OBJECTIVES:To investigate the prevalence, genotype distribution, and associations of HR-HPV infection with cervical lesion grades among Chinese women aged 35-64 years. METHODS:A cross-sectional analysis was conducted using data from women aged 35-64 years who participated in China's national cervical cancer screening program across 13 provinces in 2021. HR-HPV testing was performed at local laboratories using clinically validated assays approved in China, including pooled detection and genotype-specific platforms following standardized national protocols. Epidemiological characteristics were analyzed in 445,045 women, and genotype distribution was assessed in 113,149 women with available genotyping results. Group differences were assessed using chi-square tests, and factors associated with HR-HPV infection were further explored using multivariable logistic regression. RESULTS:The overall prevalence of HR-HPV infection was 10.42% (95% CI: 10.33-10.51). Significant regional variation was observed, with higher prevalence in Western China (11.48%; 95% CI: 11.30-11.66) and Central China (11.46%; 95% CI: 10.98-11.96), and lower prevalence in Northeastern China (9.12%; 95% CI: 8.89-9.36). HR-HPV prevalence increased with age, peaking in women aged 60-64 years (12.69%; 95% CI: 12.30-13.09). The most prevalent genotypes were HPV52 (2.36%), HPV16 (1.73%), and HPV58 (1.40%). Single infections predominated among HR-HPV positive women (87.91%). HPV16 was the most frequently detected genotype across all cervical lesion grades, while HPV52 (10.35%) and HPV58 (9.69%) accounted for a higher proportion of high-grade lesions than HPV18 (7.27%). CONCLUSION:HR-HPV infection remains prevalent among Chinese women, and these population-level findings may help inform age- and region-specific cervical cancer screening strategies and provide epidemiological evidence relevant to HPV vaccination planning.

BACKGROUND:Primary human papillomavirus (HPV) screening is recommended for the detection of cervical intraepithelial neoplasia (CIN) in the general population; however, the triage for HPV-positive women remains a challenge. This study aimed to evaluate the age-specific effectiveness of primary HPV screening versus primary cytology screening for identifying optimal strategies for women of different ages. METHODS:The dataset of the prevalence round screening was derived from the National Cervical Cancer Screening Program in China. Primary cervical screening protocols included cytology only, HPV testing with cytology triage, and HPV testing with HPV-16/18 genotyping plus cytology triage. The primary outcomes were age-specific detection rate, colposcopy referral rate and positive predictive value (PPV) for CIN2+. Multivariate Poisson regression was used to evaluate the relative effectiveness of HPV testing and cytology according to age groups. The I2 statistic with a random-effect model was used to test the heterogeneity in relative effectiveness of HPV testing versus cytology between age groups. RESULTS:This study included 1,160,981 women. HPV testing with HPV-16/18 genotyping plus cytology triage significantly increased the CIN2+ detection by 36% (rate ratio [RR]: 1.36, 95% confidential interval [CI] 1.21-1.54) for women aged 35-44 years and by 34% (RR: 1.34, 95% CI 1.20-1.51) for women aged 45-54 years compared with cytology only. HPV testing with cytology triage had similar CIN2+ detection rate compared with cytology only. The PPVs were substantially increased for both HPV testing groups. Among women aged 55-64 years old, HPV testing with HPV-16/18 genotyping plus cytology triage increased the colposcopy referral rate by 19% (RR 1.19, 95% CI 1.10-1.29) compared with cytology only, but did not increase the CIN2+ detection (1.09, 0.91-1.30). The effectiveness of HPV testing with cytology triage did not change in older women. The between-age-group heterogeneity in the effectiveness was statistically significant for HPV testing with HPV-16/18 genotyping plus cytology triage versus cytology only. CONCLUSIONS:Our results suggested that the effectiveness of primary HPV screening with different triage strategies differed among age groups. HPV testing with HPV-16/18 genotyping plus cytology triage could be used for women aged 35-54 years to detect more lesions, and HPV testing with cytology triage could balance the CIN2+ detection and the number of colposcopies for women aged 55-64 years. Longitudinal data including both prevalence and incidence screening rounds are warranted to assess age-specific triage strategies.

