重要性人数占比17.65%,了解宫颈癌筛查方式人数占比为9.80%,了解HPV相关知识人数占比0.00%,了解宫颈癌筛查可早期检出病变人数占比为15.69%。结论：HPV-DNA检查应用于宫颈癌筛查中具有较高的灵敏度,而细胞DNA定量检查具有较高的特异度以及准确度,筛查阳性者的认知状况有待提高。     

MALDI-TOF-MS技术检测宫颈癌中HPV感染状态

目的:本研究拟评MALDI-TOF-MS技术在HPV分型中的实际应用效果.方法:采用MALDI-TOF-MS技术检测河南安阳地区94例宫颈癌样本中HPV感染状态,并与普通PCR方法得到的结果相比较.结果:94例宫颈癌组织中HPV感染率为92.6%,共检测到10种常见的高危型别,以16为主,其次是58和18型.样本单一HPV型别感染为主,其中16型单一型别感染占6I.7%,见多种型别和组合的多重感染.与普通PCR检测结果比较发现两种方法样本HPV(不分型)检测一致率为95.7,样本HPV16型检测一致率为93.6%.结论:MALDI-TOF-MS技术能够精确、快速、高通量的对宫颈癌中HPV进行检测和分型.