Background Randomized controlled trials have shown a higher sensitivity and longer negative predictive value of high-risk human papillomavirus (HPV) testing than cytology for cervical cancer screening; however, little is known about the effectiveness of HPV testing in middle-income countries. Understanding the characteristics of HPV testing may increase the priority of HPV testing in health policies. The study aims to evaluate the effectiveness of HPV testing in the national cervical cancer screening programme in China. Methods We performed a nationwide, population-based study using individual data from the national cervical cancer screening programme in rural China between 2015 and 2017. The analyses included 1,160,981 women aged 35–64 years who underwent cytology alone or high-risk HPV testing with cytology or genotyping triage. The main outcome was cervical intraepithelial neoplasia 2 or worse (CIN2+). We used multivariate logistic regressions and performed sensitivity analyses with propensity score matching to compare the screening positive, colposcopy referral, detection rate, and positive predictive value (PPV). Results The screening positive rates for HPV testing and cytology were 10.1% and 4.0%, respectively. The per protocol colposcopy referral rate of HPV testing was significantly lower than that of cytology (3.5% vs 4.0%), and this difference was mostly due to the low referral threshold of cytology (≥ASC-US). Overall, HPV testing detected more CIN2+ (5.5 vs. 4.4 per 1000, adjusted odds ratio [aOR]=1.18, 95% confidence interval 1.11–1.25) and had a higher PPV (13.8% vs 10.9%, aOR 1.29, 95% CI 1.21–1.37) than cytology. The colposcopy referrals of HPV testing in comparison to cytology differed by income status; it significantly increased in lower-middle-income areas (3.7% vs 3.1%, aOR 1.21, 95% CI 1.17–1.25) and significantly decreased in upper-middle-income areas (3.4% vs 4.9%, aOR 0.69, 95% CI 0.67–0.71). Sensitivity analyses demonstrated the reliability and robustness of the results. Conclusions The introduction of HPV testing could improve both the CIN2+ detection rate and efficiency of cervical cancer screening programme, supporting the introduction of primary screening with high-risk HPV testing in China. Further study is needed to investigate the long-term effect of this change.

目的 了解我国妇女常见病筛查工作现况,分析工作中存在的内部优势(S)、劣势(W)以及外部机会(O)、威胁(T)因素(SWOT)并提出针对性改进措施.方法 采用信函调查、现场调查与专家咨询相结合的方法进行资料收集;采用SWOT分析方法对资料进行系统分析.结果 优势:有多层面免费检查项目且覆盖范围不断扩大、三级妇幼保健服务网络运转良好、宣教力度不断增大;劣势:包括资金不足、数据来源未明确、缺乏规范化管理、专项筛查项目不足、医务人员对筛查工作的了解程度不够、基层筛查能力不足;机会:有政府重视、贫困地区的政策倾斜、信息平台的建设、各类社会医疗保险的覆盖、适龄妇女健康意识和健康需求增加;威胁:包括未建立有效的多部门合作机制、卫生服务可及性差、基层专业技术人员流动性大,人才队伍建设可持续发展不足、流动人口增加.结论 目前我国妇女常见病筛查工作内部优势与劣势同在,外部机遇与挑战并存.为促进筛查工作的开展,应加强规范化管理,多渠道筹集筛查资金,建立与社会资源合作机制、推动区域合作和优质医疗资源下沉,不断提高基层服务能力.

Background:Cascade analysis is an effective method to analyze the processing data of an event, such as a provided service or a series of examinations. This study aimed to develop a primary cervical cancer screening cascade in China to promote the quality of the screening process.Methods:We designed a cervical cancer screening cascade in China according to the program flow chart. It had three stages, each with two steps and one result. Data from 117,522 women aged 35 to 64 years in the Rural Cervical Cancer Surveillance Project from January 1, 2014, to December 31, 2014, were collected to analyze the main results of the cascade. The data and proportion are used to describe the follow-up of cervical cancer and pre-cancer detection rate.Results:In 2014, 117,522 (80.94% of all cases reported by the Rural Cervical Cancer Surveillance Project) women aged 35 to 64 years had not received cervical cytology in the previous 3 years. The pre-cancer and cancer detection rates were 256.12/100,000 and 16.16/100,000, respectively. A total of 3031 cases failed to follow-up through the screening process, and 1189, 1555, and 287 cases were lost at cervical cytology, colposcopy, and histopathological screening stages, respectively. The estimated cases of pre-cancer and cancer cases would have been 544 and 34, respectively, and the estimated detection rates of pre-cancer and cancer would have been 462.89/100,000 and 28.93/100,000, respectively.Conclusion:In order to increase the detection rate of cervical cancer, cervical cancer screening staff should focus on increasing the rate of follow-up of those who are positive for cervical cancer screening (ie, those with positive cytology results), especially for the 40 to 44 years age range.

目的 了解我国东中西部不同地区农村妇女对宫颈癌防治相关知识及最终参与检查的情况.方法 在全国东中西部地区分别选取4个省7个农村妇女宫颈癌检查项目县(区),采取多阶段分层随机抽样的方法抽取358名35 ～64岁的农村妇女进行问卷调查.结果 2.2％的妇女未听说过宫颈癌,30.1％不了解宫颈癌可能出现性交后阴道出血,有14.0％的调查对象表示不知道宫颈癌发病危险因素,35.5％不了解高危型HPV感染是宫颈癌发病原因.认为宫颈癌是不可预防的占7.8％,仅有16.1％的妇女了解首次性行为前注射HPV疫苗可以预防宫颈癌.调查对象知识获取途径≤3种、4～6种、≥7种的分别为47.2％、32.1％及20.7％.多因素Logistic回归分析显示,宫颈癌防治知识的影响因素主要有职业(OR=1.519,95％CI:1.083 ～2.129)、文化程度(OR=1.407,95％CI:1.011～1.957)、获取知识的途径(OR=2.056,95％CI:1.453～2.909)和得到专业人士讲解(OR=1.967,95％CI:1.136 ～3.405).有91.1％的调查对象曾经接受过宫颈癌筛查,8.9％未进行.主动寻求筛查的妇女宫颈癌防治相关知识得分高于被动筛查的妇女(P＜0.001).结论 农村妇女宫颈癌防治相关知识缺乏,宫颈癌防治相关知识水平与最终筛查行为密切相关,应采取各种有效的手段对农村妇女及社会公众进行更广泛的健康教育.

BACKGROUND:China carries a heavy burden of cervical cancer (CC) and substantial disparities exist across regions within the country. In order to reduce regional disparities in CC, the government of China launched the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in 2009. Critical to the success of the program are the health care workers who play a pivotal role in preventing and managing CC by encouraging and motivating women to use screening services and by providing identification and treatment services. This study aimed to assess cervical cancer knowledge among these health care workers at the county level in maternal and child health (MCH) hospitals across different socio-economic regions of China. MATERIALS AND METHODS:A cross-sectional survey was conducted and self-administered questionnaires were sent to all health care workers (a total of 66) providing cervical cancer screening services in 6 county level MCH hospitals in Liaoning, Hubei and Shaanxi provinces, representing eastern, central and western regions of China; 64 (97.0%, 64/66) of the workers responded. ANOVA and Chi-square test were used to compare the knowledge rate and scores in subgroups. RESULTS:The knowledge level of the respondents was generally low. The overall combined knowledge rate was 46.9%. The knowledge rates for risk factors, prevention, clinical symptoms, screening and diagnostic tests and understanding of positive results were 31.3%, 37.5%, 18.1%, 56.3% and 84.4%, respectively. Statistically significant differences in scores or rates of CC knowledge were seen across the different regions. The total and sectional scores in the less developed regions were statistically significantly lower than in the other regions. CONCLUSIONS:The majority of the health care workers who provide CC screening service in NCCSPRA at county level MCH hospitals do not have adequately equipped with knowledge about CC. Given the importance of knowledge to the program's success in reducing CC burden in rural women in China, efforts are needed to improve the knowledge of health care workers, especially in less developed regions.

目的 分析我国农村妇女宫颈癌检查项目的实施,并了解该项目对基层医疗保健机构宫颈癌检查相关服务能力的影响.方法 2014年对183个国家级宫颈癌项目县2011-2013年所具备的宫颈癌检查相关医务人员和阴道镜设备情况进行调查,对6个省12个项目县项目开展前后898张细胞学涂片进行专家复核,并对77家提供宫颈癌检查的服务的医疗保健机构的服务情况进行调查.结果 2011-2013年具备细胞学和病理阅片人员、阴道镜检查人员和阴道镜设备的项目县所占比例逐年增加,分别由2011年的61.2％、59.6％、66.1％和65.6％,增加到2013年的89.6％、87.4％、96.2％和95.1％ (P＜0.001);项目县具备细胞和病理阅片人员、阴道镜检查人员以及阴道镜设备的数量逐年增加,分别由2011年每县平均5.23人、3.20人、7.79人以及3.02台,增加到2013年的7.93人、4.82人、12.97人和4.92台(P＜0.001).细胞阳性涂片满意率和专家复核符合率,在项目开展前后明显提高,分别由项目开展前的92.9％和57.4％,上升到开展后的99.5％和69.1％ (P ＜0.05).项目开展后能提供阴道分泌物检查和宫颈细胞涂片取材的乡镇卫生院所占比例较项目开展前有明显增加(89.4％ vs60.6％,83.3％vs 45.5％;P＜0.001).结论我国宫颈癌检查项目的实施,不仅加强了项目地区基层医疗保健机构的人力和设备资源,同时也促使医务人员的服务能力和宫颈癌检查服务的可及性得到了不同程度的提高.